Yesterday marked an anniversary of sorts. It was the 5 month of being in the hospital mark. This is the longest hospitalization yet.

It was not a good day and I should have expected it since there was that "something" not quite right the last few days. Bill was, sleeping is not the word, because he was not sleeping, he was laboring when I got there. His heart rate was up, his blood pressure was down, you could tell he wasn't resting. He was still on the vent, which isn't unusual, it depends on how busy the respiratory team is early in the morning.

Crystal came in shortly after me and she couldn't get him to wake up. She could also tell that he was not resting so decided that she would wait a bit to switch him to trach collar. She went ahead and suctioned him and after she did that, he threw up. We got his nurse and she said that it was reported in the night that he also threw up. The night one was his formula, this time it was bile again. Yolanda went to get some Zofran while Crystal and I cleaned him up.

He did tolerate his meds, but during his bath, while turning him, he threw up again, this time it was a clear mucus, and then tinged with a little blood. They said the blood could have come from the trauma of throwing up to get it past the trach.

The lung doctors ordered a chest x-ray (don't know what it showed) and Dr. Edwards came in and said couldn't get him to wake up. He asked if he had interacted with me and I told him no. He thought he was retaining CO2 again and ordered some blood gases drawn. Crystal did that and while I was in the hall waiting for the x-ray to get done, she came back and with the results and sure enough, his CO2 was high. Dr. Edwards ordered some Albumin, thinking he needed the blood volume bumped up and Dr. Wright increased the pressure on the vent. It was also decided to leave him on the vent all day since he was already laboring. 

His food was stopped and the bottle of Albumin was hung and pushed through in about 10 minutes. After a few hours the blood gases were drawn again and while the CO2 had come down, it was still high. So, a bigger bottle of Albumin was hung and ran for a longer period of time and the breathing rate was increased on the vent. This means that the vent was forcing more breaths through in the same amount of time. The theory behind this is that Bill doesn't exhale deep enough to force the CO2 out, so the vent, by breathing more forces it out faster.

Dr. Morris added a bag of fluid, but I don't think they are going to do it as continuously as before since it caused so much swelling.

All of the doctors, including Dr. Threlkeld, were concerned with everything going on, but he also said that his white count had dropped. This is usually good, because his count is usually high, but since they were all concerned, it had dropped too low. This can mean that his bone marrow has stopped producing the white blood cells, it could also be a reaction to medications, a new infection that attacks white cells, just lots of different things, none of them good. Dr. Threlkeld didn't think it would be caused by the Bactrim, but he said he might hold it for a couple of days. It wouldn't be long enough to kick the virus from the heart mismatch into gear since he's been on it so long, but it might be long enough to see if that was the culprit.

Yolanda had to restart the Levofed for his blood pressure as it was getting dangerously low at times, and that is a drug that you have to play with, to fast a drip and it can sent the heart racing and cause a heart attack, too low and it doesn't do any good. They just try to keep his top number above 100. It did finally stay barely about 100, but the drip was still a pretty big dose at 8. When I left his pressure was 127/70, which would be normal for most people, but they wanted it a little lower. So, she was probably going to adjust it again. His food was also started again, and she had to adjust the drip on his flush as his urine was again red. When she emptied, he didn't put out much urine, but I could milk the tubing, which is just holding it up to let the urine drain and he was putting some out and it was the color of urine again.

In the late afternoon, you could tell that he was finally resting and he was starting to respond by just nodding his head. He opened his eyes a couple of times, but never came fully aware.

I think I covered everything. It was a nerve wracking day and I was exhausted when I got home. I had been talking to Yolanda about the bands that everyone is making to save the ears from the elastic on the masks and I told her they wouldn't be hard to make but I didn't have any buttons. Well, while my supper was cooking, I looked in one of my knitting boxes and found a package of buttons, just the right size...and promptly forgot where I put them when I took them out! I have looked all over for them. Maybe I dropped them into my backpack and don't remember doing it. I did find some specialty one, footballs and puppies, so I'm taking some cotton yarn and a crochet hook with me and can make several of those today. Of course, Yolanda gets the first one!

I got through Caleb's last day with no problems, mostly because he made himself scarce after Bill's bath. He didn't get his good shave with everything going on with him, but he did get a good bath between Caleb and Yolanda. I am still going to miss him. He gives the type of care you like to see for a patient, yet he's also good with the families. 

That's it for this update. Hopefully he will have rebounded in the night now, especially since I didn't get any calls, and we'll figure out what is going on again and we can get back on track with trach collar. Of course, I'll let you know. Today may be a day to bring the laptop again in case any immediate updates are needed.