Breathing, the Name of the Game

When I was allowed to see Amanda first, I was surprised to find that she wasn’t in the Critical Care ICU but in the Cardiovascular ICU. You have to get a badge and go through an intake process with the receptionist. I was glad to find I could stay in the ICU, but still planned to get some decent sleep in the hotel anyway. I was already checked in for two days, so why not. I noticed her rate was paced at a steady 105 when I walked into the room. She was out, but they said they would be weaning her off the sedition to do a neuro check soon. I had a pain medication talk with them, explaining how she had a high tolerance to them. This may not be a CCICU, but there is one nurse per patient for us right now.

As they weaned her off sedation, I was right by her side. They had given her some pain meds ahead of waking her, but she was still in pain. The neuro check was ok at first, but her left side wasn’t waking up as well as the other, and her toe wiggling wasn’t stellar. After she woke up, it was better, and I was getting a firmer squeeze on my fingers. She was squirmy after waking up, moving her legs and making the nurse mad. She was cold, then hot, then cold again. Her heels hurt too; this is typical after long surgeries for her. This was all while she was intubated, and the nurse and I played 20 questions to figure things out.

She needed more pain meds, and we had to wait for the PA to put the order in. The problem with more pain meds is that it was making her sleepy. So when they tried to wean her off the vent, she wasn’t responsive enough to breathe on her own. She really wanted a drink of water, but she was still intubated, and she kept not understanding that. After we didn’t understand some of what she wanted, she became frustrated, it was hard to watch. Then we were still playing the sleeping game, and she was too sleepy to breathe. I kept having to wake her up to breathe; it was a continuous cycle. The nurse was reassuring her that she was doing well, and saying how I told them she was strong, but she shook her head no!

The charge nurse was rounding and checking off her list. She said she looks wonderful. The issue was keeping her awake. Respiratory therapy came in again and tried to wean her off the vent, but she was still pretty sleepy. So she blasted the lights on to help keep her up. She didn’t want the TV on either, but when the PA came in and said, ‘Turn the TV on,’ the nurse tried to find a channel. When it landed on the News, I said, ‘She hates that; it’ll keep her awake!’ They couldn’t find anything and landed on the weather channel, which was probably just as bad as the News.

I left early in the morning, around 6 am, to go to the hotel to get a nap. The hotel is within walking distance, a few blocks, but I was tired and opted for the $6 Uber. I crashed hard for about 2 hours. It’s a good thing I can sleep through a lot, because my phone was blown up while I slept, and I didn’t hear any of it! I called the nurse to ask about things as soon as I woke. I was thinking Amanda would be off the vent, but she wasn’t. The team was rounding, the nurse mentioned, and they were getting close. I hopped in the shower, half asleep. The warm water after a short nap felt too good, and I ended up barely missing the team. I didn’t miss much, according to the nurse. 

The nurse, who was very sweet, said it took her a while to figure out that Amanda wanted the back of her head scratched. Not long after I arrived, I got the itchy head hand signal, so I obliged. She wanted the tube out and kept flailing her arms, which were strapped down, around. She was coughing and choking a little. She was frustrated and miserable; it was hard to watch. Finally, around noon, after rechecking the blood gas, she was extubated. Right as they were about to pull the tube, Dr. McChicken came by. It was good to see a familiar face; he was happy to see her doing well. 

They needed to use a bigger cannula than normal, about half the size of her nostril, for some medication that had to be run through that line. It was a vasodilator to help relax and widen these blood vessels from the heart to the lungs. Pain was still an issue I had to set them straight about what she was on before; their turnover was bad, and they thought she was on methadone. I explained what she was on before arriving at Vanderbilt and what she’d been on since being here. The PA, a boisterous lady with a heavy Southern accent, was telling me how it was a balance not to make her sleepy and zonk her, but still keep the pain under control. It was nothing I didn’t already know. They finally got her an extra dose of pain meds and ordered a pain pump she could push herself for a dose.

She was still in a lot of pain before they finally got the pain pump set up. The pain was making her not want to take a deep breath, which was in turn hurting her saturation level. They called pain management to do a nerve block on her sternum. The resident came in and reviewed the details, and I signed the consent form. The attending came in to instruct. They had an ultrasound machine to guide the needle placement for lidocaine. I stepped up to watch, and the attending physician asked, ‘Would you like to step out?’ I said no and kept watching. He was kind of a pill then, and said I needed a mask, guess he didn’t want an audience. 

I texted Dr. Nair to share the news; he’d already received an update and spoke highly of the Vanderbilt team, saying that all their cardiologists had been attentive and communicated throughout the process. I also emailed the St Luke’s coordinator and the PA we like. The breathing treatment was very wet and would drip, bothering Amanda. So, she’d keep fiddling with the cannula. They put a towel under it to help absorb the moisture. The town was draped over her mouth, and if you’re a Mandalorian fan, she looked like Fennec Shand with her mask on!

The social worker was walking by and saw us. She stopped in and talked for a while. I was telling her about the apartment dilemma. She said she could put a referral in to a housing place for transplant patients, but it wouldn’t be a long-term option, and only for me, essentially. I’ll be okay being able to stay in the hospital. That’s not much help, and there’s a waiting list. I am going to hold off and take the ‘I need an apartment now’ attitude for a day or so, since I can stay here. I may tour the apartment tomorrow when I get my belongings from the hotel. The nurse mentioned checking Facebook marketplace to see about a sublet. I found a couple and sent messages out. I only spent a few minutes looking and need to dive in later. 

The biggest issue now is the blood gas and saturation levels. Neither has gotten better. The PA, nurse, and RT were all in and arguing about the pulse ox and her nails, and wanting a different location besides her finger. They settled on the forehead. They swapped back and forth from the cannula to a mask. Even though her saturation level was ok, her gas levels did not look good. She was becoming acidotic, and her blood gas was low. They decided to switch to a BiPAP machine, which is like a CPAP. The CPAP provides constant air pressure, while the BiBAP delivers two different pressures: one for inhalation and a lower one for exhalation. 

They ran another blood gas level, and it hadn’t changed, so it didn’t look good, and there’s a possibility they will have to intubate her again. She is miserable when she’s awake and the tube is in place, with her hands tied down. Really praying that they don’t have to do that. She’s been wanting some water, but they have her NPO. The nurse is running another gas level now in hopes that the numbers have improved before the team rounds. 

Just as I was about to publish this post, the ICU fellow came in. I could tell in his tone and somber look that they were going to reintubate. He said there’s something on the X-ray that didn’t look good on her lungs. They want to clean them out, give her over night, and reassess tomorrow. So, they are putting her back out and intubating again. Thankfully, she’ll be asleep till they get her off the vent. Both the fellow and the ICU attending are anesthesiologists, so they will perform it bedside. I got kicked out of the room while they do their thing, so I ran to the hotel and cashed my free drink chips in. There’s good live music in the odd lobby bar combo. She’s singing my music too; I quickly recognized a couple of Lumineers songs, one of my favorite bands, and then found a better seat for the show. It’s a much-needed break from the hospital and the turn of events. I really wasn’t expecting this after Amanda was doing so well. I’m going to grab dinner and head back when the nurse calls to tell me they are done.