The one thing I did not mention in Saturday’s post is the thing that came back to haunt us today. Multiple times.
During the multiple events of Saturday, the Surgeon had to come and re-suture David’s breathing tube. If you recall, the other Surgeon had sutured it to his cheek after David had extubated himself 2 days in a row. In between then and now, the Surgical Fellow had re-sutured the breathing tube on 2 more occasions.
Just before David’s brachycardic episode on Saturday, the Surgeon had been back to do the re-suture. That was the 4th time the breathing tube has been sutured to his little denuded face.
So fast forward to 1am Sunday morning and the Fellow and the Surgical Fellow come in because the Chaperone’s are concerned for the suture – it looks loose, they are worried it may become looser and he could run the risk of being extubated, again. Surgical Fellow feels it can wait until morning. (Rounds are at 7:30am.) He suggests a Patient Care Attendant if we’re very concerned.
Let me clarify – he has 2 full-time nurses all night long, the RT checks on him every hour or so AND I am sleeping (if I can actually get to sleep) right next to him. The Surgical Fellow wants to add a 4th person to the mix to do what exactly? In the words of said Fellow: “You can get someone to sit in here and read their magazines and keep an eye on the tube.”
I told them flat-out – No! I understand the risks of him being extubated, but having someone sitting in the room reading magazines until morning is not the answer. Especially someone who is not even a nurse – what would they be able to do, exactly? I say damn lazy Surgical Fellow – he could have added a couple quick sutures around the breathing tube – as an added measure – if he truly felt there was concern. I just think he didn’t want to mess with the Surgeon’s handiwork.
So they agreed to be “generous” with his sedation. We made it through just fine until….
What? It’s 4am? Really?
This time it’s not the breathing tube. Capt Snuggles is bleeding. Profusely. From the open areas on his back. We had to change the dressings and all the pads underneath him. It just soaked all the way through. This is relatively new. He has had some bleeding during the dressing changes, but this is the first ‘spontaneous’ bleed.
We get him cleaned up and re-dressed. He’s snuggled back up, I try to lay down for an hour before rounds.
Shift change (7:30am) Just as the Chaperone enters the room the ventilator starts going off – David’s moving and just as he turns his head – I catch the breathing tube. The suture has come undone and desperately needs to be replaced. If I hadn’t been standing next to him , there’s no way I could have stopped him from extubating himself. Just like someone reading a magazine wouldn’t have been able to do anything. The Chaperone held the breathing tube in place until the Surgeon came in. Since it was time for rounds, the Surgeon wasn’t far away.
I listen to rounds while the Surgeon sews the breathing tube back in place. After the Surgeon leaves, the Chaperone calls out that he’s bleeding. Again.
The ICU Attending, the BMT Attending, the Fellows, the Surgeon and more Chaperones all race into the room. It was a little unsettling, to say the least.
Our Designated Chaperone had been changing David’s diaper when she noticed the bleeding from his back again. This time there were areas on his right and left sides. Pressure wasn’t stopping it. They had to use a special spray that helps stop bleeding. They also went through gobs of ‘quick clot’, special gauze that helps stop bleeding. It took almost 4 hours to get the bleeding under control, re-dress him and get him cleaned up.
In the middle of this mayhem – the Surgeon had to come back – you guessed it – the damn suture came undone, again.
To say I’m frustrated almost belittles the whole situation. We have been in high gear everyday for a solid week. It’s an odd disparity – his skin is so improved, but the rest of him is suffering.
The Surgeon wants a call-back to Shriner’s for help with the breathing tube situation. The logic is there are patients with severe facial burns that require breathing tubes – how do they keep them in?
As for the bleeding? *shrug* BMT seems to think it’s the ‘mechanics’ behind his skin healing. He needed a full unit of blood today to make up for the loss – that’s a lot of blood. He’s had approx 22 blood transfusions since we arrived here on August 18.
5 of them in the past week alone.
It’s 1am Monday morning and there’s still hustle and bustle about the suture holding the breathing tube. Surgeon gets called, yet again. I’m sure he’s not pleased with this whole fiasco.
He arrives promptly at 7am, adds to the sutures already there. He is unhappy that he has to extend the suture to David’s little cheek, but he does it.
Rounds will start shortly and our days’ activities will be back in full swing soon.
I’m hoping for a peaceful day.
I think we deserve it.