I've discovered that I am a horrible lip reader. Never really had much need to develop the skill until now. But I am flat out awful at it, and now that would be the most effective way to communicate with Shirley, I really wish I was better at it.
To recap, Shirley has a tracheotomy and it prevents air from passing by her vocal cords and hence producing sound. She also is on a variety of medications that cause her hands to be a little jittery, so writing notes is a bit of a challenge.
The most effective communication method right now is the use of a large cardboard mat that the ICU has with a variety of fill in the blank sentences with multiple choice completions. E.g. "I am..." Short of Breath; Anxious; Frustrated; Disappointed; Tired... Too bad they don't have an "all of the above" option.
Today, they swapped out the oxygen enhanced trach collar for one that is just pushing humidified room air. This is exciting because Shirley has now been weaned off supplemental oxygen. This process has made her nervous. The nurses, RT's and I have tried to reassure her that even though she may feel short of breath (most likely due to anxiety), we can see on the monitors that her oxygen saturation has remained between 96 to 100%.
We received a visit today from a representative of the Palliative Care team. This further freaked Shirley out, as she had associated Palliative Care with hospice or end of life care. We quickly got clarification that the Palliative Care team hear helps patients in all phases of their illnesses deal with their hospital stay and the transitions after stay. We shared with them that our biggest frustration is that we don't have a road map of where we go from the ICU and what the criteria are for getting there. They have indicated that they will help chart that course for us.
2 comments:
Greg - the word I was looking for when we talked about Shirley's recovery plan was benchmark. Does the medical team have a benchmark defined for Shirley?
I've requested some benchmarks, but so far we don't have any. In our previous time, we knew that once Shirley could tolerate 2 hours of PT a day, she'd be moved on to the Rehab floor. This time, part of the issue is that there were so many different issues and some had almost opposing objectives. For example, the lung doctors what her as "dry" as possible, but the kidney doctors want some fluid left to help get the kidneys going.
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