the know how

i had planned to go out tonight. but at 9:00pm it felt like my insides were shaking, i determined it the effects of exhaustion and gave in to going to bed early. it's 11:15pm now - but i couldn't sleep for distraction; my mind turning over possibilities, likelihoods and completely unlikely scenarios. i got rather stuck on the scariest of the unlikely and had to turn on the light to bring things into focus, if only my hands. my therapist's voice says "you can only work with what you know" and so i got up to write to you, about what i know. at least until nick comes home from his work thing. seeing nick is like turning the light on.

i know that we're working towards extubating Ford - the plan is to try tomorrow, as long as he handles the weaning of the vent over night. we went down on the PEEP today from 8 to 7 to 6 and he tolerated it nicely. a bit of indrawing and nasal flaring, but short lived. he has to handle 5 to be extubated.

i know it's quite possible he'll be weaned to bi-pap or c-pap, which i definitely know Ford hates. i hope he does well enough over night to warrant at least trying high flow first.

i know Ford has been spiking temperatures for a few days - as high as 40.5 (104.9 f) - and that they've been changing his antibiotics based on the findings from the blood/urnine/ET tube goo cultures. today ID (infectious disease) consulted and made further recommendations in that department. some things are growing in the ETt tube cultures, but they're not sure if they're indicative of infection or not. they're trying to cover their bases, in case.

meanwhile, tylenol and what one doctor calls "chapeau de glace" bring down the temp often enough to keep Ford settled. my friend Lindsay visited today and enjoyed the fact that for all the medical technology in and around Ford, it is a plastic bag of ice on his head that's treating his fevers best. yes, even the medical profession can appreciate the basics sometimes, gratefully.

i know they've managed to get about 500mls of fluid out of Ford in the past couple days after some agressive diuresing. they hoped for another 150 loss today, but he was positive 70 when i left. they still have the night to meet their target. while on the lasix infusion, they check his electrolytes regularly and he's been getting the occasional potassium bolus to accomodate for what they're taking out of him.

i know that Ford's most recent echo did not show improvement in his heart function, as the team hoped. i know also, though, that it is still too soon to think that it won't. he's on inotropes and sedated, and still recovering from/adjusting to the latest physical change in his blood flow.

i know what Dr. Human said it would take for them to decide to give up on this whole modification process and list Ford for a transplant - and i know we're not there yet (see above: too soon), so i shan't elaborate on that conversation as of yet. can o' worms, that one.

i know it felt really great to go to my acupuncturist and learn some pressure points to work on with Ford - for his heart, for his lungs, and for his right arm. it's nice to have intention with touch. she actually reiterated what our acupuncturist in edmonton said in june - "what's most important is that he feel loved" but she was happy to give me a few things to DO beyond that. and yesterday, Ford moved the fingers in his right hand! he hadn't wiggled those since the stroke. i thanked him for it - these little signs of improvement are the moments of encouragement that fuel me.

there. i think that's it. the rest is unknown. except that if i want to get up to make it to rounds on time, it would be very good to be sleeping now. nick still isn't home, but i'll try it again.

good night.