Tuesday, May 31, 2011

PT Day 4, by David

My Little Darlin, PT day 4

We are four days out now and there are small changes of improvement.  She in now on only one medication that is used for blood pressure support but its' dose is at a level below what is used to support blood pressure.  At this dose it does provide support for the kidneys(TIGT).  Her kidney function remains good.  Her lung function continues to improve.  The oxygen concentration she is on is at 50%(TIGT).  She remains heavily sedated.  Can not evaluate her neurological status with the sedation she has but her intracranial pressure remains normal.  We still can not predict what potential neurological problems she may have long term.   She is in a hard collar for her neck.  Do not suspect significant cervical (neck) spine injury but the neurosurgeon will keep this on her until he can confirm that by a physical exam after she has been taken off the sedation.  She continues to be very edematous(swollen) which is not unexpected with the severe trauma she experienced. This will improve over time.

As I said above she is showing slow signs of improvement. This is going to be a long hard road and it is going to be slow.  Some day in the future this will be a distant memory, hopefully my Little Darlin will be back to her usual vibrant self.   I want everyone to have and not forget a mental picture of how she looks now lying in the critical care bed.   This can not be forgotten because somebodies life may depend on it.  Ask the Frerer family here in Tupelo who lost their 18 year old son and brother John Paul last year while riding his bicycle.

Jan is in a small critical care room. There are no windows. Their are innumerable monitors surrounding her producing an endless stream of vital information about various critical organ functions.  There is the ventilator.  Its' monitor filled with information that is a foreign language to most.  There are infusion pumps showing rates, volumes and concentration of more different bags of medication than most people take in a lifetime.   All of the monitors are some how attached to Jan, most in an invasive way.  She has a bolt screwed into her skull. This continuously measures her intracranial(brain) pressure. She has a pulse oximeter clip clipped to her nostril.  This measures the concentration of oxygen in her blood.  This is usually on a finger but her fingers are too swollen, bruised and bloody to give an accurate reading.  She has an endotracheal tube coming out of her mouth and taped securely to her face.  The end of this is in her trachea(windpipe).  There is a tube coming out of her nostril.  Its' tip is in her stomach.  She has a stiff plastic collar secured to her neck to keep her cervical spine stable.  There is a large multiple hole IV line that was inserted under her left clavicle(collar bone) into the subclavian vein.  Its' tip is in the right atrium chamber of her heart.  Through her right and left chest walls there are large tubes about a 1/2 inch in diameter.  These are between the lung and the inside lining of the chest wall.  These prevent the lungs from collapsing.  The lungs were likely punctured by her own ribs(the sharp edges where they were broken).  There is a small catheter in the artery of her right arm to constantly measure her blood pressure.  She has a catheter in her bladder to allow it to drain.  Just about everywhere you look on her the is a cut, bruise or abrasion. You can not see the innumerable bone fractures but they are there.

The bed is kept at a fairly steep head up angle.  This helps keep the intracrainal pressure down.  She has to be gently turned on a regular basis so that pressure sores don't develop.  Although she is sedated she will still grimace from pain when this is done.  Her whole body is swollen from the accumulation of body fluid throughout her soft tissues.  This is from the massive injuries she has had.  We have all had small traumatic injuries that have caused localized swelling.  This is occurring all over her body.  Her usually small fingers are double the normal size.  Thankfully her wedding band was cut off in the ER on arrival.  I have had it on my little finger since.  Her fingers are mottled blue from the bruising and broken bones.  The skin weeps fluid from the multiple cuts and abrasions worsened by all of the fluid that has accumulated in her soft tissues.  Even the sclera(lining of the white part of her eyes) was swollen early on but this is better now.

Every time I walk into the room I see this.  I quickly glance at the monitors.  This gives me peace of mind to see good numbers.  She lies there motionless except for the movement of her chest with each breath given to her by the ventilator.  Her eyes are closed.  I kiss her and tell her I love her but she still does not respond.  I gently stroke her face, her skin is stretched slightly from the swelling, she still does not respond.  I am still waiting patiently for a her to respond to me, she has not,  it is hard and it hurts to see her like this.  But by some miracle, after the horrendous impact she took, she is still here.

I am almost always up before Jan in the morning.  For as long as I can remember every morning before I leave the house I kiss Jan goodbye and tell her i Iove her.  It was the last thing I told her before this happened.  I never expected it to happen but I have been in medicine long enough to know bad things happen without warning all the time.  None of us know if we will be here tomorrow.  Let those you love know it often.

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