Not only was yesterday Bill's 77th birthday, it was day 100 in the hospital. It was also a cold and rainy day, a good day to just sleep...and that's what Bill did...almost all day. After talking to his nurse, we think it's the Xanax. Stephanie said that when she changed it from when needed to scheduled, she also put a note for the nurses that it he wasn't agitated and his numbers were good they could hold it so that he wouldn't sleep all the time. I think the night dose, on top of the Seroquel, was what did it. So, Nick was going to hold his 5 pm dose since he was sleeping. I think he needs the morning dose and the 5 pm dose because that's right after I leave and he usually gets agitated then. But, he doesn't need the 9 pm dose on top of the Seroquel. We worked to hard to get that given at the right time. So hopefully today he'll be awake.

The plan is still to switch to trach collar, but his numbers were all over the place after Stephanie left yesterday. At one point he was breathing so hard and fast that his head was raising off the pillow. It was showing 41 breaths, his oxygen was in the low to mid 90s and his heart rate was about 115. But, when I would wake him and tell him to relax, he would calm down until he went back to sleep. I don't know if he was dreaming or what. And then, in the mid afternoon, everything changed again. His respirations dropped into the 20s, his oxygen went up to 97 and his heart rate was 85. So, depending on how his night went and what his morning looks like, he may have to stay on CPAP another day. I wouldn't be surprised.

When I got there Albert told me it was bath day and he wanted to do it while I was there. Bill will refuse things when I'm not and the night PCAs apparently have given up giving him a bath. Of course, I can understand that. Why wake someone up in the night to give them a bath. I can understand also that they bathe the ones that are sedated in the night because that frees the day staff to tend to awake and more "demanding" patients in the day. But, anyway, I told him whenever he wanted to do it. And it turned out we did it right then. And by we I mean me and Albert. Bill had had a bowel movement and had tried to clean himself with his padding and...well you can guess what happened. So, Albert tossed me a pair of gloves and off we went. And, during the process, somehow, the trach cannula came completely out! I put it in a little way, but they haven't shown me exactly how to do it, so Albert held it steady while I ran and got help. We ended up with respiratory, a head nurse, and 2 other nurses! But, that was my fault. I told Pam, the head nurse who was the first one I saw that his trach had come out and they thought it was the entire trach, which would have been quite serious. It turned out that when the cannula had been changed last, it was not locked into place completely so that every time Bill moved his head, it came out a little further.

Bill did tell me that his belly hurt and I did tell his nurse Nick, but Bill couldn't define just where or how it hurt. He did have a lot of gas. Maybe whatever was going on there also contributed to him sleeping all day. The little bit he was awake he kept grabbing his belly and telling me he had to poop. His only option is to just go. They won't bring his bedside commode since he's now probably too weak to stand, going to work on that today, hopefully. And he refuses to use a bedpan, which does hurt if you don't have any "padding" and he doesn't. And I thought that the belly pain might be just because he's holding it as long as he can, which was doing more harm than good.

I checked with Nick, the nurse, and he said he could have either a stool softener or a laxative, both were ordered as needed. We decided to go ahead and do the laxative to really get him cleaned out. It worked pretty fast and must have been a little painful, because Bill grimaced and grabbed his belly. And after he went, Albert said that he could see some blood. It was not old blood, but bright red and not a lot, but it was there. I couldn't look because I was on the other side of the bed holding his vent tubing. So, something to report to the doctors today. Since he's not being seen by gastro I guess the person to really tell would be Dr. Muir the hematologist. He's the one who wanted the iron checked the other day and it was fine, so I'm hoping he comes rather early today.

Bill roused up enough to open his birthday cards and his gift from his sister. She sent him a stuffed cat that looks kind of like Cat, which is his favorite of our 2 cats. I took a couple of pictures of him with it. And then we sat it on his tray table so that it's looking at him, like a real cat does, just staring at him. I think he's going to name it Shirley after his sister!

So, that's our day. I had a little stomach upset yesterday. I felt fine until after I ate breakfast and it just didn't settle well. I think part of it was also anticipation of the day. But, I'm better now, at least for now. Today will not only be trach collar day, but talking to therapy today and probably the case manager. I still want to know why I was not included in the decision making at the interdisciplinary meeting, or at least had a one on one with either Phyllis the case manager or Pam the social worker. So, it may be another nerve racking day. I didn't even knit or read or crochet yesterday. 

Hopefully we'll progress through everything today and it will all go smoothly. And of course, I'll let you know!