Yesterday was a pretty quiet day, mainly because Bill slept almost all day. Yes, he was up almost all night again, very agitated. The Ativan that was ordered didn't help much and seemed to have the opposite effect according to his nurse.

The nurse he had during the day yesterday was Laura, one of the ones I was hoping for. When she told me that he had been awake all night, I told her I had my notes from last year in my bag and I would see what he was given last year when he did this same thing. So, it didn't take long to find what I was looking for (helps to have things dated) and as I was telling her what cocktail he was given, she said that she remembers discussing this with me then! Stephanie, the lung nurse, was still on the floor, so Laura told her what he had been given. They neither one could access the old records to see the dosages, so they were going to consult with pharmacy for their records. All I know is that he was given a combination of Xanax, Seroquel, and Respiradol. They tried taking away the Respiradol and double the Seroquel and the report for that, according to my notes, made him more agitated. So, Stephanie ordered the Seroquel with Melatonin on request. The Melatonin is actually the Respiradol in generic form, I think. We also know from last year, and Laura remembers this too, is that he had to be given them shortly after I left so that by bedtime, they were already in his system and working. When I left yesterday I told her to use her discretion as far as the melatonin went because Bill wouldn't ask for it and would probably decline something to help him sleep if they offered it that way. She told me she had me covered and to go home and get some rest. She's also on today so we'll see what happens.

Walt was the respiratory tech, and when I told him about the way they were moving Bill, when he had been taking steps before and standing, he did explain that as long as he was on the vent, it was just safer to move him with the sling. And that does make some sense. He did try to stop the trach from leaking and it worked for a little bit. There is a little bulb attached to the inner collar that can be filled with air. This inflates/deflates the inner collar to allow sound or not. On the vent it is supposed to be inflated so that all of the air goes into the lungs, off the vent it has to be deflated or Bill will suffocate because it would close off his airway from the trach site. Anyway, the inner tube has shifted, which allows the collar to deflate. To add air they simply take an empty syringe and push air into it until it is firm. Walt then taped the syringe to the bulb hoping that would make a difference. And it did for a bit. But every time Bill woke up, he would start talking and the inner tube would shift and it would deflate. I imagine tomorrow they will change the inner collar again and use the longer tube so that this won't happen. He did turn the vent down, and we both told Bill that he had to work harder to breathe because the machine wasn't working as hard and he seemed to understand that. When I left his oxygen concentration was set at 50% and the respirations were set at 12, hoping to go to 10. Stephanie made the comment that there was a problem with his oxygen in the night but he was stable now, but she didn't elaborate. I wonder if it had been set at 40%, which seems to be a magic number for medical personnel because they kept telling me in ICU that if he could get to 40% then he could go to step-down/Restorative Care/home.

I went down and talked to the ICU nurses yesterday afternoon. Emily, Bryan and McKenna came by, just as Bill needed cleaned up, so to kill time we went down there so that Emily could see her friend Pete. While they were in with him, I was talking to some of the nurses and told them how Bill had regressed since being moved. They couldn't believe that they weren't talking him through the weaning process and that he was getting very little therapy, since that is what that unit if for. And, actually it's not a unit, it's a separate entity in the hospital. When he was moved, he was actually discharged and then re-admitted. But, we had a good chat and I told them that, since his room was empty, we could just come back! They all said they missed him, even though he did blare the TV. He's doing that upstairs too, but I can't hear it outside the room. They must have it turned lower on the TV itself so that all the sound comes through the speaker on the bed. 

I did get a tip on something that might help with the sundowning from my sister who used to work in a nursing home. I haven't gotten it made yet, again not enough time and it won't take long. And maybe that will help, especially with the agitation when I'm gone. I'll keep you posted on that.

I got to bed a little earlier than I had been, after several phone calls. But, since the ones I talked to, I hadn't talked to for a few days, so I couldn't ignore them. I slept pretty well on the corner of my pillow since Kitty had most of it. She lays on it like a queen on her throne. I wish she would lay on Bill's. but she wants mine (it's softer). And I looked at the clock as I was buzzing around and for the first 20 minutes I didn't even have a chance for a sip of coffee. Bathroom, feed the cats inside and out, take meds, and then get coffee. I've tried to not sit at the computer in the morning but to read my devotions and my Bible reading, but I'm behind on all of that since I'm not taking the computer to the hospital the past few days. I tell myself I'll get it done in the evening, but I'm too tired usually to pick up the books!

So, that's it. Hopefully he had a good night, the vent will be turned down still, he will get in his chair (at least I can insist on that) and it will be a good day. I'll let you know whatever happens!