Yesterday was aother bust. Bill was very junky and he tried every trick in the book, complete with pretending to be asleep, to get out of doing things. To his defense, he was very junky again and they were having to suction frequently and he was coughing up lots of stuff.

Stephanie wanted to try to speaking valve again and when we finally got him to agree, after she suctioned him, he had to pee. He he took so long Stephanie just said she would come back, which she did not do.

Lorie came in to do PT and he was adamant that he was not doing it, but I told him that if he didn't do at least half of the exercises, I was just going to put him in the nursing home and he could live there forever because I can't take care of him. He did half of what he usually does, but refused to get out of bed.

He did a little bit of speech therapy and swallowing and she covered his trach with her finger to get him to make some noise and he wouldn't talk.

We had a long talk before I left that if he ever wants to come home again, he has to start doing these things or he will go to a nursing home. He said he would do better today. Of course he probably won't remember the conversation so we'll have to have it again this morning.

I met with Phyllis the case manager and she said they are going to round today. She said that her managers are the ones pushing to have him transferred and there are only two facilities that will take vent patients and they are both in Memphis. She said the one in Jonesboro is the same type of facility as they are and they can't do lateral transfers. But, I wonder if it could be done by showing a hardship for the family with of the travel, which would be just about cut in half. She said depending on what the decision was today I would probably start getting some lessons on trach care and suctioning so if he goes home with the trach, I'll know what to do.

Dr. Mohratra, and I think I'lve spelled that wrong but he's the dr. I just about ran over one day because he was looking at his phone, came in and he's the one who will be rounding today. He was pleased that Bill was one trach collar and he said when it can stay capped for a week, they will work on reducing it and then removing it. When I told him I was under the impression it was to be permanent, he said no it wasn't. So, I'm not sure on that. He also wanted to know if he was walking and I told them they weren't even letting him stand yet, so maybe he'll tell therapy this passive stuff has got to stop and get more aggressive.

I felt much better after talking to him that I did after talking to Phyllis. Still, today is going to nervewracking until I know what they decide.

So, that's it. Another up and down day. Today I guess I put on my bad guy hat and make Bill do what he has got to do. If I can only get him to understand that if he wants to come home, which he does even if it's after skilled nursing for rehab, he's got to try. Yesterday he was even tapping on his tray table for me to hand him his urinal...which was next to where he was tapping. It's like he's decided that he's a total invalid now and can't do anything for himself. I did not get the urinal but told him he could reach it! I've also told him if he wants to use the bedside commond, he's got to do his therapy.

Let's hope today is better. I'm exhausted again and only got half of what I needed to do last night done. There needs to be more hours in a day!