Lea had a restful day today. Not that we wouldn’t have liked for it to be otherwise. She just wasn’t strong enough today to do any work at all on the ventilator. Her breathing rate was still quite high this morning, running in the 28-34 breaths per minute range with her pulse hitting over 130, She also began running a temperature during the night, indicating an infection has started somewhere.

I met Dr. Mah early this morning, who said that he suspects an infection in the abdominal cavity, and that it may be fairly general, rather than localized in a specific area. This isn’t totally unexpected, and is the reason he didn’t want to close up the wound earlier, saying that he would rather leave it open so infection could work its way out the open wound.

Since she was working so hard to fight the infection, he didn’t want to try her on the ventilator, and didn’t want to get her up in the chair today. He did, however, order another ultrasound and chest tap, and another 900 CCs of fluid was removed from the cavity around the left lung, which reduced her breathing rate and her pulse, as she was able to expand her lung to full size again. She was put on rest all day, and her peep was increased to 12, to give her all the support she needed. She was still sleeping soundly when I left tonight. She was really tired.

She was somewhat alert this morning when I washed her hair for her, but slept quite comfortably after she was tapped. This morning she was feeling quite chatty, actually, and mouthed something at me almost all the time I was fixing her hair. She once opened her eyes and looked at me, or, at least in my direction. The rest of the time, today, she slept well enough that I didn’t bother her with much more than applying lotion and reading her email and greeting cards to her.

I received a request for a listing of all that is wrong with Lea, and don’t know that I can actually do that, but I can give it a try. I certainly don’t know all of the problems that might occur as we go through the healing process. I’m no medical expert, but I can try to give you my observations and understanding. I guess we can start with the major systems, and work through it that way:

Skeletal System: She has hereditary arthritis and a bum right knee that is probably going to have to be replaced. She’s already had arthroscopic surgery on it, and that only made the condition worse. I have prayed to God to just go ahead and miraculously heal the knee while He was fixing everything else up, but we’ll see. She had recently been complaining of her left shoulder hurting, but I don’t know much about what that is all about. I am concerned about how well she is going to be able to do physical therapy, and anticipate that she will have to be in a wheel chair for some time.

Muscular System: Her muscles have atrophied from misuse. She is going to be very weak and very frail. I exercise her ankles, wrists, shoulders and knees, but can’t easily do shoulders and hips due to the pain it causes her. Physical therapy will begin as soon as she is awake, but her recent lung collapse has set us back a week or so. She won’t get strong, however, until she can push herself.

Skin: Her skin is soft and supple. Even her back, which she has been laying on for 64 days, is in good condition. The nurses turn her and put lotion on her back several times a day. I wash and lubricate her each day, paying particular attention to areas where skin might break down; around the finger tips, heels, toes, etc. These I try to keep lubed up with lotion, very regularly, to get rid of dead tissue. Of course, she’ll have to rebuild all her calluses. She will probably have stone bruises on her feet when she starts standing again.

Circulatory System: Her heart seems to be working just fine. She may need to have some blood pressure medication after her hospital stay, but we won’t know until she is awake and managing her other systems consciously. Right now she needs occasional units of blood and albumen, etc. to keep her volume of fluids at the correct level. Once she is able to consume fluids herself she should be able to control her intake normally. How she will handle the stress of rehabilitation will determine a great deal about her need for medication during that time.

Respiratory System (Nose, trachea and lungs): This is our major battle at the moment. She has a tracheostomy tube in her trachea and a ventilator to support her breathing, because she cannot yet breath for herself. That was the first system to fail when she went in the hospital July 16. She can’t breathe deeply enough, long enough, to absorb enough oxygen to support her system’s needs, even when at full rest. She has had fluid removed from the left lung cavity three times now. Hopefully, the cardiac chair will reduce future build up of this fluid.

We don’t know specifically where the fluid comes from, but it takes up room in the cavity that the lung normally expands into. This collection of fluid is caused by the blood vessels allowing fluid to leak through the walls and pass into surrounding tissue. This is a naturally occurring phenomenon that the body uses to dilute the effect of trauma or introduction of nasty stuff into the body. She has had a major trauma, and her systems are all confused.

As to what can be done from this point, it’s simply a matter of testing to see when her body is ready to take on the chore of breathing for itself. So, she has to be slowly weaned off the amount of peep (currently 12, ideal is 5), and then reduce the number of breaths the machine takes for her each minute, allowing her to take enough additional breaths to put adequate oxygen into her blood to take care of the body’s needs. She has tried to take off twice, and failed both times.

There are a number of things that can go wrong with the lungs, and I’ll leave that for you to research. As of right now, we don’t know of any medical reason for her to be unable to begin breathing for herself, other than simple strengthening the lungs. If she could do the pace she has started in the past, and just keep going, she could be off the ventilator in just a few days. The best she’s been able to do so far is 18 hours of breathing on her own.

Digestive System (Mouth, esophagus, stomach, liver, pancreas, small and large intestines): I added the pancreas here, because it is such a major factor in Lea’s digestive system. Fifty percent of her pancreas has been removed. It produces insulin, digestive enzymes and other fluids used in the digestive process. When the pancreas ruptured it sent digestive enzymes out into the cavity, and to the major systems, effectively starting to digest her body.

Currently Lea’s remaining pancreas is healing, and it is unknown how well it will function. She could be diabetic. She may have to take prescription digestive enzymes. We don’t yet know how much damage has been done to the other organs, such as the liver, until they can be returned to as normal a state as possible. Then assessments can be made. Sensitive organs like the liver can take quite a while to heal and return to normal.

She is still unable to make a solid stool from the food being fed into her small intestine. This may be caused by a lack of pancreatic enzymes from the pancreas. It is possible the pancreas will no longer produce these, and we won’t know until quite a bit of time has passed and the pancreas shows what it will do.

Excretory System (Kidneys, ureters, bladder and urethra):It appears that these systems are working properly, although the bladder has not had to work at all for these several weeks, and it won’t be known how well they will recover until Lea regains consciousness, and tries to regulate that system. She may have severe sphincter muscle damage, and not be able to control the system completely.

Endocrine System (Many glands secrete endocrine hormones. Among these are the hypothalamus, pituitary, thyroid, pancreas and adrenal glands): This is where the pancreas actually fits in the description of the anatomy, but again, I felt it needed to be discussed in the digestive system in this case. We don’t know what damage may have been done to this system, and won’t have any clues until she wakes up, and in some cases, won’t know until she is on solid food again.

Lymphatic/Immune System: The immune system is pretty well crashed. She has been on such heavy medications, she is likely to undergo four or five years of low resistance to every kind of bug there is. She is being closely watched here in the hospital, and will have to be closely watched when we return to the “outside” world. I am trying to learn as much as possible about how to care for her, and possibly will need substantial support to be able to care for her properly.

Reproductive System: This is definitely working, because I am reading testimonies from folks every day who are trying to become more like her. 🙂 Praise God!

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