Since she got the ventilator tube out yesterday, Heather has been breathing moderately well to poorly at times. Last night she seemed to be working pretty hard (i.e., quick, short breaths - about 35-45 breaths per minute, whereas they would like her down in the teens). They debated whether to intubate her again, but decided to put her on a bi-pap machine that supports her breathing through a mask on her face instead. She does not like it very much, but has kept it on throughout much of the night and this morning.
Something that has made it all more interesting and difficult is that she has been quite delusional since last night. She has been able to talk a little (her voice is very gravely and quiet, but if you get right up to her mouth you can hear what she says), so we have a better sense of what is going on for her. She seems quite confused and scared, believing that the doctors and nurses are out to get her. I really don't think she was feeling that way while she had the ventilator tube in. Last night she thought that they had taken her to laundry room and that they had been performing transplants on her. She felt that they were hooking her to a vacuum cleaner that she had seen an aid using earlier. She plead with me to take her home, where she felt she could heal better and do fine. She refused to have the bi-pap mask put back on. It was really hard to see. This morning she continues to express her suspicions and frustration. I really can't blame her because people are constantly talking about her instead of to her (though they try to speak to her too) and she is continuously having procedures done to her that are out of her control. They doctors say that this happens all the time in the ICU, but that they are investigating for other possible causes (eg., infection, stroke, etc.). They feel it may be related to the dead skin on her legs, which brings us to surgery.
Heather will be going up to the burn unit this afternoon to have the dead skin on her legs surgically removed. They will then put cadaver skin on the wounds to stimulate growth. Then, after about 5 days, they will take the cadaver skin off and use her own skin to graft onto the wounds. They think she will probably come back down to the ICU after her surgery, but are unsure. It is likely, since she has struggled so much with her breathing, that she will likely remain intubated after the surgery.
****News Flash****
As is common here, plans seem to change quickly. Dr. Morris, the doctor that will be performing the surgery on her legs, just stopped by as I was writing this. He and his team just went in to talk with the ICU team to decide whether it is in Heather's interest to wait a few days until she is breathing better and is more settled to begin the work on her legs. So, we are unsure whether she will be going to surgery today or not. We should know shortly.
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One other issue of concern is that Heather continues to have dramatic vagal responses (i.e., her heart rate quickly drops down to the 30's and threatens to stop) to just about anything, but particularly things having to do with her throat and breathing. The bi-pap machine seems to trigger it quite a bit (i.e., a couple of times per hour). The doctors are unsure why that is the case, other than her just being really sensitive to that vagal response. They said they could give her a medication to increase her heart rate, but they gave it to her yesterday it jacked her heart rate up to the 140s. So, they feel it is better to watch her carefully and let her ride these episodes out.
It is tiresome to ride this roller coaster of emotion and worry. Like she does, I wish we could just go home.
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