Someone was awake and aware and "talking" yesterday when I got to the hospital! H e said he felt better and he looked better. His numbers were good, but his oxygen was down a little. His vent settings had been changed again. His oxygen was lowered to 40% from 50, his peep, which is pressure was increased from 5 to 8, his breaths given was increased from 20 to 26 and and pressure was decreased from 480 to 450. He said it was harder to breathe and I told him about the oxygen being lower and to just let the machine do it for him. 

The doctors are having a little war over the cause of his episode Wednesday. Dr. Edwards thinks it was a pulmonary event that caused the problem, and Dr. Aswan saiys it was not pulmonary, there was no reason to change the vent settings, and that it was all metabolic, with everything that is going on in his body. As he left the room, he just reminded me that we had talked about recurring pneumonias happening. He's the dr. that initially told me to call the kids and start the palliative care process. This was the first he had seen him in a month and I think he was surprised that he was still with us. He then said we would just see what Dr. Edwards was going to do. So, I think Dr. Edwards won the battle.

Dr. Edwards was also surprised at the turn-around, although by now he shouldn't have been. He made the comment that Bill definitely is a morning person. He said they would continue to check the blood gases and adjust things as necessary. Then, to my surprise, he asked if there was anything he could get for ME and told me not to worry too much, they were taking good care of Bill! The man continues to surprise me!

Part of the reason for the vent settings change is that Bill is still retaining CO2. So these settings help his lungs expel it. His pH has been out of whack through all of this, and that could have been the start of the episode. Normal pH is 7.35-7.45. His yesterday morning was 7.3. So, still a little low. I think it dropped it the afternoon because he got another boost of sodium bicarb. He had also gotten a bag of Potassium before I got there so it must have been lower.

When Dr. Nara came in to check his feeding tube site, it had drained a large amount of a gray, think, sticky substance. She didn't seem too concerned about what it looked like, just kept wiping it up. At one point she pressed around it and I could hear it bubble and gurgle. He was still on the IV nutrition, but the tube feeds were also restarted, and as of when I left, he had not had any episodes of vomiting.

He was still on the Levo for his blood pressure, and Ella kept adjusting it as his pressure fluctuated. During a cleanup (I asked him if he pooped and he just grinned and nodded like a little boy) we noticed that his PICC line site had been weeping and the bandage was coming off. This has to have a sterile bandage covering it so that it doesn't get infected. When Ella came to put a new one on, she noticed that it had come out about 3 inches. So, a call to the PICC team, a chest xray to see where it actually was, a new PICC line placed, another xray to see where it was, and we were back in business. During all this time, all of his IVs had been stopped and when she was hooking them back up, she did not start the Levo again. It was just put on standby since he had maintained his pressure all the time it had been stopped.

Dr. Morris said that his kidney function had improved and that his creatinine was coming down! He was quite thrilled with that. He did order a once a day dose of Lasix to draw the extra fluid off and make the kidneys work more. His urine looked good, although at one time what was coming through the tubing looked awful, about what was coming from around the peg site, but for the most part it was clear or barely pink tinged.

Dr. Threlkeld doesn't think that it is cellutlitis on his left arm. He thinks is echymosis (I'm not sure of the spelling or if that's exactly what he said). That means it's just bruising. But, his left hand is still very swollen, he said his arm hurts at times, so we're just going to keep an eye on it. That's the arm that had the infected midline, so there could be the infection still in it. He's still on antibiotics so that's about all they can do for that right now.

It was a much better day compared to the day before. He was awake when I left and he said he would behave himself but couldn't guarantee that there wouldn't be any shenanigans. It will be interesting to see if this is the day they tell me not to leave. The Tennessee governor has issued a mandatory stay at home order. Now Arkansas is the only southern state  without one.

One thing I've noticed are all the out of state cars on the highways, complete with families. I guess they decided to go ahead and go on their spring break vacation. There are bicycles attached and some cars are so loaded down it's like they are trying to outrun this virus. In some ways it reminds me of The Stand, a book by Stephen King where a supervirus overtakes at least the US and turns into good vs. evil with the people who didn't catch it. It has some eerie parallels. I had started re-reading it (it's one of my favorite books) until the virus started spreading so fast and then decided I didn't need to read it right now!

The traffic in Memphis had been very light until the last couple of days and now it's business as usual it seems. No curfews have been lifted, non-essential businesses are closed, they finally closed the parks but not the golf courses. I go by one when I go home through town and the parking lot has been packed, but the course looks empty, so they are all in the clubhouse!

All for this morning. It's late and I'm not dressed yet. I hope my clothes got dry last night, otherwise I'll be even later getting started. Stay safe!