Tuesday, January 26

It's only Tuesday but Bill has had a big week so far.  When I came in this morning Bill wanted to know what the temperature outside was and how warm it was supposed to get today.  I was a bit puzzled by these questions, but then he told me that his nurse (with whom he has been clashing with over any and everything the last few days) suggested Bill go outside for a bit before lunch if it was warm enough.  He was looking forward to this prospect although it may not be that obvious in the photo.  One of the things going on with Bill is that his affect (or the way he displays emotion) does not always match the emotions he says he has.  His facial expressions display his anger and fear, but the positive moods don't always work that way.  He will flash a smile now and then, but it's very fast and sometimes it seems more forced than genuine.  No one is sure if this is because of the brain injury, the fact that he went from physically active to quadriplegic in a matter of moments, or if it's because he's on a lot of medication.  Sorry for the digression there, this just seemed like a good place to describe some of that.

Anyway, yesterday he spent seven (grudging) hours in the chair, left his room twice, went to a group therapy session, and successfully worked himself down from an anxiety attack without medication!  Last night the chest tubes were removed (click here for a somewhat graphic photo of the chest tubes in place) and I heard that the PICC line (the IV line in his right arm) may be removed in the next few days.  It's very exciting to see so much of the medical hardware being removed.  After it comes out we are left with just the stomach feeding tube (which he no longer receives nutrition through, just extra medications) and the trach...

Which brings us finally to ventilator weaning.  I believe it has started.  Today the respiratory therapist tried to tweak back some of the settings without telling Bill and I don't believe that was working out well.  It will be interesting to see what, if any, agreement they come to.  Bill absolutely wants to get off the ventilator, but his anxiety is a real concern and when it gets out of control, he can't breathe very well.  And if he can't breathe very well, he gets more anxious.  I'm not sure what the best approach will be and I suspect that it will vary each day.

UPDATED: Another seven hours in the chair, another anxiety attack thwarted without medication, PICC line removed.