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.

Later links, for Keith, when he wants to read through this:
I announced the hospitalization at Just Add Light and Stir, and brought that part to this blog, too.
That has the link to the next part of the Hospital Saga.

1 comment:

Unknown said...

So glad that he can do his own suction! That helped Larry immensely, because he didn't have to sit and choke till someone got there. I'm so glad you have a good team in place! It's sad that you do have to get snarky sometimes to advocate for the patient, but ultimately, you are his last line of defense. I'm so sorry the family is going through this. Having spent 40 days in ICU with Larry, I truly feel for you. I'm praying for strength and endurance for the family. Happy birthday Destiny!