Wednesday, August 02, 2006

Grandma is broken

Friday morning my grandmother had an episode of severe respiratory distress that necessitated ambulance transport and ventilatory support. she remained on a ventilator until yesterday. this is an update i wrote yesterday:

just wanted to get out a little update on Mickey. the doctors determined she had pneumonia in the base of her left lung, which probably caused 'the incident' Friday, versus it being an irreversible deterioration. the pneumonia is slowly responding (based on rads and her temperature) and her coloration is quite improved. Mickey's oxygenating ability remained pretty terrible over the weekend; the secretions from her lungs were quite thick but have improved slowly.

this morning, given persistently improved parameters, she was taken off the ventilator and extubated. Grandma has had a lot of challenge in clearing her airway and has had recurrent bronchospasm. she is on pretty aggressive inhalation treatments to try and help with that. it has been very rough today and we are unsure if she will exhaust and require re-intubation tonight. i am guessing 20-30% chance that she will have to be reintubated to rest and then retry in another day or two. obviously that would be a setback, but not yet a decision of quality vs quantity of life.

toward the end of the day, Grandma was able to talk a little though she was still somewhat out of it and her interests were immediate 'miseries,' most notably the nasogastric tube. i give even odds on it being out in the morning regardless of doctor interests... we mainly stuck to a binary blink system so she could conserve energy for breathing. she did know us and said she trusted me (to be honest) when i promised things would be a lot better soon if she could stay calm (to help with the breathing) and work on strength of her coughing. i reminded her i always kept my two 'rules' with Mom and would be playing by the same rules with her: 1. Never lie. 2. Never promise something i couldn't deliver.

her pulmonologist is very good and i like him a lot. her nurses are also top rate. the doctor let me stay with her for the extubation and the nurses thanked me for staying, saying that she certainly seemed to respond better when i gave their 'orders' to her, esp when they had to do nasotracheal suctioning. overall, we are just very grateful to have her in such good and open hands, and we count on her and God to determine what is the right thing to happen.

i have shared all of your well wishes. tomorrow we should have a better idea where the cards may fall.

Grandma made it through the night without either reintubation or removal of her feeding tube. nasal swab culture came back positive for MRSA; vancomycin has been started. kidney function is being monitored fairly closely and medications were adjusted after a drop in urine output last night. nasotracheal suction for sputum culture today was unsuccessful.

the propofol wore off during the night and now Grandma is much more alert. this, of course, is a double-edged sword. the upside is that we can better assess her mental status. the downside is that she is miserable and feels tortured by every little thing that is happening. she cannot get comfortable and still struggles to breathe in spite of intravenous and inhalant therapies. Grandma did try and laugh a couple times today and her swearing is increasing, both things i take as good signs.

the waiting game continues. i will try and keep everyone updated.

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