As good as the last 3 days have been, this one has been just the opposite. He was semi-awake when I got here. He looked at me and yawned really big...and started throwing up. I just yelled for help and his nurse came running in. She said that at about 4 this morning, he was hard to wake and they actually had to do a sternal rub. This is where they start rubbing really hard in the middle of the chest. They were finally able to get him to respond, but his blood pressure dropped along with his sats. Dr. Edwards ordered the Levophed restarted to bring his pressure up and they increased his oxygen to 60% from 40. He was in SIMV mode still and that continued.

He had lost the condom catheter again, twice, so he was just covered with wet towels again. Since they had to clean him up from the vomit, we decided to go ahead and diaper him since the diapers were in the room. I don't know why they didn't do that last night. Anyway, got him all cleaned up and settled and as soon as Molly gave him his meds through his feeding tube (which she had stopped when he vomited) he vomited again. We think he got enough of the meds in because it included some Xanax and he has been asleep now all day. After the second time, he got some Zofran to stop the vomiting.

Dr, Edwards wasn't too concerned about the vomiting of the meds and he consulted with Dr. Threlkeld. He's going to start some precautionary antibiotics. He also wanted some blood cultures and the midline checked. It has been in for quite a while and he wants to make sure there's no infection starting there because that would be a disaster.

His heart rate stayed about 110 but the rhythms were all over the place, lots of extra beats and some v tach (ventricular tachycardia). The wave line on his monitor was all over the place! His blood pressure came up nicely and has maintained all day. His respirations varied from the 20s to the 40s, according to the vent. Even in SIMV mode it's hard to go by the ones on the regular monitor. It showed at one time that he was taking 85 breaths a minute, but only about half that on the vent monitor.

And, all of a sudden, everything went back to normal! His heart stabilized, his sats were in the high 90s, blood pressure better than mine and respirations in the 30s. Andrea, the respiratory tech, turned his flow down to 50% and said she would try to get it back to 40, depending on how he did. He's still on the Levophed, but the rate is lower than it was when I first got here.

He's still hard to rouse up, but he is waking some, and he tries to focus on me. He did keep his afternoon robitussin in since it goes through the tube. So, the Zofran worked. Molly and I checked the chart and the only meds he got last night as far as something to calm him was his Seroquel at 8 or 9 and then some Xanax at midnight. So he must have been agitated then, too.

His glucose was 152 this morning, which is decent for him and doesn't require any extra insulin. When she checked it at noon it was 59! So, he got a boost of glucose and it came up to 70 within 30 minutes. Dr. Oktied ordered the NPH held as long as the feedings were on hold.

Dr. Wright, the pulmonologist came in and did put him back on full vent. I was surprised to see that he wasn't this morning through everything. He said the x-ray didn't show any significant change and after making the vent adjustments and listening to him, just said to hang in there.

Dr. Muir was just in and he said that from what he's seen, he can only take being off the antibiotics and vent 3-4 days, he starts plugging up again. Yet, they aren't getting much of anything when they suction him. So, since he usually bounces back pretty well with the antibiotics, we'll see how it goes tomorrow.

Again, I didn't have any problems getting into the hospital. I told Molly what Sara and Jennifer had told me the other day and she said that every patient on the unit had full family members (meaning more than 1) visiting. 

I got permission from Dr. Threlkeld to keep my gown in the room instead of throwing it away and getting a new one every time. They are getting scarce in the hospital. And since I have no contact with other patients, he thought that was a fine idea. I'm actually going to hid it when/if I leave, or put a note on it not to throw it away per Dr. Threlkeld.

And, as I'm typing this, Bill's heart has started going a little wacky again. But, he doesn't seem to be in distress at all.

His room hasn't been cleaned. The regular housekeeper is apparently off today. The other one came by, but there weren't any gowns. The secretary got some from somewhere but the housekeeper hasn't been back and since it's after 3 she's probably off for the day.

He's trying to wake up some now. He's focusing on me, but I don't know if he's actually understanding what I'm saying. But, he's moved his legs some like he's trying to re-adjust his body.

So, not a good report today. I'll see how he is later and decide then if I'm staying or not. Again, part of me wants to stay and another part says go home, rest up, and come back to help fight another day tomorrow. Right now I don't know which side will win out.