Ending the day on a bad note . . .

Bob's back on the NG (nasogastric) tube, back on an NPO (nothing by mouth) orders, because he threw up again last night, has been having endless diarrhea (well, eventually ended once he had nothing left to give . . .), slightly distended stomach, running a low grade fever, white blood cell count elevating over the course of the days since his surgery. . . his NG tube pulls fluid and air out of his stomach, helps to decompress a distended stomach . . . the CT scan he had yesterday didn't show any signs of abscess in the abdomen, but the colorectal team seems to think there's some kind of obstruction—whether it's solid substance blocking the system, or some post-surgery irritation/swelling, no one really knows.

So, they had to come in and insert the tube at 2 a.m. . . . I don't know what the emergency was, why it couldn't have waited till daybreak. It was an involved procedure—as it had been when he had one in the ICU—took several tries by several people to get the tube in, Bob said he was gagging, nearly drowning in the water they were trying to make him drink, which I guess is supposed to make him swallow, which helps the tube through his nose, down the back of his throat, to his stomach, nearly threw up again, in the process. . . so much for a good night's sleep. . .

Bob called me early this morning to tell me the latest, was clearly near crazy for lack of sleep. I told him to rest as much as he could till I got there, and could ask others exactly what was going on. When I got to his bedside, I could tell he was so distraught, so exasperated . . ."I can't believe I allow all these people to do these things to me," he said with tears in his eyes. I had no words to respond to that, nothing at all. All I could do was rub his arm, massage his hand, kiss his forehead. That's all . . .

Colorectal people couldn't tell me much—other than the low grade fever, a slightly elevated white blood count, it doesn't strongly appear to be an infection—stool sample came back negative for infection, urine is clear, not cloudy. They hadn't done any blood work or urine tests yet, to look for infections there, but now it's too late, as antibiotics have already been started . . . CT scan didn't show any abscess, which is good, and the contrast fluid appeared to move through the small and large intestines just fine, also good . . . They suspect it's likely just a prolonged delay in his system, perhaps still some residual irritation and inflammation that's obstructing the bowels, due to the extremely stressful and lengthy surgery, though without doing an invasive surgery to see for sure, there's no way to really tell what exactly is going on. The NG tube will give the stomach a break, help things calm down. They're going to repeat the CT tomorrow, and check both ends then—including colon and rectum at that time, to make sure all lengths of the digestive track are working. . .

"So, let me get this straight," I say. "Bob doesn't show acute signs of infection, you didn't do blood work or take a urine sample for more definite signs, but you blast him with heavy-duty antibiotics, 'just in case?' I hope you're all well aware of how hyper-sensitive to antibiotics Bob has been during this ordeal—at least twice, he's suffered severe diarrhea, which led to severe dehydration, which lead to an extended hospital stay because of plummeting electrolytes. Someone has to monitor this very closely—"

Well, a dose of Flagyl is standard, when we suspect an infection in the bowels or urinary tract. We'd rather treat him as though he has one, rather than wait until it's too late; that, and doing blood or urine tests now would be pointless, because the antibiotics are already in him, and would affect the test results . . . So, not only does all this sound ass-backwards to me to begin with, but not three minutes later, same doc says, And so, we'll be sending lab down to draw blood and get a urine sample from Bob, so we can run tests on them, too . . . I heard the proverbial needle rip across the record as I jerked my head back toward him. "You just said that would be pointless!" Well, there could be a hidden infection that may show up on the test . . . Serious as shit, do these people make this up as they go along?!? I give up. Uncle . . .

Overall, he's had so little to eat in the 10 days since surgery, another repeated concern of mine, so he also has orders for TNP (total parenteral nutrition, liquid "food" administered via IV), which will require a PICC (peripherally inserted central catheter—like how I'm getting this little alphabet game down? God, if only I could clear all these acronyms that stick in my brain like prickly burrs . . . clear the debris, make room for happy things, hopeful things, pretty things again. . .) line inserted at some point.

Even though Bob has been feeling generally, overall crappy, he really seems to like getting up and out of bed, to move his body around, release some pressure on his backside, get things moving, it's good for his lungs, even the change of scenery is refreshing. So have we seen PT and OT lately? Not so much, even though he has orders to have it twice a day. . . several times, no one even showed up, despite calling Bob's nurse in to find out what was going on, couple other times, someone showed up just to tell Bob, "Sorry, but we just can't fit you in today, Bob—maybe tomorrow!" and disappears. . . yesterday, no sessions, today, no sessions . . . other times, if PT or OT does happen to show up, they don't know how to get Bob's brace on, have no clue about his condition and how to transfer him, and end up consulting me on what to do. On more than one occasion, I've had to jump in and assist when I watched in horror as Bob was being twisted, turned and manhandled by the staff who seem to forget there's a person under their hands. wtf, wtf, wtf???!!!???

Last night, Bob's nurse and I, along with an aide, got him into a wheelchair ourselves, because he needed to get up and move around. Did the same thing today, because he needs to get out of bed, he needs to move around, needs to do this twice a day, not at someone else's whim or convenience. . .It's good for his body and soul . . .I am not trashing the PT/OT profession (no offense at all to those of you whom I know and love dearly who are members of said professions); just furious, once again, with the huge lack of communication that is soooooo rampant at the U, like a big ol' cancer all its own. . .

I called Bob's primary team contact (Dr. BoHunk) and dumped my shitload of complaints and frustrations on him this afternoon, poor guy. He told me, call any time, that's why he gave his direct number to me. Wouldn't blame him if he changed it to unlisted soon. . . I figured I needed to go to the top of the line and he's the "go-to" on the primary team, to let them know what 's going on, from colorectal to Bob's daily therapies, or lack thereof, the seemingly willy-nilly dispensing of antibiotics without more information on which to base that decision, to the fact that Bob's as groggy, lethargic, loopy as ever, if not more so, and finally, how soon can we possibly get him out of 6B and into transitional care, so we can start making some real progress. . . Bob's going nuts, I'm going nuts, his progress seems to be spinning in the mud, I get it that the colorectal stuff needs to get figured out, but c'mon . . .

Okay, I will end this on a high note—our dear pal, Dan, from Alaska (half of the famous "Dan and Wanda" duo . . . both soon to be permanent citizens of the lower 48, Tennessee, to be precise), was in town on business and paid us a visit at the hospital tonight. Bob was barely able to partake in the visit, seemed to sleep most of the time, but now and again would surprise Dan and me by chiming into the conversation at the oddest, yet most appropriate times. . . as I said before, he may not remember that Dan was here, but I know that deep down, somewhere inside of him, he knows. . .was great to see Dan, can't wait to visit him and his lovely bride, Wanda, in their new digs in Tennessee—on our way to Memphis, remember?!

Thanks for letting me rant tonight, peeps. Tomorrow will be better.