CVICU Days

There was sleep again last night, Amanda got a little more than before, but I don’t think much more unless you count the good after-dinner mini-coma last night! The day nurse is one we had before; she was with us when Amanda was intubated and wasn’t doing great, so she didn’t remember her. I’d seen the nurse in the hall after the extubation, and she commented on how happy she was that the tube was out and thought Amanda looked good. 

Amanda did eat some breakfast. I ended up helping; her coordination just isn’t back, she’s just slow with things. It will just take some time to get her motor skills back. Nothing new in rounds. They did start some diuretics and upped the medication to help her BP stay up. She had some bowel blockages that they noticed on her morning chest X-ray. So, they ordered another of just her stomach area. It showed significant blockages, but could be gas. The NP was going to confer with the team to see what to do. 

My biggest question was the air under her skin from the pneumothorax. It is awful and has only been getting worse. When I say chipmunk face, I mean almost unrecognizable. I was trying to explain to the new docs how she was petite, and it was really bad. There was one there that had seen her since day one, and I mentioned that they knew what she looked like before. They took her back to CT late this morning to figure out the issue.

All in all, these things are small compared to what we’ve been dealing with. I stepped out to grab a refresher. Amanda wanted the real deal, she said the hospital ones taste different. I think she just thought that one yesterday tasted weird, like she thought the mashed potatoes were spicy. The nephrology team came by while I was gone. It looked like they were planning a spot dose of dialysis tomorrow. 

When they rolled Amanda back from CT, it didn’t look good. She was on an O2 mask for breathing, and it was maxed out. Her lips were blue, and even her skin was discolored. She had issues during the CT scan. They ran a blood gas level quickly. The NP stood in the doorway watching as they hooked her back up in the room. I went over to talk to her about her thighs. The blood gas had come back; she was acidotic, and her potassium was low. They decided to restart the CRRT. Amanda was up and felt like crap; she wanted a cold towel on her forehead.

I had planned to go to the apartment to straighten things out and put the beds and recliners together at least. That’s on hold while she isn’t feeling great. I’ll get to it sooner or later. Nephrology was the next to come by for a second time. She told us about the CRRT starting back and said it wasn’t a big deal. They were going to do dialysis tomorrow anyway. She said this happens now and again. The bigger thing was that they wanted to keep her from going back on the vent. I just think it’s a bad combination of the fluid coming back, the NG tube, and the air around her neck, making her breathing so challenging.

The CT showed the air from the pneumothorax had worsened. I didn’t need a CT to tell me that; the sub-q air had only gotten worse since the chest tube was placed. Surgery was called in for a consult. The PA came by first and was just trying to reassure Amanda, talking about anxiety. Amanda’s been through a lot, I don’t think she’s anxious, and that’s what’s causing her breathing issues and the current need to be maxed out on an O2 mask! I quickly showed the PA a pic of her before transplant and told her she was petite. It’s crazy how bad it is, a new experience for us. If it’s still there when she can look in a mirror, she’ll be mortified. The PA then said she’d seen cases much worse where patients’ eyes were swollen shut from the air. She thought that it would dissipate over a few weeks. The teams were going to confer and come up with a plan in the morning during rounds.

After all the commotion, Amanda was pretty tired and was napping good. I took the time to grab a late lunch. I was stuffing my face when speech therapy came by. I told them that Amanda was pretty out of it, so I told them how she was eating and drinking. That didn’t do them any good; they needed to wake her up to tell her that the test went well and to call them if she had any issues! They could have left that for me to tell her.

They had problems with the CRRT machine again, and they had to swap it out to get it to work. It’s about an hour-long process to get the thing primed and ready to go. It took that long to find out it didn’t work. The one that did work didn’t have a heater, so Amanda is all bundled up. Another burrito under a warmer may be coming!

Amanda has just felt crappy today, especially after the O2 issues. She’s talking, but it’s labored due to the fluid. The air is also pushing on her vocal cords. So that makes her voice sound a little off. It’s tough to hear her with my old ears, too. So I have to scoot close to see her lips to be able to hear her. When I was close, she told me, “This one better last because I don’t know if I can do this again!” The night has been rough; I’ll spare you the details, but it hasn’t been a fun night.