15 Minutes at a time

Debbi slept most of the day yesterday. While she was napping, we planted another 8 hydrangea bushes. I should say Josh planted them. I selected 8 to represent Mother’s day gifts from each of Debbi’s children and from each of the significant others. Josh told me that with this planting, the bed is running out of room for additional hydrangeas. We are up to 37 bushes in the main bed. When we moved into the Cape House the main bed consisted of a stand of 18 trees and tons of weeds and other growth that gave us privacy in the front yard. I liked the privacy and naturally Debbi wanted it cleared out. In our second summer, Debbi contracted to clear the bed of the weeds and overgrowth leaving the trees standing by themselves. End of discussion.

Once the bed was cleared, and knowing how much Debbi liked hydrangeas, I made a trip to the local Agway, and purchased 15 plants. Seeing that they did well in our soil, I purchased a few more bushes each spring. Our sprinkler system did not hit the majority of the hydrangeas and one summer the plantings look so withered that some neighbors stopped by to reprimand us. The following season we expanded the sprinkler system to cover the hydrangeas with more than enough misting liquid and the plants once again yielded their magnificent pompoms. We do not have any signs of buds so far but the greenery on each bush indicates that it will be a bountiful year for the beautiful blue pompoms. I hope Debbi gets to see some of the flowerings in addition to the greenery.

I have to talk to the nurses today. I am thinking that it is becoming harder for Debbi to get through the night. She is on the morphine pump, she takes 1mg of Ativan every 4-6 hours for anxiety / discomfort, 1mg of Haloperidol every 4-6 hours to combat the restlessness, and she is on the oxygen machine which is set to 3 liters of oxygen per minute. At night, especially after 2am, it sounds as if she is trying to clear her throat or clear the phlegm from her lungs. I am sleeping solo in the rice bed and the hospital bed is along the opposite wall. Every time I hear her trying to clear her lungs, I rush to her side and help her sit up so that her effort is more successful. After a few tries Debbi would lay back and drift off. I also tried to get some additional shut eye. It just seemed that every 15 minutes throughout the night we repeated this cycle. No sleep for the weary. Even if I managed to fall back to sleep, I could not abandon my best friend when she was working so hard to clear her lungs. Maybe she did not know I had my arms around her supporting her as she tried but I had to be with her anyway.

In addition, I was nervous about giving her the Ativan and Haldol when she had trouble clearing her lungs. I was scared that using the plastic syringe to deposit 1ml of medicine in the back corners of her mouth could make her cough more. Margo had told me that codeine works to stop coughs by acting on a particular trigger in the brain and that morphine had that same action. Thus, Margot said I could just press the bolus button on Debbi’s morphine pump.  I should have called the VNA hotline with my concern but the switchboard would have asked the on-call nurse to call me back and I did not want the house to get up in the middle of the night without good reason. I am expecting to see Debbie A. today and so I will pose my concern to her and get a new set of marching orders.

Debbi has some interesting sleep patterns in the hospital bed. She always has to have some part of her body outside the bounds of the bed. Right now (7:30 AM) she has both of her feet sticking out of the lower section of the bed just beyond the rails. Knowing that she likes to do this, I pre-staged the upholstered two-step mahogany stairs that match the rice bed just at that spot were her feet are sticking out. This way she is able to have some support for her feet, as she gets uncomfortable, when they are dangling.

At 6AM, I sat her up and surrounded her with king size pillows holding Debbi’s torso more upright in order to make it easier to rise to a sitting position. Being that her head is higher than the pillows, we use our favorite bear, Ralph (given to Debbi by her Physical Therapist of the same name), to cradle Debbi’s neck and head. Ralph the bear is great at giving Debbi hugs and unlike me, he never gets tired. Even with the pillows and Ralph around her, the shiny rails of the bed make it seem as if Debbi is in jail. It is a fitting analogy because she is always trying to get out. Her speech is now soft and slurred but she asks to get out of bed and explaining that she is too sick and that her legs do not work does indeed make me feel like a jailer.

An hour after stuffing the pillows around her and moving her to a more upright position, Debbi is coughing less and sleeping more. She looks comfortable but daytime comfortable… not nighttime comfortable. Just the positioning of the body looks like someone taking a nap in a chair. If someone went to sleep for the night in such an orientation, they would certainly have a sore neck or back when they awoke.

Sometimes Debbi’s breathing is very shallow. Sometimes it seems as if she is barely breathing or maybe not breathing at all. Not wanting to disturb her at these times, I slip the Nonin Oximeter on Debbi’s fingertip, give it a few seconds until the blinking light turns green, and I can then read Sp O2 (the saturation of peripheral oxygen) and the pulse rate without waking her. The oximeter just read 110 beats per minute for her pulse and 98% SpO2. Happily this means that Debbi lungs are working fine in conjunction with her Invacare Platinum Oxygen Concentrator. Together they are delivering enough oxygen to her extremities to register at 98% of the theoretical maximum even if she happens to be breathing shallowly at the moment.

Today, we are thrilled that Debbi is still with us and we hope that she will come out of her shell and be able to spend even a few minutes with us.

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