Yesterday was not a good day, the first in more than a week. Molly said that he had a good night until about 6 in the morning and then his oxygen level started dropping and become somewhat unresponsive. He also vomited again. Dr. Edwards ordered an ABG which tells if he was retaining CO2 again, and as I walked in, Molly was rushing out with vials of blood cultures. She and Andrea both told me he did not react at all to the blood sticks, no pulling away, no stiffening of his arm, no grimace. He did open his eyes when I touched his shoulder and said hi but closed them almost immediately.

Dr. Threlkeld had already ordered 2 different antibiotics and the first one was hanging, just waiting for an IV pump. He is the one who ordered the blood cultures and those take a little bit of time, even if they are done STAT.

He was doing what they call guppy breathing where he just kind of gasps shallowly for air and I asked Andrea if she thought he would do better in full vent volume control mode. She agreed, but she couldn't make the decision, it has to come from the doctor, which it did soon after. He fought it for a bit before he settled with it, but he was still really struggling to breathe.

He did finally respond to Dr. Threlkeld some, and said he felt OK and was good. We both called him a liar! When he would open his eyes, it would take him a bit to focus on whoever was talking, usually me. His heart rate was up, his oxygen sats were good, but on 100% oxygen, they should have been, but his blood pressure was on the lower side and it wasn't long before it started dropping. At one point in was 88/55, so Molly got a bag of Levofed ready and let Dr. Edwards know. It was then started, after getting another IV pump, at a pretty low rate. His pressure went up and the Levo was slowed again, and his pressure went down, so it was increased again. That's a tricky thing, to get the  right rate going.

A chest x-ray was done and Dr. Spooner said that it looked worse than the previous one. I told him that he had vomited and probably aspirated some and he said he did not know that. I don't know if it didn't get charted, or he just overlooked it. Anyway, Dr. Edwards personally told the pulmonologist on for this week, Dr. McCarthy, that he wanted him bronched and that was finally done about noon. Even with a little Fentynal, Bill did not go completely out and, as I came back from the cafeteria, I watched the end of the bronch from the hallway since his door was open, he was fighting the tube being down his throat. They got a lot of gunk out that looked really nasty and sent it off to be cultured. Dr. McCarthy and Dr. Spooner both said without knowing what was in there it was hard to say what was causing the secretions. I told them he had colonized pseudomonas and Dr. McCarthy just said that's some nasty stuff and with it being colonized it will keep flaring up, as if I didn't know this already. But, I didn't say anything. He did say that Bill just doesn't have much reserve left, which I also already knew. So, we'll see what the cultures show.

In the afternoon, he finally really rested and his breathing slowed. HIs numbers were fairly stable and I could tell he was sleeping, but that would only last a few minutes and then his eyes would fly open. He finally watched some TV and seemed to be coming back to "his" normal.

His urine output dropped off again after normalizing in the night. From 6 am until noon he had only put out 50cc of urine, which isn't much at all. His creatinine was 1.29 which is in the normal range, so Dr. Morris changed his Lasix from twice a day to 3 times a day IV instead of pill form. He also ordered a big bottle of Albumin to run to give him some volume. But, there was no blood, it was nice and clear. That much Lasix will deplete his potassium, so he'll probably get a bag of that in a day or two.

He woke up when I told him I was leaving and he was very lucid. I told him not to scare us like that again and he said OK. He told me he loved me and then went back to sleep. Since I didn't get any phone calls, I'm taking it as a sign that he had a good night, with no problems.

All of this proves my point that he doesn't need to be moved! If he had been in a nursing home, he would have been dead, probably before I got there. They would have had to move him to a hospital to have any of these measures done. Nothing was said about it yesterday, other than Mark, a nurse case manager, telling me that Tomika was off yesterday but would be back today. 

I looked at the advance directive Bill signed and I get to make all of the decisions on where he is placed and what is best for his care. So, that eased my mind some. I thought this morning that we always get a notice that if we think he's being discharge too soon we can appeal it to Medicare. But since he doesn't have any Medicare days left so they aren't paying, that's out. But, I also think we get one from Tri-care too, which is paying. So, I'm going to look at that today. It's in his folder that I keep in my backpack. I have several copies of it so will make sure I've got one with me.

That's it, I think. I took 5 pages of notes, which really isn't much because my new pocket notebook is smaller than the old one. Same brand, just a different size. I don't like it, but what can you do? Anyway, if I find I've left anything out, I'll add it to the next update.

Hopefully I'll get through to the vet today to see if the cats can come home. There was a lot of rain again yesterday and it messed up the phone lines. I still don't have the paperwork from the dumpster people so that's still on hold. And now, if I don't get a move on...well, you know the rest.