A tracheostomy is not a permanent thing.
The scar, well. That is permanent. But, your left arm, shoulders and back kinda beat this little circular scar you'll have all to heck.
And they have milestones for you to hit. (Which might piss you off a bit. I don't think you've ever been on a "performance plan" before.) Right now you're given pressure control assistance on the ventilator. As the pneumonia clears and your lungs strengthen, though, you will be given less and less assistance. And finally, no trach.
And this could happen over the course of a few or several weeks, but it's going to happen.
Showing posts with label ventilator. Show all posts
Showing posts with label ventilator. Show all posts
Wednesday, July 16, 2008
Monday, July 14, 2008
Day fifteen: Preferred guest status
Tomorrow, you're getting a tracheotomy.
Aw, for crying out loud.
The hospital called Asia all casual-like, about "the surgery" tomorrow, asking her about your history with anaesthesia, do you have any allergies, blah, blah, blah, and she said, "WHAT surgery?"
We seriously didn't know anything about it. When I called back after talking with Asia, your nurse Gill said that, yep, it probably seemed pretty sudden because they kind of make the call and then, boom. An anaesthesiologist is calling you.
So, why a tracheotomy? Basically, Daddio, it's a function of how long your lungs are still going to need help. You're not over your pneumonia yet, so it's sure those lungs need assistance for as long as that takes to clear, plus however much longer they need just to get strong again. Clearly, you still need the ventilator.
Okay. Well, right now, the ventilator tube is attached to a tube that goes in your mouth, past your teeth, over your tongue, and down your throat. It is taped and tied into place, with stuff that digs into sides of your mouth, sometimes causing you to bleed. And every time they need to get down there, or if something slips (as it now has, causing a cuff leak, which is making this noise that I know must be driving you crazy) they have to wiggle and shove and your airways swell, and, ugh. Dad. It's friggin' uncomfortable. And it's one thing to put up with a situation like that for two weeks. But two or four or six more?
Basically, Dad, you can consider the tracheotomy an amenity the hospital provides for "preferred" guests who need the ventilator and have been invited to stay longer than two weeks.
How's that? Perfectly pukey? Me, too. I know that you would hate this. But given the alternative, we are all for it. The tube situation now is one that is like breathing through a straw, I'm told. And the new situation for you will be one in which you can breathe much easier and more comfortably.
So, why wouldn't they just do this from the get-go? If you only needed the ventilator for two weeks and they were able to begin weaning you off in order to extubate, then it would've been a needless surgery.
Tracheotomy.
That word and all the other words that have crept into my vocabulary can all go piss up a rope. I have even, much to my chagrin, begun to shorten them. "They're going to trach him." "He'll be on the vent for a while." Getting the hang of a subculture's lingo means you either want to be a part of it, or have accepted that you are. Like my use of corporate lingo, when I say things like, "moving forward," "add value," or "net net." Eek.
But you continue to improve. With a temperature of 38.3 when we left this evening, I am encouraged.
I thought on the way home about how you decorate the Christmas tree. When I was younger, I remember wanting to get right to the ornaments. They were so beautiful, all those antiques of Mimi's and Boppa's, and I wanted to put them on as soon as possible. Especially the ones that had the little fan inside. "Well, first we have to get the lights on. Or there'll be no heat to rise up into that ornament and turn the fan." Great. Let's get the lights on then! "Well, first, let's wrap this string of lights around the trunk."
Uh. Huh?
But, you'd get to it. And patiently twirl a string of small white lights 'round and 'round in the innermost parts of the tree. All that rustling in there would get the pine smell going in the living room. I'd begin to relax. One of us would be steadily feeding you the string of lights.
And I'd be glad that it was taking so long. Because maybe there was hot chocolate, or there'd be music playing, or we'd all be chatting. The moment was lasting. It was becoming a memory and not just a happening. Soon enough, the trunk was wrapped, and we'd graduate to weaving lights onto the branches like normal people do. Then, maybe garland. But finally, it was time for the ornaments.
And oh, how many places we had to hang all of those ornaments! Because you had lit the interior of the tree, there was a whole other world in there to decorate. Little havens, settings for perfect vignettes created by the criss-crossing of pine needles and branches. It was illuminated from the inside out. No matter where we chose to put an ornament, it was assured to take on the glint of Christmas magic and reflect the warmth of a tree decorated together and carefully. Thoughtfully.
Somewhere, deep inside, you are wrapping lights around the trunk. And I promise, from this day forward, to stop worrying about the ornaments for right now. To hang on, give you time while you heal in deeper places than any of us can see or even know. And no matter what you are decorated with when this is all said and done -- new skin or new scars, working or impaired lungs -- they will all have a place. As you, too, will be illuminated from the inside out.
We will just keep feeding you the light.
Aw, for crying out loud.
The hospital called Asia all casual-like, about "the surgery" tomorrow, asking her about your history with anaesthesia, do you have any allergies, blah, blah, blah, and she said, "WHAT surgery?"
We seriously didn't know anything about it. When I called back after talking with Asia, your nurse Gill said that, yep, it probably seemed pretty sudden because they kind of make the call and then, boom. An anaesthesiologist is calling you.
So, why a tracheotomy? Basically, Daddio, it's a function of how long your lungs are still going to need help. You're not over your pneumonia yet, so it's sure those lungs need assistance for as long as that takes to clear, plus however much longer they need just to get strong again. Clearly, you still need the ventilator.
Okay. Well, right now, the ventilator tube is attached to a tube that goes in your mouth, past your teeth, over your tongue, and down your throat. It is taped and tied into place, with stuff that digs into sides of your mouth, sometimes causing you to bleed. And every time they need to get down there, or if something slips (as it now has, causing a cuff leak, which is making this noise that I know must be driving you crazy) they have to wiggle and shove and your airways swell, and, ugh. Dad. It's friggin' uncomfortable. And it's one thing to put up with a situation like that for two weeks. But two or four or six more?
Basically, Dad, you can consider the tracheotomy an amenity the hospital provides for "preferred" guests who need the ventilator and have been invited to stay longer than two weeks.
How's that? Perfectly pukey? Me, too. I know that you would hate this. But given the alternative, we are all for it. The tube situation now is one that is like breathing through a straw, I'm told. And the new situation for you will be one in which you can breathe much easier and more comfortably.
So, why wouldn't they just do this from the get-go? If you only needed the ventilator for two weeks and they were able to begin weaning you off in order to extubate, then it would've been a needless surgery.
Tracheotomy.
That word and all the other words that have crept into my vocabulary can all go piss up a rope. I have even, much to my chagrin, begun to shorten them. "They're going to trach him." "He'll be on the vent for a while." Getting the hang of a subculture's lingo means you either want to be a part of it, or have accepted that you are. Like my use of corporate lingo, when I say things like, "moving forward," "add value," or "net net." Eek.
But you continue to improve. With a temperature of 38.3 when we left this evening, I am encouraged.
I thought on the way home about how you decorate the Christmas tree. When I was younger, I remember wanting to get right to the ornaments. They were so beautiful, all those antiques of Mimi's and Boppa's, and I wanted to put them on as soon as possible. Especially the ones that had the little fan inside. "Well, first we have to get the lights on. Or there'll be no heat to rise up into that ornament and turn the fan." Great. Let's get the lights on then! "Well, first, let's wrap this string of lights around the trunk."
Uh. Huh?
But, you'd get to it. And patiently twirl a string of small white lights 'round and 'round in the innermost parts of the tree. All that rustling in there would get the pine smell going in the living room. I'd begin to relax. One of us would be steadily feeding you the string of lights.
And I'd be glad that it was taking so long. Because maybe there was hot chocolate, or there'd be music playing, or we'd all be chatting. The moment was lasting. It was becoming a memory and not just a happening. Soon enough, the trunk was wrapped, and we'd graduate to weaving lights onto the branches like normal people do. Then, maybe garland. But finally, it was time for the ornaments.
And oh, how many places we had to hang all of those ornaments! Because you had lit the interior of the tree, there was a whole other world in there to decorate. Little havens, settings for perfect vignettes created by the criss-crossing of pine needles and branches. It was illuminated from the inside out. No matter where we chose to put an ornament, it was assured to take on the glint of Christmas magic and reflect the warmth of a tree decorated together and carefully. Thoughtfully.
Somewhere, deep inside, you are wrapping lights around the trunk. And I promise, from this day forward, to stop worrying about the ornaments for right now. To hang on, give you time while you heal in deeper places than any of us can see or even know. And no matter what you are decorated with when this is all said and done -- new skin or new scars, working or impaired lungs -- they will all have a place. As you, too, will be illuminated from the inside out.
We will just keep feeding you the light.
Thursday, July 3, 2008
Bucking the ventilator
So much for sleeping peacefully, Daddio. You gave 'em hell last night. You had begun to breathe in opposition of the Agitator 4000. Your blood pressure spiked (over 200, I believe?), and you had a period of time in which you were experiencing PVCs every 2nd and 3rd heartbeat. By the time Lee and I got there at 11am, your PVCs were much less frequent, but your nurse Jill was trying to get your fever down and was only just starting to feel a little better about your bp at 169. I guess you were giving them a hint. Maybe you were back for the helm.
They need to keep you on the bucking bronco for at least another night, but it looks like they'll move you to a normal ventilator soon. In the meantime though, they're inducing chemical paralysis to keep you from digging in your spurs. The paralysis is temporary, and within 2-3 hours of not receiving a scheduled dose, you'll come right out of it. It's tough for us to think about your not being able to move if you wanted to, but then again, you haven't been playing too pretty with the ventilator. Without this paralysis treatment, when we saw you at 11am, you were "see-sawing," or "bucking the ventilator," two phrases Jill used. Chest up, tummy up, chest down, tummy down. And by the time Dixie, Sammee, Nik, Forrest, Asia and I were there again at 2pm, your breathing rhythm was much smoother, your fever was going down and your bood pressure was down to 139. (Incidentally, when I list that many people, there aren't that many people in the room at one time. They don't run that kind of ship!)
Your doctors and nurses have also taken you off the medication they were giving you to help loosen the particulants in your lungs. It is a blood thinner, and this morning when they went to suction the goop from your lungs, they saw a little blood, too. (Not an unexpected side effect. A doctor gave the heads up to Dixie that it sometimes happens, and when it does, that's their signal to stop it. But it's worth the better chance it gives you to get the crap out of there, as long as your body allows them to use it.)
So, you're calling several new plays on the field. And they're responding like the amazing team they are. We'll see what the next day at the rodeo brings us. (And what various mixed metaphors I can throw out there.)
They need to keep you on the bucking bronco for at least another night, but it looks like they'll move you to a normal ventilator soon. In the meantime though, they're inducing chemical paralysis to keep you from digging in your spurs. The paralysis is temporary, and within 2-3 hours of not receiving a scheduled dose, you'll come right out of it. It's tough for us to think about your not being able to move if you wanted to, but then again, you haven't been playing too pretty with the ventilator. Without this paralysis treatment, when we saw you at 11am, you were "see-sawing," or "bucking the ventilator," two phrases Jill used. Chest up, tummy up, chest down, tummy down. And by the time Dixie, Sammee, Nik, Forrest, Asia and I were there again at 2pm, your breathing rhythm was much smoother, your fever was going down and your bood pressure was down to 139. (Incidentally, when I list that many people, there aren't that many people in the room at one time. They don't run that kind of ship!)
Your doctors and nurses have also taken you off the medication they were giving you to help loosen the particulants in your lungs. It is a blood thinner, and this morning when they went to suction the goop from your lungs, they saw a little blood, too. (Not an unexpected side effect. A doctor gave the heads up to Dixie that it sometimes happens, and when it does, that's their signal to stop it. But it's worth the better chance it gives you to get the crap out of there, as long as your body allows them to use it.)
So, you're calling several new plays on the field. And they're responding like the amazing team they are. We'll see what the next day at the rodeo brings us. (And what various mixed metaphors I can throw out there.)
No promises
Colleen and Dixie say the doctor alluded to two glimmers of good news: 1) You are starting to exhale less crap out of your lungs, which hopefully means time on the "Agitator 4000" is coming to an end, and 2) You may not need skin grafts.
These are not official prognoses. These are guarded musings.
But we'll take 'em.
Forrest came home today. Asia and I watched him walk into the waiting area from customs, and he just looked so great. Big smile. Cool hat (hope he finds that -- it sort of disappeared). He was Mr. Continental, Photographer At Large. He took the news in the best possible way you could expect. He was a champ. Tore up, but standing up. We waited at Chaise's parents with Trish and Lydia until your next visiting hour, then headed over. It was hard on Forrest, but he did well. He happened to see you at a time of complete and total sedation, so you didn't much move at all. Which really disturbed him. That hadn't happened yet. Funny, Dad. With your kids, you're damned if you move, damned if you don't!
But seriously, I think you're finally sleeping. I feel as if you're actually getting rest these last couple of times I've seen you. As if your consciousness has finally said, "Okay. I trust these people now. I'm tired. You have the helm, I going to bed." And I think that has to be doing your body some good.
Tonight, Lee, Colleen, Jeff, Dixie, Byron, Asia, Forrest and I all gathered at Dixie's to get the download on progress with the house. Then we went to grab a bite and a drink. Forrest's girlfriend joined us. Once again this week, we thought, "Well, crap. He'll be pissed he missed this, too!"
These are not official prognoses. These are guarded musings.
But we'll take 'em.
Forrest came home today. Asia and I watched him walk into the waiting area from customs, and he just looked so great. Big smile. Cool hat (hope he finds that -- it sort of disappeared). He was Mr. Continental, Photographer At Large. He took the news in the best possible way you could expect. He was a champ. Tore up, but standing up. We waited at Chaise's parents with Trish and Lydia until your next visiting hour, then headed over. It was hard on Forrest, but he did well. He happened to see you at a time of complete and total sedation, so you didn't much move at all. Which really disturbed him. That hadn't happened yet. Funny, Dad. With your kids, you're damned if you move, damned if you don't!
But seriously, I think you're finally sleeping. I feel as if you're actually getting rest these last couple of times I've seen you. As if your consciousness has finally said, "Okay. I trust these people now. I'm tired. You have the helm, I going to bed." And I think that has to be doing your body some good.
Tonight, Lee, Colleen, Jeff, Dixie, Byron, Asia, Forrest and I all gathered at Dixie's to get the download on progress with the house. Then we went to grab a bite and a drink. Forrest's girlfriend joined us. Once again this week, we thought, "Well, crap. He'll be pissed he missed this, too!"
Wednesday, July 2, 2008
On the subject of talking to you
So, Asia, Colleen, Dixie and I all got a little concerned Tuesday, when you seemed to be responding to our voices by getting agitated enough to open your eyes and shuffle your legs around, knocking off the little heart monitor they have on your right toe.
We became a little dubious of the whole situation, as it had seemed we'd been told that you were being kept purposely and heavily sedated so you wouldn't have to endure awarenes on the ventilator. But at the same time, the nurse that day was remarking that you'd been more responsive and had opened your eyes more, etc., etc. Our fear was that, if you were coming out of sleep to respond in that manner, you might be aware of that damn ventilator, which seemed contradictory to what they'd said they were trying to do.
Asia and I relayed this to Chaise, who really has, by the way, been a wonderful soul to have around. He offered some great perspective which was, essentially, "Hey. Your dad is theirs. They're not going to let you guys do anything to hurt him." It made sense and calmed us a bit, but we decided to pursue a conversation the next day. So, yesterday, Asia and I talked to your nurse (the guy. I promise we'll start logging names), who said that they do, during the course of the day, allow your sedative levels to come down so that they can run tests. Basically, they lift the veil to make sure you're still under there. THAT, along with Chaise's perspective from the night before was very settling for us.
Still, Asia and I decided as we went in for that visit, that we would simply hold your hand, stroke your hair, and breathe with you for a while. Just have some quiet time with you. I'm starting to be able to tune out the shaking that the ventilator does, and I think, so are you. You seemed more peaceful yesterday, even with outside stimulus. Like you were actually starting to be able to "rest" rather than just lie there, a vessel on choppy waters.
Then, the rhythm of the room gave way to a hum. And finally, gave way to song. Asia and I sang to you a song my mom sang to me, and I sang to Asia and Forrest, and yesterday, it took on a whole new meaning for us:
And so, I think, we've found a ritual that we will continue with you. Something they cannot give you in an IV drip, or squeeze into your eyes. Something we can leave with you every night.
We became a little dubious of the whole situation, as it had seemed we'd been told that you were being kept purposely and heavily sedated so you wouldn't have to endure awarenes on the ventilator. But at the same time, the nurse that day was remarking that you'd been more responsive and had opened your eyes more, etc., etc. Our fear was that, if you were coming out of sleep to respond in that manner, you might be aware of that damn ventilator, which seemed contradictory to what they'd said they were trying to do.
Asia and I relayed this to Chaise, who really has, by the way, been a wonderful soul to have around. He offered some great perspective which was, essentially, "Hey. Your dad is theirs. They're not going to let you guys do anything to hurt him." It made sense and calmed us a bit, but we decided to pursue a conversation the next day. So, yesterday, Asia and I talked to your nurse (the guy. I promise we'll start logging names), who said that they do, during the course of the day, allow your sedative levels to come down so that they can run tests. Basically, they lift the veil to make sure you're still under there. THAT, along with Chaise's perspective from the night before was very settling for us.
Still, Asia and I decided as we went in for that visit, that we would simply hold your hand, stroke your hair, and breathe with you for a while. Just have some quiet time with you. I'm starting to be able to tune out the shaking that the ventilator does, and I think, so are you. You seemed more peaceful yesterday, even with outside stimulus. Like you were actually starting to be able to "rest" rather than just lie there, a vessel on choppy waters.
Then, the rhythm of the room gave way to a hum. And finally, gave way to song. Asia and I sang to you a song my mom sang to me, and I sang to Asia and Forrest, and yesterday, it took on a whole new meaning for us:
Well the sun is slowly sinking downIt seemed that we were leaving you with something real during the times that we can't be there. A melody stamped with our voices that could float through your mind in one long wisp. Voices, they say, and Colleen confirmed with the staff last night once and for all, are definitely recommended medication for your recovery. The sound of your loved ones, regardless if you comprehend meaning, is healing. But you, Daddy, are a talker. A storyteller, a discussionist, a debater, a reporter, a participant. So if we speak, it feels like you want to return the favor somehow by piping up. But you've always enjoyed sitting back and listening to song. You've always given so freely and easily the gift of listening.
The moon is surely rising
And this old world must still be spinning 'round
And I still love you
Well it won't be long before another day
And we're gonna have a good time
And no one's gonna take that time away
And you can stay as long as you like
So close your eyes
You can close your eyes
It's alright
I don't know no love songs
I can't sing the blues
Anymore
But I can sing this song
And you can sing this song
When I'm gone
And so, I think, we've found a ritual that we will continue with you. Something they cannot give you in an IV drip, or squeeze into your eyes. Something we can leave with you every night.
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