Positive impressions (day 18)

Everyone,

Each day when I come here, I look at Nancy, and get an impression. The last few days, my impressions have been steadily positive, as I see Nancy's swelling go down, her pallor improve, and sense her general energy level coming back. It just feels like she is overcoming the infection, or perhaps has overcome it. We seem to be out of the really critical period, and into a time of regeneration, as her strength and speech and physical ability return.

She's spending more and more time off the respirator each day, and today we tried the Passy-Muir valve again, which would let her speak. Now she can breathe with it in place, so she is able to exhale past her trache tube. But speech is not there yet, perhaps because she still has a size 6 tube. They are discussing a change to a smaller trache tube, which will make speech easier. That would also be an indication that they think she is stable enough and oxygenating well enough that a smaller tube will be fine. A size 4 is the smallest, so the step after that would be removal of the trache entirely.

The dialysis has been cranked up to remove 25ml of fluid per hour from her body, so she will gradually lose the excess faster. This is also a good sign, as the last time they did this, her blood pressure dropped. Now it's steady. There have been no more issues around her pulse and blood pressure for over two days. She is still making just small quantities of urine, but no one is worried. Tomorrow, they will probably switch back to intermittent dialysis instead of the continuous setup, another positive step.

Today she has either been completely present (and trying to talk!) or taking a nap. No more periods where she just seems fuzzy or withdrawn. She wanted me to help her write a task list (!) today, but I'm not good at lip reading, and we gave it up after a while. Knowing Nancy, she must be feeling a bit more like herself. I'm amused that this is the first thing she wants to do.

Her heme-oncologist dropped by to tell me that her tachrolimus level is where they want it. I asked her about the status of Nancy's leukemia, and she assured me that they check the blood cultures for abnormal cells with regularity, and Nancy is still all clear. That's a nice piece of good longer-term news...it hasn't been on my mind much, as she's been facing more immediate problems. Perhaps this is another good sign, that there is room in my awareness to even ask the question.

What a fine day. The 49ers are even winning :-)

Love,

-tdc