(Caroline):
I rode in ambulance with Dad - seemed like longest 1.5 mile ride of my life to Virginia Hospital Center (where Caroline also has her endocrinology practice).
Was seen immediately in ER - and Dr. Smith determined Dad needed immediate intubation and ventilatory support. Was stabilized in the ER, then transferred to the Intensive Care Unit (ICU) for further care.
In ICU: Dad's blood pressure dropped and required aggressive support - he quickly started to required pressors (medicines to keep blood pressure up).
Because of Dad's severe breathing difficulties and maximal vent support which was still not giving adequate oxygen - Dr. Duhamel -the critical care/pulmonary specialist decided to do a bronchoscopy (look into his lungs with a small camera that goes in through the mouth) - he suctioned out a large volume of fluid from the lungs - fluid that looked like stomach bilious fluid - evidence that Dad had aspirated -likely after 2nd fall. this explained the rapid decline in his breathing problems.
Aspiration (the entry of secretions or foreign material into the trachea and lungs) is a known problem in people with Parkinson disease - due to the motor decline in swallowing function and ultimate inability to protect the trachea that lives next to the esophagus. Dad has had swallowing problems for a while - with food or his meds sometimes getting stuck, requiring more food to get it down.
Around 1am - Dad's condition seemed to have stabilized - but obviously in serious condition, still requiring the ventilator and pressor support. Advised by Dr. Duhamel to go home for a few hours to rest. Kelly took Mom back to Kelly's house to spend the night.
I went back home, but couldn't sleep, felt uneasy and returned to the hospital around 2am. Within 30 min of arriving - the activity with nurses and medical housestaff started to increase around my dad. I called my mom and sister in a panic to return immediately to the hospital.
Dad's oxygenation was declining despite maximum vent support and BP (blood pressure) dropping despite the presence of maximum pressor support. His heart rhythm was entering a junctional pattern - a precursor to asystole. I saw the nurses flurrying around - pulling the code cart into the room - getting a back board under Dad - things which I knew meant preparations for an impending CODE for cardiopulmonary arrest.
The resident approached me as asked about code status (which was already addressed when he was admitted - i.e. are we to do all lifesaving measures if he stops breathing or if heart stops) - and encouraged me to consider not proceeding with any CPR if his heart was to stop as the hypoxia was not thought to be reversible.
I said - "Dad would want to be a FULL CODE" ...how could my dad not be a full code? he is only 67 y/o and otherwise quite active even with the motor limitations that his parkinson's lays on him. Was I being unreasonable? In my sobs of tears - I asked that Dr. Duhamel be paged to ensure that I was making the right decision - but as he called back...my dad HR stopped and CPR had already started.
Miraculously - Dad's heart rhythm returned with chest compressions, atropine, bicarb.
His oxygenation improved after about 1 liter of lung secretions were suctioned out.
We haven't left Dad at the hospital by himself since....
Wednesday, September 23, 2009
What happened...
We've created this blog to help keep everyone updated on Dad's medical condition.
We are so blessed to have so many friends and family who have been so concerned for him and us. Thank you so much.
The concern has been so great that my mom's phone has been ringing off the hook, so please use this blog as a place where daily updates can be found. Feel free to forward to any of our family or friends that I may have omitted.
Kelly and I want to ensure Mom gets her needed rest for the physical and mental strength she is going to need to get her through this period - so please limit calls to her - as she is refusing to silence her phone. We will ensure she checks her email and she will have also have access to the blog comments.
------------------------------------------------------------
WHAT HAPPENED:
Sept 16th - Dad started having dry cough that kept him from sleeping.
Sept 17th - because of new low grade fevers and without an already established primary care doctor (his new appt with Dr. Rimicci was scheduled for Oct 24) - Caroline sent him for a flu test - concerned that Dad caught the flu from grandson Collin (age 4) who had been diagnosed with the flu (presumed H1N1) Sept 4th. Flu test was neg.
Sept 18th, 19th, 20th - My mom checked his temperatures - all normal - but dad still with headache and decreased appetite and fatigue. B ut did feel well enough to go to Caroline's house to unplug her shower drain (despite Caroline telling him not to do it!) and then make it out to Home Depot to buy a new replacement shower head for their own bathroom. (he read that shower heads should be changed regularly due to build-up of mildew, bacteria, etc).
Sun - Sept 20th (Mom's 65th birthday):
Mom said Dad looked the best he had in the previous days - he got up and got ready for the day, and got out his new showerhead and tools that he was going to install. Because Mom and Dad had quarantined themselves away from the grandchildren to prevent them from getting sick....we hadn't seen them in several days. Since Dad looked better, Mom joined Kelly and baby Norah for a short walk to Caroline's house to spend a little time on her birthday with all the grandkids - Collin (4y), Cary (2y), and Norah (11m). and Dad wanted Mom to borrow tools from Caroline's house - ones that he realized he was missing and needed to replace the shower head.
A combined birthday celebration for Mom and Caroline was postponed until everyone was feeling better (Cary had been having a cold too).
Mom spent about 90 min visiting at Caroline's house - returning to the condo around 4:30pm.
When she returned she found Dad had fallen, lying on his back on the family room carpet (has happened in the past with his parkinson's, especially if he forgot to stay on schedule with his meds). He was lucid and told mom he just couldn't get up - it was evident that he had prepared a bowl of ice-cream for himself and appeared to have slipped off the chair in the eating area.
Mom helped him up and he walked to the couch. Because he looked so pale and she knew he had not eaten much in 2 days - she fixed him homemade chicken noodle soup and fed him that along with his afternoon Parkinson's meds - Dad ate the entire bowl. Afterwards Dad took a nap on the couch. Mom decided herself to get some rest too - so napped as well in their bedroom.
Around 7:30pm - Mom heard a loud crash and hurried out into the family room where she saw Dad had fallen again - he stated he was trying to get to the bathroom. He was still mentally alert and conversing appropriately - but obviously really weak. Because she couldn't get him up and was a little more concerned - called both Kelly and Caroline. Caroline advised Mom to call 9-1-1 immediately and both Kelly and Caroline headed over to their condo.
Mom said she told Dad: "Matthew, Caroline wants us to call 9-1-1". Apparently Dad said to her - "Don't call 9-1-1 - just call a taxi". Minutes later, Caroline and Kelly arrived to find Dad lying on the floor with difficulties breathing, not talking, and in more distress. He was able to squeeze Caroline's hand upon command. Paramedics arrived -he had a fast heartrate but in normal rhythm. During the 10 min they were in the condo - Dad deteriorated quickly in front of everyone's eyes with more labored "agonal" breathing.
We are so blessed to have so many friends and family who have been so concerned for him and us. Thank you so much.
The concern has been so great that my mom's phone has been ringing off the hook, so please use this blog as a place where daily updates can be found. Feel free to forward to any of our family or friends that I may have omitted.
Kelly and I want to ensure Mom gets her needed rest for the physical and mental strength she is going to need to get her through this period - so please limit calls to her - as she is refusing to silence her phone. We will ensure she checks her email and she will have also have access to the blog comments.
------------------------------------------------------------
WHAT HAPPENED:
Sept 16th - Dad started having dry cough that kept him from sleeping.
Sept 17th - because of new low grade fevers and without an already established primary care doctor (his new appt with Dr. Rimicci was scheduled for Oct 24) - Caroline sent him for a flu test - concerned that Dad caught the flu from grandson Collin (age 4) who had been diagnosed with the flu (presumed H1N1) Sept 4th. Flu test was neg.
Sept 18th, 19th, 20th - My mom checked his temperatures - all normal - but dad still with headache and decreased appetite and fatigue. B ut did feel well enough to go to Caroline's house to unplug her shower drain (despite Caroline telling him not to do it!) and then make it out to Home Depot to buy a new replacement shower head for their own bathroom. (he read that shower heads should be changed regularly due to build-up of mildew, bacteria, etc).
Sun - Sept 20th (Mom's 65th birthday):
Mom said Dad looked the best he had in the previous days - he got up and got ready for the day, and got out his new showerhead and tools that he was going to install. Because Mom and Dad had quarantined themselves away from the grandchildren to prevent them from getting sick....we hadn't seen them in several days. Since Dad looked better, Mom joined Kelly and baby Norah for a short walk to Caroline's house to spend a little time on her birthday with all the grandkids - Collin (4y), Cary (2y), and Norah (11m). and Dad wanted Mom to borrow tools from Caroline's house - ones that he realized he was missing and needed to replace the shower head.
A combined birthday celebration for Mom and Caroline was postponed until everyone was feeling better (Cary had been having a cold too).
Mom spent about 90 min visiting at Caroline's house - returning to the condo around 4:30pm.
When she returned she found Dad had fallen, lying on his back on the family room carpet (has happened in the past with his parkinson's, especially if he forgot to stay on schedule with his meds). He was lucid and told mom he just couldn't get up - it was evident that he had prepared a bowl of ice-cream for himself and appeared to have slipped off the chair in the eating area.
Mom helped him up and he walked to the couch. Because he looked so pale and she knew he had not eaten much in 2 days - she fixed him homemade chicken noodle soup and fed him that along with his afternoon Parkinson's meds - Dad ate the entire bowl. Afterwards Dad took a nap on the couch. Mom decided herself to get some rest too - so napped as well in their bedroom.
Around 7:30pm - Mom heard a loud crash and hurried out into the family room where she saw Dad had fallen again - he stated he was trying to get to the bathroom. He was still mentally alert and conversing appropriately - but obviously really weak. Because she couldn't get him up and was a little more concerned - called both Kelly and Caroline. Caroline advised Mom to call 9-1-1 immediately and both Kelly and Caroline headed over to their condo.
Mom said she told Dad: "Matthew, Caroline wants us to call 9-1-1". Apparently Dad said to her - "Don't call 9-1-1 - just call a taxi". Minutes later, Caroline and Kelly arrived to find Dad lying on the floor with difficulties breathing, not talking, and in more distress. He was able to squeeze Caroline's hand upon command. Paramedics arrived -he had a fast heartrate but in normal rhythm. During the 10 min they were in the condo - Dad deteriorated quickly in front of everyone's eyes with more labored "agonal" breathing.
Subscribe to:
Posts (Atom)