Mr 23
Bed 23 is a 67 year old gentleman from the South West.
Retired.
Hx T2DM (likely leading to) HTN and some CKD.
His wife was also unvaccinated. His children (adult) are vaccinated.
He got covid, strain I don't know.
Here he lays in ICU, his son is allowed to visit for 1 hr per day if he chooses - and this was granted via an exemption from the execs -
and no one else. His wife, is unvaccinated = but also recently had covid. She managed to stay home with it, and got better - but as she still remains with vaccination status "unvaccinated" requires a letter from State health (don't want to say which state) to explain she is exempt from vaccination for 6 months. Meaning, she cannot visit (until this letter is sought).
State health is run off its feet at the moment with an insane number of cases and changes and all sorts - so this could take a while.
If she had been vaccinated prior to getting sick, this wouldn't have been an issue. As she would have been fully vaccinated. Got sick. Got better. and remains vaccinated status, well and symptoms resolved.
Just think. If you choose to remain unvaccinated, and your family member is dying in hospital - you won't be allowed to visit. And it's not like you can just wait until this happens, and then quickly go get your vaccination: you need two doses at least x number of weeks apart. And now, supposedly you can choose whichever vaccination you like. Unlike previous when only under 65s were allowed to have pfiser (should that be one's preferred).
I wonder if anti-vaxxers are okay with this. That if this happens to them they'll feel like they their bad fortune is entirely brought on by the government - and not by their own choosing.
This poor man. His body looks over all well but his lungs are stuffed. He's not for ecmo. We learnt in the last wave there just is no point to putting people on ecmo - because the majority of them died, or had strokes and ended up vegitated and hemiplegic doomed to a life in a nursing home, or - at best, with a lot of care at home.
No one think's it'll happen to them.
I've set up a zoom meeting using the unit's brand new ipad (wonder where that came from) that family members can use to have a zoom call with their loved one. I've proped up the ipad on a Large box of gloves, on a bedside wheely table so they can see his face whilst he lays there, ventilated, heavily sedated and on a mode of ventilation called PC-AC which I'd never seen before and had to look up.
Basically on pressure controlled - assist control, the pt can choose his RR, and at the slightest evidence he is choosing to breathe the machine will deliver a breath - and will not deliver the next breath until the Time inspired has lapsed? It's just a different combination of spontaneous breathing and ventilatory support. It seems to require a lot of fiddling though, with the doctors coming in and rejigging the settings every time I do an ABG - which, I just do... as I feel... I have no rhyme and reason really. Sometimes if they've changed something in response to high RR or tidal volume - and it's been 2 hrs or I'm thinking to roll soon, ill do an ABG ($60 a pop, in house. using our brand spanking easy to use new ABG machine) because post a roll - he will likely desaturate during, and change the dynamics of his chest/water/ventilation - so I try not to take ABG post any events that would effect the result.
Twice today he's done large poops. Watery. Unable to tell me, it's only when I check under the sheets and see a tell tail brown stain that I'll know he's gone.
The zoom call is ongoing. They don't live close by (but not so far) - I reckon with the driving and the parking it would take about 1 hour to get here. stay for the hour or so and then return will take another hour. Totaling the entire morning or afternoon.
I haven't done my notes yet. I'm feeling lazy today. It'll get done though because he's only on a bunch of aperiants (prior to yesterday he hadn't pooped for 8 days), a new diuretic I never heard of until today - via the NGT - along with a bunch of free water to bring down his sodium. No antibiotics. He's not been febrile. Mostly stable. Droping Hb and heparin for PEs is his main concern otherwise but the Hb has stablised at 79 (we accept greater than 70). So onwards we go. Low sodium and low fluid feeds at 40mls/hr + insulin infusion at 1.7mls and hour to keep his BGLs somewhere in the vicinity of 6-10.
PPE rant
We really aren't wearing too much in non-covid ICU: just goggles over the eyes and an N95 mask.
I see pressure injuries all around me on peoples noses and ears. I seem to be ok in terms of pressure injuries but the mask is so darn hot.
I can feel my face sweating beneath it. As my breath is hot its just so moist and wet under my mask. The aircon in here is amazing but its just like having a mini heater on your face.
Today I had an ice pack down the back of my neck for most of the day to take the heat away from the mask. If the ice machine breaks I'm screwed. Or I'm gonna take a walk down to old non-covid ICU (now returned to TPU) and borrow some ice. The other machine is now locked in covid ICU) next door.
In other news
My cousin - the clever one - who, also I suspect is somewhat introverted and totally fine with lockdown - somehow, has tested pos on a RAT. The last time she saw anyone unmasked she says was 2/1/22 but if that wasn't an N95.... Which most people aren't using - I'm not too surprised. her symptoms are mild and she's due for a booster soon but that'll now get delayed.
She works from home anyway in a nice $$$ job. So that's not a worry, and I can't think of any comorbidities she would have (unlike myself, should I end up with covid I have a fair few currently) so I think she'll be fine. Hopefully it's omnicron and it'll go away soon. No fevers yet supposedly.
Pete still has this cough. I asked the doctors at the appt yesterday if he would need some sort of exemption letter considering he's had covid recently, and is fine otherwise except this pesky cough. They aren't asking women and partners to get a 3rd daily PCR test (boy was that a drastic waste of money seriously - prophylactic testing. Who came up with that one. State Health seemed unaware about it until people started calling the media and complaining how were they to get this test considering results are taking 6 days to come through and the lines were hours long ( if you could even find a testing center that was open). So the whole system, including MSH and SSH have moved to RATs for women and partners. I haven't tried a RAT on Pete to see if he'd pass. I sorta don't want to "waste the test" if I can avoid it. Prices are a little high at the moment, and I have some spare from work because there was some miscommunication about how frequently they wanted us to use them.
Pete's working from home again. The whole office is shut. Poor thing is stuck in the living room too (albeit, with a portable air conditioner at the least) because whilst he was in ISO he got off his bottom and moved his work desk and computer from the room with the bed I plan to use when the baby comes - to the only other logically available space. We have too much furniture. I need to get rid of a few things. I haven't set up the room properly though yet. Just been too busy prioritising other things.
Like -- going away this weekend on what will hopefully be, a covidsafe holiday. We booked a holiday home with 6 beds, a deck and a view of the beach which is only a 2k walk down the road. Forecasted to rain however this weekend but I reckon it'll be fine. A bunch of us just wanna chill. Hang. Relax. Maybe go for a walk. I'm planning to make breakfast for tomorrow morning (French toast has been the request) and other suggestions I've thrown out is a BBQ on the deck. A walk on the beach in the morning when hopefully it's not raining. And some crafting. Perhaps, if they have a smart TV we can throw on some netflix and just pretend we don't have covid back in the city. Even Moe plans to come, for one night. Leaving her almost 1 yr old. With covid going on I wonder if she'll have a birthday party for her daughter. Probably a small one with family only. I want to get her a gift anyhow. Covid ruins all gatherings.
34 weeks +1 Day
I feel officially fat.
The linea nigra showed up yesterday as a small 5cm line below my belly button that smiles more so than puckers as it's getting stretched.
Baby rolls a fair bit but I couldn't tell you if it was less or more than previous. Space seems limited in there.
BGLs have been ok, although yesterday and today it's been really up (8 and 9) and really down (4.4 after lunch, but also, I went swimming after lunch and before the reading). Maybe my finger was wet - although I didn't take the first blood.
Sleep, in my own bed at a reasonable time each night has actually been really good. Maybe it's the extra dark room. It's a bit muggy, and we don't have aircon in the bedroom, but tonight I'm planning to put on an extra fan to go along with the fan we already have over head (that I've been staring at for a year now and planning to clean the dust off it) and it should be okay for tonight.
Summer when your third trimester is really shite. Unless you have aircon everywhere you go .... and then how are you supposed to be encouraged to excersize? This is where swimming comes in. Going is a drag but it's the only summer friendly excersize I can think of. At least my bikini fits top and bottom : although, I am a little concerned my boob haven't gotten that much bigger. I've gone up approx one size. Inadequate increase of breast tissue does signal potential issue with milk production. As does insulin resistance and GDM in pregnancy. The key goal here, is to reduce the insulin resistance with excersize. Although insulin resistance increases as pregnancy increases I wonder if this is really due to reduced activity due to just feeling fat and cumbersome, rather than actually increased resistance. Either or. I must have been really nuts thinking it would be okay to go away (although just for 2 nights) to stay in a house 1 hr out of Syd. -- I saw the house has aircon ❤️ Hopefully, it's near where I'm sleeping.
If so, then that's a number 1 reason to go away for two nights. And sleep in delicious aircon.