There was something off yesterday, but I can't pinpoint what it was.

Bill was awake when I got there, but that seemed to be it. He was still on the vent and almost as soon as I arrived, he went to sleep. His numbers were all good and the only thing I could see was that the Levo was running again, so his pressure must have dropped and stayed under 100 for awhile. Mike came by to check his vent numbers and then suctioned him and switched him to trach collar.

Dr. Threlkeld came by and I think he could tell that something was off, too. He said maybe he was just tired from working so hard to breathe and needed a day off. He looked at his PEG site and ordered the 2 antibiotic creams to be used on it. I didn't look at it, but there wasn't a flurry of activitiy around it, so I don't think it was draining again.

Dr. Morris has gone back to Lasix once a day instead of twice, and he wasn't too thrilled that his urine was again bloody; Dr. Hassan was in the room for about 2 seconds. I told him that something was off and he looked at everything and said we will just continue with the way things are. 

I noticed throughout the day that the back of saline that is used to flush his bladder was a new one and when I left at 4:30 it was still completely full. I couldn't tell if it was dripping at all, So I mentioned it to Tyler when I was leaving and she said she would check it. I have a feeling that when it was hung, it was never turned on. So, now we are kind of back to square one with the bladder. They worked really hard over the week-end to get a happy medium of flow, not too fast, not too slow, and it had worked with clearing the urine nicely.

He's not swollen anymore, but he will hardly try to raise his arms now, and he was doing that over the week-end and the last few days. He did give me a double wink in the morning, but in the afternoon, after he woke up, I had to take my mask off when I talked to him. He seemed a little disoriented and looking at his eyes, they weren't really focused. But, when I got ready to leave and told him it was time, he said OK and to be careful and just seemed more alert.

I don't know if he was awake most of the night again, or just what it was. Like I said, something is off and I can't pinpoint it. I didn't keep this to myself either, I told everyone who came in, but most just said to watch him.

An exception was made for the patient next door Sunday night. He hasn't been doing well and I noticed that someone from neurology had been in Saturday with an EEG machine. When I walked to Bill's room and his and this other patient's rooms are in the corner and are offset, the other patient's wife and 2 daughters, or a daughter an granddaughter were all there and had been all night. A couple of them were curled up in straight back chairs (oh how I remember trying to sleep in those) and there was a lot of activity in and out of the room. I have a feeling that they are going to take him off life support, if they haven't already. I did not see anyone from the palliative care team and usually Dr. Mullinax or someone from there will be in the unit when death is imminent. A sad situation and I feel so sorry for the family. So, I guess I'll see what happened after I left yesterday.

That's it for this update. Not much to tell, but the days again are running into each other. At least he was still able to maintain on the trach collar. Still coughing up a lot of gunk but getting it to the top of the trach and most times getting it coughed out himself. 

I let you know how today goes!