Saturday, October 29, 2011

The ICU vigil

I feel adrift in space and time, my reality is Nancy and a room full of sensors. Read this at your own risk, only if you want to enter the raw reality of today.

Pulse 123 BP 165/88 SPO2 97% Temp 37.9.

This is not going in the right direction so far. Nancy has stopped making urine, and they are expecting to put in a catheter and put her on dialysis. Yes, this is the kind of thing that happens when someone has a bad septic infection. No, not what I was hoping to report. She also gets distressed with the breathing tube in -- that's got to be very uncomfortable -- so they are giving her a fentanyl drip for pain. She can barely respond when we ask her to move her fingers and toes. Once in a while, she has a few seconds of tachycardia, and she's retaining about 15 lbs of water, which has got to be putting stress on her heart.

Just had one. Pulse 150 BP 190/95. Ah, now it's back to 123, and 168/87.

For someone as literal and mental as i am, this is really hard. I take data way too seriously. I sit in this sea of numbers and graphs, fighting back my tears. One of my friends just sent a note with some great comments about prednisone and helplessness in the face of modern medical magic. I feel helpless, a witness to Nancy's struggle, so aware of both her and her data.

Pulse 125 BP 174/89 SPO2 97% Temp 38.0

Her temperature is edging up. Oh hell, there's another EKG alarm. The nurse comes in and says to the machine, "She's not having any PVCs!" Apparently, the machine is smart enough to detect some kinds of heart malfunctions, but it's not perfect. Anyway, we're concerned about her temperature too. It was 37.6 when I got here this morning.

EKG alarm. Pulse 196 BP 163/82. Looks like a v-tach pattern. There, it's stopped, pulse 126 BP 186/94. God, I'm swimming in new terminology, and my restless brain sucks it up. Sinusoidal tachycardia. Renal this, hepatic that, lactate, Continuous dialysis. Fentanyl, propofol, oxycodone.

The renal doc comes in, and tests her neuro functions. "Nancy, can you squeeze my finger? How about with your other hand, over here? Nancy, wiggle your toes. That was great, can you lift this leg? Lift this leg!" The EKG alarm is going off in the background again, pulse 127 BP 184/95. Must be the high BP.

Just back from a chat with the renal doc. She's concerned that the abscess is putting pressure on her spinal cord. Nancy isn't moving her right leg very much at all, though she moves her left.

Pulase 133, BP 171/73, SPO2 96%, temp 38.2. Damn, up another two-tenths. They are about to start the nursing shift change, and I have to leave for an hour. I have to eat something.

Very scary indeed.

No comments:

Post a Comment