October 31
Happy Halloween!

3 PM

Hello to all Blog followers. In my conversations with Pat yesterday and today. We had the longest conversation ever. Pat is doing well, off oxygen, and walking farther. She's eating regularly and I can hear a hint of a smile in her voice. Estimates for coming back to GR are for early next week

Today she said some kids would be coming by her room doing trick or treat, and she was looking forward to that because she has always had fun at Halloween. Speaking of which, I've been given orders to get out the ol' orange and black stuff and put it out on the porch. I'll be thinking of Pat as I hand out the goodies.

Suanne took some pictures of Pat when she got out into the sun room. I hope they brighten your day.

Greg

Monday, October 28
Live from Grand Rapids

Hi, Pat's followers! I've made it home to GR. Pat is still at the NIH with her mom and Suanne. She is doing much better and is gaining strength every day. Willie (the physical therapist) can really encourage Pat to get up and move, so she does.

Plans may be to come home some time within a week, but it depends on how she is doing medically. In any event, it will be nice when she gets home. When I spoke to her today she sounded a bit tired, but overall more energetic than I thinks she has been since surgery. I like it.

I will be talking to her every day, and I'll try to put a note on the blog whenever I can. Thank you all for your comments!

Greg

Sunday, October 27 9 am

Hi again from Pat's room!

Pat has a huge window in her room and she can look out and see all the fall colors on a beautiful autumn day here in Bethesda. It is even more beautiful because Pat's smile is shining right back out the window. She continues to improve, still needing oxygen, but breathing easier. We have been through breakfast and the morning doctor parade and so now there are a few minutes down time.

Last night when dinner came we put the iPad on the tray table and Pat ate while we watched a couple of Big Bang Theory episodes. It was dinner and a movie. It was cool.

There are still some things that need to improve before Pat can come home, but we haven't had any major setbacks so we are heading in the right direction.

I'm heading back to GR today. I don't want to leave, like always, but this time it's easier than last time. The blogs may get less frequent, but I'll try to avoid a long gap like last time!

Pat says 'hi' and thanks for the blog comments. She also says the food is yummy. Best bananas in town.

Greg

Saturday, October 26

Hello, all followers of Pat's blog!

I was so happy to walk into Pat's room this morning and see her sitting up and smiling. Sitting up and smiling is a lot of work, but you all know Pat. She was doing it. And when Physical Therapy came by (in the form of Willie, a physical therapist Pat really likes and would do anything for) she put forth her best efforts. She walked and joked and rolled her wheelchair. She is a real trooper.

Today Pat said the three words I most wanted to hear: "I am hungry." She is eating better, and it seems as if she is sleeping better, and this leads to a more comfortable Patricia.

I have to head back to GR on Sunday, 10/27, but fortunately (and there is no way I can be happier about this) her sister Suanne will be heading back down to Bethesda. Pat's mom, Vi, is still here, and she stayed the night in Pat's room last night (10/25). When some of the nurses went in checking Pat's vital signs, her mom was there, something very reassuring to Pat. I think Vi is really wonderful.

We're not exactly sure when Pat will be coming back to Grand Rapids, but I hope it will be within the next couple of weeks. But, also, I want her to be okay. And the docs want to make sure when she comes home (to physical rehabilitation) she will be doing okay.

I love my Patricia. She is a gem. And thanks to all of you for your comments. As I have said, I read them word for word to her. And she loves hearing them.

When I am home, I promise to update the blog whenever I talk to my wonderful lady.

Greg

Friday, October 25

I'm blogging from Pat's room, and Vi is here as well. Pat says 'hi' to everyone. She appreciates all the work everyone is putting in on all of the projects, and keep her informed on Second Best sale. Also, thanks much for all the comments!

Today had its ups and downs but is ending on an up note, though everyone is wearing yellow. The yellow is paper disposable gowns that we have to wear. Pat had a 'surveillance' culture, which everyone gets who has been in the hospital for more than a week. They swab various body parts to look for 'bad bacteria,' (our own E is a good bacterium) and one of the cultures is growing a bacteria, we just don't know what the bug is, if it is a bad one or one we can just ignore. So, until we know, we wear yellow gowns.

Pat is getting an upgraded diet. She can have a little more fat, which makes for a much more palatable meal. Angel food cake today!

So we keep on working and walking and trying to get things better. The docs have been very quick to respond to problems and the nurses are doing a good job, too.

Now Pat is on unit 3 Northwest Room 1648, but otherwise the address is unchanged. Thanks for your blogs, everyone!

Greg

Thursday, October 24, 9:45 PM

A busy day for Pat. She was visited by PT (physical therapy) and OT (occupational therapy) and SLP (speech and language pathology) as well as multiple doctors, nurses and other staff. She walked out into the hallway, she sat for a long time, and she ate more than ever before. And, by the end of the day, Pat was transferred to the regular floor. I hope she stays there.

I left her bedside about 8 PM after seeing her be comfortable for the night. It is quite a transition. Pat is determined to not go back to ICU. She uses her breathing stuff, she sits, she walks, she talks - sounds like a doll. Well, she is my doll and I think she is the bravest woman in the world.

The doctors don't give a definite time for transfer back to Grand Rapids, but it will be a 'few days' yet (that's doctor talk for 'we don't know', trust me).

Pat overcame a number of hurdles today. She was a bit scared to eat for fear of choking. The SLP person came by and made Pat take BIG bites of food instead of LITTLE bites of food. Surprisingly, it went much better. Pat overcame her fear (like she always does) and now is eating better.

When I asked Pat if she would like to hear the blog comments tonight, her eyes lit up and she smiled and was all set for some fun. She really does take comfort and encouragement from all your blogs. She likes the Palmer and Park updates (thanks Sara and Deb) and family updates (from Deanna, her side, and Sue, my side, and Dawn, every night I'm here I watch another Doctor Who-I'm actually growing to like Matt Smith) and the kind thoughts of Kim and Ria and Leslie and everyone whose name I haven't included for the sole reason that I have a Y chromosome. Your replies and comments make Patricia happy. And that is good. Thanks to you all.

Greg

Thursday, October 24
7:30 am

I'm getting ready to head back to the NIH from the hotel. Pat is still in ICU, but yesterday (Wed) she walked several steps and is better and better at transferring herself. She loves to have PT and OT come by.

The respiratory setback that put her back in the ICU seems to have gotten better, and yesterday afternoon Pat went from her bipap device (helpful but quite inconvenient) to regular nasal prongs for her oxygen. She is still having some trouble eating, but we are coming up with ways to work on that. The sun is coming up and the weather looks clear, so I'm hoping that is how the day is going to go.

Pat likely may be here through our second-favorite holiday, Halloween. Each year she sits at our kitchen table at home and hands out goodies to the neighborhood kids, and she loves it. So, if anyone has a Happy Halloween greeting, feel free to mail it to

Pat Trowbridge, Inpatient, ICU
NIH Building 10
10 Center Drive
Bethesda   MD   20892

Thanks!
Greg

Tuesday, October 23

Hi, Pat's friends (of whom, I know, there are many)!

We have spent the day together, and Patricia started the day with fatigue and respiratory distress, but through the work of the staff and most importantly herself, Pat has improved. She still has a lot of fluid in her lungs, but less than anticipated, and after spending a lot of the day upright (tiring, but worthwhile) she is gradually better. Pat is getting stronger now, and able to do much more for herself and is able to take a little more food with each meal.

This just might work.

I have said it before and I will say it again, Pat so much loves your comments. They make her smile and when she smiles she gets ready to do more, more steps on the road home.

Thanks.

Greg

Monday, October 21

If anyone is still checking the blog, E has an update.

When I left the NIH last Tuesday Pat was out of the ICU, gradually improving, starting to eat some, and working with physical therapy. Unfortunately over the past weekend she began to have some more problems breathing an ran a fever, and is back in the ICU. She did not have to go back on the ventilator, but is getting some oxygen assistance (bipap) and is back on the antibiotics they discontinued. She's able to eat, but it bothers her stomach some when she does.

Once again through schedule adjustments graciously made by my co-workers, I was able to come back down to the NIH and arrived early today. Though Pat was quite tired, she was able to participate in physical therapy and has kept up some of her strength.

I hope the doctors can work to get some of the fluid off so she can breathe easier. The surgical team has consulted the ICU staff and pulmonology, so they are working on the problem.

I'll keep doing updates as long as I'm here.

Greg & E

October 14, late

Hello to all followers of Pat and Froggie. Unfortunately, E has to head back home, leaving Froggie behind at the NIH for a while. But she is slowly getting better, though still weak. And, most graciously and helpfully, Mother Vi and sister Suanne are staying behind to help, watch and report. She is able to take more by mouth, and is trying to pick things to eat that food services will send. And she is gradually more comfortable and working hard to gain strength.

Blogs may be a bit irregular from this point on, but E will work to update all the essentials.

Thanks to all, and for your comments, that Pat loves to hear.

Greg

Sunday, October 13

I'm updating the blog from Pat's room. She is now on 3W, transferred out of ICU yesterday. The night nurses took good care of her (tonight she has a nurse named 'Princess' - thought you would like that, Kim) and the docs are allowing her some actual food, but Pat is being careful not to overload the system too much at once. Not much happens on a Sunday here, so it is quiet, which is good and not so good. Good because, well, it's quiet. We sure don't miss beep, beep, beep. But we do miss physical therapy and nutrition not being here. Also, tomorrow is Columbus Day, so many Federal agencies and services are closed (a microscopic bit of humor, there)

Pat is awake right now (7:30 PM) and on the phone, giving Brian instructions on how to pay bills. We did NOT expect to be here even half this long. I have to head back to GR on Tuesday to do stuff at home, but Vi and Suanne will stay for a while - not sure how long yet.

Take care, everyone. Suanne is putting up the good wishes paper chain links in the room. Pat has been really excited to get to them

For stimulation and eye-hand coordination, Pat and I played catch with E and Froggie today. Fun for all! Pat says (this is a direct quote) 'thanks for your messages. Keep 'em coming.' Me too.

Happy Columbus Day,

Greg

Saturday, October 12

Thanks to the generous gift of time from my friends and fellow physicians at Helen DeVos Children's Hospital, I am able to stay some more days with my Honey. Thanks to Brett and Mike and Martina especially, and to Dan and Becky and Jeri and Bob and James and Leslie and Julie and Jodi and Hilary and Amanda and everybody.

Progress - slow, but progress. It is now the three day weekend (Columbus Day, Monday the 14th, is a Federal holiday, and the staff is trying to figure out what that means in the perspective of the shutdown). It is quiet on the NIH campus. Not even deer are wandering the streets. The patient population is down and lots of things are closed. Fortunately I have family, and a sweetie who is getting better.

Pat got hot tea today. It was delicious, she says. They have expanded her diet to sundry clear liquids, and a nutritional beverage called 'Ensure Clear.' If it was me in the same position, a useful nutritional beverage would be called 'Chardonnay.' But, alas, none available on the NIH campus. But the doctors are encouraged. They are anticipating moving Pat to a regular floor this weekend. She is getting a little cranky, now, which I take as a good sign as she is 'more interactive with her environment,' i.e., she is giving me orders. I love it.

Thanks to all Pat's followers!
More updates tomorrow.

Greg

October 11, evening

An interesting day. When I arrived on the unit (Pat is still in ICU, not because she is that critical but because meds and things take a lot of time) they were whisking Pat away to radiology so, of course, I went there too. She had an ultrasound to look for blood clots and there were some small ones in the usual places, like where she had her big IVs in. The doctors are debating what to do, and ponder and consult other doctors ... just like I would do on the pediatric unit. There are a couple of really great fellows (not guys, they're girls, but they are doing additional training after their 5 year surgery residency) who take the time and patients to explain things to me and Vi and Suanne. It helps.

Pat also had a swallowing study, where she had to drink some disgusting stuff to test her swallow and how things are working. The swallow study was OKAY and the rest of the stuff was okay and so they are letting Pat have a few sips of clear liquids now. You should have seen her face with her first real sip of water. Big time smile. The smile I love to see.

She is spending more time up in the chair position and tolerating it better. So we work on strength and movement and being awake during the day and sleeping better at night, and it is good. Pat is smiling more, and protesting more and questioning her doctors more, all of which I like! We have a ways to go, but we're going.

Thank you all for you comments. I love to see Pat smile when I read them to her.

Greg

October 10

Ah, another day, another test...

Actually, the test was yesterday. A CAT scan showed some things, but her tummy is looking better. No abscesses. Things are looking up. Tomorrow (10/11) the 'pod,' as Pat calls the group of doctors that come by, are going to do another contrast study. If this goes okay, they might let Pat start some oral intake. She's looking forward to that, let me tell you.

She is kind of sleepy today, so the nurses and physical therapists are pushing her a bit, which is good. She did some more weight bearing today, also good.

So things are moving along. Fewer lines, fewer beeps, less pain, makes a happier Pat!

Greg

October 9

Pat says 'hi' to everyone following her on the blog. So, hi!

She is a little tired but she has big smiles for everybody, especially for Suanne who brings the brush. Pat loves having her hair brushed. And we are going to get some of the dry shampoo to clean her hair, too.

Pat did some standing at the bedside and more weight bearing and moving this morning. She had her dressing changed and everything looks good. She's had more meds discontinued. She is still NPO (nothing to eat or drink) and she gets intravenous nutrition, but the surgeons think things are getting better. It is possible she will go from ICU to the (I almost typed 'peds floor') general floor tomorrow (10/10).

Pat is doing her incentive spirometer (she calls it her 'barometer') and a curved device that vibrates when she breathes out. It looks vaguely obscene, but it helps to clear her lungs and she works at it pretty well every 1 - 2 hours.

She did get her triple lumen IJ out today. This is a large intravenous line that goes into the right side of her neck and it had lots of plastic spaghetti hanging from it and was cumbersome when she was trying to move. It was valuable when she needed it, but now she doesn't, so it's gone, which makes life a bit easier and it's just one more step on the path to home.

Thanks for everyone's comments! She loves to hear them, and I read them word for word. I love to see her smile and laugh. Laughing makes her tummy a little bit sore, but helps her pulmonary mechanics. When she smiles, everybody smiles.

So thanks to relatives on both sides of our family, and to our friend Ria in the Netherlands, and friends from Park Church and at Curves and Miss Fit.

Greg

October 8 2013

Hello to all followers of the adventures of Pat and Froggie

As you can tell from the intro, today, Tuesday, is looking up. As noted, Pat, Vi and Suanne stayed up

late last night watching "Dancing With the Stars." Pat stayed awake throughout the show and then had a pretty good night's sleep. Today Pat has put for the supreme effort and has participated in physical therapy, other activities, and stayed awake most of the day. I think she will sleep well tonight and start getting stronger every day.

At last she was able to sit up for a long time and Suanne did her hair which absolutely delighted Pat. She's thinking of getting her hair cut very short so it is easy to care for. There is apparently a service in the NIH that does this, hair care for inpatient ladies (and gorgeous women like my Sweetie, too), but, wait for it, the service isn't available because of the Government shutdown.

This morning (10/8) we had a most interesting experience. We (Vi, Suanne and I) were in Pat's room when an armed policeman (yeah, that means wearing a gun) put his head into the room and asked if this was the Trowbridge family. After a few puzzled looks we said yes, and he took Suanne and Vi in tow. They didn't come back for a while so I just assumed they had been hauled off to the pokey by the popo.

Vi and Suanne had done a simple and trusting thing. Considering that everyone at the NIH Clinical Center is already checked and has a badge, they left their ordinary, flowered and cheerful bags beside the chairs in the common area near the ICU when they came in to see Pat. Some 'good' soul saw the bags, called security, and security called the NIH Campus Police, who brought in bomb-sniffing dogs (all true) and dumped the bags out and examined the contents (benign lady stuff inside) and, after talking with Vi and Suanne, all was well. I think that Violet DeMeester hardly meets anyone's definition of a threatening individual. Here is a picture of Vi and Pat and me and Suanne, who is hard to see because she is in the background behind me.

So, we are looking at improvement. It might be slow, but we are expecting improvement. Tonight Pat seemed to be ready to rest, to sleep, and be fresh for tomorrow.

I listened to music for the first time in two weeks. It was good.

Greg

October 7

Hi, Pat's followers! Pat had some tests this morning, but overall the results were optimistic. Pat is ready to move and when the physical therapist came and made her exercise, she did all he told her and asked for more.

There are some things that may take a while to get better, but as of now we don't know how long Pat will be here. But she is smiling, and tonight she sat up for an hour and watched 'Dancing With the Stars," with her mom and sister (they are sisters-in-law, but as close as sisters) Suanne. When I went into her room to kiss her good night, Pat was sleeping comfortably, and smiling. More tomorrow.

Greg

October 6, Late

Hi, blog followers!

Pat continues to improve. Slowly, but definitely. And she is definitely tired of the ICU. There are a couple of tests tomorrow (Monday, 10/7) that will help determine how things will go over the next few weeks. Pat's labs and numbers are good, per the surgical staff. And the nurses have been good at trying to minimize the numbers and kinds of beeps on the monitors. I think she has been getting better at getting some sleep.

Last night I read Pat your blog comments and you should have seen her smile. Everyone's comments (especially about rattlesnake hunting) got very big smiles.

Pat's mom, Vi, and sister-in-law (though they are essentially sisters, in my book) are staying around to help pat get through the day (and they help me as well).

It's a short blog, but thanks so much for your comments (letters to Pat).

Greg

Saturday, October 5

Greetings to all Pat's blog followers. Pat remains off the vent, breathing on her own and just on nasal cannula at 2 liters. This is good. So far, no signs of infection. and Pat's numbers are gradually improving. She is smiling at times, and working hard to get better, doing some of her own stretches and physical therapy. Not yet walking, but that will come with time. She is also getting more of her lines out, including both art lines and all her peripheral IVs (she still has central lines).

Now ...

Go to bed tonight. Set your alarm clock to go off every 5 - 8 minutes. Have the AC or heat go on 10 to 15 times an hour. Invite the neighborhood over for a 24 hour pizza party in your living room. And when you just fall asleep, make sure one of people from the party comes into your room to fluff your bed (which is lumpy and isn't yours) and, about once an hour, to poke you in the finger or arm. That's a good day in the ICU. Pat is kind of getting tired of that routine.

But ...

As of this moment she is sleeping, and everyone is working to get her better (except the monitors, which beep at everything including passing motorists).

The shutdown continues to be a curse, but also a little bit of a blessing in some ways. The original plan was for me to have to leave the Safra lodge for a few days because of other scheduled patients and families. Not a disaster, but an inconvenience because I like to stay in Pat's room late, and the lodge is very convenient for that. But because some patients were cancelled due to the shut down, I can stay more days. That's good for me and Pat.

Pat's mom and Suanne are here, and they've been working hard too, to keep Pat comfortable and distracted a little. Valerie brought videos of the grandgirls on her iPhone and showed them to Pat. You should have seen the smile that got.

So we are planning on a bit of a stay yet. We'll keep you posted and, as always, thanks for your comments!

Greg
The good news is she can tell us how she feels, and what position she likes better

October 4

IT'S OUT!

Hello to all Pat's followers. At 9 am today the team removed Pat's ET tube. Which is good; if they hadn't, Pat was two shakes away from pulling it out herself. She's tired but happy to have it out. She has a lot to say, but we're taking it slow. The surgeons are happy with how everything is going so far. For my hospitalist followers HDVCH: all cx neg, CMP and ABGs good, starting TPN (finally!), NM scan of biliary tract 10/7, less output from JP drains.

We're encouraged and happy. Over the next 24 hours she'll get more of her lines out, and start to walk (Pat has been laying in bed doing exercises in preparation). Family is here and we're able to make sure Pat has company whenever she needs it. Now she needs some decent sleep. She is really not hurting very much at all.

Thanks for your comments!

Greg

Thursday, October 3, 10 AM

Whew! Pat came through the second surgery very well. It was shorter than the first, not so much fluid resuscitation required, and overall she seems to be more comfortable than yesterday, even considering that, as of this moment, she is 10 hours post-op. The problem was fixed, per the surgeon, and he seems pretty optimistic, and though she has a little extra hardware (couple of drains) that may be in for a while, the recovery from this surgery should go much better (as the recovery from the last one wasn't going anywhere at all, any recovery is better, by definition).

Pat is awake, tired, smiles at times, wants us to talk to her (she's still on the vent) and after the PT/OT crew came by, she is doing exercises and making us help her with range of motion, which we do gladly.

She already is much stronger than she was yesterday, pre-op. Her numbers (the ones I can see, anyway, on the monitor) look good, she has a triple-lumen IJ CVL this time which means easier blood draws and IV and med management without five (yes, count them, five) separate IVs in her arms.

She is bound and determined to get off the vent within the next 24 - 48 hours and, by golly, I think she'll do it. Vi and Suanne are here and are just fantastic to have around. Despite being sleep-deprived themselves, they are on the job, talking to Pat, reassuring her, keeping Pat's spirits up, and keeping me from going completely crazy. The docs have been good, the Physiatrist (who plans rehabilitation) was a pleasant, friendly guy who knows some of the docs I know in Grand Rapids, the surgery fellows focused and attentive but also good at keeping us informed despite being sleep-deprived themselves; the ID (infectious disease) team, well, hmm, they acted like ID docs, and the nurses are all doing a great job and are good at picking up subtle cues from Pat that she needs something. The respiratory therapist re-secured her ET tube which is now much more comfortable and as a bonus put Pat's hair up in a knot which is much nicer. Even the social workers are proactive in helping our stay go well. All in all, I am much less frantic than last light, and Pat looks so much better.

E and Froggie are feeling better too. They are perched on the back of a chair, keeping a watchful eye on Patricia.

I am cautiously optimistic. I love her very much. More soon.

Greg

Late, October 2

Hello to all Pat's followers.

My sweetie has been a brave girl. Unfortunately, there were some complications of surgery done a week ago, and Pat had to go back to the OR at 8:30 pm (10/2) and is still there as of 11:30 when I write this blog. I've been told to expect a long surgery. This time, I have backup while I wait, and Pat's mother Vi and her sister-in-law Suanne are here with me.

Pat has been aware of all of this. She is such a trooper and a strong lady, but, as you can imagine, two big surgeries in one week takes a toll on the body. But they are going to do some things to make sure she gets nutrition now and, well, we will see how things go.

Keep on sending those comments and words of encouragement. I will read them to Pat as soon as I can.

Greg

Here is the blog for whichever day of the week this is, October 1

Happy Government Shutdown Day

Pat is still in the ICU, and still getting some vent support, but we are inching closer to our goal. Pat has generally been doing well, but had a fever today and had to go for a CT scan. That was a bit of an adventure. The staff lets me help, and I went to CT with Pat to whisper words of encouragement in her ear. The nurses, as noted have been attentive and perceptive, and have done their best to keep her comfortable. She's had a good response to medications.

As mentioned, her mother and her sister-in-law are here, which gives Pat a lot of comfort. She likes to have us talk to her, and her mom and Suanne can talk to her more than I can, at least without lapsing into a discussion of Starling's principles of physiologic hydrodynamics and renal handling of sodium. They are also good for a hug, when I need one (a lot). I'm grateful for their presence.

I'm back in the Safra Lodge, it's 11 pm. It's an absolutely wonderful place, a short walk from the Clinical Center (where Pat is). It is very difficult to get onto the NIH campus after 10 PM, but I can walk to and from the CC and the Lodge anytime, so I can stay late with Pat. One of the NIH social workers, on her own, got me set up for a room in the Lodge. I love social workers.

The Clinical Center patient care areas still function as usual, but the Government shutdown has affect us, somewhat. Some parts of the Clinical Center have shut down, including some of the research areas, and the au bon pain café where I usually get coffee. I use the DC Metro to travel, as it's easier than trying to find parking and it's kind of fun. Plus, usually, I can get back onto the NIH campus pretty easily, using the visitor entrance. But today, 10/1, the visitor entrance was closed, so I had to walk about a half mile to go to the alternate entrance, and walk back to the CC. I don't mind walking, but when my Sweetie needs me, I want to be there fast. We are hoping for a swift resolution of the situation.

Thanks for your comments! This morning (10/1) I was trying to understand what Pat was trying to say around her ET tube. With a little work I figured out that she was saying 'For heaven's sake, read the blog posts to me!' She loves them, and thank you for each and every one.

Keep your fingers crossed.

Greg