Wednesday, January 14, 2009

Today Donald witnessed Christy lift up both her arms in front of her as if she was carrying some logs.  I don't know how to describe the flexion better than that, but it's the most movement we've seen from her upper body ever!  She is still extending/straitening her arms as well, which isn't good, but we're so happy to see her move more.  Christy is continually trying to open her eyes and she's blinking all the time.  She still has the twitching on the face, still more prevalent on the right side than the left.  Christy is coughing somewhat frequently due to a couple things. Christy is no longer on her continuous pain medication IV drip-- allowing her to wake up more.  It makes her more sensitive to that Endotracheal tube in her mouth going to her lungs to help her breathe (The endotracheal tube or ETT is the purple thing in the picture above). Waking up more means your gag reflex is also more sensitive, and that's probably making her want to cough.  She also has some white secretions that need to be coughed up.  It's good that they're white and thin looking.  Sputum (gulla gullas) that's green or thick or grey or smelly is always bad and means bacterial infection-- you need antibiotics.  Christy has been on antibiotics and they are doing blood and sputum and urine cultures as she needs it.  To culture something means that they take a sample of mucus, or she-she, or blood and send it to the lab to be examined under the microscope.  They usually call this the "gram stain" part of the test.  It's a first look at identifying any bacteria that may be there, but it just tells the shape of the bacteria.  They also inoculate agar plates (for anyone who took biology, remember the round plastic dishes that had a hard gel medium in it that served as a friendly environment for bacteria to grow?).  The she-she or mucus or blood is allowed to grow out bacteria in the plate over a few days.  When they look at what is growing they look at the shape of the bacteria and how it hangs out-- in pairs or chains or clusters-- they can identify what specific bacteria it is.  If Christy has any bodily fluid that looks suspicious for infection, they will culture it.  They also watch for a spike in temperature. A spike in temperature means having a fever. Having a fever is the body's way of heating up the bacteria to kill it.  Like boiling water to kill the bacteria & making it safe to drink.... except blood doesn't reach boiling temperature (obviously!).  It's also possible that with Christy's brain injury, she will not be able to regulate her temperature perfectly, so they just have to culture the blood to assure there is no infection in the body with fevers. They also look at white blood cell counts.  These go up when fighting an infection because they are the body's defense army against infection.  Christy is more susceptible to infection with all the tubes and IVs she has in her body. When the cultures don't grow any bacteria, we know she's on the right antibiotic to kill the bacteria growing.  She's had a sinus infection and a bladder infection, but they have been treated.  They are all under control.

So back to the ETT and suctioning the mucus out of her lungs.  When Christy is coughing and she has some mucus to get out, the endotracheal tube (pictured above) has a suction attached to it.  The suction catheter lies right outside on the tip of the ETT in a plastic wrapper (to keep it clean).  When suctioning is performed, the clear plastic catheter (looks like a super super long, skinny clear straw) goes into the ETT, down into the lungs and automatically makes her cough to bring up the mucus to be suctioned out.  Your body just feels the suction catheter down in the lungs and the body tries to cough it out.  The cough brings the mucus up from the deeper areas of the lung so the suction catheter can reach it. Christy needs this suctioning of the lungs to clear out the mucus, since she can't cough and spit it out herself.  The suction for the catheter comes from the wall suction unit.  The hospital rooms are built with suction in the wall.  The mucus collects in a canister hanging  against the wall and the canister can be changed when full or when up for a day or two.  She also has a second suction that is built into the ETT.  It is along the part of the ETT that sits at the very back of the throat.  It catches any mucus that may fall back there while she's lying down in bed and prevents it from going into the lungs.  This is good for helping the prevention of pneumonia.  It's called a Hi/Lo Evac.  

Chrsity still has a tube in her bladder to help her go she-she and she is still eating via the tube in her small intestine.  All of her internal injuries are very stable and her blood pressure and heart rate remain stable as well.  

 I feel so selfish..... I can not wait for Christy to wake up and be with us again.  I can still hear her talking and calling us "nails", I can hear her laughing, and remember her listening and caring.  We all long to hear her voice again and can't wait to give her the very first taste of an ice cold diet coke.  It's a lesson in patience, i guess.... Every day without Christy is a heartache for the whole family.  When I say family, I mean her friends too.  The friends who love Christy so much, they are there every day, all day long. They have not left her side. That's true love. Our constant Love is what will bring her back to us.  So many of the people who know the family are sharing their own amazing stories with us.  People who have pulled through what was called an impossible journey.  I also have seen it myself, working in the ICU for the last 8 years.  The family is encouraged by the "miracle" stories of others in Christy's situation.  All we can do is continue to love and pray for her.  We Love you so much Christy...with all of our hearts.