Monday’s are usually pretty busy. We get new Attending’s for each service: ICU, BMT & GI. We spend a great deal of time in rounds filtering through the legacy left from the previous week (New, as in different, not new as in never met before. We’ve recycled all the Attending’s on all services.) . My job is to bear witness to all things David. I attend all the dressing changes. I am his constant companion. I see what works and what doesn’t.
I am an outsider, still. Sometimes my suggestions are laughed at, which is, at times, frustrating, to say the least. David is still unable to regulate his body temp. Someone, in passing, had mentioned that fluids can be warmed before being administered through the IV.
So I asked the obvious question, can we warm his TPN ( IV nutrition, largest volume of IV fluids he receives) The suggestion was met with lots of head shaking and smirks. No, No, warming fluids is only used in emergent situations, to rewarm a critically hypothermic patient. Yet, here I sit listening to the warming box as it works to warm the TPN before it enters his little body.
I think it becomes a matter of suggesting it enough times, to various people, until someone takes the idea seriously and runs with it.
It’s helping, too. His temp is only 1 degree shy of normal, instead of 5.
Go! Baby! Go!
His dressing change went well today. The doctors all ooohed and aaahed when the dressings were taken off. His skin is looking better. He still has quite a few areas of breakdown, but the overall feel is that his skin is improving.
I have helped streamline the dressing process. Sometimes you just have to jump in and do something. That’s exactly what I did.
The dressing consists of this sticky gel sheet applied to the skin then wrapped with gauze. Each day prior to the re-dressing of the babe, I lay out pieces of the gel sheet, cut and backed with gauze, to fit all of his body parts, all except his boy bits and his head/face. Those don’t get a dressing. It takes me about an hour to set it all up before the dressing change starts, but it saves a significant amount of time in re-dressing him.The first day took 4 hours. 4 hours in which he was naked and open to the chill. Today it took an hour and a half.
The Fellow joked with the Chaperones that maybe I should get a percentage of their salary for my contributions.
More good news is the assumption that his gut is improving, as well. He’s having considerably less poopie diapers, so that’s a good sign. AND he did not need any additional campath or any other med, for that matter, today. That’s an even better sign. All in all he had a
pretty good, awesome, phenomenal day except for the eye doctor’s report and the fact he’s not peeing. Not much pee, anyway.
His eyes are of great concern. He was having GVHD involvement with his eyes since the beginning, but they had been getting better. Today they were considerably worse. They increased his eye drops back to every hour around the clock and tomorrow they will put a contact lens in each eye to help protect them.
Onward we plod.
The doctor’s from Shriner’s will come to oogle the babe, tomorrow. (Another apt suggestion that took a few days to come to fruition.) It only makes sense that the doctor that suggested this particular type of dressing should come back and assess his progress in terms of continued use of the dressing.
Sometimes my logic even impresses me.
All in all, though, I think Capt Snuggles is on the right path. I think he has improved ten-fold from where he was at this time last week. He’s still not out of the woods, not by any means, but my shreds of hope have graduated to full – fledged scraps.
Maybe we’ll be home by Valentine’s Day……