The night was uneventful with Erica RN caring for him with his periodic awakenings for his norm. Dialysis was started at 730a for a 3 ½ hour session. Perry slept during a majority of the treatment. Only 735 mL of fluid was removed & his session ended @ 1108a. While I was out of the room during his disconnect from the dialysis machine, the break room where I was going to have lunch was occupied by an education class. I went to sit in the J5-5 Family Lounge & encountered a large Italian family & support network gathering, comforting, & supporting each other & soon a priest arrived. I have spoken with one of the sons of the patient & a few of the other family members on occasion over the last several weeks. We have passed & greeted each other on multiple entrances & exits from J5-5 as well as at the Transplant House. I provided the keys to my apartment to the patient’s wife so that perhaps a few of their family members from New York could stay close at hand since the time for her husband & their loved one to leave this world was soon inevitable. It was the only thing that I could do to help. With Perry requesting me to stay with him, it was the least that I could do since all I’ve been doing at the apartment is showering, replenishing food stores, & returning to the hospital.
Dr. Lane, Pulmonologist, plans were to continue with trach capping & CPAP. He would like for Perry to also be trach collared with the trach cuff deflated to see how he does. I reinforced that Perry is a mouth breather & inquired if warm humidity could be utilized instead of via the bubbler humidifier to see if that could help Perry break up a few lung secretions which he agreed could be done. I also reminded him that with the trach cappings Perry has not experienced the repetitive abdominal distention he had been experiencing with trach collar breathing nor has an abdominal KUB xray been required for the last several weeks. Waiting to hear the plan regarding whether the pigtail chest tube catheter will be removed or redirected &/or whether or not tPA or Streptokinase will be used to breakdown the blood clot consolidations. I asked the Intensivist team to please discuss with the Pulmonary team as their plans conflicted each other. I also asked that Dr. Koval be included in the formation of the plan. The blood cultures taken yesterday have not grown any particular organisms thus far.
The nutritionist has requested a repeat Metabolic Cart be done. She has not made any changes to his formula rate or quantity & will continue to overshoot in amount of volume he should be getting in order for the actual target to be met as his feeding volume is decreased every time his feedings are put on hold for position changes or during part of his PT therapies, & the many times that the nurses forget to resume his feedings after giving his medications which happens quite frequently.
Varsha RT capped Perry’s trach @ 1230p on 4 liters of oxygen per nasal cannula. He was able to tolerate capping until 139p for a total of 69 minutes with complaints of pain to his abdominal sides & was given Tylenol. He then was placed on CPAP & completed 3 hours & 26 minutes of CPAP before being taken off so that he could rest his lungs/chest.
We received a phone call from Nick to update Perry on questions he had regarding insurance concerns. We learned that Char was also discharged today & home from the hospital & was doing well.
Lung ultrasound was completed however the technicians only scanned his posterior regions which seemed rather odd. Perry again was very tired throughout most of the day & slept quite a bit during the day & into the evening. Even though he sleeps, he keeps me extremely busy when he awakens periodically to reposition him, raise or lower the head of his bed, remove or add sheet or blankets, provide oral suction, turn his pillow to the cool side, or try to help decrease his restless tremors with light pressure. I was able to depart to go to the Transplant House to shower, gather food items, & then returned to the hospital. While I was at the Transplant House, Jim & Diane had asked to FaceTime as they were with Sam. Erica RN had tucked him in for the evening, & he was stirring upon my return but back to sleep in no time so missed out on a FaceTime call to Sam.