Some clinical improvements, but still unresponsive

sinus-rhythm-stripJuly 26, 2015. Mom and I arrived at the hospital shortly after 8:00 A.M.; I looked at Dad, and then over to his IVs. Amazingly, Dad’s night nurse, Tyler, had been able to wean Dad down to one vasopressor. Dad’s day nurse, Kristina, also noted that he was down to one antibiotic. Unfortunately, his WBC count had ticked up to 21.2.  Dr. Pan, the nephrology resident, stopped by a few minutes after we arrived. He had reviewed Dad’s early morning lab results and recommended that they dialyze Dad again to remove more fluid, although they probably wouldn’t clean his blood.

Some of Dad’s other lab results looked a bit more promising. Although his poor liver was still in shock, his highly-elevated liver function had inched down slightly. The sparks of good news were tempered by Dad’s continued unresponsiveness.

eeg_waveWhen Dr. White arrived, he acknowledged that while there had been some clinical improvement in my dad’s condition, Dad was still critically ill and his mental status was not improving. To ensure that Dad hadn’t suffered a stroke or a bleed, he planned to order a CT scan. Dr. White restated his concern about Dad’s toes and thought that he probably would lose at least one toe.

A few minutes after Dr. White and his residents left the room, Rob, a PA who had worked with Dad back in May, stopped by. He said that he had seen us in the waiting room the other day and thought that we looked familiar. After he realized who we were, he wanted to stop by and see how Dad was doing. We didn’t have great news, but so far, Dad had survived four days longer than the original prognosis.

Stan was in Temple for the weekend, and he arrived at the hospital at 10:15 A.M. to stay with Dad while Mom and I attended church. At the church, our friends were anxious to hear about Dad’s condition. One friend is a nurse practioner with the dialysis center and receives a daily schedule of dialysis patients in the Scott & White system. She was shocked when she saw Dad’s name on the Memorial list. My father wasn’t a patient of hers, so she couldn’t access the details about his transfer, but she knew that the transfer from the CCH to Memorial wasn’t good.

According to Stan, Dr. Issac, the nephrologist, stopped by right after we left for church and said that they would not dialyze Dad today. Dr. White wanted to further reduce Dad’s vasopressor therapy. The process of removing blood during dialysis lowers a patient’s blood pressure, which would have been counterproductive to the daily goal.

The tube feed, which had been stopped on July 22, was resumed today. The thought of the tube feed scared me, but Dad needed the nutrition, and this was the only way for him to get it. The rate was restarted at 20 ml/hour, which was considerably less than it had been when he aspirated on his tube feed four days earlier.

Stan said that Dad was transported to radiology at 11:40 A.M. for his CT scan. He was returned to his room shortly before Mom and I returned from church.

musical-notesWhile Mom, Stan, and I were at home for lunch, I decided I would try some music therapy with Dad.  KNCT, a local public radio station in central Texas, plays big band music on Sundays. Armed with a small radio and headphones, I hoped that having Dad listen to his favorite genre of music might spark some response from him. We returned to the hospital at 2:30 P.M., and I placed the headphones on Dad’s ears and turned on the radio. Maybe I’d seen too many movies, but I was disappointed when we didn’t detect any response from him. We also tried yelling at him, tickling him, and shaking his arms, but we still got no response.

Charris, his assigned resident, stopped by to talk with us about Dad’s apparent stupor. She showed us the CT scan results and the radiologist’s assessment. Everything seemed to be normal from a brain trauma point of view. She agreed that he was just about in a coma. She suggested that they request a consultation with a neurologist.

Around 5:00 P.M., a nurse entered the room and introduced herself as Melissa, Dad’s new nurse. Because the MICU had too many nurses for the number of patients, they had to send one home, so Melissa would be with Dad for the next two hours. Mom and I left around 5:15 P.M. to visit the next-door neighbors and share some of the bounty from my parents’ garden.

When Mom and I returned to the hospital at 7:00 P.M., Tyler was his nurse again and the other Tyler was the respiratory therapist. I probably shouldn’t have, but when Tyler said that he was doing something barbaric to see if Dad would withdraw from pain, I asked Tyler to stop hurting him.

Nurse Tyler’s goal was to further reduce Dad’s vasopressors overnight.  Tyler performed a pretty thorough assessment of Dad tonight while we were there, and then showed me how to use the music on Dad’s super expensive bed. I set up nature sounds, which later confused a nurse’s aide who stopped by to take Dad’s blood sugar. She thought that there were crickets in the room, which really isn’t too unusual for central Texas.

Mom gave Dad a goodnight kiss, and it looked like he kissed her too. We left the hospital for home around 8:30 P.M.

Before I went to bed, I emailed my cousin, David, who is a cardiovascular diseases fellow at Brigham and Women’s Hospital in Boston. I updated him about Dad’s condition and then asked about his thoughts pertaining to my father’s mentation. My question was way outside of his specialty, but I was hoping that he might be able to help me understand my father’s catatonic state.

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