A Lot Going On

I don’t feel I’m as involved with this team. The cardiologist must be a late riser; I don’t see him till rounds and then after lunch for his “post” rounds. I like the evening ICU team, though, in particular, the doctor who did the intubation. There was a discussion of a CT to check her lungs. I felt she needed it, so they would know what was going on in case there was an issue. A few others did, including our nurse, but they decided against it. One of the NPs stayed back to talk with me and explain things better.

They all agreed she needed to lose some fluid. Having already talked to nephrology and decided to start the CRRT. It’s a slower dialysis. Instead of the typical three times a week, it operates 24/7 and takes off a much smaller amount per hour than regular dialysis. The machine takes a long time to set up and prime. Amanda was cold before they started; her temperature was around 95, and the CRRT was only going to make her colder. The machine they had didn’t have a warmer.

They piled warm blankets, but it wasn’t enough. One of the floating nurses told our nurse to Saran Wrap her. She thought it was a joke, but it wasn’t. She found it was a real thing when asking another nurse. It wasn’t “Saran Wrap,” but a plastic blanket. They also got a heating lamp. She looked like a burrito under a warmer, she’d kill me for posting the pic, so I took her face out of it! I love the new clean-up feature with photos on iPhones. At first, they put the plastic over her face, and I was like Wait, then realized she was intubated, so it didn’t matter. The nurse didn’t like it and just wrapped her head up in a blanket, too.

Nephrology came by, I like the lead nephrologist. Maybe I’m partial because she liked my raise a hallelujah hoodie yesterday! I asked about the time on the CRRT, and she said it’s day by day. Sometimes two days, sometimes two months. She averaged it at two weeks, though. They start it off slow and don’t take any off, then gradually raise it up. It’s all balanced with how much fluid they give her and how much they take off.

I took a break for an early lunch at a breakfast place Beverly had suggested. I underestimated the portion sizes, but I still managed to eat it all! I’m still running on that big breakfast for lunch now, and I didn’t eat the rest of the day. I don’t know why I post food pics! I guess because I’m used to it from writing travel posts. It’s the only non-hospital thing I do. After that, I took a walk to a nearby park. I arrived at the park and realized there was a playground with children. I wasn’t about to be the creepy guy sitting watching kids! So, I sat on an uncomfortable beach far away from the playground. Then walked around on the phone.

Nathan and Kim, close friends back home, are planning to come up and bring the first of two trailer loads of our stuff. Nathan called while I was walking, and we talked about them coming up. I knew he’d be worried about coming up with Amanda reintubated. That’s what it was, he said he could come up right away, so I didn’t have to be away from Amanda. I’m in and out anyway now, the last couple of days, and I’m leaving to eat. I can’t stay here nonstop, I see that now. I need some breaks, or I’ll be the one getting ICU delirium! I told him that whatever worked for them was fine, but I’d prefer them to come together as planned. They’d planned to leave on Wednesday and drive a good way to shorten the second day’s drive, arriving on Thursday. They stuck with the plan and are leaving in the morning. They had some unexpected expenses arise in their lives, including a broken back window in their truck when they went to Houston to retrieve the trailer. Their son, Ryder, had helped load it and had it stored at his house. I felt so bad about the window. Still, now they’re coming up here while he’s on his vacation, spending money on hotels and burning a ton of diesel. We have the best friends and support system!

They finally got Amanda’s temperature up a bit and did a neurological check; she did well. When she woke up, her stats dropped a bit, though. They gave her some pain meds and turned the sedation back up. I wasn’t a fan of the day nurse; she was just as uncaring as she was yesterday. She had a nursing student, and they would be whispering about things. I’m a big boy, just say it or step outside if you don’t want to hear it. Don’t make me worry about something by whispering.

I needed to get part of my undergarment order that I had delivered to Beverly’s house. I also needed to run to the apartment to pick up the key, fobs, and paperwork. I stopped at the apartment first. It took a while to get the key fobs and whatnot. The leasing agent also needed to show me around to the mail room and delivery lockers. I also had the move-in list to attend to. So I just went ahead and took care of that. I nailed them for every little hole, mismatched paint, dripped paint, and scuff mark. The only thing I needed them to deal with was the AC, which didn’t seem to be cooling as well as I thought it should. Also, the towel bar in the bathroom was pulling out of the wall. I turned my list in and dropped off a form for the mailbox. Then I headed to Bevs to pick up my delivery. I guess we don’t have to do that anymore.

I’d called the nurse to see how Amanda was, but the receptionist said she told her she was busy and to have me call later. I told you I didn’t like her. When I got to the room, Amanda was gone, and I was mad that I didn’t know where she was. I immediately started looking for the nurse. I saw the nurse from last night, and she said she’d be with us tonight. I told her that I had just returned and didn’t know where she was. She already knew and told me she was down for a CT scan.

I sat down and got my Mac out. The ICU doc I like came by. He said Amanda’s gases hadn’t looked the best. They did ultrasounds of the arteries in her legs, arms, and upper chest. There were some blood clots. So, they sent her to get a CT scan. The clots are in her right arm, left upper chest area, and some in the lower extremities. None of those are bad enough to require action. There was still concern about clots in her lungs. They will talk in rounds if it’s worth the risk to her kidneys to look for them using contrast for another CT. He still wanted to take a look at her lungs with the ultrasound, another conclusive test.

They switched to a CRRT machine with a warmer for dialysis because she got too cold with the non-warmed one. It probably took an hour to get this one set up. The plan is for her to stay on the vent all night and assess getting her off it in the morning. I can see now that this is all going to be a long process. I’ve decided not to mess with the two-on-two off leave of absence. I’ll to request an extension of my current leave, which is set to end next Wednesday, for another month. I’ll have to shell out the few grand for August’s insurance; it’s just going to be the “cost of doing business,” as Brittany said about me getting the apartment early. I may be able to finagle something and get a week of vacation right behind my current leave, then start a month’s leave after that, and reassess in August if I need to extend that, then pay for September. Big prayers, Union Pacific management will work with me. I’ll be working on a letter to present later this week.

Amanda is sedated fairly heavily. She will respond with squeezes and toe wiggles, but her eyes rarely open. I’ve only seen her whence once. The RT said she was initiating too many breaths, and it looked painful, and thought she should be more sedated. Her chest still seems to be moving a lot to me. Praying we don’t come off the vent too early, but at the same time not too long either. It’s going to be a delicate balance. Praying so hard she won’t need to be back on the vent and require a tracheostomy.