Sunday, July 17, 2005

Sunday July 17, 2005 when I arrive Zack’s respiratory rate is very high 33-38. He is not moving at all. His white count is 11.3 and he is running a fever of 101.5. He won’t cough. Although his chest x-ray looks better today than yesterday he has a lot of fluid in his upper respiratory and it sounds like he has the croup. He struggles to breathe, you can see his rib cage expanding. It is like he is breathing through a straw. His blood gases are good but once they become compromised we worry about the brain swelling. I call Scott and tell him to get in touch with Southeast and get everyone praying. At 10:00 AM they start him back on Vancomycion (antibiotic) to treat his pneumonia. Dr Reed his respiratory therapist decides to try old school methods and he puts an anti-inflamitory in Zack’s oxygon mask to shrink the swollen airway passage. It helps but it’s only temporary. Dr Miller (Anst. Resident) comes to tell me that Zack can’t keep this up so they will re-tube him. I explain that I won’t let that happen I would rather have him Trached. Kelly is my nurse today and although they are not supposed to voice their opinions she tells me to stand my ground. Dr. Parker an ear, nose and throat doctor shows up and I explain how concerned I am about damage to Zack’s vocal cords and trauma to his throat if they re-tube him. He agrees to review the x-rays, discuss it with the team and come up with a plan. At 1:00 they put him on Glycopyrrolate to decrease the secretions in his airway. They decide to re-tube him and perform a Bronchoscopy to suction out all the fluid from his lungs. At that time they will look at his vocal cords and if they are swollen they will Trach him. His procedure is scheduled for 2:00. There are about 15 of us who pray in the 2nd floor waiting room. It is an emotional time. The procedure is successful and he now has a Trach. There was not much swelling in his vocal cords but he has an ulcer on his bronchi. This is why he didn’t want to cough and it would not have healed as long as he had the tube down his throat. We made the right decision on the Trach. We discover that in addition to pneumonia he has MRSA, which is a bacterial infection that is rampant in hospitals. This is causing more problems than the pneumonia. Dr. Let from Infectious Decease Control (ID) is brought in to consult. They will determine the best antibiotic to treat him with. Dr. Reinhardt explains that he is trying to get him approved for a new drug that only ID can prescribe. By 6:00 Zack is breathing on his own again. The night shift nurses fight over who will get Zack. Sandy lets Stephanie win because she has become attached to us (Scott calls her his angel nurse). At 10:30 Stephanie gets him to squeeze her hand. A glimmer of hope that all will be well. This is the roller coaster they have warned us we would be riding through Zack’s recovery. I was prepared for that one but not the roller coaster that the doctors keep throwing us on. We did a lot of praying today. Everyone was praying at church at just the right time and Dr Miller shows up. Zack’s procedure goes smoothly and we seem to be back on track. We ask for prayer now that Zack will recover quickly from pneumonia and MRSA so he will feel up to working on his responses again. God is in control and we must wait for his timing. I’ll probably say that a million times this month.