Getting Nutrition In And Keeping It In

Cathy is having to deal with bouts of nausea again. Combine dealing with the nausea with a lack of desire to eat the purred foods and the issue becomes about getting adequate nutrition. Tonight I by-passed the 'system' and brought Cathy some food from the cafeteria: Cheese quesadilla with lots of sour cream and guacamole. So far she has done pretty well (about half of it down and it is staying down). She is still getting her tube feedings from 6 pm to 6 am, but she needs to take in more calories to put on the weight and strength for the transplant surgery.

Nothing News Worthy

There really wasn't anything significant about Cathy's day that is update worthy. However, I felt that if I didn't post an update some may worry that something bad happened today. (Besides, I'm getting kinda addicted to this blogging thing).

This evening she is resting. She did not go on the Bi-Pap last night, so she has been on the trach collar since Saturday morning. All her numbers are normal (including the potassium) and the results from all cultures taken are negative (so far).

Just waiting for "The Call".

Potassium

Everything you ever didn't want to know about potassium, that is what today was about. The potassium levels in Cathy's system have been a little high the past few days. This has been her biggest issue to deal with. Her blood gas levels all the other 'numbers' are good. Just potassium... I will spare everyone the details about how potassium levels are reduced.

Kaitlyn came down for a visit this afternoon and the three of us went for a stroll around the unit.

Last night Cathy passed on being put on the Bi-Pap. By this afternoon she was feeling the effects of her lungs not being rested overnight. She says that tonight she will use the rest.

A Day Of Visits

It was a busy day filled with visits from friends and family. I think Cathy will sleep well tonight.

Dr. Saggar told Cathy it will be up to her tonight if she goes on the Bi-Pap. As long as her blood CO2 and pH hold good levels, it will stay her decision every night.

The healthier Cathy becomes, the less there is to update.

Nothing New Is A Good Thing

Today Cathy has graduated from doing laps around the unit (7 East) to doing a lap around the entire seventh floor. She tells me that she had a very good day.

Cathy is looking forward to visiting with Becky, Jessica and Miles tomorrow, along with Bonnie and her family (Kaitlyn will not be able to make it down).

I don't have much else to update, but I guess that is a good thing.

David

PS. Happy Birthday Mom from both of us.

Everyday, Its Getting Closer

Blood pressure - normal; Temperature - normal; Blood Gasses - normal; Magnesium - normal; Pulse rate and potassium - a little high (we can't have it all); and so it was for today.

Once again, Cathy has fought through a set back. Today she went for another cruise around the unit with the physical therapist. Her headaches are still there, especially when she is suctioned. Her nausea is now only a minor issue. She is still receiving tube feedings from 6 pm to 6 am. During the day her consumption of food by mouth is getting better, but it is still not enough to provide all the nutrition she needs.

Everyday: getting stronger, getting rest, getting nutrition and getting closer to a transplant.

Remembering A Code Blue

Here we are again, seventh floor east. Right across the hall from the room Cathy was in way back on June 29/30. Cathy does not remember much about that half day, but I still shudder every time I think about it. I thought we lost her that day.....

ICU Graduation

Tonight Cathy's spirits are much better than they were yesterday afternoon. Much of the credit has to be given to the fact that there is a bed available up on the seventh floor. She will be transferred up within the next hour or so.

Cathy did a couple laps around the ICU unit with the physical therapist again today. Her strength continues to build every day.

So far all cultures taken since returning to UCLA are negative. The doctors ordered more cultures taken today and tomorrow.

Cathy will be put on the Bi-Pap again tonight to rest her lungs. Results from a blood-gas test performed this afternoon show that the CO2 and pH in Cathy's blood are back to normal (normal for Cathy). The doctors do not want Cathy to overexert herself again and have another set-back, so for the next night or two (possibly more) she will be put on the Bi-Pap.

Stay Away From The Tortilla Soup

Tuesday night.... cream of mushroom soup night in the cafeteria (or the dinning commons as they call it here), mmm good stuff. Sunday night's leftover clam chowder is better, but the cream of mushroom soup ain't half bad.

So why am I rambling about soup? I guess because I do not know how to start describing Cathy's day.

I called earlier in the day and spoke with Cathy's nurse. I was told that she was doing well and, at that very moment, she was up and walking around with the physical therapist. "She is having a good day" I was told. I felt a sense of relief.

When I walked into Cathy's ICU room this afternoon, she was in tears. Not at all what I was expecting. "I am having a bad day" she mouthed to me. Lesson learned: The nurses will report on a patient's physical health not their mental state. To the nurse, Cathy's temperature and blood-oxygen saturation were good. She was exercising and not vomiting. This was all that is needed to make for a good day. For Cathy, today she ran out of emotional gas. The memories of being in the ICU previously, and seeing some of the familiar faces during her gallivanting today, were too much for her.

Cathy has made it on the trach collar since Sunday morning. However, this evening her blood gasses are heading south (high CO2 and low pH). She is scheduled to be put on the Bi-Pap tonight to rest her lungs and allow her blood gasses to straighten out.

Tomorrow...Wednesday, I think its split pea soup, yuk.

Lost Cookies

Cathy has been dealing with more than the usual amount of nausea today. At times during the day she has been hit with productive heaves.

She has been on the trach collar constantly since Sunday morning. Tonight she tells me that she is having to concentrate more than 'normal' on her breathing. I suspect that she may need to rest a bit on the ventilator.

Cathy is still being given IV antibiotic and antifungal medications. The nurse could not tell us if the results from the cultures taken at St Johns are available. I suspect that it is still a little to early for these results.

Sleeping Beauty

Cathy has been on the trach collar since 9 am. She has been told that if she can tolerate it for several hours, orders will written to move her back 'on the floor'.

More samples were drawn this morning for cultures. As a precaution Cathy is being treated as if she has an infection. The final results of the cultures taken at St Johns will determine if these treatments continue. This morning, Dr Saggar (the brother) reiterated that they do not believe Cathy has an infection.

This morning Cathy is relaxed and calm. The stresses of the past 72+ hours are showing less and less on her face.

Deja Vu

Cathy is back in the fourth floor ICU at the Ronald Regan UCLA Medical Center. This is the same unit where she spend all of July and most of August. She made the trip from Oxnard by ambulance while on a ventilator.

Currently she is sleeping. She will be left on the ventilator for the next 12 to 24 hours while the doctors here reassess her condition.

Dr. Saggar stopped by and spoke with us for a few moments. He mentioned that he is confidant that there are no infections and therefore he has not taken Cathy off of the transplant list (Big YIPPEEE!!!!!).

An Inviting Bed

The pulmonologist here at St Johns has just informed us that there may be a bed opening up at UCLA. We are hoping the return to UCLA happens sometime this afternoon.

Negative Cultures

Cathy was able to spend a few hours on a trach collar today. This evening she is back on the ventilator in a pressure support mode.

An infectious disease doctor stopped by this evening and spoke with us for a few moments. So far, the cultures taken since Cathy has been here in St Johns are negative. However, he said that they do not normally test for the exotic things like they test for at UCLA. Unfortunately, the para influenza virus, aspargillis fungus, and some of the bacteria that Cathy has tested positive for in the past are included in what this doctor classifies as exotic. So, for now all we can say is that Cathy is negative for all the common ailments.

The doctors here have been communicating with the transplant team at UCLA. Although the cultures have been negative, there is still a high level of concern because Cathy's white cell count is down. Unfortunately, a few of the medications recommended by the transplant are not immediately available here at St Johns. The doctors have to make special requests through their system. I sense that they are stalling on doing this in anticipation that Cathy will be leaving at any moment.

Still no bed available at UCLA. Although it is possible, it is unlikely that a bed will open up over the weekend.

Quick Turns

I have often heard the expression about things turning on a dime, today I saw an example of this up close and personal. Yesterday evening at this time Cathy's primary worries were about getting used to her new location. Tonight we are worrying about infections and blood gas levels again. Since there is now a concern for an infection, if a lung were to come available for Cathy, she could not take it. They will not perform a transplant if there is any hint of an infection. There is also a concern for Cathy being on the ventilator. Every moment she is on it, her body becomes more dependant upon it. Cathy will have to be weened off the ventilator all over again (the thought makes my stomach turn). Being ventilator dependant also effects the surgeon's willingness to perform the transplant.

A few moments ago the nurse informed us that the pulmonologist here at St Johns has OK'd Cathy to be transferred back to UCLA. Earlier today he felt that she was not stable enough for the move back. I am holding on to this as the "up" for the day. Her return trip will be by helicopter. I think the doctors here are trying to blame the possible infection and even the mucous block on the care given during the ambulance ride up to Oxnard from UCLA. Also, since Cathy is now an acute care patient again, there is a greater sense of urgency to minimize the transit time.

Tonight Cathy is in good spirits considering the events of the past 24 hours. She is still running a low grade fever, fighting her headaches and a little of the nausea.

Ya think during the next 24 hours we can turn back on that dime?

A New Trach

When the respiratory therapist attempted to put Cathy on the ventilator she could not tolerate it. The pulmonologist here at St Johns removed Cathy's trach and put in one a size or two larger. While doing this procedure he also performed a bronkoscopy. Cathy is now back on the ventillator - life support - so much for not needing acute care.

The pulmonologist believes Cathy's difficulty with being put on the ventilator and the blood gas problems were caused by a mucous blockage at the base of the trach tube. (They saved a souvenir for me to see, it looked nasty).

This blockage does not explain the fever or the color in her mucous. Cultures were taken this morning and more were taken during the bronkoscopy. Now its a two day wait to see if there are bad things growing.

UCLA does not have a bed at this time. It may take a day or two for one to open up (boy they sure rented out Cathy's room fast).

Quick Stop

Things were moving slow here at St Johns when compared to the operations at UCLA. However, in the past hour and a half the pace has steadily picked up. It is official, Cathy is being transferred back to UCLA.

It May Be A Short Stay

When I left Cathy last night just before midnight, everything appeared fine. Sometime during the night Cathy spiked a fever and her blood gasses went out-of-wack. As I walked in this morning to see her on my way to work, she was being transferred to the ICU. The doctors here are going to put her back on a ventillator (no Bi-Pap). The doctors have also mentoned sending Cathy back to UCLA.

The Start Of A New Chapter

Oxnard Base here, Cathy has landed.

We had a little 'stutter start' but everything worked out. When the ambulance arrived to pick Cathy up at UCLA it was not properly equipped to care for and monitor Cathy during the trip to Oxnard (I think the discharge coordinator missed a paragraph or two in the doctor's discharge instructions). Two hours later a properly equipped ambulance arrived to carry Cathy to her new digs.

We knew it was going to be different, but BOY WERE WE SPOILED at UCLA. St. Johns is a newer hospital, 6 to 10 years old. The facilities are showing every minute of those years. I guess we are in the real world now. So far the staff has been great. When we finally arrived, it was just before shift change for the nurses so there was an elevated amount of rushing around and confusion.

We met with one of the doctor's that will be caring for Cathy - Dr Yanik. He is an internal medicine specialist. He will be taking care of Cathy for a couple days in the acute care unit to ensure she is stable and 'up to this hospital's standards' before being moved to the sub-acute (rehab) unit upstairs. Tomorrow Cathy will meet the pulmonologist that will be following her care - Dr Achira.

It will probably be a bit of a rough night for Cathy as she adjusts to her new surroundings and new routines. Knowing Cathy, by tomorrow she will have several new friends and will feel right at home.

UCLA Base Here, Signing Out

The nurse informed us a few moments ago that the ambulance will be here in less than one hour. After 81 days, its like packing up and moving away from the old neighborhood. I think what I am going to miss the most is the support from other families that I have become close with. Many have loved ones here for as long or longer than Cathy has been here. One familiy in particular has a son in the ICU. He was Cathy's neighbor and is in desperate need of multiple organ transplants (kidney and lung). If you can spare a good thought or prayer, please use it for this family.

The routine will continue up to the last minute: doctor's rounds, physical therapy, pain management, nausea management, nurses and care partners stopping by to say good bye, add in a little anxiety management and you have the morning's complete picture.

UCLA base here, signing out. See you in Oxnard.

Its Oxnard.....maybe

After several days of back and forth between myself, hospital discharge coordinators and insurance case workers, it appears that Cathy will be transferred to Saint John's Hospital in Oxnard Ca. As late as 1 pm this afternoon, the wheels were in motion to have Cathy moved tomorrow morning to a hospital in Hancock Park, Ca (between UCLA and downtown LA). Once I had convinced the insurance case worker that they were relying on outdated information (their records indicated that Cathy was still needing the Bi-Pap every night), it was agreed that St. Johns in Oxnard would be a better facility for Cathy.

The final piece of the puzzle that needs to come together so Cathy can go to Oxnard is for the pulmonologists from the transplant team to communicate with the pulmonologist at St Johns and work out a plan for Cathy's care. This is still a big piece, but it should be easier than changing the directions of two huge bureaucracies. As of this evening, Cathy is scheduled to be transported by ambulance to Oxnard around 2 pm tomorrow (pending the afore mentioned conversation).

Cathy had a pretty good day today. She had physical therapy this morning and has been sitting up in a chair for most of the day. Her headaches and nausea are 'still there' but did not dampen her day.

Morphine Today None Tomorrow

Cathy's pain medications were changed again today: Morphine out; dilaudid, oxycotin and vicodin are back in. As a result of no morphine, Cathy was more alert today. She had enough energy to walk a lap around the unit with the physical therapist.

There is not much else to update this evening, an uneventful day with no setbacks.

Eight Days Without Respiratory Support, And Counting

Today was a sleepy day for both Cathy and I. The doctors have adjusted the pain medications Cathy receives for her headaches. They took away the vicodin (this worked the best) and increased her morphine dosage. The morphine makes Cathy very groggy.

It wasn't quite a patio visit, but earlier this evening Cathy and I took a wheelchair stroll around the seventh floor. (Shhhhhh, we did sneak downstairs for a few moments).

Cathy has struggled with her breathing on and off today. The Bi-Pap machine was removed from the room this morning. I think the thought of not having that safety-net at her bedside may add to the stress during these times.

Today was the eighth straight day of being on the track collar and the thirteenth day without a significant amount of blood in her lung secretions. The pressure sores are slowly getting better and Cathy's spirits are staying bright. Cathy has asked me to tell everyone once again that she thanks you for all your good thoughts and prayers and she loves you all.

Watermellon And Peaches

After yesterday's news, today's activities were anticlimactic. We did confirm that Cathy will still have to be transferred to a rehab facility. This move will probably happen early next week.

Cathy is still dealing with the headaches and nausea. She is getting stronger every day. She can now get in and out of bed without assistance.

This morning we asked if Cathy could start ordering her meals from a regular menu (I had already begun sneaking in soft foods to her). Starting with today's lunch, Cathy started to 'officially' eat regular, soft, foods.

Cathy Has Been Re-Listed For Transplant

The title pretty much says it all. It is definitely an UP day. I do not think this will effect the move to a rehab facility, but this will be my first question to the first doctor I see.

More to follow....


.......YIPPPPPEEEEEEE..........

Not Sick Enough To Stay; Too Sick To Be Somewhere Else

Cathy had a very good day today. Cathy says her headaches and nausea were not any better today, she just had more energy and was in better spirits. Cathy was cared for by a team of two nurses today. One of them (who had cared for Cathy in the past) brought in brownies for Cathy and I.

By the time of this blog posting we had not heard anything about the transplant committee's decision regarding re-listing Cathy. However, a surgeon did drop by and evaluated Cathy this morning.

I have spent most of today dealing with discharge coordinators, administrators at prospective hospitals, and insurance case workers. At one point this morning it was looking like Cathy would be able to go to a hospital in Camarillo CA (just a few miles up the road from home). This hospital has a sub-acute care unit (health care lingo for rehab facility). Initially the administrator I spoke with said that they would take Cathy. However, after the doctors there reviewed Cathy's case, they thought that Cathy needed more care than what they could provide. They also could not provide the isolation that Cathy requires. (They actually thought Cathy should stay at UCLA). It was the same story for a facility in Santa Barbara and Goleta. So far, the only facility that will accept Cathy is one that has had 13 substantiated complaints for substandard care during the past 24 months (several more are pending investigation). This is the most of any of the facilities that have been proposed. Additionally, this facility is on the other side of downtown. The insurance case worker understood my concerns and, for now, will not require Cathy to be moved to this facility.

The last word I got from the discharge coordinator this afternoon was that a hospital in Oxnard may accept her (St. Johns, its a good one). I am not getting my hopes up. The insurance coordinator and I had discussed this hospital and she did not think they could accept Cathy because of her oxygen and Bi-Pap requirements. UCLA's discharge coordinator is trying to have Cathy placed and moved by tomorrow or Monday at the latest. The insurance case worker does not think this will happen (wink, wink.... she is my new best friend).

A Ticket To The Unknown

The most significant thing about Cathy's day today was that nothing significant happened. Walking and being on the trach collar are now routine. Eating is also becoming routine, although Cathy is still dealing with a bit of the nausea. In spite of the nausea, Cathy has managed to put on another three pounds.

The discharge coordinators have begun talking to us about rehab facilities for Cathy. So far, of the three that have been mentioned with a bed available, two are on the other side of downtown LA (30 to 40 miles, and 90 minutes, further commuting each way). The one that is closer to Ventura (by only a few miles) does not look that appealing when I looked at the complaint and facility audit records on the California Department of Health Services web site (one of the ones on the other side of downtown did not look that great either). As of today, there were no beds available in any of the facilities that are in our back yard. There is a facility that the pulmonary doctors prefer out in the "Valley" (about the same distance from Ventura as UCLA), but there are no beds available at this facility either. This facility also has a better that average complaint and audit record. Cathy and I are both a little stressed about where she is going to end up.

Tomorrow the transplant committee meets again. We have been assurred that Cathy's case will be discussed again. I cannot see the logic of any doctor saying that Cathy is not ready for a transplant and yet she is ready to be moved into a rehab facility as a bridge to going home. If she is strong enough to not need the daily care of the medical and transplant teams, then she is strong enough to receive a transplant. (My opinion, but we all know I am biased).

A Track Star

Well, when I arrived back to Cathy's room this evening, Cathy was still sitting up in the chair where I had left her this morning. More importantly, she was still on the trach collar. During the day the physical therapist had Cathy walk the corridors again. This time instead of an up-n-down route, they did a complete lap around the ward (a little under four times yesterday's and Sunday's distance - its a geometry thing). London 2012 here she comes!

So far tonight the vicodin is working for Cathy's headaches. Let's pray for no repeats of last night's dilaudid fiasco.

Experience Is Priceless

It turned out to be somewhat of a long night. After things were settled from the dilaudid incident, Cathy started to comment that things did not feel right. After ten weeks I have learned that when Cathy says that something is not right, things aren't right. The respiratory therapist caring for Cathy last night did not have the luxury of this knowledge nor the experience to listen to the patient. Throughout the night the RT kept reassuring Cathy that things were OK, her oxygen saturation was good, she just needed to relax. By 6:30 or 7 am this morning the RT was beginning to realize that things were not right. Cathy was undergoing distressed breathing and was asking to be put on the Bi-Pap. The RT began the process of hooking her up to the Bi-Pap. However, when it came time to insert the inner cannula into the trach (the connection needed between the trach and the ventilator), it would not go in. I do not want to be to critical of the RT, but at that moment she panicked and left to go get help. It seemed like forever, but it was probably a little less than 30 minutes of Cathy and I wondering where the help was. During the time she was seeking help, the RT must have realized it was time for shift change. So, she went "down to give a report to her replacement". Fortunately, the replacement RT was very experienced. Within a minute or two she had diagnosed a malfunction in the humidifier. Cathy had been receiving dry air since before she first started to feel things were wrong around mid-night. The dry air had not only dried out Cathy's sinuses, mouth and trachea, but had also dried out the trach passageway so the inner cannula would not slide in. A quick dash to the 'supply closet' to retrieve a new humidifier and the problem was solved.

By the time I left the hospital (just before 10 am) Cathy was relaxed, sitting up in the chair, smiling, breathing comfortably again, and still on the trach collar. As of this morning at 5 am, Cathy had been on the trach collar for 76 hours straight. I am happy that this streak was not broken this morning. More importantly, I am ecstatic that Cathy is under the care of an experienced respiratory therapist today.

Continued Improvement (and an ooops)

Cathy has not been on respiratory support (Bi-Pap) since Saturday morning. When I walked in the room this afternoon, she was sitting up in a chair, kickn' back watchn' the tube. She walked with the physical therapist again this morning and she ate 'OK' for her meals today. Overall her improvement continues.

.....Having said the above, a little over an hour ago Cathy was given some dilaudid for her headaches (a normal dose). Within 10 minutes of receiving this medication, Cathy's blood-oxygen saturation dropped drastically. Cathy was breathing too shallow. With the volume she breathes at her best, shallow breathing is not giving her much support. Two or three nurses and the respiratory therapist have been working steady on Cathy, keeping her breathing (keeping her awake and telling her to breathe). I asked about giving her narcan (a drug that reverses the effects of narcotics). They do not want to administer this because Cathy's headache would come back and they would still need to deal with that. The effects of the dilaudid should peak soon and Cathy will breath deeply without having to be told to.....

In the time it took me to describe the situation, Cathy has already begun to breathe deeper on her own. This day will end on the upside.

Have a good night everyone and a pleasant day tomorrow, I am confidant that Cathy will.

A Stroll Along The Promenade

After her dinner this evening (turkey and mashed potatoes), Cathy said she felt like going for a walk. So, with portable oxygen and a walker, Cathy and I (chaperoned by a care-partner) strolled up and down the corridor: from her room to the window at the end of the corridor, back past her room to the nursing station at the opposite end of the corridor, returning to her room. She maintained good blood-oxygen saturation the entire stroll. Ten weeks ago I could not even imagine that this would be possible without a transplant. The progress during the past two days is nothing short of a miracle.

Thank you all for the good thoughts and prayers.

Karaoke

This morning, while waiting for the her morning medications, Cathy was sitting up on the edge of her bed taking in the view from her room. She had been sitting there for a while when I thought she was trying to say something (mouth the words) to me. After a few "what's?" and "say that again please", I realized that she wasn't trying to talk to me, she was sitting there singing to herself. Singing and swinging her legs to the beat of the song that was playing loudly in her head (she wouldn't tell me the name of the song). At that moment I knew it was going to be a good day.

During their rounds, the medical team again discussed moving Cathy to a long term care facility. This time the discussion focused on the move being more of a bridge to going home. Who would have thunk it? Cathy may actually be able to go home and wait for her transplant. They still have not had their discussion with the transplant team. This should occur on Monday. It sounds like once a decision is made, things will move fast. Stay tuned......

One of the transplant attending physicians (Dr. Lynch if your keeping score) also stopped by this morning. He acknowledged that the G-tube procedure was a big set back for Cathy, but she is doing a lot better now. She was severely anemic earlier in the week, which was why they gave her the two units of blood. He also said that Cathy's case is discussed every Thursday and with the progress he has seen, he believes Cathy should be re-listed this Thursday. Three Votes!!!!!

Cathy was able to eat a full serving of pureed eggs for breakfast along with half of a yogurt. For lunch she ate an entire serving of pureed egg salad and and about half a portion of cottage cheese. She is still fighting the nausea, but it has diminished to a point where she can 'eat around it'.

Cathy's pain management is back to dealing primarily with her chronic headaches. The pressure sores are slowly healing. To top things off, Cathy has been on the trach collar since yesterday morning at 5am!!! Thirty-six hours and still going strong.

A totally UP day!

Should We Pack Our Bags?

Compared to the past six days, today was a good day for Cathy. She managed to eat a little of her breakfast, and about one-fourth of her supper (or dinner, Cathy only eats dinner). She sat up for a few minutes several times today. More significant, she managed a smile a few times today.

I confirmed that the sedative is being given for nausea. Since Cathy did start to eat today, I guess we will have to trust the doctors.

During rounds this morning the doctors from the medical observation team discussed with us the logic of moving Cathy to a nursing facility. It sounds like they would like to see Cathy moved soon. We listened to what they had to say, when they were done I mentioned that what they were saying was contrary to what Dr. Saggar had told us last week. A couple of the doctors said that they had discussed this with other doctors on the transplant team. After a minute or so of some pretty fancy 'word-dancing', they said they would talk to Dr. Saggar and get back with us. Back on Aug 25th I suggested that there may be a communication problem between the two teams. I think we saw more evidence of this again today.

Sedation

Cathy was sleeping again when I arrived this evening. I was a little 'taken back' when I learned that they began sedating Cathy yesterday. (This may also explain why she was sleeping so soundly when I arrived last night . It may also be a factor in Cathy not remembering what the doctors tell her during the rounds in the morning). The nurse thought she is receiving the sedative to help relieve the nausea. Cathy is receiving sedation throughout the day.

At some point in the day today Cathy did have physical therapy. The nurse said she walked around the room and did some marching in place.

When I left this morning, Cathy was awake, alert, and looked like she was heading for a good day. Tomorrow morning I will be able to ask the doctors about the sedation.

No Word

Cathy was sitting up in bed when I came into her room this afternoon. Quite a change from the past four-plus days. She is still fighting the nausea. She was unable to eat anything again today. The pain is still with her, but is becomming bearable.

Cathy is currently receiving two more units of blood (I think these are her eight & ninth units since being admitted in June, I lost count). Cathy was told that this blood should give her more energy.

One of the doctors from the transplant team did visit Cathy this afternoon. He did not say anything about her being relisted (he also did not say she wasn't re-listed). Cathy does not remember to much about the visit, I am chalking up the poor memory to the narcotics.

Less Pain, Less Nausea, More Sleep

Cathy has been sleeping pretty steady since I arrived this afternoon. She is still dealing with pain and nausea from the G-tube procedure. The nurses have told me that she has been asking for her pain and nausea medications less frequently than yesterday. From this, I guess we can infer that she has improved. She is still not eating anything. All nutrition is being provided through the tube. For the last two days, they have been holding all tube feedings from around 5:30 am until after 9 pm in an attempt to promote an appetite. I think the nausea is still winning this battle.

Her pressure sores have not gotten any worse. Considering the amount of time she is spending in bed, I am taking this as a good thing.

I am unsure how these latest developments (nausea, nutrition & sores) are going to influence the transplant committee's decision tomorrow. At this moment, I do not believe Cathy is strong enough to survive a transplant surgery. In a day or two, things could be totally different: Cathy could be up and prancing through the halls again. I will trust the Big Guy on this one.

One big difference between being in the ICU and being in a medical observation room is that the doctors come by less frequently in the evenings. During the week, when I cannot be here during the morning rounds, I must rely on second hand information through the nurses and what information Cathy picks up from the doctors. With the quantity of narcotics Cathy has been receiving the past few days, she does not remember to much about the morning doctor visits by the time I arrive in the afternoon.

Your Title Here

Today was pretty much a continuation of yesterday for Cathy: Pain, Nausea, Nutrition & Breathing.

Yesterday evening it was discovered that Cathy has developed a few pressure sores. Since the G-tube procedure on Saturday, Cathy has found one position that gives her the most relief from the pain. Staying in that position has promoted the development on these sores.

Four days of pain and nausea are beginning to show on Cathy's spirits. Not to many smiles this evening.

One up-note for tonight: There has not been any blood in Cathy's lung secretions during the past 24-hours.

A Simple Procedure

It took the surgeon about 5 minutes to place the G tube in Cathy's stomach. A little over 50 hours later, Cathy has still not recovered. The nausea is preventing her from taking any food by mouth. This morning she 'returned' the feeding she was given through the G tube. The pain has subsided a little bit, but is still preventing Cathy from giving a good cough. If Cathy cannot cough strong enough, she develops mucous blocks in her trachea. The nurses and respiratory therapist have been asked not to suction Cathy unless it is absolutely necessary. They want the trauma at the back of Cathy's trachea, that was caused by aggressive suctioning, to heal. Cathy's care during the last day and a half has been a delicate balancing act between pain, nausea, nutritional and breathing management.

On an up-note: Several doctors from the transplant team and medical team have all commented that any time a patient has a procedure, it is expected that they will have a set-back on their recovery. Additionally, Dr Saggar (no, not the brother, Cathy's transplant physician) said that he feels Cathy is ready for a transplant and she should be relisted after this Thursday's committee meeting. Additionally, he feels it is best if Cathy stays in the hospital here until she receives her transplant. (We had been hearing rumblings again about moving Cathy to a long term care facility. Cathy is much more comfortable knowing that she will remain here until she receives a transplant).

Up-note number two: The initial results from the cultures taken after Cathy's fever Saturday night show no signs of infection. The antibiotics she began receiving that night will be discontinued after today.

Up-note number three: Day fourteen out of the ICU. It is a sunny southern California day. Even with this set-back from the simple G tube procedure, Cathy is progressing so much better that she was in the ICU. (I know it is a little weak but I felt I needed a third up-note).