Sunday, August 7, 2011

Day 6 (Sunday) - Here we go, swingin' low

Once again, a logistically complex day, made moreso by the first blood transfusion which commenced at about 2pm. The second transfusion is occuring as I write this post, which surprises me, as I thought they did not embark upon transfusions during nights.

I visited Kirsten from midday until 230. Tony and Pam then visited whilst I shot back to care for Alannah whilst Darren visited. She was pretty tired by then, but here's hoping she will get some sleep during this night. Last night she reckoned she had little more than about 2.5 hours worth.

As I walked in just on midday, she was having one of the hacking coughs that Darren described this afternoon, but squeezed out a grin for me. The trachy had just been removed and now ALL the saliva was streaming down her throat. Kirsten noted that we produce, and swallow about 1 litre of saliva a day, and that as we swallow it we use our throat, tongue and lips to control its passage. This is what she has to retrain: the controlled swallowing of saliva. I think, but I stand to be corrected, that there were a couple of stitches at the base of her tongue. At this early stage, the trachy hole has not closed over obviously, making the process just that much harder.

However, Kirsten is a good one for practice if she knows the usefulness of it. Beside her was some Bicarb of Soda to rise her mouth with (and then spit), plus some weak tea to drink. She is still hooked up to the 'restaurant'. After watching just a few mouthfuls of tea go down, the swallowing effort was already greatly diminished. The liquid was inserted into her mouth by the smallest syringe you have ever seen: 1 ml. When lunch (ordered by the speech therapist) arrived it also required the use of the same syringe. Kirsten started with the apple juice, with warm broth as the main. She had quite a few squirts of each of these, before declaring it onerous and tiring. But progress was made.

Prior to lunch, a doctor from the ICU (who drew the short straw) came around to obtain Kirsten's consent for a blood transfusion. He had to explain the risks to her, she had to explain her phobia to him, and then we discussed the progress in the Hb rate over the last few days, and maybe that trajectory would be maintained. I think on Wed Kirsten had been 67, on Thursday 77, on Saturday 85. However, both Dr P and Dr L had agreed that neither the 95 nor the 100 would be achieved by natural processes. Eventually, Kirsten cut all this short by saying she would do it. He gave her the consent form, and I told him to hang about because she would read every word. He swung to me with a bit of a gaping mouth: 'Why? Is she a lawyer?'

We had agreed with the nurse that it would be called the 'afternoon process' and that the bag of blood would be covered. They would cross identify the patient and the bag of blood, confirm Kirsten's blood type to her. And nothing more. In the meantime, Kirsten had asked me to continue on with the reading of "Pastures of the Blue Crane'. We got up to Chapter 8, BTW.

She kept her eyes shut and concentrated on my droning voice for about 30 minutes until Tony and Pam arrived. Tony then had to continue on with the reading. Not sure how long he kept this up: but he sms'd me later to say that she was in good spirits but that his 'read aloud' skills had deteriorated over the last twenty years! Hopefully, this first process made the second process easier for her to endure. Each bag of blood to be transfused was about 300 ml.

I nipped back to Double Bay to look after Ally and to enable Darren to drive out to spend some time with Kirsten. She was incredibly tired by this time, and Darren was back in Double Bay just before 5pm.

A looming issue is the reunion of mother and daughter. There is a difference now in Alannah's behaviour. She is not eating as well (or with good manners) and she is not settling to sleep as well. She is clinging to Darren when he has to go, and then clinging to me when I have to go. I will cut back my visits and their duration once Kirsten is fit and well again, but this might not be immediately she returns home. I need Ally to stop clinging to me, and to refocus upon her mother. Yet, I must not abandon her either. Must handle this all with the utmost sensitivity.

I have included this third image because there was a 13 page screed about the importance of the thoat, swallowing and speaking. Kirsten spoke a number of times this afternoon. She had to state her full name and date of birth to verify the packet of blood, for starters. But she spoke on a number of occasions during my time with her today. It is a visible effort, and the sound seems to me as though it is coming out of the trachy 'hole'. Perhaps that will close over during tomorrow. Her voice occasionally sounded like Kirsten, but was very breathy. But knowing her, she will have worked on this by the time I see her tomorrow.

Tomorrow, I have to be at Legacy House in Hurstville by 9:45am to meet my stepmother, Peggy, and fill in all the forms to enable her to become a 'war widow' with the extra benefits that implies (her own gold card, and about an extra $200 per fortnight). I have read the rules and their definitions and don't think Peggy will have any trouble qualifying. At the same time, my father's will is progressing towards Probate, so all that will soon be complete. After doing this chore, I will train up to Maquarie University Hospital and keep Kirsten company for the first half of the afternoon, before going over to DB to enable Darren to go out to the hospital, too.

No need to explain the images for this post, so straight on to our Yeats' verse for the day, Verse 6:
May she become a flourishing hidden tree
That all her thoughts may like the linnet be,
And have no business but dispensing round
Their magnaminities of sound,
Nor but in merriment begin a chase,
Nor but in merriment a quarrel.
O may she live like some green laurel
Rooted in one dear perpetual place.


diane b said...

Already trying to eat and talk. They are big steps. Poor little Ally she is looking a little sad, she must be fretting for her mummy. It is a difficult time, surely she needs as much comfort that she can get from Darren and you until mum returns. She will remember her for sure. If not visually she will know her smell.

brattcat said...

A very good verse to end this bittersweet post.

freefalling said...

Please tell me you are eating your vegies and getting some good sleep?
I know Kirsten is in great need, and you would sacrifice all for her, but you gotta leave something in your tank.

Sounds like Kirsten has inherited your hard head - (or a "testa dura" as Vince used to call me) - she's a determined missy, isn't she?
Thank goodness.

Ann said...

Just popped over to Kirsten's blog. Can't believe she's already posting herself. She really is doing well. You make sure you look after yourself.

Joan Elizabeth said...

So much too and fro for you all. It makes me feel exhausted reading about it. But also great to read of Kirsten's progress.