29/03/12

I arrived at ICU about midday and the difference in Jules from my last visit was amazing.  The nasal feeding tube had been removed and the "tree" which held the various drugs and dosing equipment was gone.  Jules is now only on oral Paracetamol, and Oxycodeine and Tamezapam in the evening to help her get a good nights sleep.  She was looking refreshed after having a shower earlier in the morning on a device like a pallet on a gurney.  Tomorrow they are going to try a shower in a chair, she is looking forward to that.

When I arrived she was in a sitting position with Val feeding her an egg sandwich.  She requested a latte and while Val went to get one from the cafe I fed her the rest of the sandwich and a strawberry sorbet.  She had all the coffee and a couple of grapes to finish.

 She asked me to check out her chart and see her lung X-rays.  The chart is on a computer monitor, Sam the nurse showed me the X-rays her left lung was whited out last week but is now clear.  The right lung is also clear.  Her current program is to wean her off the respirator and today was scheduled for 4 periods of 3 hours of unassisted breathing, she has handled it well but it is tiring for her.

 During the afternoon she was attended by the speech pathologist and they removed the manifold from the stoma and fitted a speaking valve, the first valve was painful and the changed it for a different type.  I will find out today if it is a Shiley phonate or Passy-Muir valve.  See details on speaking valves here http://www.hopkinsmedicine.org/tracheostomy/living/passey-muir_valve.html basically the valve opens to allows air to be inhaled into the tracheostomy tube (Stephen Hawking uses one).  The valve closes when exhaling directing up through the trachea larynx and upper airway to allow sounds to be vocalised.  Because the airway is obstructed by the tracheostomy tube ( the inflatable cuff to seal the tube against the trachea is deflated to allow the air to pass)  breathing is harder because the clear airway is reduced by the tube.  The schedule is to have Julie use the device three times per day for one hour with the duration progressively increasing as she gains strength. Her voice was quite strong and clear.  She was allowed to make a surprise phone call to Darrel, the first conversation since her accident it was a powerful moment.  When her breathing is strong enought to allow the tracheostomy to be removed she will not require the speaking valve to vocalise.

 Jules was showing off to me during the afternoon breating deeply unassisted. the monitor showed she inhaled 1187cc of air on her best breath.  A week ago she could only make about 550cc.

During the afternoon she had some other visitors,  teeth cleaning, hair brushing, treatment by the physiotherapist and occupational therapist, and was turned a couple of times.  Then a late afternoon snack of Castello cheese and smoked salmon on crackers with a cup of tea, before an early dinner of vegetable curry with extra chilli.  In between the above we found time to check Jules email on the new Ipad. before tuning in to The Biggest Loser.  When we left she was tired but watching I wouldn't be surprised if she dozed off though.  

Jules motivation and spirits are high she wants to understand all the various procedures, asks the doctors and nurses to explain things, and assists the nurses as much as she can.  I have never heard her complain.  Her goal is to be able to get back to her apartment, she is totally focused an understands that it will be hard work but she is up to the task.

 The hospital food is well very "institutional" so we are taking in palatable food for her.  With her seafood vegetarian diet getting enough protein is important for her recovery so we are taking in a gourmet selection.  There is mushroom rissotto for tomorrow.  I am getting some prawns and bugs for for Saturday.

 Altogether a very busy day, but another step forward in our journey..

Kind regards Norm