I had hoped to have this updated early this morning when I got here, but nothing wanted to work. Not only was the hospital internet down, my phone wouldn't connect as a hotspot, so I was dead in the water. But, just a little bit ago, things worked, so decided to update this before I head home.

It has not been a good day. The scan was not done overnight. I don't know why really, although Dr. Muir was just in and he said he had a hard time rousing Bill last night. Usually he wakes easily. But, if they awaken him in the night, he has a hard time going back to sleep. He has wanted to sleep most of the day, so who knows.

His oxygen had been increased to 10 liters again, so his numbers must have dropped in the night. Usually when he's sleeping his numbers have been excellent so he must really breathe through his nose when he's sleeping.

The ultrasound of his legs was negative, so no bloodclots there. They've decided not to do the scan. Dr. Wozniak thinks that, even if there are clots in his lungs, he's already on blood thinners, and steroids, and a diuretic, so there wouldn't really be anything non-invasive that could be done. He still doesn't want to do a bronch. He said that he's had patients who were only on 1 liter of oxygen and need 3 liters after a bronch. He said that as high a flow as he is on now it could mean that he would need to be intubated and he thinks he would have a hard time being extubated.

The blood culture they did yesterday came back positive for something, so Dr. Threlkeld had it repeated from a different site but also gave an IV of Daptamycin (sp) as a precaution. The usual antibiotic that would be used is Vancomycin, but Bill is allergic to that, so he had to use a substitute. He said that nothing was growing from the other culture, so it may just have been a contamination from something else.

Another change that was made was to take him off Symbicort inhalers and do it as a special nebulized treatment. It is done in 2 different parts, one where it blows air forcefully into the lungs and then the drug is inhaled through the mouthpiece. This was done over about a 12 minute period, alternating between the 2. I don't know if it has made any difference or not, but his sats have stayed higher this afternoon, even when agitated. But, at some point, whether I was in the bathroom or getting lunch, his oxygen has been increased to 12 liters.

They have also taken him off pill form prednisone and started IV Solumedrol. They did that the last hospitalization. I don't know how many times a day that will be done, it seems like it was a couple of times a day the last time.

His nurse Stacy showed me how to do the bolus tube feedings. After his morning one and taking his meds, he complained that his stomach hurt. I know Ensure and Boost give him stomach cramps, but Glucerna hasn't and that's what he's getting. He didn't eat any solid food for breakfast or lunch, just drank his shakes and water and tea. He seems to want to drink constantly, yet his urine output has really dropped, to me it's almost to the point that they will go with a catheter before much longer. He's also still constipated, which is surprising now since everything he is taking in is liquid.

He tried to work with therapy but only managed 8 leg lifts with 1 leg and 2 with the other. But, Travis woke him up to do it and his sats dropped pretty low. Travis said they will try again tomorrow.

BREAKING NEWS!!! I just talked to Dr. Hadad, who is the ICU dr. who has been working with Dr. Wozniak. He said Dr. Edwards called him and would like him to go ahead and do the bronch. And even if it means he might have to be intubated, Bill told Stacy it was all right with him if it was alright with me. I understand the risks and I'm OK with it. So, it will be scheduled for tomorrow morning. Stacy is getting the paperwork ready now.

This bit of news has perked me up a little. I was getting the impression that the drs. were not very hopeful that he was going to recover from this. And, he may not. But, as he told the palliative care drs. Tuesday, he wants whatever it takes to keep him alive, even if it means intubation. I told him being on the vent just lets him not work so hard to breathe.

His numbers on his monitor right now are absolutely perfect...heart rate 92, oxygen level 100%, blood pressure 120/62 (bottom is a little lower than what it should be) and resp. 28. Just looking at the monitor you wouldn't know he's as sick as he is.

The palliative care nurse brought some paperwork in yesterday on advance directives and living wills, and while he's always been against doing this, I like this new format. Emily has looked at it and I think it's time to make these decisions. So, in a little bit I'll go over it with Bill. These "end of life" issues are hard to talk about in the best of times. I have a question for the nurse before we finalize it and I think I know what his answers are going to be on the questions.

So, that's it. It's been a depressing day and I've cried off and on, but it's mostly when people have been extra nice. I've always cried when people have tried to comfort. But, I was very calm talking to the dr. and made the decision with no problems.

They didn't know what time it would be done, so I may have to get here really early. I need to start carrying a days worth of meds with me so that I could stay over if necessary, although they stole the recline in the night and no-one knows where it went! 

I'll update this as soon as I can after the procedure tomorrow. Hopefully all of the technical difficulties will be done by then. Until tomorrow!