Monday, March 25, 2019

Keith at UNMH, Week 4

9:25 AM Friday (March 22, 2019)

It was a Sunday afternoon when Keith came here (May 3). It's a Monday, so Week Four is on, for sure.

Keith ate lunch! Really ate. Drank all his chicken noodle soup. Ate almost all of a fair-sized piece of chicken breast with some sauce on it (and Mrs. Dash on all that), and some cooked carrots. Drank milk. Ate yogurt I had brought in.

He's able to rearrange himself in the bed really well. The only thing he's hooked to is oxygen, and that's an option. The machine is quieter with the little bit of extra oxygen. But if Keith wants to take that off, nobody will complain.

From the morning, I hoped I'd get to talk to the discharge counselor, and we waited a few hours, but at that time we thought it would be about Keith moving out to a rehab facility in a few days. Since then, some things have been learned.

A physical therapist came to work with him. He stood up and walked to the wall and back a couple of times, but he was dizzy, and so that's all they did. Because of this, the recommendation will be a skilled nursing facility when he leaves, and not rehab. She said inpatient rehab costs five times as much as skilled nursing, and the insurance companies don't like that. (And Ashlee pointed out later that the co-pays might be considerable.) Also the PT said that if Keith were to go prematurely to rehab, he could be "demoted" to skilled nursing, which would be another ambulance transfer, or if he got hurt or medically affected by the rehab, he might end up back here at UNMH. There is a possibility (likelihood?) of being at skilled nursing for a while and then transferring to inpatient rehab from there. She said I should advocate for that.

What we already did know about the difference between skilled nursing and rehab was that rehab expects one to have the stamina to do three hours of PT a day. Skilled nursing might only have one or two hours of physical therapy. When that was first said, it went with the idea that Keith might have to go to skilled nursing first if he still had any tubes in him (feeding, or drainage). With tubes gone, we thought rehab was a default, but he's dizzy.

The internal medicine lead came to talk to him and said that after he's out of the hospital, and out of rehab, there will still be at least three months of follow-up appointments with EP (Electro physiology), Cardiac, and his primary care physician.

Someone came by from cardiology to say that it will be Wednesday afternoon before they can implant the ICD, so his nothing-by-mouth starts tomorrow night, not tonight. (And he might still be bumped from the line, but she didn't say that this time. The last time she said if more pressing cases come along, he might be bumped.)

So at the moment, the vague plan is:
  • Tuesday: More sitting up, maybe sitting to eat (though he's not eating much).
  • Wednesday, no eating at all, surgery in the afternoon (with light sedation and local anesthesia)
  • Thursday... maybe (MAYbe) moving to a skilled nursing facility, or not... or having surgery, or not...

I told Keith I'm hoping we will look back and say that he was in the hospital for nearly a month. Not "for a month."

Friday, March 22, 2019

A few days of waiting

UPDATED 7:20 PM Sunday (March 24, 2019)
Keith is still in room 560, 5 West

9:25 AM Friday (March 22, 2019)

Feeding tube is out, Keith is taking pills himself with water.

He's having a bit of his breakfast, and with the pineapple and orange slices (real, not canned), I made a bit of juice for him. "Glucerna carbsteady therapeutic nutrition", chocolate, on corn flakes was the best part. (Better idea than full skim milk and artificial sweetener on cornflakes.) Still, he doesn't want much.

He's wanting to go home, but there's no way. Because the feeding tube is out, and the chest tubed is clamped off again (trial to see if it's really needed). When the chest tube is out, he'll be waiting for physical therapists and being frustrated that he'll probably be here another week. He said he's getting bored, which means he's better.

Kim from occupational therapy is here. Hooray!!

10:05 AM Friday (March 22, 2019)

He sat up on the bed, transferred to a toilet chair, got tired and hot, and got back in bed. That's a pretty big deal, and though his joints are stiff, he still has his strength, and bodily awareness, so I'm guessing physical therapy will go smoothly.

Here's how aware he is: He told the PTs that he was having an xray at 10:30, ordered by Pulmonary. That's true. Nice.

11:15 AM Friday (March 22, 2019)

The chest tube is gone. (Third chest tube, removed about 10:45.)
They said they might need to turn the oxygen up, later, but the nurse just came in and turned the oxygen down. Keith's sensor was disconnected (by PT, or X-Ray, or Pulmonary), so when she hooked it up he was like a genius of oxygen-breathing.

10:20 PM Friday (March 22, 2019)

Kirby visited Keith after I left, and said Keith wanted him to make sure I knew that Keith does NOT want a mechanized electric bed, when he gets home. Fine. But he's willing to have a new mattress. Good.

I posted this on facebook just now:
A little Keith report:

On the 17th (five days ago) I wrote "Yesterday Keith was so much better that today I'm taking his glasses and his phone to him."

He still hasn't wanted his glasses, or his phone. He said he doesn't want to try to focus. Sleeping is his favorite thing, but it's hard for him to stay asleep because so many people are in and out, including me. I've tried to go less, or not stay as long, but sometimes it's good that I'm there for one reason or another.

He'll probably be out of there in less than a week, and into a rehabilitation facility for a while, and then home in April, sometime.
He seems to have all his mental facilities in there—not always all unhindered by exhaustion, frustraion and confusion, but he's remembering details about the work being done at our old house where Marty lives, like company names, his contacts, the name of the woman who answers the phone at one office, what we owe, and what needs to be done before final payments—his passwords to online banking. This are the kinds of things I can't remember on a healthy, calm week!

Every day I carry the comb and detangler Holly sent with me nearly two weeks ago, and a bag that has Keith's phone, his charger, and his glasses. I offer glasses every day or two, and so far he has said no. I think tomorrow might be a hair-combing day. I have little rubber bands, and if I can get it combed, I plan to make a braid.

5:45 PM Saturday (March 23, 2019)

I was at the hospital in the morning and left for a few hours, during which Bela came but Keith was sleeping and he went away for a while.

My trip out was to buy a new mattress (to be delivered April 5), and to go home and look at some bills, to come back and report, and to print something out from Keith's computer notes. Done and done done.

Keith is eating a few bites of this'n'that now. Three bites of grilled chicken, a couple of bites of mashed potatoes, some cooked carrot, and some leftover pears. Ate all of some salad with italian dressing. Drank skim milk. End of dinner report. :-)

Outside his door is a sign about letting him sleep. They've tried to let him sleep in the daytime, too. I was sneaking in this afternoon and his oxygen monitor beeped. Being awake in the day might help him with this, though:

6:10 PM Saturday (March 23, 2019)

Two days ago when Keith found out he can't drive for six months, he said maybe we should go on a cruise to the islands of Denmark. So I thought a bit about getting him a passport, and visiting Carolyn in Sweden, and whether we would really do it.

This morning before daylight, all the electricity went out at the Albuquerque airport. Backup generators failed. Big mess. I didn't know, but Keith had seen it on the news, and told me when I got here. What I had seen, to tell him, was that a Viking ocean-going cruise ship was disabled off Norway, in bad weather, and all the passengers were being taken to land by helicopters that held 15 to 20. That was going to take quite a while, to get everyone off, but at least the ship didn't sink. That's good.

Those are not good omens for a Viking cruise tour of the edges of Denmark, but on the other hand, the odds of it happening twice are small. (Right?) Like the odds of having two (or three) cardiac arrests in one day, and living to talk about going to Denmark as a distraction, if one couldn't drive (to the swimming pool and to breakfast, to music practice, to SCA events, to Lowe's to buy lumber, to Steve's to work in the shop and swap stories, to Costco, to take my van to get gas at Costco, to take Holly's pickup to Costco for gas...)

Keith's asleep, but his oxygen went below 90, so the machine is beeping. He woke up. I told him if he could let that machine train him to breath deeply when it beeps, he wouldn't hear it so much. He went to 87 before breathing it back up to 91, where the beeping stops. He's not using outside oxygen at all now.

He's not able to get out of bed, or walk, but he can rearrange himself in the bed, and I saw him turn over completely on his side yesterday, to go to sleep, before I left. He's starting to watch TV, too. He's still not interested in having his phone or iPad, though. He wore his glasses briefly, to look something up on the computer, and then said they were too uncomfortable, in the bed, at that angle.

I'll go home soon, and tomorrow I'm doing some things around the house.

9:00 PM Saturday (March 23, 2019)

I just got home. When I left, Keith was watching figure skating on TV, and was hoping to see Saturday Night Live, if it's on, but he was also sleepy. He reminded me to get gasoline on the way home; the van was below a quarter tank, and he's usually the one to buy gas. I asked if he cared where I got it, and he said no, but closer to the house would have better prices than there by the hospitals and the freeway. Very Keith-kind of thinking. :-)

7:20 PM Sunday (March 24, 2019)

I didn't go in today, but I have reports from two groups of visitors that he looked great, was mobile in the bed (could rearrange himself easily), was chipper and talking politics. I'm glad to have missed that part. :-)

Monday/tomorrow I'll go to hang out and see if it's time to start his exit strategy. If all goes well, he might be out Wednesday or Thursday, to another facility, but we don't know where yet.

Tuesday, March 19, 2019

New bed, more awake

Last updated 10:00 PM Thursday (March 21, 2019)
Keith is still in room 560, 5 West

9:30 AM Tuesday (March 19, 2019)

Keith is in room 560 in 5 West. This isn't 7 South. I see the new south building out the window. It looks nice. :-) One of the student nurses said he overheard that they're still trying to get Keith into 7 South. Seems they needed his ICU bed. I called the ICU before I left home, and was told he was still there. So I went there and pushed the button and said "Keith Dodd in 3, please!"

"Come on in!" So happy.

The guy in #3 wasn't Keith.

So I began my trek to find 5 West.

The nurse just told me that 7 South is "The Penthouse." I hope they do move him there, then. :-)

So before anyone visits Keith, check where he is. I'll leave notes here.

This room is extremely small. It was probably built before the fancy plastic beds were invented. I'm picturing some iron bedframe from 1920, but it's not that old, either, I don't think. (1960s, it was built, seems.)

Keith's not happy with the food or with thickened liquids. Unless he eats, though, he's still on tube feed and can't get out of here.
They brought him sugar-free Jello. "Vile," he said. But he said his throat hurts, from the respirator tube, and food that's cold hurts.

Keith kept asking which ribs were broken, and finally a (frightening) report:
2nd through 7 on the right
1st through 7th on the left
and sternum

That's thirteen broken ribs. Hiccups must really be awful. He didn't want to eat because he thought it was causing hiccups this morning, but then he hiccuped a few times even though he didn't eat.

The view is a reflection of this building in a newer building.

10:10 AM Tuesday (March 19, 2019)

Two doctors from Pulmonary were here. They're the ones with the news about which ribs were broken. They also said that his chest tube, which has now been in for over 16 days (since March 3 mid-afternoon, and this is day 17, I think) is sticking into the hole in his lung. Oops. The idea was for it to put suction in the area outside his lung, so the lung could re-inflate and heal. They put a clamp on the tube to see whether it was making any difference anyway. If it's not, they'll pull the tube. THEN the hole in his lungs can start to heal. If his breathing becomes difficult, they will unclamp it, and might need to put in a new tube.

There's something about this I don't understand, because they said if they take the tube out and he has problems they might need a new tube, but that with the tube that's in there, they can't pull it out of the hole just a little bit and leave it in.

Bad news about the penthouse. He was going to be in the care of the cardiac team, but because there are other issues, he's assigned to internal medicine. Pulmonary would have been consulting for cardiac, and now they're consulting for medical.

I think. They have hospital jargon/code on top of medical terminology here.

Keith is snoring. I don't know if that's good or bad, considering all. I'm going to go look at his readouts.
Seems fine.

Maybe "New bed, more awake" isn't the best title for something that ends up being about him being asleep and snoring.
The sleepiness was something one of the pulmonary doctors said was a problem that cardiology thought would be better handled by someone else.

2:30 PM Tuesday (March 19, 2019)

Pulmonary doctors put a clip on the chest tube (drain), sealing it up for a couple of hours to see if it was making any difference. If Keith's breathing became difficult, the nurse was to remove the clip. He was breathing fine, so they pulled the tube out. They'll ask radiology to look at last night's CT scan to see if they think there is blood outside, or just water or what. Some circumstances might cause them to put another smaller tube in, but if not, then they'll be done with him (pulmonary will be).

People keep on and ON coming in here and not letting him sleep. If today had been scheduled and scripted for humorous/irritating effect, it would have been difficult to plan this many credible excuses to come in. And I've been in and out, and furniture has been rearranged for various needs and purposes (the two guest chairs and the hospital table). it's about as fast-paced as Noises Off, though a few times (unlike in the play) someone has been waiting for an entrance, while another character finished a scene.

The photo above is what I can see out the window, not what Keith sees from the bed. Here's Keith's view:

6:45 AM Wednesday (March 20, 2019)

Yesterday late afternoon I was surprised by two things I hadn't known. Things were updated or changed and I had missed it. One was that they re-instated and kept) the feeding tube bag (they had left the tube for drugs). The word "tube" is starting to grate on my emotions in general. So he's not hungry, and all of the real food (such as it is—thickened liquids, thickened fake milk, solid foods he might not be able to eat even if he were well) is spit right back out, if he will even try it. But he's nauseous, and threw up again last night.

The second thing I wish I had known sooner was that the drug they gave him for nausea (sorry I didn't note its name) makes him very sleepy. Too sleepy to speak or think clearly. I thought yesterday was a big step backwards, but it was about being tubefed (...something that nauseates him?) and having meds for nausea that make him less coherent, and very weak.

I called this morning and was told Keith had a good night, no complaints of pain, threw up once, but had no ill effects on heart rate because of it. That sounds pretty good. If he's sleepy, and sleeping, without opiates, that's great. The anti-nausea drug might be an opiate, I suppose, but I don't want to think about it right now, because I can't go in today until late afternoon. It's a babysitting day! :-)

5:20 PM Wednesday (March 20, 2019)

I just got to Keith's room. I left home about 4:40. I think half the time was driving, and half was hiking through the hospital, though I did find the room in one shot this time. Good for me. It's a crazy maze.

Keith is asleep. He's so asleep he ignored the food-delivering attendant, her talking to him, me talking to her... anyway, very asleep.

Marty was here mid-day and said Keith's voice was strong nd he was aware and alert, joking with nurses. They had put in another chest tube. Keith told Marty it had been half an hour, but Marty said it had drained so much he figured it must've been longer.

I can stay a couple of hours and then I need to pick Devyn up from gym. Things are moving back toward more normal, in a few more ways, sometimes.

10:50 PM Wednesday (March 20, 2019)

I did leave the hospital about 7:30, but still I know a bit more.

Keith threw up there. He was still super sleepy, but had not been given anti-nausea drugs (which had made him sleepy the day before). Without even tasting any of his dinner, with no ice, nothing, he threw up. I was quick by, so it wasn't bad, and it didn't affect his heart rhythm. Mim, his nurse Tuesday night (and tonight again) said that he threw up then too, but his heart stayed good.

Today what he had in way of sedation was fentanyl, for the insertion of a new chest tube (the third), and 5 mg of Oxycodone for the discomfort of the new tube afterwards.

Keith was trying to sleep, but various things kept waking him up, so I decided to talk to him a bit since I needed to go. It was fun. He wasn't hallucinating. We talked about very routine kinds of things, like which bank account what bills should be paid from, and which were automatic. It's not very exciting objectively, but knowing he was that cognizant of things thrilled me.

Just near the end I was told that the ICD (implantable cardioverter defibrillator) might be put in tomorrow morning. WHAT!? This disturbed me. I had been told it would be done the day before Keith was leaving. Also, I heard the hospital is full. Also, I've heard little snippets of this and that, about skilled nursing facilities, and rehab hospitals, and it was a swirl. Tomorrow I'm going in early to see what's what, and to find and talk to the social work case manager (each floor has one, I've been told) to see if there is a plan and what it might be.

Since Keith can't stand up, or eat, it seems to me I can't take care of him yet. Chest tube. Feeding tube.

In the past couple of days I've been told by two different people that they were there the first day. One was in the emergency room when Keith came in. One was up in the ICU when he had another cardiac arrest there. They remarked how well he looked and how happy they were to see him that way (alive, I thought they meant). Seems this is unusual.

I told Rebecca the nurse that Dr. Ling had said only 30% of those with a cardiac arrest outside the hospital live. She said she thinks it's fewer than that—that it's not that high for people who have a cardiac arrest AT the hospital. And Keith had both of those, May 3. One or two at the park, depending how it's counted, and one in the ICU. Thinking back tonight, I think what he said was 30% get to the hospital, not that they live through the emergency room or later treatments.

I talked to Ashlee and Marty about it some. They knew enough to know the numbers were very small. I just had a 30% in my head. I went to find more.
U.S. Cardiac Arrest Survival Rates Around 6 Percent for Those Occurring Outside of a Hospital
It's short, and (literally) clinical, but it made me appreciate Keith being alive and wanting to talk about checking accounts, and when payments are due.

Ashlee said she thinks for people with two cardiac arrests, the chance of living is less than 1%. Keith had two or three on the same day.

I need to stop reading that stuff; it's scary. But Keith is alive, complaining about food, and talking about when to pay which bills.

9:00 AM Thursday (March 21, 2019)

I came in early to find out more about today's plan for the insertion of the ICD. His tube feed was cut off at midnight, so they could do this little surgery. I looked up the cost of the device and I'm sorry I did. Keith needs to live about twenty five more years, I think, for that much, but they don't go by costs here. They go by "This will save his life," and "95% chance of surviving a cardiac arrest with this."

It seems I'll be happier if I stop googling stuff.

Physical therapists came, two, female. They helped him sit, and then he stood up! Honestly full height, without slouching or squatting. Two seconds, and then he said "That's enough." They helped him comfortably back into the bed. He was shaking, when he was up, but he was really up, and it was good to see, for the first time in 18 days or so. Counting the days doesn't work well. The first day he was here was March 3. But also on March 3, he was walking, driving, fencing.

10:30 AM Thursday (March 21, 2019)

A pulmonary doctor came and said they will leave the chest tube in a while, because it collected a liter overnight.

The nurse came in and gave him this'n'that. I couldn't hear everything, but none of it was painkiller. and some was blood pressure med, blood thinner, aspirin for "a plateley aggregator," Atorvastatin, potassium... Part of it is to want to prevent blood clots, because of the upcoming insertion of the ICD.

No one knows when the cardiac guys will do what they're going to do, because if there are people who aren't stable, they go before now-stable Keith.

6:05 PM Thursday (March 21, 2019)

I was too tired to write, earlier. The ICD was NOT inserted today. They were wanting to do it when Keith was stronger, and more tubes were out. Communications were imperfect, and when they said NPO / nothing by mouth from midnight (meaning also no feeding-tube food), the further message that they meant IF the chest tube was out, and if the feeding tube was out was not processed or passed or explicit or something. So Keith had not a drop of anything from midnight to 3:00 in the afternoon or so for no good reason.

Some people came by, though, notably two doctors from pulmonary who wanted to take a sample of what was coming from Keith's chest tube, but they needed fresh and current, and he didn't provide enough while they were there. The two liters in the collection recepticle weren't clean enough for use, or something. They hadn't been so particularly interested in Keith himself, as the mystery of what could be draining for so long from a person's chest cavity. This is the third tube. He doesn't have fever, his white-cell count is fine... The tube might come out tomorrow.

The speech therapist came by, the first one he ever saw, and approved water (and thin liquids). So as part of that test, Keith had some ice, some water, a cracker, and then the guy went and found a few other things. A little lunch-cup of canned pears (in tiny baby bites) was one, and I gave Keith one bite, and a drink of the juice/water, and that was all he wanted. Still... maybe he can build up to actually eating.

A resident named Dr. Nelson came by to talk to us...


The sweet and good thing about Dr. Nelson is that she's the one who had noticed Keith's rough and elevated heart rate last Tuesday, when he was on 7 South briefly.

... Dr Nelson came to talk to us about the ICD, to answer questions. Tomorrow/Friday is too soon for the procedure now. Even if the tubes were removed, it's late on Thursday. They don't work on Saturday or Sunday. Monday isn't a good day. [A hospital as large as a small city might want to do some seven-day-a-week scheduling, it seems to me.) TUESDAY. That's what she wants to aim for. So she will recommend NPO / no food for Monday night, hoe they can implant the device Tuesday, and then Keith can be discharged maybe Thursday after? This is tentative.

That's tentative, but it's more definite than most things have been so far.

It will be up to the recommendation of OT and PT (occupational therapy and physical therapy) whether Keith will then go to a skilled nursing facility, or to a physical-therapy rehab facility. I hope physical therapy. Keith was able to pull himself up to sitting, today, and stay there (if he could grab the sides of the bed).

What we learned about the ICD is not good. The papers a doctor had printed out for me earlier from their approved website had some very-dumbed-down information. I looked on the internet. DID I NOT JUST WRITE this morning that I should not do that? He won't be able to drive for six months. That seemed bad. And if the thing does set off its electric charge, he is to go to the emergency room (by ambulance, unless he's awake, and someone can drive him there very quickly), and they will do what they need to do, and then his six months of no driving starts over. Also, even without that, it can cause depression, to have an ICD. But it will save his life, they assure us.

The driving problem, I read about myself, on the same evidence-based site the doctor said was their only and best source, The emergency-room-every-time part, Dr. Nelson told me. She also clarified for Keith, who loves to drive, that if he were to opt out of the ICD, he could never drive ever, for risk of cardiac arrest or heart fibrillations. But *with* the device, if he's clear and good for six months, driving would be okay.

All of that made me sad, and tired.

Ashlee had come, and asked the best of the questions, about heart defibrillator implants, and hospital eventualities. Kirby came later, to visit, and I walked out with him, and came on home.

So it was an improving-health day, with frustrations.

10:00 PM Thursday (March 21, 2019)

Tried to speak with the nurse (by phone, from home); didn't connect. Front desk said he was probably in the process of getting meds, that he had slept in the afternoon, that they tried to keep interruptions to a minimum and that they plan to remove the NG tube [nasogastric (nose to stomach)]. Good! That was what the speech therapist said he would recommend. That's what Keith wanted me to remove a week ago. he said I wasn't on his side, and I wasn't a good wife, if I didn't pull that tube out of his nose.

I'll visit in the morning, and start a new post. No more here, probably. Click the "Sandra Dodd" title of the blog to go to the newest things.

Monday, March 18, 2019

Halfway out of the ICU

Updated 8:00 PM Monday (March 18, 2019)

11:00 AM Monday (March 18, 2019) week three, still in the ICU this morning

Keith will be on 7 South (again, where he was temporarily a week ago) when a bed opens up there. Today, then, the doctors skipped him, on their rounds.

Yesterday he was approved for thick liquids, and eating. Within an hour, they brought him a full big meal with thickened lemon flavored water which he didn't like or want, Jello which he had some of, applesauce he didn't want, turkey with gravy, mashed potatoes, and the vegetable he hates most in the world, peas. But that was easy to leave on the plate because he wasn't even close to nearly ready to eat turkey, and didn't want to try mashed potatoes.

This morning, the nurse said breakfast, for Keith, was two bites of an orange, one bite of eggs, and one bite of French toast, which he thought was vile. Still, he's starting to eat. (and complain)

A chaplain came by—nice guy I met before, AO Ferguson of the Palliative team. Keith had no concerns, so AO and I talked about harpsichords and Renaissance music a bit. He said world recorder day just passed. Ah. I missed it. :-) He saw in on CBS Sunday Morning, a show I usually watch, but yesterday I came to the hospital really early. Maybe a chaplain should've been in church on a Sunday morning, but he probably gets enough service and inspiration at work.

Now there are two physical therapists, and that's probably way more interesting to Keith than anything else that happens here. Yesterday was the first day, and he sat at the side of the bed, but today they're doing lots more, and they've brought a walker, to see if they can get him standing.

Of his big IV tree, he's only on antibiotics, now. There are a couple of things going into the feeding tube, which is still in though they're not putting the bag-o'-food in. None of it is sedative, though. Since Saturday afternoon or so, if he's sleeping it's real sleep.

Two doctors were here from "the pulmonary team" earlier to evaluate whether to take last and original chest tube out. They're starting to think maybe the oxygen it's pulling is coming through his skin and not from the space outside the lung, which is shrinking anyway. They ordered a CT scan, and he will be wheeled away for that, in a while. Other scans happen in the bed. I've asked, and the doctors asked, too, for them to say which ribs were broken. That's Keith's main question, and people have shrugged like it's not important, but it's important to Keith.

11:20 AM Monday (March 18, 2019)

Though they did some moving around in the bed, when they had Keith sitting up, he was too dizzy, then to do more. They asked him to tap his feet on the floor, and he was too dizzy to help, then, so they're putting him back in the bed.

3:15 PM Monday (March 18, 2019)

Two odd things are happening. One is that though Keith is no longer an ICU patient, really, he's still in the ICU. His nurse has four patients—1, 3/Keith, 17 (where he used to be—can't even see it from here, it's on another hall), 19. Before now, Keith's had a nurse to himself, or a nurse with one other person, next door. I was assured that she checks once an hour. That's not much, but if he's not considered to be in need of intensive care, that's enough for them. Only he can't use the call button. :-/ So I stalled before going to lunch, as long as I could. He's trying to sleep, but can't, very well.

The second odd thing is related. Keith thinks he can move more than he can. He wasn't able to tap his feet on the floor, for the physical therapists, earlier. He has not stood, nor sat up on the edge of the bed without support. But he asked me sharply "Where's that toilet? I need to sit on the toilet." There's no way. I asked for help, and got the bedpan to try to help him, and he peed in it, but I couldn't do more, and we didn't get help in time. At least I was here.

Then when he was cleaned up and was relaxedagain, he told me he wanted to sleep on his side. I asked if he wanted me to get people to help him, and prop him up with pillows. No, he said, he could do it. He can't, but I didn't argue. I figured if he fell asleep that would be good enough, and he did. I makde sure the sheet and blanket were good before I went to eat, but when I got back he said he didn't want anything, just to sleep on his right side, but he could turn himself. So I pulled the covers up and toward his left, saying that way he would still be covered up when he turned. He can't turn.

I'll be glad when he's moved somewhere where it's warmer and he actually is a patient. He has hiccups again, and they're painful even at home on a good day, but with broken ribs, it's worse. Yesterday there was a drug for hiccups, so that he could get rid of them befoe the speech therapist came. Today, doctors on this floor aren't his doctor, and unless cardiology prescribes for him, he can't get anything. And all they care about is his heart—not his ribs or hiccups or pain or delusions. The delusion of he afternoon, though, is that he can turn onto his side, or get up and go to the toilet. Not yet.

8:00 PM Monday (March 18, 2019)

I'm home. They were going to take him for a CT scan, so I left when they wheeled him away. They think he'll be moved to 7 South tonight, so I'll check before I go in the morning.

Two things I learned later in the day to day that others knew earlier:
Because he only ate some jello for dinner, and three bites of not-much for breakfast, the tube feed was reinstated. They never took the tube out because they were using it for a couple of drugs, but they put it on at 40 instead of 60 (numbers that might make sense to some of you). I wish I had known before I kept trying to get him to take at least one cracker and a bite of his lunch banana. I ate those myself on the way to the parking lot.

And the other thing is that his sternum is broken and several ribs. He kept asking which ribs and nobody would tell him, so I've pressed them to find out and let him know. I bugged every human who came in the room today and they mostly said they had no idea and no way to get an idea and I'd tell them to find someone who did, because it's the only question Keith had asked at all in two weeks. (Before, I thought two ribs on the left were all.)

Photos from the parking lot, looking west on Saturday morning, and east as I was leaving today. I thought mountains over and among tall buildings might be of interest to flatlanders. The parking structure is tall enough that I can see the mountains over some of the rest of the hospital, from the top.

The first is the Sandias from where I was parked, but then I backed up to show you the nearer mountains and the moon.

Sunday, March 17, 2019

At my more regular blog...

If there is not a post above this, go to the post below for news of Keith's Hospital Adventure.

The only blog I keep up regularly is a daily inspiration blog for unschooling parents. Last night I posted this:
Time out

Time out, please. I have tried to keep up here as though everything is normal, but I've missed a couple of days, and had more re-runs than usual. Tonight I'm too tired, but will share two things. #1 is this photo of me and baby Kirby Athena, taken by her dad yesterday; and #2, that her only grandpa, who is also my husband, has been in intensive care for two weeks. Today he's better than he has been, but it has not been steady improvement over the two weeks.

I might miss a few more posts in the coming days, or share more of the "greatest hits" or special forgotten posts from the past eight-and-a-half years.

Be happy with your families, please! Be grateful for all good things.

photo by Kirby Dodd, the Elder

Friday, March 15, 2019

Ventilator off, breathing tube out

Last updated 5:30 PM Sunday (March 17, 2019)

Friday midday (March 15, 2019)

They've taken the ventilator off, and the tube out. Jeff/Artan was there; I was not. I had been there earlier, and Marty was on his way when Jeff needed to go back to work, so there won't be much time when he didn't have a family member or longtime friend right there. Beau will come after Marty. I can go back later today.

Sandra editorializes: It's Friday. They put that ventilator in on Tuesday, not because there was a problem breathing, but because they were afraid the defibrillators might stop his heart. Okay! Then they should have taken it out Wednesday. But he was agitated, they said. Same on Thursday. But they know (or had the potential to have known) that last week he was off the ventilator for three days or so, and able to talk, and cough. They ignored all that, until I called last night and pressed someone (gently, I tried). Lawrence, the charge nurse. And Dr. Harkins, who had come up with the extubation-first plan on Saturday the 9th, was there last night. They discussed it and Lawrence called me at 11:00 pm to say it was a good thing I had pressed them, and I was right.

So I hoped that going in this morning, I'd get to be here, but the schedule was very slow, and it didn't happen until after noon. I was back home, but Jeff was there.

Before they extubated, I got a call for permission to move a tube (for what all, I'm not sure) from his femoral artery into his left wrist. I asked if they were not also going to take out the bigger chest tube, which has been in longer than anything, but they said they've considered the possibility of infection from that and they're being cautious, but they would rather remove the smaller one from his chest and leave the larger one.

Now Marty's there (Friday 12:45), and said they're doing an untrasound on his veins.

Friday 2:30 PM (March 15, 2019)
Beau visited while Marty was still there, and after. She said they took some more tubes out. I'll go when I'm through babysitting.

Friday 6:15 PM (March 15, 2019)
I called to get an update, and was told by the nurse "I'll call you back, we have an emergency situation." I said ok, but I called the desk and asked if the emergency was with Keith or someone else. She transferred me to the charge nurse who said he got agitated and pulled "a bunch of his tubes out." She said they had all tried to stop him, but couldn't.

I asked if he had a visitor, she went to check, and said Ashlee was there (she arrived after the agitation, I think), so I've been messaging with Ashlee. He pulled out the chest tube, but they were planning to remove it anyway. I don't know what they'll do about that one. She said he pulled on the foley, but not all the way out. (That's the urine-collection apparatus.)

Friday 6:40 PM (March 15, 2019)
The nurse told Ashlee that he's as stable now as he was when they transferred him to 7 South Monday night. They think it's better not to have people coming in and trying to interact with him, because he's still and resting. Bela showed up there while I was on the phone with Ashlee, so she will brief him. Bela is soothing, for Keith. Whether he stays a while or not, it won't hurt Keith.

I'll go back in the morning / Saturday morning.

8:00 AM Saturday (March 16, 2019)

Brad is the new nurse.
Keith can speak, softly and unclearly. He said "h" is the hardest sound to make. He said his big toes hurt, like there's pressure on them. He squeezed Doctor White's finger to show how hard it felt. There's nothing obvious.

He wanted water or ice, and Brad let me clean off a mouth-wssh sponge and dip it in ice water three times. He said he could cough up better when he had ice (which was nearly a week ago, but he's right).

Poor Keith is restrained, but he really is wanting things gone. He wanted me to pull the feeding tube out. I didn't.

10:10 AM Saturday (March 16, 2019)

Occupational therapist is here. For the first time in 13 days, he's been helped to sit up on the side of the bed. He might get to stand up.
(Standing didn't happen, but he sat a while and stretched a bit.)

The speech therapist should be here sometime today to do a swallow test. That's in hopes of taking out the feeding tube. I'm sadly frustrated and I have a hard time not being snarky, because all of this has happened before, but they don't refer back to last week's notes. And they left the breathing tube in longer than they should have, so it will take some more time (again) for his voice to recover. And water would help, for sure, but until he has the swallow test, they only let him have a little bit of water to suck off a sponge. Keith's getting mad at me about it.

10:33 AM Saturday (March 16, 2019)

He's back in the bed, more comfortable, I hope. I feel really bad for him, and there's not really a lot I can do. He wants me to go and touch, or get, or take pictures of things that aren't there. But they're talkinga bout weaning him off of more drugs, all the time, and going to pills when he can swallow. They're also (again) talking about taking him to another area/room/section/whatever. Formerly called "ward."

7:50 PM Saturday (March 16, 2019)

Bob Cooke was here this afternoon when I went to Devyn's 10th birthday party. He said Keith was talking some nonsense, but Bob could understand him well, and Keith seemed happy. Bob said Keith was singing some.

I came back at 4:30, and Bela came back not long after. He had come a bit earlier, but they asked him to wait a bit, because Keith was getting a bed change and kind-of bath.

Keith's voice was better, and he was happier than this morning. He's still seeing things and commenting a bit out of the blue sometimes, but also communicating real things well.

He threw up, the brown tube-feeding stuff, and his heart went a bit goofy. Two nurses and a doctor rushed in, but Bela and I had been fairly on top of it, though I didn't know where a regular pan was, so I grabbed the bedpan. It worked fine. They're giving him zofran-something for nausea.

Earlier today, Brad-the-nurse showed Keith how to use the suction.

1:15 PM Sunday (March 17, 2019)

Keith didn't sleep much last night, I heard, and threw up a couple of times.

Brad is his day nurse again. Keith didn't get the speech therapist visit he needed yesterday. Until he's approved to swallow, he stays on tube feeding. But this morning he started hiccuping and the speech therapist can't evaluate him if he's hiccuping. So Brad got approval of Reglan for hiccups. It stopped the hiccups immediately. Or else they stopped. That's why people keep trying all kinds of paper bags and breathholding and upside-downing, because at some point the hiccups stop. :-)

So if he gives him the second Reglan and they stop..... still not definite proof.:-) But if they're stopped when the speech therapist comes, that's good. I would at least like to give Keith ice chips.

They might move him to another floor today. The last time, he didn't last long there.

Keith is talkative today, and easy to understand. He's seeing things on the wall, or alight fixture, and then associating them with things from the 1970's. Coincidentally, I think, in a way. Not consciously, but somehow the memories he's coming up with are 70's. It's not like soap-opera amnesua though. He also knew Holly was in California. He remembered Sadie's husband's name, when I couldn't name him. So it seems things are triggering oddly random thoughts. LSD does that, and he's no longer on any sedatives. Brad says having had cardiogenic events take a while to come back to their right thoughts. He said after open-heart surgery they call it "pump head," that after coming back from the blood pumping machine, it takes them a while to get their thoughts working right again.

We're waiting for a speech therapist, and from people from the internal medicine team to come and evaluate him.

5:30 PM Sunday (March 17, 2019)

It will be cardiology and not internal medicine, claiming Keith when they move him to "7 South." Same floor, different specialities. Dr. Mac told Keith he has a lung infection, but I don't think that's true. This morning when others did rounds, they said his white cells were down and his fever was gone. There might still have been a standing anti-biotic deal, but the potential for aspiration pneumonia was decided againast a week or so ago. So unless there's something new nobody mentioned to me, I don't think he has an infection.

Sarah from speech pathology came and gave Keith water, ice, thickened something, apple sauce, little pieces of pear (cousin of apple sauce) to see how he swallowed. He had a graham cracker, but didn't like it. Thick things were better than plain water, it seemed. So he's approved for thicker liquids and softish things (maybe). But even the little practice samples were too much for him. He wanted to stop. His stomach wasn't feeling great, but he didn't throw up.

There isn't a bed on 7 South, so he'll be here until tomorrow, at least.

To get to older posts (there were three, as this one was started) about Keith's hospitalization, click the title of the blog


to see all the recent entries.

Monday, March 11, 2019

Keith, out of the ICU—I MEAN WAIT, back in the ICU

Updated 5:55 Thursday afternoon (March 14, 2019)

Monday night (March 11, 2019) about 9:30, they got word in the ICU that there was a room for Keith: 720, in 7 South
Same parking, where we are, which looks like it will be a long walk each time.

Bela was with me when they told us, but we were about to leave. He needs to go to work tomorrow, and I had been at the hospital since Saturday early evening—over 48 hours. I will report again tomorrow, but Keith's out of the ICU!

9:00 AM, Tuesday, March 12
I called to 7 South, where Keith was moved last night. I haven't been there yet.

Last night he had emesis (throwing up) so they have cut his tube feed. I didn't ask whether they took the tube out.

He's in stable condition, still delirious and muttering, and the nurse I spoke with didn't know if he had a fever.

It's not much information, but enough that I feel calm about staying home for a while today.

3:30 PM, Tuesday, March 12

I was calmly home when I got a phone call from a nurse saying Keith's heart was beating in a new and different way, and the doctor would like to speak with me. Dr. Brown, a cardiologist, wanted permission for them to use electro cardioversion to try to get his heart settled. And also, to do that, they needed permission to re-intubate him so he would have oxygen during that, or if something went wrong. I agreed to all that.

Also, he said they would like to do another catheter angiogram, to see if there might be a problem with the stents from Sunday the 3rd, or what might be going on. They thought I should come in and that Keith would be back in the ICU. I drove over, heard more explanations, and agreed to the test.

Leaving out some of the minor-er details, they didn't find any problems they hadn't already seen March 3, and the stents were open, and fine.

He's in the same ICU, but in #3 now, near the door. He is on

  • amiodarone
  • phenylephrine
  • propofol
  • fentanyl
  • insulin drip
  • vasopressin
  • lidocaine (temporary)
Propofol+fentanyl, together, will keep him still until tomorrow. It seems a bit like starting over, except there was no cardiac arrest, and no CPR.

What there WAS was a heart rate of up to 280. It was over 220 when they first started to work on him, as high as 280 260* between shocks—there were eight shocks—and it settled back closer to 100 after that. When I was there, it was 80 or so, I think, but that was because of two of those drugs: amiodarone and lidocaine

* I looked back at my notes. There was a 6, and an 8. And I heard again there were eight shocks, so that means it must've been 260. I'm sorry for the confusion, but I'm pretty sure 260, and eight times.

I'll go back Wednesday morning.

9:30 AM, Wednesday, March 13

From a racing uneven heartrate of high 250s (260 once) yesterday morning, later in the day it dropped to the 40-60 range, and I don't think it's been that low since he came here. He still has fever, and it hasn't been lower than 38 recently, I was told. They don't know what's going on with his heart.

A cardiologist (I can't tell who's who here sometimes) came to say that before Keith leaves, like the day before he's leaving, they want to install an ICD defibrulator, that would give his heart a shock if it went into an irregular pattern. (one of these)

Yesterday and this morning, I read a lot about temporary blindness or various partial blindness cases, following cardiac arrest and CPR. But it seems it's not going to be of interest to anyone here. At least I'll be able to reassure Keith that if he's not seeing as he used to, that the problem is rare and documented and temporary. The opthamologists only care about his physical eyes. Cardiologists only care if the heart is beating. Some things fall between departments, I guess. Here's where I have links about it, and I invite ideas. It's a facebook group, so if you're not on facebook, maybe you should be. :-) Trivial Curiosities, Rants and Philosophy with Sandra Dodd The link should go straight to that topic.

11:00 AM, Wednesday, March 13

Spontaneous breathing went okay. They put the pain meds on pause, so he could wake up enough to respond to things, in a while. He's in pain, and is answering yes/no questions really well. So he can't breathe deeper because of pain in his ribs. He didn't want a heat pack, said yes to a cold pack, but later wanted it out (they had putit under where his ribs are broken).

They're put a bit of pain med somewhere, so he can be calm for the spontaneous awakening trial (which he might already have passed, from being responsive. If they don't take the tube out, he can't answer the irritating name/birthday/where-are-you/date/do-you-know-why-you're here questions.

11:25 AM, Wednesday, March 13

He started biting on the breathing tube, and getting agitated. He tried to sit up, with legs and back, so that's kinda dramatic. His wrists are restrained, or he would've been up, and maybe out of the bed. Several people came in including the main doctor, and they put him back so the machine is the primary breather.

He's trying to push the breathing tube out, and they're putting the propofol back on. Just as I was leaving the nurse said they had replaced propofol with precedex.

The next spontaneous breathing trial will be tomorrow morning (Thursday, March 14).

I forgot to add, earlier, that they had send urine and blood samples to the lab to see what Keith's infection might be—why he has fever. I called earlier, and the results weren't in yet.

8:00 AM, Thursday, March 14

Today's nurse is John. I called and talked to him. Keith's the same as he was a few days ago, he said. Fever? It's down now. Awake? Not really, but maybe later today after the spontaneous breathing test, which will be today after doctors' rounds, probably.

Marty was there last night and said Keith was able to communicate by nods and head shakes, and wanted that music off I had put on in the morning (and then forgotten about). The TV remote / nurse call button hand set has the speaker on it, and I had put on the soothing water-and-mountains channel, with the soothing music. I didn't turn it off when I left, late morning, and it was on soft enough nobody was hearing it but poor Keith. He probably heard it eight times before Marty rescued him.

Sorry there's not more to report, but not sorry things are calmer. I hope the breathing tube will come out today. Some of you, and maybe all of you, might know how confusing and awful it is for me to feel like it's in there again because of me not saying "leave him alone now," but that because he can nod and shake his head and communicate about where he's hurting, that he's likely to get up and get out of there and come home where you can all visit him.

I dreamed he was home and there was a dream-kind-of party at our house, but everyone was coming in the back, and standing around, talking happily, in his office in the corner near the printer, and it was getting crowded. I asked whether we shouldn't go up in to the main part of the house where there was more room. Keith said no, it was fine. Then I realized that it had been more than an hour since anyone was up front, and other visitors had probably come to the door, not gotten a response, and gone away in the dark. And lucky me! That's the worst dream I've had about all this.

Maybe Keith is also having relative peace. There were no invasive procedures yesterday. They didn't have him on a cold-water mattress pad.

If anyone wants to visit him, don't take anything but maybe a card he can see later. Put in that top drawer of the little dresser by the window before you leave, please. And don't feel bad if he doesn't remember you being there. He's sure who I am, sometimes.

He's in #3, MICU (medical intensive care, so check, because there are three of them all in one area up there).

Thursday afternoon, March 14—other people's reports(I was home with Devyn and little Kirby)

12:31 PM, Beau (who had been there with Laurie B. to play recorders)

Keith was thrashing about when we played or talked with him off and on. After about an hour they sedated him more, he was moving his arms and legs about. Did settle down after they suctioned his air passages.

Nurse said they will try pulling the ventilator again later today. His oxygen was good with the ventilator providing only oxygen, I guess weaning from the pressure.

1:41 PM, Marty

John, his current nurse, said that he failed SBT again because of agitation. And that two women came and played flutes fo rhim.

SBT is spontaneous breathing trial, and Laurie and Beau were playing recorders earlier.
5:15+/-, Kirby

I've been here with dad since 2pm. Dad is asleep, though was immediately responded to my saying hello. He shook his head "no." I replied stating I'd leave him to rest, to which he shrugged.

The nurse reported earlier in the day his chest tube was out a little bit. So they reinserted two centimeters. Current drugs:

  • Phenylephine 40mcg/min
  • Amio 0.5mg/min
  • ZosenEX 25ml/h
  • Precedex 1.5mcg/kg/h
  • Fentanyl 125mcg/kg/h
  • If there are errors and it doesn't make sense,
    maybe it's close. I transcribed from Kirby's notes,
    and it won't stay formatted here.
  • Insulin 2.1 u/h
  • Propofol 5mcg/kg/min
  • Vancouver, standby
Chest x-ray at 3:05 pm

3:30, Dad's breathing machine started spinning an alarm. The doctor said he was coughing. They gave him some more sedatives to assist.

His nurse changed to John, the guy I've liked best so far. They gave him anti-inflammatory meds through a shot and it's been very calm.

Newer: Ventilator off, breathing tube out, Friday, March 15

Or click the title of the blog, and read through all the entries that way.

Friday, March 08, 2019

Keith, better days in the hospital

Updated 8:50 PM, Monday, March 11 Newer things are here:

One story has been added, from Sunday, that I didn't put in at that time. Click here if you were up to date, to see that.

To read the earlier notes, March 3-7, go to Keith and a medical situation, but now you can read it without the fearful tone I had at first.

9:08 AM Friday, March 8

Marty stayed at the hospital with Keith last night, and said things are better, because they discovered that the breathing tube wasn't going deep enough. When they readjusted it, the hiccups stopped immediately.

They put a bite guard in so he won't bite his airflow, too.

Today's spontaneous breathing trial should go better than yesterday's. He breathed right away yesterday, but the equipment wasn't right for it.

They weaned him off the insulin. Fewer things on the IV stand, now.

I feel much better. "That's is a relief" is a figure of speech used about all sorts of minor and incidental things, but in a situation like this week has been, "relief" is relieving me of life-size frights.

10:50 AM, Friday, March 8

Got a call requesting approval for a PICC line, a more long-lasting IV to replace the one they put in last Sunday. Joe, the person who called, hadn't been up to the room yet so couldn't tell me whether the spontaneous breathing trial went well. This may or may not be a follow-up to that.

I was a bit spooked by "I need to speak with someone who can make medical decisions for Keith Dodd," because I'm home with just baby Kirby, but this seems routine, so good.

Ashlee's on her way over there, so she will let me know later how spontaneous awakening and spontaneous breathing went.

1:15 PM, Friday, March 8

Ashlee was there when a test of responsiveness was done, and Keith was hearing and following requests, but was uncomfortable and agitated, so he's not yet left awake on his own, quite.

I'll come back and amend this if there are errors, but what I think Ashlee said ws that the PICC line was in, in his right bicep, the IV was taken out of his neck (the one that had the cooling loop that's no long needed, and three blood pressure assists). the IV that was in his right forearm is out. One of the two in his left hand/wrist is gone. So I think his remaining tubes are feeding (to stomach), breathing/ventilator (also down his throat), the new PICC line, and one in his wrist maybe. And a catheter for urine. He's much less wired up now.

The only heart medication he's on now is Epinephrin, I think Propofol (the most sedatious of the sedatives) is gone, and they're only using Fentanyl.

These are steps toward independent functions, it seems, surely.

10:30 PM, Friday, March 8

I've been here for a couple of hours. Things are mostly calm. I have one more tube to report—femoral artery, for checking blood pressure, and it's there in case they need to run something into the heart (I think). A sheath line (?? Yes the "sheath," but I don't know what else went with that term). There was another such thing they removed, but I don't remember the name, and had ever known it was there. I can't keep up with it all, but other than letting the rest of you know, and recording it to show Keith later, I don't guess I (personally) need to know.

There was an anti-anxiety drug added when Propofol was dropped: Precedex.

For unknown reasons he has a fever of 38.2 C. It's higher than the other day. The other day's translated to 99 F, and today's is 100.76

10:00 AM, Saturday, March 9

This morning I'm a little bummed, but that's benign. It's the most wan of the emotions of the week. But I've expressed myself as politely as I could, and I cried for the first time, and that's because it looked to me like the respitory therapist had made a mistake. Maybe he did and maybe he didn't, but by then I was already past my original calm. I was asking questions about how he would ever wake up if every time he showed agitation (or strength—he can't help that), they gave him more fentanyl. I was asked if I wanted to talk to a chaplain. I said I had already talked to four of them, but I didn't know how they could help with this. (<--"this" being the question about how many times they would let be BARELY coming out of anesthesia, and then put him back).

Dr. Harkins, the attending physician, came to talk to me, then. On weekends they don't have the palliative care team, or that might've been who they would have sent. She was able to answer the questions for me, but sadly part of the answer is that it can take weeks, of a brief attempt every day, and waiting for the next day.

I asked someone else (Jason, a nurse I like, who's not assigned here today) whether they couldn't restrain his head. At that moment, I was thinking that if some of his strong and knowledgeable and calming friends could hold him and talk to him while he was waking up, they wouldn't need the fentanyl. If Katherine Moseley and Wendy Neathery-Wise and Bela and Jeff-Artan were all here at the same time, they could hold him until he was awake enough to know where he was and that if he was still he would get some tube removal. But these people don't know him well enough. And when Dr. Harkins (a very nice woman) said that she had opened his eye, and she showed how, with her hand, and he was agitated, I got big eyes and said he can't stand to have his eyes touched. He had to change majors from theatre because he couldn't put eye makeup on himself (nor let anyone else do it). That's minor, but would TOTALLY add to agitation.

THE GOOD NEWS is that after all that, when the same doctor came by with the gaggle of student doctors, they said to put him on the spontaneous breathing mode, and that went well.

11:00 AM, Saturday, March 9
[a little time has passed, and...]

Right now, they're pulling the breathing tube.

Noon, Saturday, March 9

Keith is waking up, but even though there are no tubes down his throat, he has some tape on his neck hair, and his back was already hurting before he came here and lay on his back for six days. So his discomfort earlier was assumed to be tubes, but I think now it's back pain and tape in weird places.

Holly is here with me.

12:13 PM, Saturday, March 9
Keith is making wookie noises, but not too loudly. I hope he'll be more conscious before he gets his volume back!

1:36 PM, Saturday, March 9

They're going to take the sheath tube out of his femoral artery (left leg, where it bends) to avoid infection, since they don't need it anymore.
He's on a high dose of Fentanyl now that they know his back is hurting. All his motions seem to be back-stretching and rearranging things.

MAYBE he responded. Maybe not.

When I said "Can you open your eyes?" he did, and rolled them around and closed them again. I said "There's not much to see. You're at UNM." I really think he said "yeah." I couldn't swear in court that he did, but I could swear in court that I think he might have.

3:00 PM, Saturday, March 9

He can talk, but not much and not clearly enough yet, to be sure. He spoke a solid "I don't know" that Dr. Harkins also heard, when we were trying to figure out how he was trying to position himself, in all his raring and twisting. He's a bit to the left side now.

They're about to add some Ketorolak to the Fetanyl and Precedex. Ketorolac, I am told, is a big ibuprophen.

Now that I know he's aware of what hurts where, and can talk some (he said a few other things, half of which I understood, about whether the bed was better flat and suchlike), I'm fine with them knocking him out.

They can get him a steroid shot in intensive care, but said maybe when he ws in another room, a few days from now, maybe. Maybe what, I'm not sure. :-) Maybe I could persuade the pain clinic to communicate with someone here (there).

Anyway... his breathing and heart are functioning.

5:30 PM, Saturday, March 9

Kirby and Destiny were here, I was home. From Destiny's notes: Provider pulled left femeral/sheath and placed feeding tube in nose.

9:07 AM, Sunday, March 10

Because Keith's back hurts so much, he's been medicated so he could relax and sleep. Fetanyl and Precedex in constant IV, and Toradol (the brand name or type of Ketorolac) injected into some line or other occasionally. There is Abilify and Gabepentin, too (delivered in the feeding tube) since Saturday night (last night). He has gabepentin at home, prescribed by the pain clinic that gives him steroid shots a time or two a year, and he has taken them before, but doesn't like tonormally. They've ordered some Oxycodone to try as they wean him off of IV painkillers (or while they're considering trying to do that), and there's talk of getting physical therapists to get him up, but it might not be today.

Another IV stand was taken away. It's gradually less "equipmenty" every shift, now.

There will be some attempt later this morning to turn down the Precedex (anti-anxiety) so he might clear his head a bit, and maybe communicate again as he did yesterday. They might turn everything down, gradually, today, and try to put him on oral Oxycodone and Tylenol (through the feeding tube). Abilify it to help him come off the Precedex,and Oxycodone will help him come off the Fetanyl (says Eric, today's nurse).

It's hard for me to see him in that much pain, but it's happening right under a monitor that's showing his own unaided heartbeat and breathing, so that's good. Seeing him able to express (even if non-verbally) that his back hurts is way better, and safer, than the first few days here.

In a few hours it will have been a week since the first cardiac arrest.

2:15 PM, Sunday, March 10

He's sleeping a lot. They're still moving toward oral (feeding tube) drugs, rather than IV.

When he wakes up he makes wookie noise and wiggles to be rearranged. He's making more human sounds now—some aren't words, sometimes there is something, just a word or two. I asked if he wanted the oxygen mask off, and he said yes. The elastic ws tangled up in his (tangled up) hair, and was pulling when he moved. So now he has the nasal cannula (thanks, Ashlee).

(I'm sorry, I keep missing notes from people, which are scattered, in phone message, FB messenger, comments on blog, comments on posts, and e-mail. I check a couple of places, and then get sleep or distracted by something else.)

Instead of wrist restraints now, he has two "mittens," so he can't pull tubes off. They look like these, only white, and without thumbs:

When he's as talkative as Strongbad, they'll discharge him for sure.

3:33 PM, Sunday, March 10

Story added later:

I was asleep and woke up to hear Bela talking to Keith, and then Keith asked if he broke his back, and Bela said no. I totally understood that part, even from behind them with noisy machines on. Bela talked about broken ribs, and his lungs, and breathing, and Keith asked "punctured?"

Then Keith asked if he was in traction. No, Bela said.
Keith said something about legs, and Bela was reassuring him that his legs were okay, and Keith said "My leg's off."
Bela, still face-to-face with Keith was reassuring him that his legs were good, and they were there, and then I saw that his right leg was hanging off the bed. So I put it back, and his leg wasn't off anymore. Tadaa!!

And that is how he is sometimes confused, and sometimes not at all.

I took a nap, and woke up to hear Bela talking to Keith, and Keith asked Bela if his back was broken. So not only he's talking better, but Bela managed to help him know what's going on, and talked about the broken ribs a bit and breathing, and Keith asked if his lung was punctured. He had asked about his legs, too. I don't think he's talked about his heart yet.

Bela was talking to him about coughing harder, and caughing stuff up, and asked if he wanted to be suctioned, and Keith said yes. So they're doing that right now—his mouth, and his nose. He's really listening to Bela.
4:44 PM, Sunday, March 10

He's coughing up and Bela or I wipe the stuff off for him. He sucked on a wet wash cloth a little, and so the nurse gave me a sponge on a plastic mouth-washing thing, and said I could dip that in water. Keith sucked that a couple of times and was happier.

He's partly delusional, and partly clearl. He was gazing up at the big (very cool) light, and Bela asked him what he was thinking about. He said something twice, and I said "Shatner?" He shook his head and very clearly said "Ja-pan-ESE." But mostly he's talking about real things.

8:30 PM, Sunday, March 10

Keith is asleep. He talked so much cute nonsense this afternoon that he's exhausted.

8:00 AM, Monday, March 11

Same as last night. He's mostly awake, muttering, can talk but not perfectly clearly, usually. Drugs and disorientation, I think. Some of the things he says sound like he's dreaming. He was moving his mouth but not really vocalizing, and I asked him what he was saying. "The piles are getting deep, I need to figure this out." A very Keith thing. I told him everything was okay, that things would be fine. He seemed to be asleep, though.

There is a light in this room that looks like Stargate, sort of, and once when a doctor was in talkig to him he said there were beautiful people here, and stuff like lasers, and gestured (with his glove) at that time, at the light. It has a handle sticking down in the middle of it. I called it Stargate, but he saw a laser.

They're controlling his back pain, mostly with Tylenol, and I'm amazed.

He's on another blood pressure med, but to lower it, now. He has had fever all night, but it started at 38 and is 37.6 mostly.

I asked the nurse to recite the drugs for the day:

Abilify (once a day)
Tylenol (as needed for back pain and fever)
Oxycodone as needed
Captopril (lower heart rate and blood return)
Docusat (a stool softener)
aspirin and phlavix to thin blood, because of his stints, to prevent heart attack
Gabopentin for nerve pain (for his lower back)
Buspirone, a calming mood stabilizer

There's a request in for physical therapy, to help him move and maybe get him into a chair, maybe today.

He will probably be moved elsewhere in the hospital soon.

11:15 AM, Monday, March 11

A speech therapist came to "swallow test" him with ice, water in a spoon, apple juice through a straw. He's not ready to lose the feeding tube yet. He didn't do perfectly well.

The speech therapist was trying to get him to talk, and seeing how with-it he was. I was sitting where he could see me and the therapist said "Who's that?" I waved and smiled. "Sandra" he said (but slowly).
"How do you know her?" the speech therapist asked.
"Marriage," Keith said, slowly.

But he couldn't say what month it was.

What he did say, that was interesting, was "They're trying to decide where to put balloons. What are these balloons? Pop, pop, pop."

Yesterday he had said "What is this bubble game?" I didn't think much of that yesterday except it was fun, and I reported it on my facebook page:

"What is this game of bubbles?"

That was Keith, in his low-feverish, sleepy, drug-addled delirium.

Sounds a touch Shakespearean, but happier than "What is this quintessence of dust?" Bubblier.

I guess it's not an important question, because not long after, he said "It doesn't matter."

I just asked Dr. Ling, who is the... I don't know. One of the teaching doctors. He's "the fellow." (I asked.) So attending physicians are here for a week (last week, Dr. Harkins, and starting today Dr. Vasquez from Barcelona whose accent will be hard to understand, they said. On rounds, he only said one thing, and Dr. Ling did most of the talking), and fellows are here for a month. He said it's confusing even when you're in it.

So... maybe as Keith's zoning out he's seeing spots (like dust motes maybe) and looking at them, because the view from his bed is not very busy or interesting. And we can ask him when he's more alert, how his vision is doing.

They decided to leave both chest tubes in for now, but hope to take the larger, older one out in a day or two. That can be done elsewhere. When they move Keith to another floor, he will take his feeding tube and chest tubes with him. Chest tubes are the business of the pulmonary team (lungs), and not just an ICU thing.

12:21 AM, Monday, March 11

Addition of atorvastatin, for cholesterol.
... deletion/abandonment/no-more-ness of "Buspirone, a calming mood stabilizer." Discontinuance. Demise.

7:00 PM, Monday, March 11

Keith has fever. It goes up and down from 38C. I've seen 37.6 to 38.4. That's 99.7 to 101.1, in numbers I know better. They're thinking it might have to do with the fluid near his lung, where the ribs broke and punctured.

Once, maybe about 3:30, a nurse rushed in and asked him if he was okay. I was behind him, and didn't know why she did. Nothing was beeping. She saw his heartrate suddenly go up, and figured he was having a bad dream.

He's in and out of sleep, and mutters to himself and mostly stares up into the corner where the TV is not. The TV is on a long nature thing, of water, mountains, soothing music. He watched it a while, and told Kirby that water was crashing down. Just now, though, he was looking up into the corner with interest. I asked him if he could see me and he said yes, but he wasn't looking at me. I asked him to look at me and he looked. Then he looked back up into the corner. He said something else about bubbles. I asked if the bubbles were up there, and he said yes. I asked if here were two of them (wondering if it was the after-image of something, and he said "four." Four bubbles. What color? Yellow and brown.

They've approved a move to somewhere else. The doctors who came to look at him were from the medicine team and internal medicine. They need a room with a roommate who is also positive for staph infection, or a private room. Whichever comes first, Keith will be moved there. I will call and check before I come back tomorrow.

I can't stay over, once he's moved. Probably best for me. I was going to go home tonight even if he'd definitely be staying in the ICU. I've been here since Saturday afternoon. I have extra clothes in the van, but it was raining and I stayed in.

8:50 PM, Monday, March 11

Temperature is down to 37.0. Still a fever, but lowest of 10 hours or more. They've given him meds for the night. Melatonin added. No Oxycodone (none all day, I think). Tylenol. Abilify. And all the cholesterol and heart pressure stuff, still there.

I'm going home.

Newer things, from March 12 after he was moved to "7 South," room 720

Easier, to get to newest stuff, click on the blog title or right here for hewer things, and to see all of them (there are four, as of Friday March 15).

Tuesday, March 05, 2019

Things I can see this week

What I see from where I'm sleeping. Keith is right over there. If you came here to read about Keith, click here. The doorway look like it opens into a sunny vista with greenness, but it's just a wall. Because this room was dark, the hallway seemed lit up like The Emerald City or something. Contrast.

I don't want to take a picture of Keith. His hair hasn't been put up the way he likes it, and he's a little tubey. Intubish.
(Also it's against policy, and decorum, so I won't tell you what hospital we're in or which department, and don't ask.)

Out the window, though, is the roof of some of the 1st floor, in the foreground. Center is Hokona Zuni, with Zia to the left—dorms I lived in when I was 17 and 18. The first year I lived there was the last year it had its own dining hall. 1970/71. The second year I lived there was the first year it was a co-ed dorm instead of all-girls.

To the far left is another paired set of dorms, Laguna/DeVargas. I lived there as a senior. They were nearly new when I was in there.

You might notice those photos were taken at different times of the 24-hour clock.

The top of the parking structure has an unobstructed view of the western horizon. Wow! THIS would be the place to come to watch balloons. I wonder if people already know that and it fills up? All you have to do to get up here is to drive 5 mph through about a quarter mile of very tight spirally parking lot, in the dark, before you pop out into "There are the volcanos; where are the balloons!?" glory.

It was only shady for being 7:15 a.m. Much of the time it's full sun. My van doesn't care, but today I didn't make it to the top, because someone had left me a spot right near the elevators. This is as close as I park to my front door at home! I am commemorating this today, because it will never happen again. NOTE: It happened again the very next day, very same spot.

I looked carefully to make sure there were no signs like "this space is preserved for pregnant law enforcement officers," or "employee of the month" but no... unmarked and empty.

So as days with comatose husbands go, this one is a good one, and I wanted to share some of the views (and save them for my own nostalgic future).

Monday, March 04, 2019

Keith and a medical situation

Newer notes, from Friday March 8, are at Keith, better days in the hospital

And NEWER newer things: from March 13

Summary in advance as of 3:30 PM, Thursday, March 7
Keith/Gunwaldt is stable but critical, unconscious and well attended, in intensive care at UNMH.

Coronary fibrulation, cardiac arrest (at Montgomery Park Sunday noonish—CPR by SCA friends, then by EMTs)

Coronary angiogram (UNMH 4:00 or so)

Another cardiac arrest after that (CPR in ICU, 6:30 pm?)

Stabilized but on many machines and IV, since later that night.

I'm gathering things I wrote as they unfolded, to put in one place and share with friends and relatives. I'll add to it as more is known. Feel free to send the URL out and about to others who might wonder and worry.

Elizabeth McLaughlin wrote:

More info from the park. Everyone there helped. Albinas dialed 911 the instant we saw Keith's condition, and stayed on the ph w/ dispatch, keeping them informed of everything we were doing, so when the paramedics arrived, they jumped out with equipment in hand, and a plan to help. Jenn, Loucretzia, Rados, & Constatine stripped Keith of his armor, in seconds, helped with CPR, and they and everyone there cleared all the arms & armor, preparing the area for the emergency crew. People were in the street to flag the ambulance, and point the crew to Keith. Anyone not actively helping, stood out of the way, but close enough to help, should anything be required. No one had to tell anyone what to do. Everyone acted as a well oiled machine. Loucretzia organized gathering Keith's gear, and getting it in Marty's car. Kayda and Bela both interfaced with the paramedics, to inform them of what we knew of family coming, and Keith's health history.

from Sandra:

THANK YOU, one and all. I am very grateful, both for the help people offered so quickly and generously, and for the account and the credits of it.

Midday Sunday, March 3

Keith went to fighter practice to fence. During or after a bout, he said he was out of breath, stepped back, and fell backwards. Someone called out for help and Brigitta, Bela, and Kayda (Sherri) ran to do CPR. Someone called 911, and called Marty, who called me. Holly and I started over to the park and got there as he was put into the ambulance.

Bela drove Marty to the hospital, and Holly drove me. Bela's account (and action) were important for them all to hear, as various doctors came and talked to us about different aspects of what was happening.

NOTE to Paul, Jeff and Steve-&-Beau, 5:45 pm Sunday (still Day 1):
They did the coronary angiogram. It wasn’t a heart attack, but there was blockage, and they put two stents into the LAD / front wall artery.

The doctor said that at some point in the past, Keith had a heart attack, and the front wall broke, and blood leaked out into the body cavity and calcified—on the heart, and maybe also lower down, but they’ll know more later. The heart had developed collateral vessels (like a natural bypass, he said).

The left side of the heart didn’t have significant disease, but the right had not much flow to heart tissue.

What happened at the park was that he had coronary fibrulation and cardiac arrest. So not a heart attack today, but the effect of a heart attack whenever-back. Dr. Garcia described coronary fibulation later as "an electrical storm of the heart," and I wrote the phrase down. It didn't seem to be a good time to point out that if someone said that at our house on a normal day, probably Keith or Holly or I (if not two or three at once) would have started singing it to the tune of "sudden eclipse of the heart."

When he had his shoulder surgery most recently (November?) they made him get approval of a cardiologist first. And that test showed that he had had a heart attack at some point. That seemed odd, because we couldn’t think of anything.

Today, though, I’m wondering. Beau, do you remember when or where at an Estrella (or maybe a Battlemoor) when Keith went to the toilet at night and then had pain and a hard time getting back to the tent? He thought it was because of his back. He said he eventually made it back to the tent, and barely made it into the bed, and then stayed there for hours, and could hear people in the morning saying that he had probably already gone to the field, or had left early. He could hear them, but couldn’t get up. Then he said Beau came and checked on him later, and helped him for the rest of the time.

That might have been a heart attack.

Keith and his high pain threshhold…..

The’re putting him into the ICU, and just called me (we’re in a cafe down the hall) to get permission for a unit of blood and a blood-pressure medicine that goes by IV, but needs to go into a bigger vein, so they’re putting it in his neck. I said okay, becuase I don’t know how or why I would not say okay.

That’s what we know now.

I took notes to tell you that stuff, Jeff, because I knew you would want to know. I wish I knew more.

7:00 p.m. to the same group, plus Ashlee, who was in the Presbyterian Emergency room while were at the UNMH (university hospital, a mile and a half or so from there). Ivan's mystery rash and hives had worsened.

We’re still all waiting to go in and see him. Kirby and Destiny will go first, when they let us in to the ICU room; their kids are with a friend. Then Bela and Marty, then me and Holly. Bela will take Marty and Holly back to the park to get Marty’s jeep and Keith’s truck. I’ll stay here a while, probably.
Or if they say Keith will be fully unconscious, maybe we’ll use my van to get people to cars.
Transport ended up being different, but all vehicles were retrieved before long.
Later note, for the record. Holly didn't see Keith that night. She left with Kirby to retrieve Keith's truck from the park. Bela would have taken Marty over to where Ashlee, Ivan and Treva were, at Pres, but they were being discharged already, so Bela took Marty to his jeep, at the park.

There was a time, earlier today, when they said he would be sedated for at least two more days. Since they’re not needing to do a surgery, though, that plan might be cancelled.

We might or might not know more after we see him.

They let me sit with him a bit before the angiogram. He was cold, but Bela figures cold is a good thing.

People here are cheery and telling fun stories, now that we’re less afraid. Marty’s anxious to get back to Ivan, so I hope they let us in soon.

While we were waiting, Keith had another cardiac arrest, after they moved him from the Cardio Cath Lab to the ICU.

11:30 PM they hooked him up to the big catheter. It goes in at his neck, and has blood pressure medicine and a cold water unit so that cold water circulates though a closed loop to cool his blood.

They're trying to keep his temp at 36C, which is not very much colder than regular, but cooling the blood can help prevent continuing brain damage.

He's breathing by machine, but his lung has re-inflated (it was punctured by a broken rib during CPR).
His heart beats on its own with the help of epinephren in the IV, and blood pressure meds in the newer, larger line.

2:15 AM 3/4/19

When they were changing the pads and the bedding, he moved, grimaced, opened his eyes a bit a couple of times (but didn't focus). Opened his mouth wider (discomfort of tubes maybe), but he wasn't really awake. It was in reaction to them rolling him on one side and then the other, I think.

I held his hand through most of it, but he didn't squeeze back. Still, it felt good, and I saw his eyes, even though I don't think he saw me.

4:52 AM 3/4/19
took him for CT scan. There was an earlier request for another look at the heart, but it's hard to move him with all his stuff, so the nighttime doctors were going to stall until he was more stable, or until there was more need.
They woke me up to say they were taking him for the scan so the cardiologists could look at his heart later, but now they wanted to see his abdomen to see if he was bleeding somewhere, because his blood levels were dropping.

5:30 AM 3/4/19
5:30 they came back, and it took 20 minutes to get all the hoses reconnected from the travelling units to the big solid one.
There's no news or report of it, though. Unless it's going to require a new procedure, the doctor won't come and talk to me about it.
More blood has not been ordered, but it might be.
Even if they see where he might be bleeding inside, they might be able to affect it without surgery, says this nurse I like.

The nurse says Keith is one of the sickest here, so there will be a lot of activity in here around 7:00 and I might not be able to sleep. Also he says when the residents do rounds, they do it outside and not right in the room, usually, and if I were to go home I could get a report from one of the doctors later.
I'm going to try to sleep for an hour or two anyway, since I have two blankets and a bed now.
I'll go home and shower and eat after I sleep some, I think.

10:15 AM:
I'm back at the hospital. Today's nurse called and asked me to come. There was another CT Scan this morning, and they found aspiration pneumonia. They're putting him on antibiotics right now.

Sometime during the CPR at the park, stomach acid (contents?) came up, and he breathed some, and now they're "treating him for aspiration pneumonia." Whether it is already pneumonia is kind of a grey area, though, but the official phrase is that above.

The other new concern is kidney problems from insufficient blood flow to organs, because although his heart is working, it's not working as strongly as it should. They have maxed out the doses of the three heart-pressure medicines, and the 4th doesn't make sense for his particular case, so they won't use the 4th one.

This morning between 7:30 when I left for home and 10:00 when I got back, Keith woke up some, and flailed a bit, arms and legs. The nurse (Annika) says he was trying to get tubes out, so she quickly increased the sedative, but that it was a good sign that he could wake up and move, and that he moved both sides, and not just one.

Noon, 3/4/19
I noticed even the chaplain came in in a gown with gloves. Thinking back, it's been since I got here.

There's a sign on the door, too. Keith tested positive for Methicillin-resistant Staphylococcus aureus (MRSA), so visitors need to wash hands before and after, and employees need to use gloves and gowns so they don't pass his staph infection to other patients.

Two things they may or may not recommend we consider, depending how everything else goes:
  • swan catheter (to measure pressure in the chambers of the heart)
  • impella (a pump that goes inside the heart temporarily)

9:55 PM: Kidneys are slightly improved. Kidney injury is resolving. Still chilled; the coronary proposals are off the table for now, nothing of note, sleeping, moved some.

Tuesday morning They were having a hard time getting him to 36C, so at 3:00 am (I think) they had set the machine to 35, to try to get him to 36. Shivering was warming him up, and they don't want him to be moving, either, so they added something to the cooling (something in the bed? I slept through it) and when I left, they had set it back to 36. Then there's a sort of bubble-wrap-looking layer above him, with a blanket on top of that. They blow warm air through channels in the plastic "blanket," to keep him from shivering while his blood is cooled. He looked comfortable. I've come home for a few hours, and Holly went to the hospital about 9:30.

Noonish Tuesday, 3/5 Dr. Ling called. They want to replace the chest tube that was taking out blood and air, initially, from the chest cavity outside his left lung, and replace it with a smaller tube that goes into the space near the top of the lung, through his chest. The other, bigger tube was having problems with flow, and they don't want air to put pressure on his heart in there. The new one will only be pulling air. (This is what I understand from a phone call. I asked some questions, there was a witness, and they took verbal approval over the phone.)

2:30 PM and a bit after Holly says that procedure was done at 2:30, and when needed her to leave so they could X-ray to make sure it was in the best spot, she decided to go find food. I'll leave to go back in just a bit. They have started very gradually warming him back up to normal temperature which should be completed at 3:00 Thursday morning. I think it's then that they plan to assess brain function. Somewhere around there.

9:00 PM, still gradually warming. He moved around some, and when that happens they make him comfortable and give him an extra bit of the regularly-ongoing sedative (Fentanyl). The new chest tube is working and the older one stayed in also, and is working better too, for an unexplained reason. (I will ask for an explanation, and maybe it won't be unexplained anymore. :-) )

11:50 PM I asked. The nurses know the story, but they don't know why either. When the new one was put in, the older, larger one started flowing. So they left them both. "Mystery tube," one said. Okay then.
They started a nutrition... packet, bag today. It goes through a tube to the stomach. It's flowing VERY slowly. "Tube feeding with a kangaroo bag." This is why I didn't know. It's secret lingo. :-)

1:40 AM Wednesday, March 6—Hiccups. I saw Keith moving and went to see if he was shivering. It was hiccups, the nurse said. She was right. Hiccups have always been painful, to Keith. Mine are minor, but his are deep and strong. He started to grimace with each hiccup. Amanda gave him a sedative boost, because it was looking uncomfortable. She turned the heat up on the cover, too.

Wednesday, March 6 they continued to gradually bring his temperature down, kept him sedated, monitored the pumps and substances—all the machines and IVs (each bag has a beepy thing which might beep if the supply is low, or not flowing, and might beep if the battery is low).

Wednesday was a brain rest day.

Beau and Laurie came to visit in the morning, bringing recorders with extras for me. We played music he would recognize. There wasn't any for-sure response, but he didn't grimace, either. :-)

Off and on, hiccups. No sound, just the spasms.

Later in the day the cardiology department considered a swan catheter to monitor heart pressure (Jason, the nurse, had explained it well enough that I agreed for them to use one). Given progress and the various substances and number of "insertions" already in play, they decided it wasn't needed right now. These are my words, after hearing from Sadie, who was here during the decision. They might reassess later.

7:20 AM Thursday, March 7 He has a slight fever and they gave him Tylenol. Maybe it's the inhalation pneumonia, or not.

When they get to the assessment (described above) they might restrain him.

9:08 AM Thursday, March 7, the fever (slight as it was, probably 99 or so) broke. That's good. He's at his own natural temperature, after days of cooling and heating.

11:20 AM Thursday, March 7, one of the blood pressure medicines was weaned down earlier, so he's only on one, for the purposes of the tests: SAT (Spontaneous Awakening Trial) and SBT (Spontaneous Breathing Trial).

The sedative has been turned down, too.

Spontaneous Awakening might go well, in which case they will assess, a bit, his reactions to verbal requests, and his responses to stimuli. If that goes well, they can set the respirator so that Keith is the primary breather and the machine is back-up, to see how well he can breath.

If Spontaneous Awakening doesn't go smoothly, they will restore the sedative, let him relax and recover, and probably not try again until tomorrow. Partly, if I understand it well, that's because the breathing trial (if it goes well) can lead to extubation (taking the respirator tube out). That should only be done in the morning of a day shift, because there are fewer people at night to put in a new tube if something goes wrong. So because A can lead to B can lead to C, and C is safest in the morning, they don't want to initiate A at other times. I think.

11:55 AM Thursday, March 7, he's waking up, a bit. He did do "thumbs up" when the nurse asked him if he could, and he opened his eyes, sort of. :-)

They're going to do the breathing trial right now.

12:28 PM, Thursday, March 7, Keith was calm at first but got a little agitated. They set the machine to the mode where Keith is the primary "breather" and the machine is backup. He was breathing, but the tube's position was a bit bad and he was breathing around the tube, which creates a danger of aspiration. Also he coughed up some stuff that needed not to go back down. So they put the sedation back on, and will try again tomorrow.

They just repositioned the tube with the help of an x-ray, and will try all that again tomorrow.

The blood pressure medicine needed to be turned back up, which will keep them from trying again this afternoon. Blood pressure might have gone down because of the sedative. The sedative was turned back on because during the breathing trial, Keith was getting more agitated.

But he can wake up, he can follow directions (not counting be calm, yet), he *can* breathe on his own, and it should go better the next time, which should be Friday morning.

I want to mine this for things to keep, but it's past all this now, so I'm setting it apart a bit. Sorry for the construction mess, those trying to read.

Thursday, March 7 At 3:00 a.m. Keith's temperature should reach normal. (It did that Wednesday afternoon; they took the cooling machine off right at 3:00, though.) Later in the day there will be tests of neurological function. Already they know some things, though. He has responded to some stimuli, and reached to pull tubes out. He has bitten on tubes, too. He has bitten down hard enough to make alarms go off. When these things happen, he is given more sedative, not just to keep tubes in but so he can be still and not shiver while he's being kept chilled. Keith has had a scrape on his leg for over a week, and had a Bandaid on it. A nurse took that off mid-Monday, and cleaned the wound and put Betadine on it. As though in his sleep, Keith pulled his knee up (to the side, in the bed, and then stretched it out again. Then he pulled it up again, and stretched back down again, as thothough trying to get away from the Betadine. :-) That (I have been told) is called "withdrawing," and it's a good sign. One thing they do if someone doesn't respond to verbal commands (I'm reporting what was explained to me) is to pinch a fingernail, and see if the person pulls away to avoid that pain. The Betadine on the wound was not intended to be a test at all, but it still was informational.

Bringing him to consciousness is (I think) gradual and tentative. One nurse said he could wake up like a banshee. :-) I think if that happens he would be sedated some. If he comes to consciousness in agitation (biting or jerking anything around) they sedate some more. They're after calm and responsive. "Responsive" is going to involve some things like "Can you squeeze my hand? Can you give me a thumbs up? Can you stick your tongue out?" Those are things people can do with tubes in them.

If he reaches a calm and responsive phase, they will turn down the ventilator, to see how well he can breathe on his own. The display already shows if he takes a breath, and sometimes he does, when he's not so deeply sedated, or if they're changing he bed or rearranging him and it rouses him a bit and he moves. When he inhales, the monitor shows an "A" for "assisted breath" instead of a "C" for "controlled breath." When the machine does the whole thing, it shows a C. If Keith breathes in, the machine is still going to pull air out, so that's "assisted." I think (not positive) that they turn it down gradually to see how much "A" activity comes, and if he's breathing on his own after a bit, for reals, they take the tube out. For people who are not very responsive, they might keep the ventilator going because of the danger of them not knowing they need to cough or spit.

So the summary of the preview is:
  • Don't expect anything at all new on Wednesday, unless something happens.
  • Something will happen Thursday—maybe neurological function assessment (or discovering it's too soon to do that, if he's an agitated banshee of any sort) and maybe trying to take him off the ventilator.

Newer notes, from Friday March 8, are at Keith, better days in the hospital


This is my understanding from asking questions or overhearing things or having something explained to me which I might or might not be clear about. If there are mistakes it's because I'm trying to understand things while I'm exhausted, afraid (trying not to be afraid), and moving between bafflement and glimmers.

Some vaguely related photos