Keeping track

. . . the time frame for holiday music as there are just 10 days to go.   Yakima’s First Presbyterian Church is a block from the hospital and their Carillon Bell Tower (or a loudspeaker with recorded sound) provides a nice touch for a minute as I arrive or leave.  Nancy would enjoy this but the only outside sound to enter her room is from the helipad on the top of the next building.  Anyway, it was a snowy-wet day in Yakima but warm enough that I could pause and listen for a few moments.  Nice touch.

At about 2 A.M., Nancy woke from a dream (or not quite woke) and decided she had the wrong clothes on for whatever it was she thought she was doing.  She claims to have just about gotten out of bed and was removing the sensor-sending units stuck to her body which triggered the arrival of the night crew.  When I arrived at Noon those folks were long gone and I don’t know what, if anything, got recorded regarding the incident.  Maybe there wasn’t an incident.  Nancy says so, and had on a new clean open backed hospital gown provided after the sensors units were restored.  Her story and she’s sticking to it.

The team of doctors is scheduled to meet on Thursday of this week to decide if she is ready to transition to a skilled care facility. One of the team visited with her mid-afternoon. If this means a few tests on Wednesday they haven’t informed her as of 6 PM.  They may be getting what they need from the on-body sensors.  This is yet another mystery to the uninitiated.  In her two day stay in this unit Fri/Sat after Thanksgiving they wheeled equipment into the room and did a chest X-ray and an echocardiogram; maybe more.  So, I think such may be done now either in-room or elsewhere.

I got a list of the local skilled care facilities from the Social Services person.  I used Google Earth to locate them and in addition to “where they are” I could get a sense of the neighborhood.  One is directly across the street from Yakima’s largest high school.  Another is just off a main street in a neighborhood one would not consider idyllic or serene.  They all come highly recommended (tight regulation and control here in WA State) so location and ambiance can be considered.  We are wondering if such places have high-speed internet connections.  A question for tomorrow.

Nancy is still tracking smoothly today.  I managed to get there today shortly after a rep from the rehab unit arrived.  It didn’t take long to determine that would be an inappropriate place for her.  They expect a person to do 3 hours of physical activity each day.  At the moment Nancy tires after getting out of bed and into a chair.  About when that person left an occupational therapist arrived.  These folks seem to be the ones that assess your ability to function with regard to chores such as dressing, bathing, eating, or some other number of things.  I really have read this list but that was about 7 years ago.  Anyway, this lady went and found toothbrush, paste, cup, water, paper towels – and then let Nancy brush her teeth.  I don’t remember ‘teeth brushing’ on the list I read.  After watching Nancy and some input from both of us, I think we convinced her that Nancy would be able to take care of herself as soon as her strength returned from 3 weeks of total inactivity.   The problem is that when that happens Nancy will have open heart surgery and we hit the ‘replay’ button.

We did get this person to call the hospital social worker’s desk and they sent a lady who was a bit more helpful.  We expect that within a day or two or three that the doctors involved will have a get-to-gather and decide when to turn Nancy loose – to a skilled nursing facility.  There are several choices, including a couple of places here in E-burg but, at least initially, I think closer to the heart center is better.  The ridge tops on the way from E-burg to Yakima top out close to 2,400 feet and can get freezing rain in the Winter.  That makes for nasty roads.

I have 3 inches of snow here at home.  3 miles south there is no snow and that holds all the way to Yakima.  But the weather folks think there will be about 5-7 inches of snow tonight maybe changing to rain during the early morning.  The winds are shifting, to come more out of the SE –and upslope.  Thus the precipitation in this near-desert country.  So, I’m going back down now and if the roads are too bad I won’t go tomorrow.  Nancy’s talker isn’t working well but her ears are fine so I could call if I decide not to make the trip.  All for today!

Not a lot new with Nancy.  Oxygen is still set on the lowest level of one liter per hour although it is now being trickled through water to add a little humidity to the flow.  They did take the catheter out (for urine) and shortly after paid the price!  That part of her isn’t working any better than her voice.  Maybe they should have stopped the Lasix (furosemide) a few hours sooner.

Monday she will have a meeting with the ‘rehab’ folks to see about getting her up and moving.  This will be done with monitors in place and two attendants.  She has moved very little for over two weeks and so her muscle tone (or whatever one calls it) is close to nothing.

The rehab unit sent a packet for us to read.  All the material makes the assumption that the person has heart problems because of poor diet and smoking and so on.  Not one mention of a valve problem.  There is nothing to be done about that except to replace it.  At the moment a successful rehabilitation means getting to the operation.  I’ll write more on this as we go thru it.

Here’s a thought Nancy and I talked about today.  A couple of people have asked about the hospital she is in and the RM.# with the idea of sending cards and flowers.  She is going to try to add a note to a pre-printed message I will write in response to Christmas cards for folks we do not have an e-mail address for.  If you are reading this you have an internet connection so just send a message via e-mail.  I will print these for her to read now and save them in digital format too  so she can respond later in like manner.  You can use this e-mail address:  nancyh@ellensburg.com

The hospital does have an in-house web based card service.  I think it is free but there may be a fee.  Please consider using it and, if you like, use the money you save on flowers, cards, candy, or whatever on your local food bank.  Here is the link:

http://www.yakimaregional.net/Patients/eCard/default.aspx

The card is printed in color on 8.5 X 11 inch paper and they bring them to the room and tape them where she can see them.  Works great.  However, the e-mail to  –   nancyh@ellensburg.com   –    is the best thing to do.

Still doing well.  The medicines are being adjusted just a little as tests indicate but nothing major.  The doctors did reduce the oxygen flow from 3 to 2 liters – I didn’t get to ask about the ‘time’ used in that measurement.  However, they would like to get her off the supplemental oxygen and today’s change went okay – so that’s progress.  All this past week the oxygen level was at or near 100 and the nurse took an in-room reading for us at about 5:30 and it was 95 +/- 1 over a period of about 30 seconds.  These things are also being monitored continuously at a computer screen at a central station just down the hall but the nurse wheeled the real-deal in and tested it for us to see.

It is now about 7 and I just got home from the hospital.  Not much to report from this morning’s visit.  I left at about 11.  Nancy had visitors to help with lunch and I returned to help with dinner.  Weather and roads are still great for traveling.  By Monday evening they expect snow.  We’ll see.  The rain shadow effect still works when the snow storms come from the west but an upslope flow from the east can be big time trouble.  I’ve been too busy to check the reasoning for the current forecast.

Nancy continues to improve.  I visited this morning and late afternoon.  I think her voice is stronger in the morning and by 4 PM it is more difficult for her to project.  This morning we talked about visitors again and this time she seemed agreeable.

I called a Yakima couple.  The lady of the house still works – he’s retired.  She works about 5 minutes away from the Hospital so she came during her lunch hour and brought a gift and a card.  Later a nice arrangement of cut flowers was delivered – compliments of students from CWU.  The colors were wonderful in this cold record-setting drab Yakima December.

Mid-day when I got home I called a family (she’s a nurse and the daughter who just happens to be home was a student at CWU a few years back.)

Only the daughter could go with me on the afternoon trip.  We arrived just before Yakima’s rush hour, stayed to see what Nancy got for supper, helped her cut it all up, and then left.  If I am there, or today with two of us, she will occupy herself with thinking about what I should do next and either telling me or writing it down.  If I leave, she eats better.  Today was grilled fish, rice, carrots, and angle food cake.

The blood thinner she is on interacts with several foods, especially dark green veggies and cranberries.  I’m told this would not be too much of a problem if one eats about the same amount of these things daily.  Then the amount given could be set to match.  With Nancy and veggies it is a good bet she won’t eat much of any of the boiled green ones.  If they fixed something in a different manner and she ate it, there goes the balance.

They started her off shortly after 5 AM with a chest x-ray.  Had her out of bed three times.  About supper time a helicopter landed on the roof across the courtyard.  It reminded me of a MASH episode. She might sleep well tonight.

While we are going to allow visitors, all need to be aware that she is frail and the nurses will likely limit the time to short, and the number at any one time to 2.  None under age 14.  If you visit, be prepared to wait a bit if something is going on or if someone else is already in the room.  Don’t wake her if she is sleeping.  Include a trip to the hospital along with some other purpose for going to Yakima.  There is no schedule, as yet, that we can plan around.  She is not ready for phone calls.

Nancy was moved upstairs to the fourth floor today to the Advanced Care Unit (ACU).  That was twelve days in the ICU.  I visited in the morning in the ICU where they were in preparation for Nancy’s departure and the arrival of two new patients.  They could not get her moved yesterday because of the lack of appropriate space upstairs.

When I returned at 4:30 the move had been accomplished although (in Nancy’s mind) with less than a smooth handoff to the team in the ACU.  The crew that brought her up were needed back in the ICU, she was in good shape and properly taken care of, and the ACU is, by definition, a little less intensive – care wise.

Luckily (I think) an acquaintance stopped in to see her at just that time and took on some of the welcoming function she seemed to want.  Nancy and I had talked about visitors or no and she wanted to put it off for at least one more day.

Her voice is just strong enough now that she can be heard and understood.  I don’t think she is ready for her cell phone yet.  The in-room phone triggers long distance charges so she will soon demand her cell phone back.  In anticipation of that I spent an hour in the AT&T store buying one of the darn things and switching her account (it would have expired on 12/18) to my new one.  They have to do a credit check and want both people there because they have to call an AT&T center someplace for such a transfer.  So we had to wait on another female clerk and have her ready “to be Nancy” if need be.  Being my first cell phone my homework for tonight is to figure out how it works.

I did not encounter any of the doctors today and the ACU nurses were not yet really acquainted with Nancy so they didn’t provide any new information.  I expected that, so no problem.

It is cold but there is no snow – that’s good with the driving I’m doing.

My sister lives south of Cleveland OH and they had 60 mph winds but the big snow is farther east.  I’ll post this and then check and see how it is progressing.

Mid-morning and late afternoon visits and discussions with doctors and nurses, left me feeling a lot better than yesterday.  That’s because Nancy was much better than on Tuesday and surpassed the Monday status. She was sleeping better and eating more today.  When I got there about 4:20 this afternoon she was sleeping soundly.  I stood and watched a silent television for 15 minutes before she woke up. I learned that the mid west was being slammed with a blizzard unlike any since Nancy and I lived there in the 1970s.  Also Yakima broke a record low.  With the sound off that’s about all I learned.

She needs to breathe  more deeply.  When she went to the ER last spring she had fluid in her lungs from the cell damage the bacteria were doing (I think) and the X-ray was first interpreted as her having a “piece of pneumonia.”   Not so as it turned out.  Then this latest episode caused some more lung damage (now healing) but laying in bed doesn’t get you much lung exercise. So she gets to blow into one thing and suck on another.  That’s boring after about 30 seconds.

So, …

I told them she played fiddle and visited nursing homes and such with a group of  ‘old-time-music’ friends and that she started singing in a church youth choir when she was about 3.  So they brought in a music player and tried to get her to sing along with some Christmas music.  We both think Christmas music ought not to be allowed on the airwaves until 12 days before Christmas (not close enough yet).  She was a good sport about it but when David (ICU nurse) left the room she had me turn it off.

If they had had the Virginia Reel, she probably would have known lyrics and been happier.  The rest of us would have been clueless.

So we are looking forward to Thursday.

Today is hard to characterize.  There are no major changes with Nancy.  When I got there this morning she was (again) nearly in a sitting position.  Her vocal volume seemed to be somewhat lower but she still wanted to talk. And she wanted to write when I did not grasp all that she was saying.  With the worrying she is doing she is sleeping very little and so not healing as well as she might.  The result is that her vital signs get a little ragged.  They would like to get her out of the ICU and to a quieter place and one where they can do a bit of therapy but until she settles some that may be unsafe.  They thought of moving her today but in addition to the above concern the ACU on the fourth floor did not have an open room located close to the main observation station.  I got the impression either of these things would stop the move, so, tonight she remains in the second floor ICU.

Mostly she is worrying about things she needs to do at the University although I’ve told her all is taken care of.  As this is Tuesday of Finals Week this is almost true.  By Friday I can say the quarter is over and maybe that will quiet some of the thoughts.

She also wanted me to bring some of the pills to her for this or that ailment because, I think, they are giving her some of these medicines via infusions and/or smaller pills that she can swallow more easily.  I guess she thinks they are not giving her something ( say “the big yellow pill”) that was prescribed weeks ago and she was in habit of taking at certain times and with or without meals.

Before I left there today I asked if she needed me to come back in the evening or if coming on Wednesday morning was okay with her.  She told me I didn’t need to come back unless I brought her cell phone to her.  They don’t want patients in the ICU to have cell phones and she couldn’t use it anyway, but still it bothers her.   When I called there about 6 PM she wanted to talk to me.  So we talked a little but I could not make out much because of the soft voice.  The nurse and I chatted about how we might get her to think about her health and let go of the outside world, especially the interaction with students (in this age via e-mail and cell phone).  We agreed this would not be easy for her.

All for now.  John

Each day now, Nancy shows considerable improvement.  Her voice is stronger and she can write better.  An occupational therapist got the bed into the shape of an overstuffed chair and had Nancy moving her arms and doing finger exercises, all the time asking questions.  Nancy did well on most of this.

A couple of doctors and a nurse visited and explained what they call ICU-ites.  It happens that when one spends time deeply sedated and in the intensive activity of a unit with things beeping and then someone will yell ‘code blue’ and all h— breaks out in the next room – – – one does not sleep well.  They seem to be sleeping soundly but they never go into deep sleep (REM sleep) and this means their brain isn’t getting the rest and relaxation it needs.  After several full days of this one can get a little disoriented.

They hope to move Nancy to the more restful level of care (the ACU, or acute care unit) on the fourth floor on Tuesday or Wednesday.

Today she wanted her cell phone and laptop.  The nurse and I convinced her she could not have them in the ICU.  Her voice isn’t back strong enough to talk on the phone and her arms and hands are a bit weak so she would just be upset if she had the computer.  I did not even ask if they had a hookup to the internet in there.

Her lungs still have a tiny bit of a rattle but that is lessening daily.  She was hungry and eating Jello and drinking water and orange juice.

That’s all for now.

Sunday about 5:30 PM

I called the ICU early today and then waited until this afternoon to go down to Yakima.  Nancy is holding her own without the ventilator. Because of the long time with the tubes in, her voice was very weak and we (nurse and I) tried to talk in a manner that she could nod and not have to speak.  She also tried writing on a clipboard but weakness, attached tubes, and such made much of it hard to read.

The nurse had no luck with the notes Nancy tried to write but I could make out a few words and then guessed at the rest — Nancy would agree or disagree and I would try again.  We made some progress.

She was hungry and finally we got printed “Is food not part of the service here?”  She had been well fed with a brownish liquid via a drip line and that’s probably not going to leave you full when it is taken away.  Because of the sore throat we just got her some jello and orange juice.

We played — or attempted to play — a little verbal trick on her. We have a dog named Shay and I asked if she remembered Shay.  The nurse quickly said “Is that your cat?”  With no hesitation, Nancy let her know that Shay wasn’t a cat.

She insisted on keeping the paper and pencil with her even though the folks there can’t make as much sense of  her attempts at writing as I can.

Her nurse thought Nancy was improving by the hour and by Monday AM would be still better.  I will go back early with some of her favorite yogurt as that flavor isn’t usually available.  I can also help with the communications.

More Monday evening.