I thought we'd dodged a bullet this week, but it wasn't to be. Bill saw the Infectious Disease dr. Memphis and I had had his labs done the day before and saw that his white count was up, as I suspected it was. I really wish there was a home test for that! Anyway, Janet, the nurse practitioner, listened to him she brought Dr. Threlkeld in for a listen. We also had a very frank talk about the transplant cardiologists.

Janet asked if I had contacted the transplant center and I told her no because they wouldn't care. She had a young man shadowing her that day and his head popped around immediately. I told her that I had been in touch with Mayo and they were good that he was seeing Dr. Threlkeld as this wasn't something transplant related. Anyway, when Dr. Steve (he and his brother practice together) came in he asked which of the cardiologists was Bill's and I told him we prefer Shirwany over Edwards and Yaranov over both. I also told him what Chandra had said last year about Bill technically not being their patient and not wanting to follow his meds, even after they had made the changes to them. I asked if Dr. Yaranov saw patients in an office setting and he said he thought he did and I said we would gladly see him. So, he said "Let me make some phone calls". 

After he left the room, and didn't come back, it was decided to give Bill an infusion of Rocephin and then oral antibiotics. They would have preferred to have him do daily infusions of something else, but didn't want me to have to drive down there every day. I told her we have an infusion center at our local hospital 10 minutes away, but none of them are licensed to practice in Arkansas, so they couldn't order them for our facility. She said that if, when we went back to see her on the 25th, if he was not better, it was "back to the hospital for a tune-up".

This was on Wednesday. Thursday he started the new antibiotic and did not move off the couch from the time he walked into the room from the bedroom until it was time to go to bed. He was "so weak" that I had to get his urinal from the bedroom for him to use. I don't know what he would have done if he had to...you get the picture. I decided that day, especially after repeatedly telling him that he was turning himself into and invalid that I couldn't take care of and we would have to start using his feeding tube because he was starting to not eat enough to make me happy, that yesterday would be the beginning of "Keep Bill out of the Nursing Home". He wasn't going to like me very much but I was going to make him move and eat. His regression is as much my fault as his for not making him do what he was supposed to do. But as I told Mayo once, sometimes you have to stop being the caregiver and be the spouse and it's a very fine line to walk.

Anyway, in my quiet time yesterday morning, I fixed a schedule for him. When it was time for his meds, I told him he had to get up and dressed. He managed to put a shirt on and that was it. He could barely move, so I started gathering things together to head to the hospital. I called and left a message with Dr. Threlkeld's service and when I started to get Bill dressed he just said "I can't", so I called 911. 

One of the crew members had been to the house before and remembered that he was a transplant. Another one told me, after I had told him about bumping his O2 to 5, switching from cannula to mask, and giving a breathing treatment when I couldn't get his sats above 84, that I had done everything right that was in my power. He did suggest that instead of just switching to mask to also use the cannula using tank air. That way he got oxygen no matter how he breathed. I had not ever considered that, but since I keep a tank ready all the time, I will do that the next time.

Anyway, off to the local ER and they got him stabilized. It took quite a while to get his oxygen level up and for awhile it wouldn't stay stable. It also took 2 hours from the time this ER called the ambulance provider back for transport to Memphis before it got there. The dispatcher screwed that up. It was the same crew as before, and becaue Bill was on oxygen and a heart monitor, not only did he get 2 EMTs, he also got a paramedic. So, arrived at ER a little after 10 in the moring and headed to Memphis about 2:30.

He was a direct admit to the step-down unit, which was a plus since that meant that he wasn't critical needing to go to CVICU. The nurse said that when she gave them his name, they said we were like family coming home! Not the kind of home I would want to go to, but it was a nice thought. And when I saw Horace, a favorite PCA I gave him a hug and thanked him for inviting us for Thanksgiving!

He was getting settled in when I got there and I found out that his admitting dr. was Dr. Yaranov. Dr. Edwards is the attending, so Dr. Yaranov must still be surpervised somewhat. He missed dinner and they brought him a turkey sandwich but he only took a couple of bites. They were lowering his oxygen little by little to get him off a mask and back to cannula, but it was going to take most of the night to do that. They didn't want to rush it. It was very hard for him to remember to take it off to take a bite or a drink.

They had to do another PICC line because the IV site Blytheville had put in had gone bad. It was bleeding under the covering and the nurse (a student who was very good) couldn't get it to stop bleeding. She needed to get some more gauze and told Bill to put his finger on the pad. As she left the room, I walked over and got some gloves and took over for Bill. She was surprised when she came back in with Rachel, the actual nurse, that I was gloved and holding pressure. I just told her Mayo trained me well. When she took over I took the gloves off and sat back in my chair.

Dr. Yaranov stopped in before I left and said we would discuss all options with Dr. Threlkeld, who he did talk to on Wednesday, about long term antibiotics, and of course the lung team. I told him we can't keep coming back to the hospital every 10 days. I then came home for the night and will go back shortly. I was going to stay in town a little later to take care of some banking, but I have to come home early on Tuesday to meet the chimney sweep, so it can be done then.

I did some figuring Wednesday and Bill was in the hospital these same dates last year. I also looked up all of his hospitalizations/rehab stays/skilled nursing and, out of 491 days, going from his hospitalization in June of 2018 through his last discharge Nov. 2 of this year, he had spent 177 days in the hospital! Just 3 days shy of 6 months! That's a lot!

As an aside, there is another man from Blytheville in need of a transplant and has gone downhill rapidly this week. They have moved him to the transplant ICU, which isn't unusual. What is unusual, and frankly very disturbing, is some of the information they have been given. He was at a status 6, which is the lowest status and means that you can basically live a relatively normal life. They were told the highest status was 2 and he wasn't there yet and wouldn't be able to get a heart if one became available. The highest status is 1A and Bill was at that for 2 months because of the malfunctioning seal in his LVAD. They were also guaranteed that he would have a heart in 2 weeks! Now remember, the heart is the only organ that the donor has to die for it to be able to be available. All of the others can be living donors, except possible corneas or bone. But to guarantee 2 weeks! There are so many factors against that. But, as Emily said, when the dr. thinks he's a god, what do you expect. I wondered if he was going to start killing people just to harvest their heart! Anyway, even while joking about this, the young man is in extremely critical condition, and I pray he does get a heart soon.

And, as you know God sends angels in all forms. When I was getting gas yesterday and car pulled up to the other side of the pump and a very nice black man said hello and we chatted about the warmer weather a bit. He wanted to know how my day was going and I've learned not to just say fine, so I told him about Bill and he immediately wanted to know his name so that he could pray for us. He may not, but from talking to him, I believe he did and will.

So, I think I got everything caught up. It's a little after 7 and I need to get moving. I told Bill I would try to be there by 10 but that was when I was planning on banking. So, I need to throw his pajamas in the wash and get some clothes on and gather the few things I hadn't picked up and hit the road.

Daily updates will begin again, so stay tuned!