Copied and back-posted from our CaringBridge site for permanent record here.
December 17, 2020, written by Mama
Tom was unstable Wednesday overnight so plans to extubate were further delayed. From 2:00 to 5:00 a.m., he was tachycardic (heart rate in the 160s), hypertensive (blood pressure in the 160s over 80s), and febrile (up to 102 F).
With one shift in the rear view mirror, the team suspects that this was another pain crisis. The day before, Thomas had been so hypotensive that he actually had to skip one or both of his Ativan and Methadone doses because those lower blood pressure further. Then a change in schedule spacing out both Ativan and Methadone was made for another complex reason, so by the middle of the night, those long-acting drugs were then probably too low in his system. Even with all eight-or-something of his PRN doses of pain and sedation drugs, we could not get Thomas "ahead" of the pain.
Watching him writhe and silently cry for three hours and to see how hard it was for the six folks in the room finally to reduce his pain brought my heart low for the whole day.
The team had to be sure there was not a more serious cause than pain, so Thomas had an abdominal ultrasound this morning in which the radiology tech took a good hour to scan every single organ he's got. There were no visible signs of infection. His white count continues declining. The team did culture all his lines in the middle of the night, so any results would begin growing over the coming days. Also to be safe, Thomas was put on Vancomyacin, the Cadillac of antibiotics, but also hard on the kidneys. The scans also revealed no signs of hidden bleeding, just some already-known, small hematomas. The necrotic areas of his liver have not increased. His drain output might even be what doctors call "minimal." It's definitely the lowest its ever been.
Right now, Thomas is "ahead" of the pain, he has no problematic bleeding, and he has no evidence of infection. That said, his instability last night put caution back into the team who soberly told me, "Thomas is not out of the woods yet" and that they want to wait longer to extubate. Surgery and PICU were so guarded giving me the results of the ultrasound that I had to ask for clarity: The words you are saying sound like the ultrasound ruled out all your concerns, but your body language and tone are telling me bad news, so I'm very confused.
I'm running on very little sleep last night, I feel too sad to get off of the PICU couch a whole lot, and I have tears waiting to spring out at slight provocation. The therapeutic work I did to try to take the focus off my own heart was to start my project of writing Christmas cards to the medical staff here. Service for others is medicine for one's own woes.
Tomorrow is another day.
No comments:
Post a Comment