BIG Morning, Quiet Day

We got up this morning and Seth called in to Alistair's nurse. She said he had a good night and they were making preparations to possibly extubate him today. We decided not to make it in for rounds as yesterday rounds were pretty much outside the the room and didn't include us. The weekday crew has a much different feel than the weekend crew...a little less touchy feely maybe? We arrived shortly before 9 and hung out. The nurses said we were working toward extubation but to get there he had to get less sedated and more awake to follow directions. So they started to ween him pretty much off his sedation and very low on his pain meds without making him uncomfortable. Occasionally they would try to wake him and get him to open his eyes. He would follow directions such as squeezing hands, smiling, shaking his head, but opening eyes seemed to prove difficult. I think those lids are pretty heavy right now! At one point the attending came in and asked Alistair to give her a thumbs up with his left hand. We waited a minute and then his left hand moved and his thumb twitched a bit and slightly rose. We were impressed that he even got the left side! But the other directions he got took him too long to do, so they decided to give him some more time. A little while later she swung by to check on him and we talked about how he had squeezed hands, and kind of shook his head in response to questions. She then asked for a thumbs up and he solidly put his thumb up and lightly lifted his hand. She felt that was sufficient and gave the orders to pull his tube.

We had been hearing stories about how rough extubation can be, how people can react and how much support they need to calm down. When they got ready to pull his, we steeled ourselves for the worst. They pulled out the tube and he barely flinched. I was relieved to not experience what we had heard and that it was easy. Alistair has had A LOT of narcotics and pain meds since Friday so getting him out of this sleepy state and into full consciousness is going to take some time. He spent the rest of the day in a drugged out stupor. He was somewhat interactive in that he would occasionally slightly open his eyes or move around. He would follow directions when asked...squeeze my hand, smile, thumbs up. At one point I was standing at the foot of his bed and he opened his eyes. I said Hi to him and told him I was waving at him (with both hands) and asked him if he could wave back. He was a bit delayed but then lifted both hands up and weakly flopped both hands up and down and waved back at me!

We did have some excitement this afternoon. Alistair's heart rate began to rise and his rhythm began to get off. We had half the cardiology department in our room along with a couple of respiratory therapists on stand by ready to bag. They ran some EKG's and pushed some medications as well as did some temporary pacing through his temporary pace maker wires. In the end they decided his abnormal rate was due to the trauma on his heart due to surgery and that it was just taking it's time to regulate. But for a while I was praying we wouldn't have a repeat of Friday!

We are hoping for more of an interactive day tomorrow. We just called into Alistair's room and his nurse has the All-Star Game on for him. He said Alistair is still out of it, but every once in a while turns his head toward the noise. We are hoping his night is restful. But we mentioned if he wakes up in the middle of the night and asks for us to call us and we will be there in a flash!