I will just post a typical report I try to give Marla and Diane when they come in at about 9:30-10. I also like to write all this stuff out so I can tell Denise and Jen all the latest. Between all of us we try to keep a watch on so many different readings. We do not understand as much as we would all like to, but we can read Rob pretty well and are sensitive to any little improvements, and other changes.
8 AM Sept. 20th. His nurse today is Larissa, with the “i” sounding like an e! I think this is the first time we have had her. His PCA is Lettie and she is a short little gal who has been very nice to have. Dr. Coselli and his team had stopped in earlier. Rob had asked them to come back when I arrived at 8. He had taken some morphine at 7:50 so he knew he would be out of it. He complained to me of pain in his left arm. He said it hurt so much that he needed his right arm to move his left arm. I told him I thought it was due to the surgery and the probing up and around his chest area. He showed me the pain in his arm pit area extending up to his collar bone area in both front and back from the way he was motioning. I reminded him of the recent surgery and that it will take another day or two for his body to adjust to the probing up and around his chest cavity. That is also an area of another aneurism, so I hope it is just surgical pain. He said his pain level is about a 7 when not on the morphine, and about a 2 when he has some. He says he can lay back now. When I asked him if he could lay back and still breathe, he gave me the thumbs up. He says his breathing is very labored, and that it is hard to take a deep breath. When I asked him to take a few deep breaths so I could check his volumes, he did a couple breaths over .500 CL. He was tired so I told him to rest, because that is his number one job right now. He still likes to rest in an almost sitting up straight position.
His heart rate is about 105 and BP is 145/80 and O2 readings staying around 94. His temperature is 100.2. He seems to be resting comfortably after taking the morphine. He has his feeding tube in his nose now, which he is grateful for. He is on the vent with 60% o2 and 500 as a setting for amounts to breathe as an average with 4 minimum beats per minute by machine. He is at about 16 now and was at 25 when more awake. He said he slept some during the night. He was sure glad to see me this morning. His container for collecting his chest fluids has 2 chambers, since he has two large tubes coming out of his left chest. It is measuring about 375 on #1 and about 540 on the other one. # 2 is pretty red and looks like similar blood as before surgery. It may be a little clearer. #1 is more yellow in the tube and looks less active compared to the other one. Dr. Coselli said it could take a day or two for that to work itself out. He has an IV line in his right leg for blood pressure monitoring and for infusions. They are running out of any veins they can get to stay open on his arms and I think they want to stay away from the neck areas they have used in the past. He has his special leggings that inflate and deflate to avoid blood clots. They will have to begin thinning his blood again to a good balance that will not allow clotting too much but will allow his lungs and chest area to heal without continual bleeding.
He has a drip of Propofol going, a feeding bottle, sodium Chloride, potassium Chloride, and another sodium chloride injection on some sort of pressure infusion bag. He also has a system that slowly releases local pain relief inside where the tubes are and the area of the recent surgery. I do not know how well that is working because his pain level still seems pretty high. I do not know the other injections they give him or what else they put through his feeding tube. I will try to get a review from the doctors or his nurse in the next hour or so.
His chart is so thick that they started a second one and it already has a bunch of paperwork in it. I do not know how each new nurse, specialist, doctor, etc. can get up to speed on this guy with so much to look at. We have to have faith that they can laser in on the pertinent information. It is scary, the questions that get asked of Rob sometimes. I am amazed at his recall. He knows how many milligrams of various medications he has taken and when. I do not know if the nurses tell him more when we are not there because most will come in and give him something without any explanations. We have never found Rob to be wrong in his recall of times and amounts over this period of time. It is so comforting to know that his sharp mind is all there and he is able to communicate effectively when given the opportunity.
It is now 9:10 and the doctors have not returned. They may not, since they do rounds early and then go to surgery. I would assume that the schedule for the day is to keep his blood pressure low, try to get him to breathe more on his own, and rest. If he has a good day and night, I would hope he will be put more on the trache collar. He will then be asked to do more activity, like standing up at his bedside. If the chest tubes stop draining, they will try to remove them over the next few days. If his breathing improves, and he can tolerate the trache collar, he will be allowed to eat and drink on his own. If his strength can return he will start to get some therapy and hopefully be able to walk around a bit. Once we get there - it is working to build up stamina and other therapy so Rob can go home. It has been so hard to see him struggle so much. After the first two heart surgeries, he just recovered so well and had such great and immediate progress. Hopefully we are getting back to that pattern now.
I talked to the nurse and asked what else he was getting for meds. She said he was on a couple drugs to help lower his blood pressure. As far as she knew, the morphine was the only pain killer he was on. The Propofol is like a tranquilizer to help him rest. It must be working ok with the morphine because he has been pretty sleepy since I got here. It is just great to see him sleep. I do not know how he does it in such a loud and busy setting.
9:30 - The heart rhythm doctors just came by and talked to Rob. He reached out to shake their hands and when asked how he was doing he gave them a wave of “so so”. We have never seen a thumbs down from Rob. It is always thumbs up or “so so” even when he is in pain and weak. The social administrator stopped by to check on him. She is in charge of transfers. She told Rob, “when you get better you can get out of this place.” He smiled and gave the thumbs up. Rob asked if the doctors team had been back. I said no and asked if he wanted me to ask them anything for him. He wanted to know if it was normal for his left arm to hurt so much. The nurse came in and gave him a shot of Lovanox for blood pressure control. I asked the nurse to inform the doctors of the pain in his left arm, if they are not aware of it yet, and if it is normal pain, due to the surgery. I also told her to ask if the CT scan showed any further dilation of the artery with the aneurism near his left arm.
He just had another IV bag added to give him meds that slow stomach acids since he is on the feeding tube. He is wanting to know how many surgeries he has had since being here in Texas. I explained that he has had three. He nodded like he agreed. He wanted know when he could get more pain medicine. I checked with the nurse and she said not until 10. I massaged his left arm and his feet and it was good to see his respiration and blood pressure drop. I think it was more due to the Lovanox than the massage.
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