Just before the weekend to celebrate American independence, Quintin was liberated from Legacy Emanuel! He moved on Friday, July 2 to a small specialty hospital in east Portland. He’s doing well there, and has very kind and positive nurses and therapists taking care of him. The facility is much like TRACU in the level of attention he gets, and hopefully he will have a bit more interaction with physical, occupational, and speech therapists (who, despite the title, do more than evaluate speech and are helpful even at his current level of responsiveness). If nothing else, it’s good to be out of a big hospital like Emanuel, and away from all the potential bugs roaming those halls. As one TRACU nurse put it, “there are a lot of sick people in hospitals” and we don’t need him sharing their germs.
He has a nice big room and, bonus, a television with cable. He had his eyes open when Michael and I were there this morning so we watched part of the Netherlands/Uruguay World Cup semi-final match together. Q was looking sleepy by the half (it was an exciting game) so we stopped there. He probably just doesn't want to know the outcome before he can give the tournament his full attention. :)
There were a few ups and downs in the last couple weeks, but no major changes.
On Tuesday the doctors decided to get Quintin back on a ventilator. He’s still fighting infections in his lungs, and the purpose of the vent was to help keep his lungs open so his body can clear the build up.
From Wednesday through Saturday afternoon he was moved back to the ICU (West Wing ICU this time). This was mainly because of the vent, and because for those few days he simply needed more care than was appropriate for the 3-4 patient-per-nurse ratio in TRACU. They did at least one broncoscopy, kept him on the ventilator, and decided Saturday he was ready to return to TRACU. On Sunday the respiratory therapist said she wasn’t getting much gunk out when she used the trach suction tube, and that’s great – it means the vent, antibiotics, and Quintin’s efforts combined got his lungs into better shape.
People have been asking recently what Q looks like right now. The number one question has been about his hair. Yes, they had to cut his hair, twice actually (because he had two separate brain surgeries). For the first surgery (in April) they shaved all his hair off. The second time (a month later) they only shaved part of his head, so after several weeks of growth time, it’s a little lopsided. The right side is long enough for bed head, the left is still pretty short. One of his nurses said that his hair growing this much means they’re feeding him well. As well as you can through a tube, I guess.
He has lost some weight and muscle tone, as happens when you’re in bed for this long. Thankfully he was in excellent shape going into this, and his joint mobility is still good. One of the hospital’s occupational therapists showed us how to do some of the range of motion exercises and that’s really nice – it’s a way we can actively help.
On Tuesday the doctors decided to get Quintin back on a ventilator. He’s still fighting infections in his lungs, and the purpose of the vent was to help keep his lungs open so his body can clear the build up.
From Wednesday through Saturday afternoon he was moved back to the ICU (West Wing ICU this time). This was mainly because of the vent, and because for those few days he simply needed more care than was appropriate for the 3-4 patient-per-nurse ratio in TRACU. They did at least one broncoscopy, kept him on the ventilator, and decided Saturday he was ready to return to TRACU. On Sunday the respiratory therapist said she wasn’t getting much gunk out when she used the trach suction tube, and that’s great – it means the vent, antibiotics, and Quintin’s efforts combined got his lungs into better shape.
People have been asking recently what Q looks like right now. The number one question has been about his hair. Yes, they had to cut his hair, twice actually (because he had two separate brain surgeries). For the first surgery (in April) they shaved all his hair off. The second time (a month later) they only shaved part of his head, so after several weeks of growth time, it’s a little lopsided. The right side is long enough for bed head, the left is still pretty short. One of his nurses said that his hair growing this much means they’re feeding him well. As well as you can through a tube, I guess.
He has lost some weight and muscle tone, as happens when you’re in bed for this long. Thankfully he was in excellent shape going into this, and his joint mobility is still good. One of the hospital’s occupational therapists showed us how to do some of the range of motion exercises and that’s really nice – it’s a way we can actively help.
A lot has happened in the last week. To recap:
Quintin is still breathing on his own, with the trach collar providing warm, moist air.
On Saturday (his birthday) it was determined he was stable and improved enough to move out of the ICU and into the Trauma Care Unit (TRACU). The Northwest Film Center had sent Q an enormous bunch of balloons, and the whole family was there for the move, so we made quite the little parade from ICU to TRACU – all of us following two nurses wheeling Q in his bed, balloons bumping along the ceiling all the way to his new room.
On Thursday, a team of Physical Therapists in TRACU got Quintin transferred temporarily from his bed into a “chair” to help his lungs and to give his body a general change of position. I say “chair” because it’s really a throne-like version of the bed – completely padded and structured for support. His system handled the activity and new position well, and it sounds like they’ll be increasing the time he spends in the chair each day.
Because Quintin is doing well, it is likely he’ll be discharged from the hospital entirely sometime next week. The next step will be to an acute care facility (much like TRACU, but outside of the hospital). This is both exciting and scary for his family and me. When he made the move to TRACU, we’d seen real progress happening – most obviously that he no longer needed the ventilator. His doctors and nurses have been slowly checking off the criteria required to discharge him entirely, but the milestones aren’t things we can see. At the first discharge meeting Q’s parents and I had with the doctors and social workers this week, they explained what their skilled eyes were looking for: for example, it’s been over two weeks since his last surgery, and they don’t anticipate him needing another one. His heart rate, blood pressure, and other vital signs are trending in the right range. These aren’t obvious steps to those of us observing the process. We’d spent 40 days in the ICU and I think we were ready for another long stay in TRACU. Personally, I’d imagined that he would need to be awake before leaving the hospital, but clearly that’s not the case. So we’re working on readying ourselves for the step that Quintin’s already prepared for. Honestly, remember who we’re talking about here - we shouldn’t be at all surprised that he’s way out in front of us on this!
It’s wonderful that Quintin is making this progress, and enormous credit is due to the amazing team in the ICU. We’re all enormously grateful to everyone there. We have great help in TRACU, but miss our ICU friends very much.
P.S. Although Quintin is out of the ICU, please understand that visitors are still limited to family only and we will let you know when that changes.
Happy birthday to Quintin! As the Stirlings said, this guy really knows how to celebrate a birthday. And I’m not even being sarcastic here, there’s some really good news this week!
As Adrian said, he’s off the vent, which is an excellent step. The other big news is that Quintin had an EEG (a test that measures electrical activity in the brain). The results showed no seizures (which is truly wonderful news) and no “focal abnormalities”, that is, areas of inactivity in the brain. There is “diffuse slowing”, which basically means that all over his brain the signals travel slower than they would for you or me. This is completely expected for the state he’s currently in. Dr. Chen (the neurosurgeon) remains very optimistic, and so do we.
So raise a glass to Quintin today and let’s celebrate breathing!
Here are a few updates for today.
First, it's Quintin's birthday. Happy birthday Q!
Second, Quintin has been breathing on his own for the past 24 hours.
As you know, the nursing staff has been monitoring his ventilator breathing closely. They have been slowly lowering its settings, allowing him to do more and more of the work. Their goal has been to wean him towards independent breathing. Yesterday morning around 11 am, while still under close ICU supervision, they took him off the vent and let him breathe on his own. The air they are supplying him with is pre-warmed and pre-moistened and he is still breathing through his tracheotomy, so he is not quite breathing normal room air -- but wow, this is a huge step in the right direction!
If he continues to breathe well like this, we are expecting him to be moved from the ICU to the TRACU (Trauma Recovery and Acute Care Unit; pronounced "track-you") in the near future.
We'll keep you updated.
-Adrian
First, it's Quintin's birthday. Happy birthday Q!
Second, Quintin has been breathing on his own for the past 24 hours.
As you know, the nursing staff has been monitoring his ventilator breathing closely. They have been slowly lowering its settings, allowing him to do more and more of the work. Their goal has been to wean him towards independent breathing. Yesterday morning around 11 am, while still under close ICU supervision, they took him off the vent and let him breathe on his own. The air they are supplying him with is pre-warmed and pre-moistened and he is still breathing through his tracheotomy, so he is not quite breathing normal room air -- but wow, this is a huge step in the right direction!
If he continues to breathe well like this, we are expecting him to be moved from the ICU to the TRACU (Trauma Recovery and Acute Care Unit; pronounced "track-you") in the near future.
We'll keep you updated.
-Adrian
Q had a good day yesterday. The respiratory therapist was in (as she is every day) and took Q off the ventilator. He breathed on his own for 15 MINUTES! YAY! He was taking half as many breaths as she wanted him to, but they were twice as big as they needed to be. He managed to keep his oxygen saturation level reasonable and his other stats remained good.
Great news!!
Great news!!
Q had some set backs this week.
On Wednesday the 19th his fever spiked (to about 104). They did a series of CT scans to figure out what was causing the fever. Found a couple things:
1) Even though he had been doing well with the standard respirator, there was a lot of build up in his lungs. Apparently having stuff in your lungs that you can’t clear yourself means that the lungs are partially collapsed, so it’s been referred to that way too.
2) Some small blood clots had begun to form in his lungs. While this isn’t a good thing, it’s a very common occurrence when you’re on your back and inactive for this long.
To address these issues they did a series of broncoscopies, put him back on the VDR (the stronger respirator), and started him on two broad-spectrum antibiotics and a strong blood thinner.
The chest infection turned out to be staph again, so within a couple days they took him off the broad-spectrum antibiotics and started a new, targeted one (that’s different from the last cycle, since that irritated his skin).
Very early Monday morning (the 24th) his night nurse found that his pupils were not responding as they had been. She immediately called Dr. Chen (the neurosurgeon) and he called Dale and Beverly in to the hospital to approve another surgery. There was some bleeding and clotting in his cerebellum, likely caused by the blood thinner (which they immediately stopped giving him). Dr. Chen was pleased with how the surgery went, and said the cerebellum is “very forgiving.” He placed one of the drains back in Q’s head to relieve intracranial pressure, and the ICP numbers have been good ever since. No word on how long the drain will need to stay in.
He was sedated for the first 24hrs after surgery, but had his eyes open earlier today. He’s moving his head quite a bit, especially when someone touches his face. From what the doctors and nurses are saying, even though there were some scary days this week, it’s very possible that he’ll be back to where he was last week within a few days, and we just have to hope the next steps move him forward from there.
On Wednesday the 19th his fever spiked (to about 104). They did a series of CT scans to figure out what was causing the fever. Found a couple things:
1) Even though he had been doing well with the standard respirator, there was a lot of build up in his lungs. Apparently having stuff in your lungs that you can’t clear yourself means that the lungs are partially collapsed, so it’s been referred to that way too.
2) Some small blood clots had begun to form in his lungs. While this isn’t a good thing, it’s a very common occurrence when you’re on your back and inactive for this long.
To address these issues they did a series of broncoscopies, put him back on the VDR (the stronger respirator), and started him on two broad-spectrum antibiotics and a strong blood thinner.
The chest infection turned out to be staph again, so within a couple days they took him off the broad-spectrum antibiotics and started a new, targeted one (that’s different from the last cycle, since that irritated his skin).
Very early Monday morning (the 24th) his night nurse found that his pupils were not responding as they had been. She immediately called Dr. Chen (the neurosurgeon) and he called Dale and Beverly in to the hospital to approve another surgery. There was some bleeding and clotting in his cerebellum, likely caused by the blood thinner (which they immediately stopped giving him). Dr. Chen was pleased with how the surgery went, and said the cerebellum is “very forgiving.” He placed one of the drains back in Q’s head to relieve intracranial pressure, and the ICP numbers have been good ever since. No word on how long the drain will need to stay in.
He was sedated for the first 24hrs after surgery, but had his eyes open earlier today. He’s moving his head quite a bit, especially when someone touches his face. From what the doctors and nurses are saying, even though there were some scary days this week, it’s very possible that he’ll be back to where he was last week within a few days, and we just have to hope the next steps move him forward from there.
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