December 28, 2015. When I woke Dad at 6:30 A.M., he seemed a bit perkier, and it appeared that he might have turned a corner with his cold. My assumption, short lived at the outset, was dashed when a hard coughing jag took hold of him. After “coughing up a rusty nail,” he decided to stay in bed for another 30 minutes. While Dianne tended to Dad, Mom, Stan, and I had breakfast. When he wheeled himself from the bedroom to the dining room, he announced that he was ready to resume eating. As we discussed several food options, I was cautiously optimistic that he would eat more than 1/8 cup per meal. When Dad said that he would eat an egg, I decided to make egg salad sandwiches for lunch so that we could all eat the same food. I hadn’t had egg salad for a couple of years, and Dad could use the protein.
Dianne got Dad to do some exercises this morning before he played cards with Stan. At 11:00 A.M., Kathleen arrived to administer Dad’s 30-day physical-therapy assessment. She was pleased with his progress and established some new goals for the next 30 days, which included walking unattended with a walker, transferring in and out of a car, and starting to walk with a cane. Dad had been expressing some dissatisfaction with the progress of his therapy, and he was satisfied with these new goals. Mom and I were ecstatic.
Without much prodding, Dad ate his ¼ cup serving of egg salad for lunch, which was his largest meal by mouth since the swallow test on December 21. Tracy, the nurse, arrived shortly after 12:30 P.M. After listening to his lungs, she said that Dad would benefit from having breathing treatments. She also said that she supported my decision to increase Dad’s oxygen level to 2-1/2 liters when he was using the breathing tanks. She said that the breathing treatments would require a prescription. I didn’t understand what we needed, so before Tracy left, I contacted Sue, our nurse practitioner at the dialysis center, so that she and Tracy could discuss Dad’s requirements. After speaking with Tracy, Sue said that she would submit an order to American HomePatient for a nebulizer and write a prescription for saline and albuterol. I had never used a consumer nebulizer and hoped that it came with some good documentation.
A few weeks earlier, I had downloaded the Scott & White Pharmacy app and had configured it for Dad’s prescriptions. In addition to permitting me to reorder prescriptions, it also alerted me when a prescription was ready for pickup. After receiving notification that the saline and albuterol were ready, I picked them up from the pharmacy so that we would have them on hand when the nebulizer arrived.
Stan left for our home in Houston shortly after 1:00 P.M. After he left, I tried to get some work done during the afternoon, but between my bad cold and interruptions to handle Dad’s thick secretions, I didn’t accomplish much.
During dinner, Dad joined us at the dinner table and feasted on ¼ cup of applesauce. Although he wasn’t eating much, having Dad with us at the table was a huge emotional boost for Mom and me. We pestered him constantly to tuck his chin when he swallowed, which irritated him, but having him with us during dinner was wonderful. After dinner, we played cards and Mom won.
By 8:30 P.M., I had administered Dad’s nighttime meds and trach care, and he was drifting off to sleep. I was up a couple of times before midnight to check on his oxygen saturation level. It dropped below 90%, but it returned to a more normal level of 94% after I repositioned the oxygen trach mask over his trach.
December 29. I was out of vacation time, which meant that I had to work the last few days of the year. Most of my coworkers would be taking off this week, so I decided to set my alarm for 4:00 A.M. so that I could sleep in a bit. Unfortunately, my internal clock woke me at 3:15 A.M., and left me feeling anything but well rested. I eventually pried myself out of bed at 3:45 A.M. and set up my computer, crushed some pills for Dad, and woke him up. His oxygen saturation level was holding steady at 94%, and his temperature was 98.5 degrees. Except for one short period where his oxygen saturation dipped below 90%, he had had an uneventful night.
After Dianne helped him up and to the bathroom, she said that Dad’s strength seemed better today. Dad said that he wanted Cream of Wheat for breakfast. It seemed pretty runny to me, so I mixed in some of the thickener, which changed the consistency to something similar to flubber. Left alone, Cream of Wheat will thicken. When you add a thickener to it, it becomes thicker than wallpaper glue, and just about as tasty.
When the HOP bus didn’t arrive at its appointed time, I called the dispatch office and asked about the status of our bus. The dispatcher said that they didn’t have us on their schedule, but just this once they would accommodate us, but we should call during regular business hours and set up Dad’s schedule for the next two weeks. Fortunately, we didn’t have to wait too long, and the bus arrived shortly after 6:30 A.M. After Dianne and Dad left, Mom and I ate breakfast and then I went back to bed. I was still feeling dreadful and thought that a nap would help me.
Dianne texted me repeatedly during Dad’s session to update me about his blood pressure, which seemed very low that day. After the text messages subsided, I slept until 9:30 A.M. I was able to work for a couple of hours until Dianne called to tell me that because of the scheduling mix-up earlier today, she and Dad weren’t getting a return ride for about an hour. I was worried about Dad’s congestion, so I took the suction machine to the dialysis center. There’s always a suction machine at his station, but he would have to move out of his station when his session was over. Thankfully, moments after I arrived, their bus arrived, so the suction machine and I returned home.
After Dianne and Dad arrived home, Dad joined us for lunch, and he agreed to eat more egg salad. For dinner, Mom prepared chicken thighs. I took the meat from one of the thighs and finely chopped it in the food processor. I then mixed it with cream of chicken soup and some gravy mix so that it was brown. Although it wasn’t much to look at, it had a better consistency than flubber and Dad said that it tasted OK, although he ate only ¼ cup of it.
I spent a significant portion of the afternoon talking with the manager of American Home Patient about Dad’s nebulizer. The device that connects to the oxygen concentrator and adds moisture to the oxygen is also known as a nebulizer, so when American HomePatient submitted the order to Medicare, it was rejected. The Medicare computers could not fathom why we needed two nebulizers. Holly, the manager at American HomePatient, came through for us and said that they would provide us with a nebulizer at their expense. Timothy from American HomePatient eventually arrived at 6:30 P.M. with the nebulizer. He showed me how to use it, but I got some of the instructions wrong, and it didn’t work when I used it on Dad before bed. While Dianne and I were getting Dad ready for bed, I discovered that Michell had not shown her how to care for Dad’s G-tube stoma. After a short lesson, I was ready to call it a night.
Dad’s secretions were still terrible and very thick, so I didn’t get to bed until 9:00 P.M. He slept pretty well, and I went to his room only twice during the night.
December 30. Unfortunately, after the 2:00 A.M. trip downstairs to check on Dad and suction more of his built-up secretions, I couldn’t get back to sleep. After an hour of lying awake, I got up at 3:00 A.M., took a shower, and went to work.
Not only did Dad wake up bright-eyed, bushy-tailed, and full of vim and vigor at 6:30 A.M., Dianne said that she noticed an increase in his strength. As soon as he was dressed, he wheeled himself into the kitchen and asked Mom if she would fix him some more Cream of Wheat for breakfast. He still kept to his ¼ cup portions, but at least he had progressed from his 1/8 cup servings.
Shortly after breakfast, Jared, the respiratory specialist with American HomePatient, arrived and showed me how to use the nebulizer properly. The nebulizer wasn’t difficult to use, but it came with several attachments that required assembly, and the assembly instructions were not included. I was pleased to see that one attachment would connect to his trach and the other two could be used by mouth. As soon as Jared left, I used the trach attachment to administer a breathing treatment with albuterol. Now that I saw how it worked, I realized that Dad had received similar treatments during his stays at Scott & White Memorial and the CCH.
While Dad was still full of energy, Dianne coached him through some of his physical therapy and swallowing exercises. Shortly after they were finished, Michell arrived, and then Janet arrived at 11:30 A.M. for Dad’s occupational therapy session. Dad was still feeling good, and they had a very productive session with more of their lively conversation.
Kathleen, the physical therapist, arrived at 1:00 P.M. to assess Dad’s ability to transition to the shower. She also wanted to ensure that Michell knew how to assist him during these transitions. Dianne had been trained, but Kathleen wanted both of our aides trained.
After Kathleen left, we had very little time to eat lunch before Kristen would arrive at 2:00 P.M. Dad had a small serving of applesauce for lunch and then rested upright in bed until Kristen arrived. Before starting her therapy session with Dad, we wanted to discuss some of the foods that Dad could eat and the circumstances under which he could drink water. Although water is a thin liquid, she said that Dad could drink it if he had a clean mouth. Any water that he might aspirate would be absorbed by his lungs and would not hurt him. However, if he aspirated food particles with the water, he could develop another bout of pneumonia. Kristen was just about finished with her session with Dad when our good friends, Marilyn and Earl, arrived for a short visit. After they left, Michell and I set up the nebulizer and administered a saline treatment. After the treatment, he seemed to be coughing more. With Dad now eating, I didn’t know whether to be relieved that his chest cold was breaking up, or concerned that he was coughing because he had aspirated. It seemed that I worried a lot.
Dad joined us again for dinner and had leftover chicken and cream of mushroom soup—his first leftovers in seven months. After dinner, we played a wicked game of Oh Hell, and Mom trounced us. As we were wrapping up the game, Dad triggered a nosebleed when he blew his nose. He was still struggling with it when we administered another saline treatment. His oxygen saturation level wasn’t great, but it was over 90%. I hoped that he’d have an uneventful night. I was exhausted and was headed upstairs for bed by 8:15 P.M.
December 31. Dad had a good night, and I was able to sleep until my alarm went off at 3:45 A.M. By the time that I got downstairs, Michell and Dad were up. I gave Dad a couple of pills and got him set up with the nebulizer for an albuterol treatment. After his breathing treatment, I administered his morning trach care and was momentarily alarmed when I noticed the blood in his secretions. He had had another nose bleed this morning, and Michell and I surmised that blood might have gone into his throat. By 5:00 A.M., Dad was ready for breakfast. When I prepared his Cream of Wheat this morning, I restrained myself and didn’t add the thickener. By the time that Dad was ready to eat, the hot cereal had thickened, and Dad and I were both happy.
At 35 degrees, it was feeling like winter this morning when the HOP arrived at 5:45 A.M. We all bundled up to escort him outdoors. Dad was still struggling with a nosebleed when he left.
After a shower, breakfast with Mom, and a little nap, I worked until Dad and Michell returned at 11:15 A.M. Michell said that his nose didn’t bleed during dialysis, but it started again shortly after he got home. Before serving him an appetizing lunch of blue-colored tuna, I administered a saline breathing treatment. I was now also using some of the other attachments that we received with the nebulizer and was giving myself saline breathing treatments.
After lunch, I wanted Dad back on the bed so that he could receive moistened oxygen. After having 2,200 ml of fluid removed during dialysis, he was feeling a little weak and was ready for a nap, so we got what we wanted.
While Dad napped, I worked until 3:00 P.M., when I stopped to accompany Mom to the local HEB. When we got home, Mom made some hot chocolate for the three women in the house. It was chilly outside, and the hot chocolate felt good. When Dad woke up shortly before 4:00 P.M., I administered another breathing treatment. Before he was finished with the four-minute procedure, Stan arrived from Houston. It was New Year’s Eve, and we were going to usher out this year with the family together.
Dad told me that he thought that his cough seemed different. I was encouraged and hoped that his breathing treatments were working. I felt like my saline treatments were also helping to break up my congestion. It would be nice if we would both recover from this crud in our lungs.
The five of us enjoyed our New Year’s Eve dinner together. We prepared some canned salmon and mayonnaise for Dad, and the rest of us had chicken-fried steak. Truth be told, I was pretty sure that Dad would always select salmon over chicken fried steak if he had the choice.
The five of us played Oh Hell until about 9:00 P.M., and Mom won the last game of 2015. While getting Dad ready for bed, we administered another breathing treatment. His oxygen saturation level was still good, but he was still receiving a higher concentration of oxygen. I’d feel better when his oxygen level remained normal with less oxygen.
Stan and I stayed up until about 9:45 P.M. so that I could take another dose of cold pills before going to bed. Sometime around 11:00 P.M., Stan heard a noise through the baby monitor and woke me up to check on Dad. Fortunately, when I went downstairs to check on Dad, he was sleeping.
I had some serious mixed feelings about this year. On the one hand, it was probably the worst year of our lives, and I was glad to kiss it good-bye. On the other hand, it was a year of blessings and a miraculous recovery, and I acquired some skills that I never wanted.