Yesterday was a blockbuster day! Bill was awake and talking when I got there and watching a movie on TV about high school boys in a coal mining town who made homemade rockets. It was a true story and even though I came to it in the middle, it was very interesting.

Mikala was his nurse, which made me feel a lot better about having to leave early. I knew that he was in good hands. And Crystal was the the respiratory tech, so we were all set.

Crystal put him on CPAP about 8:30 and after saying it was hard to breathe, and me reminding him that he had to do all the breathing himself, he settlefd down with his sats in the upper 90s, better than most people not on oxygen!

His potassium was a little low so he got a bag of that and his magnesium was also low, so he got a bag of that too. His hematocrit was edging toward the magic number or 25 (25.4) so, if he didn't get it after I left, in a day or two he will probably get a unit of blood. I did find out that the Bactrim he takes because of the mismatch of the hearts has been changed from daily to every 48 hours. I don't know which doctor changed it, and we've gone through changes with it before, but I think I know why, and I'm OK with it. One of the side effects of long-term Bactrim use, especially in older people, is reduced kidney function. Bill's kidney function is always marginal anyway and whatever has been going on as you know has affected his kidneys. So, to help the kidneys, but not completely compromise his heart, they've just changed it to every 48 hours. Dr. Morris also has discontinuef the IV fluids he had been getting. I missed him yesterday, but Mikala said that's all he ordered done from a kidney standpoint, so apparently his kidney function has improved enough.

He was still swollen some, but not near as much, and initially his stomach wasn't draining as much. But, after he was turned,  I noticed that his gown was wet so it must have leaked again. But, he's not vomiting anymore and this was the first time in a few days that it leaked again.

The big surprise came with the lung drs. Dr. Sheikh asked how long he had been on CPAP and I told him and he said to go to trach collar! Remember, this is just an oxygen mask that fits over the trach site and uses regular humidified oxygen. He said to try 4 hours yesterday and 8 hours today, depending on how he tolerated it. So, Crystal switched him over at 11:30. Because I had to leave at the 3 1/2 hour mark, I asked if she could switch him before I left and she said she would. And she switched him back to CPAP about 2:30 (she got sidetracked with moving a vent patient). I don't know if he went back to full vent to sleep or not. I think that was the plan. So, it was a big surprise to everyone but, unfortunately I don't thing Dr. Sheikh looked far enough back in the chart to see that usually on Day 3 is when Bill crashes again and has to go back to full vent to recover for several days. We'll see what happens.

I didn't get any calls after I left and Mikala would have let me kjnow if anything untoward had happened, so I'm believing that all is well. I'll find out in a couple of hours! 

There was one disturbing aspect to yesterday. A gentleman that I've seen around the hospital came by and stopped Magnolia in the hallway right outside Bill's room and asked her how many ventilator patients there were in the until she rattled off the room numbers and a man that was with him took notes. I have a feeling they are running short of vents on the 5th floor. I hope they aren't going to start evaluating the paitients already on them and need to make the decisions that this paitent or that patient is not going to thrive without it and is old, so let's give that vent to a younger patient who will recover and lead a productive life...over my dead body! I understand they may need to start making those decisions, but, as Bill is still very much "there" I won't let that happen. If he were not cognitive (and they ask about his mental status every day) it would be different, especially since we've made that decision. But, right now, Bill is still Bill and we're not removing the life support. End of story! Oh yeah, the 4th marked a month since we made the decision to go to palliative care...and they he perked back up. God's not ready for him yet, he still has something to teach us.

All for this episode in the saga. It's time to find some clothes and get moving. Of course I'll let you know what happens!