It amazes me how much trouble John can get into when my back is turned. It has to be turned a lot now, since he's an hour away and I'm working. (And the puppy bladder has its limits. And I really need to give up sleep for Lent.) Anyway, there've been some stretches of time that he wasn't answering my text messages and I wondered what was up.
I found out this morning. When I got there he was stoned. I hunted up his nurse and found out that he's been asking for Ativan for shoulder discomfort - the kind you get when you stay in bed all the time. Ativan isn't for pain; it sedates you and makes you stay in bed all the time. He's been compounding his problem as well as sleeping all day.
So I had the appropriate discussions with the appropriate people - including John, who will probably never think of asking for Ativan for the rest of his life. Ativan and Morphine orders have been cancelled. He now has an order for Tylenol. (John is sensitive to drugs that sedate people, but even he can't get sedated on Tylenol.) He slept all of today including his therapy times. Physical Therapy will re-evaluate him tomorrow, since he was stoned when they tried to today. Speech therapy will re-teach him all they taught him today. Occupational therapy gave up and left him alone. I convinced the nurses and nurse practitioners that he is normally a highly-functioning, independent grown-up - which didn't seem likely today. John says he's sorry.
There are two morals to this story: First, leaving husbands unattended in hospitals is iffy. Second, a moderate amount of medical knowledge isn't as much as it seems to be. All he knew was that he got Ativan at Goshen Hospital (he was - when he was first entubated and needed sedation) and it made him feel better (no comment). He had no idea he was nearly unresponsive for hours after getting it. The man needs a wife.
Meanwhile, the ventilator weaning is going very well. (Don't worry if I lose you here.) He's now on SIMV; FiO2 is down from .40 to .30, rate is down from 12 to 4, the next thing to start weaning is pressure support. For the non-medical: he's doing more on his own and needing the ventilator much less. He failed every attempt to wean a few days ago at Goshen; he got too frightened about having the setting changed. Which means that his being stoned on Ativan for a few days may be a good thing, because he slept through it. I told him today - after he'd started waking up a bit - what his vent settings were, and just thought that was cool.
Let me sum up: There will be no more sedation. Therapy should actually work when he's awake. He'll eat better when he's awake. The vent weaning has gone very well while he wasn't awake. And he says to tell everybody he's sorry.