January 17, 2022

It looks like most of what I wrote in my notes to family, I also just put directly on Facebook.

I am an old woman
Named after my mother
My old man is another
Child who’s grown old

If dreams were lightning
And thunder were desire
This old house would’ve burned down
A long time ago

Knock on wood, it looks like a slow day here today. They were going to try to take Tim down for another abdomen CT, but to do that they have to lay him flat, and his oxygen went way down when they tried that – so, since today is a holiday and they’re short-staffed today, they’re going to put today in kind of a holding pattern and try for the CT tomorrow.

Sounds like today the only real goal is to get some of that fluid out of him, that they’ve been pumping him up with over the last few days.

The nurse had the TV on when we came in, in kind of a “hey let’s keep this normal” sort of thing but he had it on football and I was like, dude, if you even KNEW Tim??? So when he stepped out I changed it to the Food Network. 😉

Speaking of nurses, I really want to say how amazing it is to see how all these people work as a team. And just in general, how they work. I was texting with a couple of friends about it this morning, and thought maybe some of you might like to hear me wax on about this as well.

We’ve been getting here between 9 and 9:30, and they’re usually just starting rounds about that time. I’m trying not to stare as we weave through them all, but it looks like about three full-on doctors and maybe about six students/fellows (whatever those are). Oh! Doctor Google tells me “Fellowship training is part of the process of becoming a specialist physician. During fellowship training, a physician follows a specialist closely to train in a subspecialty. In the program, the learning physician is known as a fellow. … The doctors who lead fellowship training are experts and leaders in their field.” That makes sense. A lot of the time when a doctor comes in they’ll point to their shadow person and say “and this is my Fellow” and now that makes a lot more sense to me, haha.

This was one of those “it looks better than it is” pictures. It looks like we’re holding hands; in reality, I’m holding his hand. He was completely nonresponsive, due to the sedatives. He was like that for… eight more days? Nine? The most response we would get out of him was him starting to cough if they laid him totally flat (which he kind of had to be for medical reasons). But even that was… that was the body, not the mind. A reaction, not a response. I hope that makes sense.

Make me an angel
That flies from Montgomery
Make me a poster
Of an old rodeo

Just give me one thing
That I can hold on to
To believe in this livin’
Is just a hard way to go

Anyway! The hall is long, ten or twelve rooms on a side, and every room has a cutout with the room next to it that houses a desk in the hallway where the nurse can sit and look into both rooms. Each nurse has two rooms, and each nurse goes out to get into the rounds discussion about their particular patient. Then, because we’re usually in here, the nurse will come back in after the doctors pass to the next set of two rooms, and will tell us what they all said. This is in addition to anything the nurse has already told us when we arrived, about how Tim’s night was or anything the night nurse told them — because the nurses also do sort of a “mini rounds” with each other, when they trade shifts. They overlap shifts by 15-30 minutes specifically so they can have time with each other to go over the patient.

After the rounds are completed on each side of the hallway (so, what, like 24 rooms total?), one of our doctors will generally come in and talk with us. I don’t know if they come in to talk to the nurse if we’re not here, but they definitely do come in and talk with us. They will go over what we might already know from how Tim’s night was, they’ll expound on anything the nurse has already told us, answer questions, talk about the plan or hopes for the day.

The nurses also really cover for each other. If an alarm goes yellow, people will come in to help the nurse that’s in here. If it goes red, people will start walking by and poking their heads in — for example, sometimes if they move Tim around and have to adjust him, the alarm on the bed will go off because the bed thinks Tim is getting up. So the alarm goes red, and even if they have the curtain pulled, other nurses will stick their head in the door (but not behind the curtain) and ask the nurse, by name, if they need any help with anything. I’m sure part of it is “well, I know you won’t help me if I don’t stop and ask you if you need help” but whenever we talk with the nurses, thanking them for everything they do not just for us but during the whole Pandemic, they always credit their other floor nurses for them being able to get through. Everyone calls it a family, on all three floors we’ve been on. In the whole, hold on, let me figure out what today is and then count…. in the whole 24 days that we’ve been here, we’ve only had one nurse that I actively did not care for… and we’ve only had her once. She said that she didn’t know if she’d be back to us or not because even though she keeps asking to work four days in a row on, three days in a row off, they somehow keep scheduling her to work only every other day and it’s almost always on a different floor from where she was yesterday. Yeah, honey, I WONDER WHY. WHAT A MYSTERY.

When I was a young girl
Well, I had me a cowboy
He weren’t much to look at
Just a free ramblin’ man

But that was a long time
And no matter how I tried
The years just flowed by
Like a broken down dam

Make me an angel
That flies from Montgomery
Make me a poster
Of an old rodeo

Just give me one thing
That I can hold on to
To believe in this livin’
Is just a hard way to go

Anyway, everyone else has been great. I’m better with the nurses names because they’re in so often I have a better chance of seeing their name tags. I have GOT to get better descriptions for people other than Doctor Big Eyes and Doctor Small Face and Traveler Nurse from South Florida. Like Southern Miss Terri and Supernurse Chris!!!
Anyway. Let me see if I can sneak a picture of the nurses desk cutout window from where I’m sitting, and add it to the post.

And then it looked like I added this in a note to family, but didn’t post it on Facebook.

Quick addendum, the Critical Care doctor just came by to say that his lung cultures finally started to grow, and he has “Klebsiella pneumoniae” in addition to the endocarditis, and that’s what’s been causing so much drama in his lungs. I am going to be honest, here, I really wish I had not just looked that up, because it looks nasty. But, the doctor is saying that he’s getting better, much better than he was a few days ago, that they’re taking out some of the lines they put into him in case they had to put him on ECMO, and that he’s well enough now that there are a lot of things they could do (and have done, that he’s responding to) before they even need to think about ECMO again. So I’m just going to sit here trying to shush my stupid brain weasels, listen to the Critical Care doctor, and not get back on Google.

There’s flies in the kitchen
I can hear ’em there buzzin’
And I ain’t done nothing
Since I woke up today

How the hell can a person
Go to work in the morning
Then come home in the evening
And have nothing to say?

Make me an angel
That flies from Montgomery
Make me a poster
Of an old rodeo

Just give me one thing
That I can hold on to
To believe in this livin’
Is just a hard way to go

OK. So, now, months and months later, let’s talk a little bit about Klebsiella pneumoniae.

Klebsiella are found in the human intestines, where they don’t cause disease/infection. To get a Klebsiella infection, you have to be exposed to the bacteria in some other way. For example, Klebsiella must enter the respiratory (breathing) tract to cause pneumoniae, or the blood to cause a bloodstream infection. Most people recover; but some cases can be fatal, especially in cases of pneumonia, or when people are already sick – some forms of Klebsiella are highly resistant to antibiotics. Patients who are already compromised are at a higher risk of developing sepsis (a systematic response to infection) which has a high mortality rate.

And what is Sepsis? According to our friend, Doctor Google, Sepsis (also called Septicemia) is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Bascically, your body starts to fight off not just the infection, but everything in you. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. According to the CDC, while most people recover from mild sepsis, the mortality rate for Septic Shock, which can result in multiple/cascading organ failure, is about 40%.

So. Remember how, the other day, he was coughing and retching? And then threw up and aspirated while being intubated? That’s how the gunk in his intestines, which were backed up into his stomach, got into his lungs, causing Klebsiella Pneumonia.

None of that was anything I even wanted to think about at the time. Yet. At this time, over these couple of weeks while he was sedated, and machines were working for him, is, I think, about when I started to allow myself to acknowledge that he might not make it through this. Not just worried about it – I’d been worried about it since the beginning. But now, it was starting to feel… real. Not just my overworked anxiety kicking in.

Moya loves her Grammy Linda. And can you blame her? This woman is immensely lovable!

To believe in this livin’
Is just a hard way to go

Lyrics by John Prine
Angel from Montgomery