This is a long post, but I think it's pretty interesting and might be educational.

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Lorraine and Mikie both slept pretty well last night.  It’s just now 6 AM and I just got here and he is breathing pretty hard and his pulse is up in the 130’s. 

6:45 AM, I just put him in his chair after they took a little blood from him.  The tech was having trouble finding a vein and Marion came in and put her finger right on one.

7 AM –I tried to get the nurse (Lecrecia) to give him his 9 AM dose at 7 AM this morning because Mikie was really struggling with his heart rate approaching 140, even though we had him sitting up, but he just wasn’t scheduled yet and she said she needed doctor’s orders to change it.  I was just a bit incensed to discover this and knew we were to blame for not keeping up with what they were doing.  I assumed they were keeping a schedule of regularly spaced doses.  She said they couldn’t vary the time by more than an hour without docs orders.  (Funny thing, when I got here this afternoon I asked for the med schedule and found that he was supposed to have Tegretol and Depakote at noon and 2 PM, and the nurse didn’t give them until 3 PM.)  My car wouldn’t start and I had to come back and get the keys to the other car so I could go to work.  The nurse was just about to give Mikie Tylenol.  I asked why and she said for his temp, it was a bit over 100.  I stopped her and told her to get him his Klonopin and the temp would go down when his heart rate did.  I don’t think she liked me very much at this point.  I checked his temp at 6 AM when I came up and again right after she tried giving him the Tylenol and it was fine.  They probably checked it at 5 AM and found it a bit high and then waited 2 hours to do something about it. Then X-ray showed up to do a chest X-ray and I gave them a hand with it before I left for work. 

We have some problems and finally got to talk to the doc sometime after 4 PM.  Boy, do we now see the importance of having your own primary care doctor and going to a hospital where they have privileges.  If you have to use one of the hospital docs for your primary, then you have a doc that you didn’t hire and they don’t necessarily work for you.  They can’t spend enough time with you, they have too many patients to see.

We need to give his meds, for consistencies sake, not 15 different nurses, 15 different ways.  We also need to adjust the schedule instead of having it at all kinds of weird hours. We discovered one of the reasons why we have such a hard time with Mikie in the wee hours of the night, and why he is so relaxed late in the afternoon.  They were giving him his Klonopin, all three doses, during one 8 hour period, rather than every 8 hours.  He was getting it at 9 AM, 1 PM, and 5 PM!  No wonder that when I got up here after work he was like a baby for me, but by 3 AM he was fit to be tied.  Dr. Sheldon came around 4 PM, he is with IMAC and filling in for Dr. Hurley today and tomorrow. He’s a pretty good listener.  We explained the problems we are having with the meds and we worked out a schedule that is very reasonable and he wrote that it be followed as precisely as possible. As for us having control and giving them to me he wasn’t sure.  We then explained that we could do everything we are doing here at home, short of taking blood and X-rays and a few other things and that we needed to go home.  We told him that we had already been trained on giving the IV meds and had done it before and that Dr. Ahuja was certainly agreeable to it. Dr. Sheldon was very agreeable to it and said he would contact the social worker and get it set up so we could go home on Thursday or Friday.

He also told me what the bug is that Mikie has and says it will take about 10 days of antibiotic to treat it.  He said that once it was cleared up Mikie would probably return to his normal state.  Since this is the first time we heard anything this optimistic our ears perked right up.  I asked if they suspect if this is the bug that caused Mikie’s initial problems, or is this something he just picked up, and he couldn’t give a clear answer.  I did ask him to spell it out for me so he wrote it down later and got it to me, not being able to spell it right off the top of his head.  After reading about this particular bug I don’t see why he had to wonder if this is the source of our problems.  It is commonly called an “ICU” bug, meaning that is where you get it.  I thought for a while that I was going to have to concede my point that Mikie was not suffering from sepsis, and I’m still not sure.  Time will tell, as it is possible that this thing is a carry over from when he was in the hospital in November. In that case, it just didn’t pop its ugly head until I and a few other docs insisted on stopping the antibiotics.  Remember, they started hitting Mikie with antibiotics before we even left the ER.  NP Johnny Hudson was smart enough to get down to the ER and check the spinal fluid before they started them.  Check it out at this link, but just in case the link doesn’t exist at a later time, here are a few notes I clipped from the site.  Believe me, it is darn good reading.  I’d say I got educated just a bit more today.  After reading it though I find it hard to believe this bug is the cause of our problems.  Too bad, it would be nice to think that Mikie would return to normal in a week or two.

 http://www.emedicine.com/med/topic678.htm

From the site:

Although community-acquired infections are occasionally observed, nosocomial infections are by far the most frequent. The patients most susceptible to acquiring Enterobacter infections are those who stay in the hospital, especially the ICU, for prolonged periods. Other major risk factors are the prior use of antimicrobial agents, serious underlying conditions (eg, diabetes, malignancies, burns, mechanical ventilation), use of foreign devices such as intravenous catheters, and immunosuppression.

nosocomial  (nos-o-ko'me-al)

1. Relating to a hospital.
2. Denoting a new disorder (not the patient's original condition) associated with being treated in a hospital, such as a hospital-acquired infection. Etymology: G. [nosokomeion,] hospital, fr. [nosos,] disease, + [komeo,] to take care of

Enterobacter species rarely cause disease in an otherwise healthy individual. This opportunistic pathogen, similar to other members of the family Enterobacteriaceae, possesses an endotoxin known to play a major role in the pathophysiology of sepsis and its complications.

·         Most of these (UTI) infections are nosocomial and are associated with indwelling urinary catheters and/or prior antibiotic therapy.