Tuesday, December 1

Today was a long day.  It turns out that one of the medications that Bill gets to keep his heart rate up happens to slow down his digestive system.  So today his doctors tried to cut back the dosage in order to get his intestines going again and he ended up having four bradycardic (slow heart rate) episodes.  His heart rate drops, the nursing staff's heart rates sky rocket.  As of the end of the day they had him back on the dopamine drip.  He may end up needing a pacemaker which does not seem like too big a deal to the rest of us, but he's having a hard time with that idea.  Honestly, though, his heart is perfectly fine.  The nerves that control his heart are seriously out of whack and if we could just eliminate one jangled component with a pacemaker then he might get farther along with all the other systems.  Nothing operates in a vacuum and in that respect the human body is not so very different than the ecological systems I study.  But I think for him the pacemaker is the first potential procedure he's been aware of and I think he might be a little frightened by the idea of surgery or implanting something in him.  It's a good thing no one asked him about the spinal fusion!

He had speech and swallow therapy again this morning.  Today's swallow test included an endoscopy (a small camera run through his nose down his esophagus so that his swallowing ability could be observed from the inside).  He had an episode during the endoscopy and apparently did not swallow very well.  Not a big deal, they will try again on Thursday.  However, he took it personally (anyone ever seen Bill bow out gracefully?  Didn't think so.)  He was pretty bummed about that and I'm sure frightened by the bradycardic episodes as well.

The respiratory therapists are still actively trying to wean him from the vent.  He can't see the monitor but he knows what all the numbers mean and asks about them constantly.  I think that Dad and I thought that telling him about all of this would empower him and I think it has, but it has also given him something to obsess about.  They are turning down the settings in such a way that he will still get all the air he needs at the pressure he needs, but his lungs have to do most of the work to draw that air into his body.  Work is the operative word here, and it feels strange for him to be breathing again on his own.  Luckily the respiratory therapists know their jobs very well and are not asking more of him than he can do, despite his attempts to convince them otherwise.  At the same time I think I may be getting more popular on the floor because I am not fetching nurses or therapists as much anymore.  We are both weaning ;-)