The Date is Written on the Wall

Yesterday, the Rehabilitation team met together after all the disciplines had completed their assessments of Shirley.  This morning, they posted a list of her goals (ones she created) related to what she wanted to be able to do by the time she is released.  At the bottom of the sheet is their projected date for discharge: August 7, 2013.  I had expected a 2-3 week stay, but if she stays on plan, this will be only be 13 days from her return to UW and only 9 days from today!

Shirley has been completing two Physical Therapy and two Occupational Therapy sessions each day. Today, she also got on an exercise machine as part of an "endurance" session that worked her skinny little arms.

Through these sessions, she has been fighting pain that she attributed to the compression fracture in her lower back.  Yesterday, Dr. Smith, the Director of the rehab program had her lie flat on a raised platform so that she could assess the potential causes of the pain.  She watched how Shirley held her body while laying flat and pointed out to her Resident how asymmetrical she was.  Dr. Smith reached over and put her hand behind one of Shirley's hips.  With a single touch she hit a bull's eye on finding the pain point. She applied pressure against this spot for a minute or so and as she did, Shirley's legs and feet moved into a symmetrical position.  It was really interesting to watch.

They've now applied some topical pain relief pads over the hip joint and are having Shirley go back and forth between heat and ice to help relieve some of the muscle spasms.

Today, on both day and night shift, Shirley had visits from Respiratory Therapists that helped treat her during her ICU stay.  Both Ron and Gerry were very pleased to see how far she has progressed.  Gerry used to work at Regional Hospital and actually dropped by and visited her while she was at Regional.

If I haven't mentioned it enough, we continued to be amazed and blessed with the wonderful care and attention that Shirley has received both at UW and Regional.

Settling back in at the U

I never though getting admitted into a hospital ward could feel like a reunion, but that's exactly what yesterday felt like.  Every doctor, nurse, aid and therapist (except the new resident) had worked with Shirley before.  She completed an assessment with Physical Therapy yesterday.  Whitney, the PT who worked with her last saw her just over three weeks ago when she was in the ICU and had a trachea tube in and was on the ventilator.  Whitney was amazed with Shirley's progress.  She got out of bed with only the slightest of assistance and then walked halfway down the hall and back.

Shirley's friend, Anisa, who is an RN on the floor was just starting the first of six days of shifts and made sure she was assigned to Shirley.

We're back on the 8th floor of the medical center, but are across the hall from the room in the previous stay. We've traded in the room with the view of the Olympic Mountains for the Northern Cascades in the background with Lake Washington in the foreground a few hundred yards from our location.  The view would be idealic were in not from the looming newly renovated Husky Stadium that takes up about a third of our view. (Go Ducks!)

Additional assessments were done today with Occupational and Speech Therapists.  OT will continue working with her on a daily basis, but Speech Therapy basically gave her an "all clear."

The one thing I will miss about Regional Hospital is the abundant free parking around the facility.  Parking on the UW campus is $15 a day.  I can get validation from the nursing station taking it to $10.  I've found a secondary visitors garage that isn't staffed on weekends (gates open for free parking) and if you play your cards right, isn't staffed when the attendant takes meal breaks.  We also start giving us free parking vouchers after 14 consecutive days in the hospital stays.  Unfortunately, this is a benefit we've  been about to take advantage of three times before.

Moving Day - on Hospital Time

I've always heard the expression "hurry up and wait" associated with the Army. But I don't know if the military has anything on hospitals in that regard.

We were told that today's move back to UW would be early enough in the day to ensure that Shirley would get transported and settled in early enough to have all the necessary assessments done before end of day. Yesterday, the social worker who schedules the transport came by to let us know that she was scheduled to be moved at 10 am.  Shirley laughed and said "so you mean between twelve and one?"  She social worker just smiled.

About 9:30 this morning, her nurse came by and advised that the ambulance company had called and they were backlogged with calls, so our 10 am scheduled move was being pushed back to around 11:30. THEN, about 30 minutes later, she came and said the ambulance company was so backed up that they had passed her transport over to a different company.  No idea at this point if this was adding or reducing time to our wait.

Ten minutes later, the transport crew shows up and it's time to pack up.  But wait, the Discharge Summary documents are still in transcription and she won't be accepted at UW without them.  The ambulance crew leaves without a patient and we go back to waiting.

Finally, around noon, we get word that the summary has been completed, a copy sent to UW and we're back on.  The ambulance company is called again and the crew returns around 12:40.

It seems like Shirley has got this whole "hospital time" concept nailed.

I'll post again to recap our first day back at the U.

Last Full Day at Regional

We received confirmation this afternoon that Shirley has been accepted at the UW Medical Center Rehabilitation facility.  Transportation arrangements are being made for the ambulance to pick her up tomorrow at 10 am.  UW wants her to arrive early enough in the day so that they can complete assessments and begin her therapy regime Saturday.

Shirley will be released exactly three weeks after her admission--despite the first week setback from her bleeding tracheostomy. The team at Regional has been terrific.  We have enjoyed her care here and look forward to coming back to visit them once she is fully on her feet.

Shirley more than doubled her steps walked again today.  She even had her lunch on a table out in the Healing Garden.

A Sleepy Day

Shirley takes a boatload of pills every day.  And most of the time, getting them from the on-site mediation supply or the pharmacy of the nearby parent hospital is no big deal. But last night, instead of getting one of her anti-rejection drugs as a 100mg pill, it came as four 25mg pills in a blister pack. And upon inspection, one of the "pills" was an empty space.  

The nurse put in the call to the pharmacy to get a replacement pill and normally there are regular shuttle deliveries making such a 30 minute wait or so. But last night, the shuttle just didn't come.  And since he had held off on her sleeping pill so that she wouldn't have to be awakened, by the time the pill did arrive at 12:30, Shirley was really off her normal cycle.

When I arrived this morning at 7:30, she was still dozing and did until well past 9.  She took another nap mid afternoon and has been asleep for another hour now (7 to 8 pm).  I'll wake her up soon so that there is a chance she'll be able to return to a normal sleep schedule tonight.

The staff social worker dropped by today to say he had initiated contact with the UW Medical Center Rehab program.  No word back yet, but the target is for a Friday move.

Between naps today, Shirley did get up.  She got herself dressed in something besides the hospital gown and brushed her teeth at the sink.  She again walked out to the healing gardens.  Her legs did give out on her once about 80% of the way there, and finished the journey in the trailing wheelchair.  After a nice respite in the sun, she got up and walked back the same distance that she did on the way out.  This amounted to at least a 50% improvement in distance walked since yesterday.

I keep teasing her that if she keeps increasing her distance by 50-100% each day, soon she'll be walking a Marathon!

A Release Date Given

I'm sitting out in the Healing Garden at Regional Hospital. It's a beautiful day--not a cloud in the sky (just lots of planes due to being in the SeaTac take-off path).  Shirley and I are sitting in the shade across from a small fountain spilling onto river rock.

And the best part of this beautiful day is that Shirley walked from her room to the door out to the garden under her own power!  Friday, it was a few steps to sit in a wheelchair.  Yesterday, she walked as far as the door of her room (10 steps).  Today, I'm guessing at least a hundred steps to get her to the building exit and into this wonderful oasis.

Today I attended the weekly team meeting where each discipline reported on Shirley's progress.  The consensus is that she has achieved the objectives of Regional Hospital's mission and is now ready to move on to a new place to complete her rehabilitation.  They have also affirmed that she has made sufficient progress so that she should be a good candidate to go back to the UW Medical Center Rehab unit.

We hope and pray that this will be the last leg of her medical journey before being sent "home" to her brother's house.  We still expect that we'll be required to stay in Seattle for a few more weeks to make sure she is adjusting to home life, responding well to her medications, etc.  But we are beginning to see the light at the end of the tunnel!

A Quart Low

Most of us an one time or another had an old car that burned a little oil.  Checking the oil level at every fill-up (or perhaps more often) became part of our driving routine and when the dip stick showed the oil level below the line, we'd buy a quart of oil, fill it up and start the process again.

For some reason, this analogy popped into my mind this morning with the Physician's Assistant came by to advise me that Shirley hemoglobin level just under 7 (normal being 12 to 15).  This is classified as anemia and the treatment is to supplement her blood supply with packed red blood cells via transfusion.  Two units of RBC's were ordered and she is currently just finishing the first unit.

Anemia can be attributed to several factors:  first, when you are sick, blood cells die faster than under normal situations.  The PA said that they normal live about 120 days, but when you are sick can last closer to 30 days.  Second, the anti-rejection drugs can slow the development of new blood cells.  Third, they are drawing blood samples daily, which is pulling from the body pool that is already in a deficit situation in terms of blood production.

Shirley is basically over being sick, so that source will go away, and as she gets better, blood tests will be done with less and less frequency.  But the diminished production due to the anti-rejection drugs will be an ongoing issue.  The PA mentioned that some post-transplant patients need transfusions every 2-3 months to counter the affects of the drugs.

Today, when Shirley got out of bed, instead of just a few pivot steps to the chair, it was placed across the room. She successfully walked across the floor with the aid of a walker and then spent two and a half hours sitting upright.  Each day this week has brought an incremental step of progress from the day before.  Dr. Roper says her days here are numbered and early next week a plan for where to go from here will be determined.

Our hope is to return to the Rehab floor at UW.  (Okay, our real hope is to be sent home, but realistically speaking, our choice of a rehab facility is UW).  One of Shirley's favorite nurses from that Rehab Unit stopped by last night with her boyfriend as they were heading down for a long weekend in Oregon. It was great to see her and reinforced the desire to return to 8th floor and the care of a staff that was again this week recognized as one of the top five rehab facilities in the country.

Improving Earth Score

Dr. Roper, the medical directory at Regional, is a fun guy.  Although he's been in the Seattle area for over 20 years, his Georgia accent is still thick and he has a folksy presentation style.  And although I haven't heard anyone call him by his nickname, we were told it is "Bubba".

Today he walked by and told Shirley that her Earth Score was improving dramatically. Earth Score?  This is a Dr. Roper indicator of how close someone is on returning to normality.  He said when Shirley got to Regional, her Earth Score was zero.  The following have all attributed to her "return to earth:"

• She's off the ventilator and breathing room air (her score will improve more when she doesn't need any supplemental oxygen)
• She has begun eating food again - pureed for the past few days, but the speech therapist just showed up with apple slices, sloppy Joe and a turkey sandwich!  She was just been cleared for a general diet.
• She began swallowing some of her smaller pills today instead of having them ground and pushed through her feeding tube
• She stood up today and was able to pivot to a chair
• The past two days, we've wheeled her out of the room and on to a deck outside her room.  She provided the power to the wheels for the first part of the journey each day.

There are more points to gain on her Earth Score, but the progress over the past few days has been remarkable and we look forward to the complete return to Earth!

Huge Milestones!

My Bad--I just went to create a new post and realized that I didn't publish the post from Tuesday...sorry for the delay. GH
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Tuesday, July 16
Wow.  Two days ago, I was thinking we were going to do baby steps to get Shirley off the ventilator.  Maybe a few more hours each day until she eventually could go full time without having to be put back on pressure support.  She went from nine to eleven to thirteen hours, so it was logical to assume the next day would bring fifteen or so.

But yesterday, Shirley surprised me by going over 30 hours and they took her off the vent.  I assumed the next step would be several days of breathing the heated humidified air, but this morning they moved on to the next step, which was to insert a valve into the air line that allowed her to speak.  This isn't that electronic thing that people whom have lost their vocal cords use.  It was something that allowed her to speak in a near normal voice.  This valve had been inserted a couple times in the past, but it had quickly tired her out.

This time, she tolerated the valve for several hours.  And then at 12:30 pm, they removed the heated aerosol AND took out the trachea tube!  So where there was a tube sticking out of her neck, there is now tape and gauze and within a day or two, the hole will begin to close--as long as they don't need to reinsert the tube.

As I write this, Shirley is working with the Speech Therapist who is evaluating her swallowing.  They want to be very sure that anything that is supposed to go down the throat goes down the correct tube and not down her trachea. She just passed the swallow test with flying colors and is now cleared to eat pureed food.

They are now talking about releasing her from Regional Hospital within the next next few days.  From here, it will be on to a rehab facility to help her regain strength.  We hope to be able to go back to UW Medical Center's rehab floor, but I'm not sure if she's strong enough right now to qualify.  They require the ability to tolerate 3 hours of rehab a day and with her back hurting her so much, she has been doing less than one.

That said, I know how Shirley can be when a goal is set in front of her and I would not be surprised to see big jumps in her tolerance for therapy over the next few days.

Vent Weaning Progress

During yesterday's post, I mentioned that Shirley was four hours into a sustained breathing test that would continue until she tired.  Today, around 3:30 pm after nearly 32 hours they ceased the test and removed Shirley from the ventilator!

The next step is what they call "heated aerosol."  This is similar but a little more sophisticated than the trach collar that was used at UW Medical Center.  A small oxygen mask is loosely placed over the opening of Shirley's trachea tube.  The room air supplemented by 40% oxygen is passed through a chamber that atomizes a pool of warm water.  This makes the air warm and moist.

While she is still hooked up to a device, there are a couple of major differences.  First, the heated aerosol only has a couple of dials for percentage of oxygen and flow rate of air.  This is compared to the ventilator that had a large screen displaying all sorts of data points to literally monitor and evaluate every breath.  In contrast, we now only have two readings from her overall vitals monitor:  oxygen saturation and respiration rate.

The second difference is that instead of having a series of tube fittings connected from the vent to her neck, there is now just a mask placed around her neck over the trach tube.  Previous, turning her head, could place strain on the tube and would cause irrigation (and potentially bleeding).  Now, there is nothing actually touching the trach tube so she has more more freedom of movement.

Shirley continues to have back pain but was able to get up and hang her feet off the edge of the bed today.  She didn't stay up for a long time, but this was her first time up in several days and so any length of time was encouraging.

The Weaning Process

I have been remiss in my blogging duties of late, so let me catch you up with events since late Thursday when I last posted.

Thursday, the scheduled six hour breathing test went well and was extended to nine hours.  The standardized plan of going 6, 12 and 24 hours is being put to the side in favor of having Shirley go as far as she can each day without being overly fatigued.  The goal will be to increase the duration daily, but not go so far as to cause her to fall back the next day.

Friday, the breathing test went eleven hours.  Shirley was hoping to get to 12, but she was showing the signs of fatigue (oxygen concentration drops, respiration rate increases but breaths become shallower, so that the volume per minute is actually less).

Also on Friday, she had a CT scan of her back to see if they could see the issue causing her pain.  We knew from time at the UW that there is a compression fracture of the L4 vertebrae, but is this the same issue of some thing new?  I haven't heard the results of the scan yet, but they have prescribed a lidocaine patch to provide some localized relief and have scaled back on her physical therapy to avoid further damage.

Saturday, she completed twelve hours on the SBT test and is now about four hours into today's trial.  Each day, a little progress towards the goal of getting completely off the ventilator.

Don't Bid the Devil Good Day

I should have know better.  And when Shirley eventually reads this blog, I can hear her scolding me for statements I made on Tuesday about her being on the fast track.  "Don't bid the Devil good day!" she'll exclaim.  Because no sooner did I mention that than she ran into the bleeding problem.

And because she had to go to the ER, the 24-hour SBT she was undergoing was ceased at about 20 hours for her ambulance joy ride. And when she returned, they gave her the rest of Wednesday off and kept her on the ventilator.  This morning, they began another SBT, but were only going to plan on doing six hours and would then assess if they could/should go longer.  For reasons explained below, I was not there at the six hour mark and she was on the vent when I did return, but I don't have the exact length that she completed.

The good news is that the bleeding from our tracheostomy incision has stopped bleeding.  And more good news, the tremors she was having in her hands that was making it hard for her to write has passed.  Her hand writing is not not only more legible, but far easier for her to write, so it is becoming a more effective means of communication when my lip reading skills fail me.

I had to make a quick work-related trip to Portland this afternoon.  Fortunately, with Shirley's father still in town, he was able to keep her company for the majority of the time I was away.  He has been bringing naval historical novels and has been reading to her.  I'm sure she is enjoying the stories, but I would guess she would be happy to hear his voice even if he was merely reading the phone book.

A Stack of Gauze and Two Ambulance Rides

Last night, I mentioned the issue of bleeding around Shirley's tracheostomy site.  Apparently the bleeding issue continued to worsen overnight to the point that at 3 am, they made the determination to transport her to a nearby ER to evaluate and deal with the issue.  I received a call around 3:15 and arrived at the hospital at 4, just as the ambulance was pulling away after dropping her off.

I was directed to the ER waiting room, where I spent an enjoyable hour with a loud, obnoxious drunk whom had been released from the ER just as I arrived.

Finally, around 5 am I was allowed to go back and sit with her. By that time, they had changed out the dressings around the trach and the bleeding had stopped.  She was calm and sleepy.  I spent about 45 minutes in the room with her before any medical staff came by (except of course for the registration person wanting her insurance card).  When the doctor came in, she said that the bleeding had not been that bad while there and that they had already called the ambulance to return her to Regional.

Another 45 minutes and the ambulance team arrived.  About the same time, the bleeding started up again.  Another round of dressing changes and off she went.

The bleeding is slowing down, but is sufficient that they are preparing for a transfusion.  They are also going to do a brochoscopy this morning to make sure that there isn't any hemorrhaging deeper down.  They don't suspect that there is, but want to do this as a precautionary step.

They have temporarily ceased her blood thinning medications so that should help as well.

Once the brochoscopy is completed, Dr. Roper will confer with the staff at UW and decide on the next steps.

A Visit from Dad

Some say that laughter is the best medicine.  Today, Shirley received a visit from her father that lifted the spirits of both immensely.  Her father recently lost his wonderful companion of the last five-plus years.  She had been in declining health which had prevented Art from visiting Shirley.  I'm not sure which was more worried about the other, but seeing the two of them hold hands for hours was a wonderful sight that I know was mutually therapeutic.

Shirley had the last of her initial assessments when the Physical Therapist came by.  Unfortunately, Shirley's back was tweaked as she was moved up in her bed which prevented them from getting her out of bed.  The PT did assess her leg strength and flexibility and suggested that taking a few steps is on the near horizon.

We heard back from the nutritionist following yesterday's metabolic testing.  Her daily calorie intake is being modified to 1500 calories.  Her protein levels are just below the acceptable range, but the high protein tube feed formula she is on should remedy that is a few days.

Yesterday, Shirley did 13 hours on the sustained breathing test.  During the SBT, they turn the ventilator settings so that she is getting no assistance besides a slightly elevated oxygen level (25% vs, 21% room air).  The test was successful and after a rest night on the vent, she is doing a 24 hour SBT.  If this is completed without issue tomorrow morning, they will remove the ventilator and have her breath room air that has been vaporized with additional moisture to protect her trachea.

Dr. Roper stopped by after the team met to review all of the assessments.  He pronounced Shirley to be on the "fast track." That doesn't provide any guarantees about duration of stay, but does suggest that if things continue to go this well, our stay may be not much more than a couple of weeks.

The only set-back today (if you want to call it that) has to do with some bleeding around the trachea tube.  The tubes attaching the ventilator to the trachea can put some torque on the tube.  This causes some iritation to the area where the incision on her neck was made.  And then, because she is on blood thinners (did I mention the clot in her neck?) a small bleed just keeps on bleeding,  Hopefully, if the vent can be turned off tomorrow, this will allow this to start to heal.

A Busy Day

While Shirley has now been at Regional for three days, today being the first "business day" of her stay here, there has been a flurry of activity.  The day has included initial assessments by Speech Therapy and Occupational Therapy, plus visits by the medical director.

The Speech Therapy session included another blue dye swallow test.  Initial results were positive, but we've been told they watch her trachial suction for the full day and will then discuss their findings with her care team during tomorrow's rounds.  At that time, they will determine if the test was a success and will advise us of next steps.

OT got her out of bed and into a wheel chair.  She stood up with a little assistance and pivoted to the chair.  Their goal was to have her up in the chair for 30 minutes, but in typical style, she stayed up for 80 minutes.

We enjoyed meeting Dr. Roper, the Medical Director.  He has been at Regional for less then a year after a 20+ year career at Swedish Hospital.  He is originally from Georgia and hasn't lost his drawl in his decades in the Northwest.

Currently, Shirley is in the midst of a metabolic test.  A very sophisticated looking machine is hooked up to her respirator.  It analyzes her exhalations and provides an assessment on her nutritional needs including percent of proteins, fats and carbs that she needs in her diet.  I'm interested to see the results.

Settling in at Regional Hospital

Saturday, Shirley was transferred to her newest home away from home. Regional Hospital for Respiratory and Complex Care welcomed her with open arms yesterday.  The facility is a small, non-profit hospital that leases space from Highline Medical Center on their Specialty Services Campus.  The hospital is located a couple miles due north of SeaTac airport (yes, right on the flight path, but fortunately the rooms are well sound proofed).

With the transfer, yesterday was a rest day with no goals for Shirley other than settling her in and getting rest. But this morning, things kicked off at 8:30 with the start of their weaning process.  For 6+ hours, her ventilator was turned to a setting that tracked her respiration rate, minimum lung pressure and expiration volume.   The objective for today was six hours on this setting and Shirley went six and a half.  

She said she could have gone longer, but tomorrow they want her to do twelve hours, so they didn't want to overdue her first day.  If things go according to schedule, tomorrow she will do twelve hours off the vent and then Monday, will go 24 hours.

Shirley had an unexpected guest yesterday as Mary, her IV nurse for the past eight years dropped by for a visit. She and her husband were returning to Portland and had seen the blog post that the move was taking place.  Shirley was tickled to see a familiar face, especially in light of the anxiety around moving.

My folks stopped by today as well. They are heading off on a long road trip and made their first stop to see us before stopping for their first night at my sister's in Renton.

We also received the sad news today that Shirley's father's girlfriend and companion of the last 5+ years passed away this afternoon.  We all loved Margie very much and will miss her dearly.

ICU Day 38 - Moving Day

All final hurdles appear to be cleared. The ambulance has been scheduled for 11 am and it now appears that Shirley really will get out of the ICU today and head to Regional Hospital for the next phase of her care.  Despite some apprehension, Shirley now seems to be excited about the move in a positive way.

This morning, she insisted that I bring in all of her clothes that were in the car because she wanted to be transferred in her own clothes and not in a hospital gown. While perhaps not 100% practical, it is a very positive sign and everyone here is supportive.

Having become used to "hospital time," I have about as much faith in the move actually taking place close to 11 as I would scheduling an outdoor picnic in May. But any time today is fine by me.

ICU Day 37 - A move delay

Plans to move Shirley to Regional Hospital have been put off for one day.  Some routine tests on Wednesday revealed a possible pneumonia from a hospital acquired bacteria.  Also, a virus which lies dormant within most of us appears to have awakened.  While cultures are confirming these, a course of antibiotics and antivirals have been started just in case.

Despite these indicators showing up, Shirley's health continues to improve overall.  This is purely precautionary and is not seen by any of the medical staff as a setback,.

Meantime, the typing of ventilator weaning that will be the focus of her stay at Regional is going on how.  Yesterday, Shirley spent four hours off the ventilator on what they call a "trach collar" where an oxygen masked is suspended near--but not completely covering--her trach opening.  They push a 33% oxygen mixture that is humidified to keep her air pipe from drying out.  Today's goal is to spend 5 hours off the vent. She is currently 2+ hours into that effort.

ICU Day 35 - Beeping, Lots of Beeping

I'm aware that sleep deprivation is a tactic used on prisoners of war to break them down.  Someone should consider locking these folks up in an ICU for 30+ days as an effective means of altering their mental state.  Last night I spent the night in the hospital room with Shirley. Something I've only done three times while she's been in the ICU.  I find it remarkable that anyone can get any rest in a place like this--and that's with a modified regime where they are only coming in a couple times a night to take her vitals.

The thing that drives me nuts is all the beeping.  Everything has alarms and they go off for all kinds of reasons:

• The monitor of her vitals signs will go off in both a yellow or red state if she goes above or below set levels.  They are monitoring her heart rate, blood pressure, respiration rate and oxygen saturation.  She kicks off the BP alerts a few times a day as she reaches the furthest times from her Metoprorol dosing, but the oxygen saturation alert goes off often. The probe used to check her sats goes on a finger, toe or ear lobe and is constantly needing to be adjusted.  Her extremities go from very warm to freezing cold and when they get cold, or if they are bumped, you don't get a good reading and false alerts go off.
• Her ventilator monitors her respiration rate as well. It also tracks lung pressure and volumes on inhaled and exhaled air.  The alerts on this monitor and louder than any other.  When Shirley sleeps, sometimes her breaths become too shallow and she will set off an alert for too low for exhalations.  The alarm kind of wakes her up and usually after two or three times of the beeping, she is awake enough that she resumes normal breathing volumes.  This morning, she kicked this alarm off eight times between 5:10 and 6:30 am.  While this loud alarm is useful to her when her volumes get low, when she gets stressed, she will begin breathing too fast.  Once her respiration rate gets above 40, the same loud obnoxious alert goes off--triggering more stressful fast breathing.  There is an override button on the monitor that will silence it for two minutes--usually enough time to get her breathing calmed back down.
• There is a master control unit for her IV pumps.  It has a shrill quick beeping that sounds when the line is occluded; when there is air in the line; when a scheduled dose is completing or -- if the unit gets unplugged -- when the battery needs charging.  Shirley is currently only using one IV pump for some antibiotics, so this one doesn't go off all that often anymore, but at the peak of her illness, she had 11 different IVs going in through three master controls and it was a nearly constant chirping of these alerts.
• Likewise, her feeding tube has a pump.  Perhaps the most pleasant sounding of the chirps, this one goes off to alert if bag of nutrition formula is near empty, if the line becomes blocked, if the scheduled feeding volume has been reached or if the battery needs recharging.
• And finally, the bed itself.  There are brakes on the bed to keep it in place.  Whenever they are released to move the bed, it sounds like a truck backing up.  There is also an alarm on the unit that serves as both the TV control and the nurse call light.  In the event of a real emergency, you can yank the cord out of the wall and it sets off alarms in the hallway that send a team of people running to the room.  This has never been used intentionally in Shirley's room, but the cord hang from the ceiling and about once a week gets pulled just enough to sound the alarm.

All of this leads to days and nights filled with electronic chirping and not much rest.

Plans for the move to Regional Hospital have been solidified and the move will take place on Friday. The ambulance is coming at 11 am to pick Shirley up.

ICU Day 35 - The LTAC

I teased you yesterday with announcement that Shirley's time in the ICU was coming to an end.  Her next stop is to be Regional Hospital, a Long Term Acute Care (LTAC) facility specializing in working with patients on ventilators and weaning them off of same. It has been described as an intermediate step between an ICU and a Rehab facility for those no longer sick, but in need of acute care.

One of the admitting liaisons (a  nurse practitioner by trade) came by this morning and visited with us and told us about the facility.  He stayed around for rounds so he got the latest scoop on Shirley's present condition and plan for the day.

Later in the day, I drove out the the facility, which is near SeaTac airport.  It is a small (about 30 beds) non-profit facility. It is not facilitated with any other hospital, but does lease space from another specialty hospital.  Their medical director is a pulmonologist who was formerly the medical director for the ICU at Swedish Hospital.  Regional has been in operation for about 19 years.

I received a nice tour of the facility from the Director of Respiratory Therapy.  It is a really different environment from UW, but seems appropriately staffed, yet far more relaxed.  While quiet busy during the day time, my guide said the place really quiets down at night--which will hopefully mean that Shirley will begin to get some much needed rest and real sleep.

The folks at Regional are expecting Shirley possibly as early as Thursday.  We should learn tomorrow from the team here at UW if they are on board for that timeline.

ICU Day 34 - The Conference

Today the road map became clearer as to what Shirley needs to do to get out of the ICU and what the next step will be after she is released.  We had a troop of doctors and other hospital staff join us for the meeting in Shirley's room.  The congregation included three doctors from the Surgical ICU unit, two from Nephrology, two from Pulmonology/Lung Transplant; three from Palliative Care; her nurse, a social worker and the hospital chaplain, whom has visited her several times each week.

The conference started by Dr. Sats Bhagwanjee recounting the recent victories:

• The General Surgery team has signed off that Shirley's abdominal issues are fully resolved
• The Neprhology team is delighted with the progress Shirley's kidneys are making and do not expect that she will need another dialysis treatment.  This in turn means that both her dialysis and Foley catheters will be taken out in the next few days.
• Shirley's lungs continue to do well.  She did go back on the ventilator early this morning, but the Pulmonologists said this is to be expected over the next few weeks and is nothing to worry about.  They attributed the need to a combination of recent nights of sleep deprivation; a very busy day yesterday; and some additional fluid build-up around her lungs.  And with her kidneys now functioning, they were able to prescribe a diuretic to help with the fluid issue.

Sats then listed the things Shirley needed to do to get out of ICU.  

1. Spend at least 12 hours per day off the ventilator for several consecutive days.
2. Get out of bed and begin taking a few steps.

Please note that there is no more disease to treat or issue to resolve. These are about getting stronger.  And the expectation is that she will be out of the ICU in between two and seven days.

And where to from here?  Stay tuned for my next posting...