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).

Later note:
When I ended this blog post, they really had showed up to take him to 7 South, but Bela and I needed to go home anyway. I never saw that room, because he didn't last ten hours before needing the ICU again.
Read about that here.


Catherine said...

Thank you for the update, Sandra. Thinking of you a lot.

Anonymous said...

I appreciate your meticulous and detailed account. We're all on the edges of our seats - right there with you. I can't tell you how much this means to me.

Jocelyn said...

Sandra, I've been following along, thinking HARD about Keith and you and your family. I hope you can feel it.
-Jocelyn, Dan too

Unknown said...

I've been hesitant to add to stuff you might feel like you need to read, but of course you two of my oldest SCA friends, and your family, have been on my mind. I'll be in ABQ the first week of April and hope to be able to visit with Keith at home, continuing to recuperate, if it works for you. Much love.

Unknown said...

Thank you so very much for keeping everyone up to date during such a frightening and stressful period. You and Keith are in my thoughts everyday all day long. My love to you both.

Unknown said...

About that femoral artery and the sheath (based on my own experience): it's how they access the heart without going in through the chest wall, i.e. open heart surgery.
They threaded a tiny balloon on the tip of the probe into my heart, watching all the way on an X-ray machine, and when they reached the blocked artery, they inflated the balloon with saline solution and opened up the clog. It happens instantly, like flipping a light switch; one second, there's pain, the next second, no pain.
With Keith's, I suspect they used it to install the stents and left the femoral artery portal in place, in case they had to go back in and open up another heart artery.
Sounds to me, from reading your past posts, that people on site did what they were supposed to, and right now he's getting the very best possible care.

Suzanne Perkowski said...

I was holding my breath as I read the Friday night update. Its Saturday morning and I am so thankful for you, Sandra. I wish I could hug you or anyone there. I'm constantly thinking of you and Keith. I can understand your frustration. They dont know him but we do and we know he is strong and has the best family. Lots of love. - Bevin

Unknown said...

Sandra - Thank you so much for your updates. This page is open all the time right now and I just hit refresh when I'm near my computer. So glad he's breathing on his own and communicating some. So sorry he's in pain and glad he's alive and with you. I'm rooting hard for his continued recovery and strength to keep on getting better. Take good care of yourself too. - Madigan

Unknown said...

Just letting you know we're here following and thinking about you and Keith - Roderick & Kate (Bill & Marie)

Linda Wyatt said...

These updates are so fantastic! Very encouraging. I'm glad to hear he is doing so well.

The oxygen-in-the-nose thing is a nasal cannula. :-)

Suzanne Perkowski said...

It's Monday 3/11 and I just caught up on the 2nd updates from Sunday afternoon. I am so glad he continues to improve each day. Thank you again, Sandra, for keeping notes and letting us follow along in his progress. xoxo Bevin -Suzanne P. (Keep Going Strong, Gunwaldt!!!! <3 )

Unknown said...

Thank you for posting all the updates. With regards to the lasers and bubbles, is it possible for an ophthalmologist to come in and look at his eyes/retinas? Flashes and floaters are symptoms of retinal issues. Just an off the wall idea some of his other didn't make sense in context statements gave me. I'm so happy to hear of his progress. Best, Mineko, Atenveldt (zero medical experience, but retinal issues are possible with my vision, so I try to keep up with symptoms)

Sandra Dodd said...

Mineko, thank you. I'm thinking about that. ( Not lasers and bubbles, but bubbles and balloons. :-) )

He had an opthalmolgy exam very recently. They said he could benefit from cataract surgery. I think I'll call that office from home in a day or two to see if they think any of these emergency medical doings could have harmed his vision.

When he's more lucid in a day or two, we'll know more.