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.


Flo said...

Whew! That's some roller coaster. But it looks and sounds from here as if he's in the best hands he can be. 7 South is much calmer than other floors there, by and large. He should find it easier to rest than he would elsewhere. I will be glad to visit after I beat this cough if it would be all right. I'm sending lots of good vibes that way.

Cindy Bachicha said...

Bless your heart. You need to take care of yourself as well. It does sound like Keith is in good hands anyway. Lighting a candle for you and yours.

Linda Wyatt said...

It is not uncommon for a heart that has been traumatized to be "irritated" and do exactly this: beat very fast. They don't want it to beat that fast because it doesn't give the heart time to refill with blood between beats, and it also makes the heart need a lot more oxygen. Cardioversion coordinates the timing of a shock with a certain part of the heart's cycle, to get it to restart at a better rhythm. They start with the smallest shock, hoping that will be enough, and if it isn't, they increase it until it is. The Amiodarone will help it "know" what rhythm it should have, and the lidocaine will help keep the heart more calm, and less likely to react strongly to things.

The human body is an amazing thing, so complex and interesting. It sounds like he is in the hands of people who are keeping a close eye on him, which is good.

I would not be surprised if they end up considering an implanted pacemaker/defibrillator.

Sandra Dodd said...

Linda, you're right! "I would not be surprised if they end up considering an implanted pacemaker/defibrillator. "

They said the day before he leaves the hospital (whenever that might be) they want to put in a defribrillator.

Linda Wyatt said...

Having the ICD there should provide some relief from worry.

Something for you to think about later, when it's closer to the time for it to be implanted: he will want to talk to the doctor about where it can be located. Most people have no issues with the location, because their lives don't include the possibility of activities where it could be an issue. The typical ICD location would literally end my career (one of them, anyway!), since part of my job is getting hit in the chest! If he will want to continue with SCA activities, he'll need to discuss that and what his needs are, and you will be in a position to support him in what his goals are.

Something for you to think about now: YOUR body is also recovering from extreme stress. When an emergency happens, your body does all sorts of things so that you can continue to function, and that's great. But when things start to wind down, meaning when there is a sort of normality, or at least a bit less urgency to everything, your body needs to rebalance all that stuff it did. I think that is where you are now. Some is physical (exhaustion) and some is physical-emotional (hormone shifts, nervous system shifts).

One of the most common things is to mentally go over and over the sequence of events and feel all sorts of feelings about it. Should this have happened? What if I had done or said this instead? Did the doctors choose the right things? It can be very confusing both because of how your brain functions and because there has been SO much that has happened that keeping everything straight, especially when much of it is like a different language, is nearly impossible.

I'm glad to see that you are taking more time to be at home, now that you can. You haven't said much about your kids, but I assume your family is holding together and supporting each other. Much love to all of you during this.