Thursday, April 9th. Obituary

You can read Rich's Obituary at nwfdailynews.com or heritagegardensfuneralhome.com

Funeral Arrangements

This is just not how our trip was suppose to end, but sadly it did, and now we just have to go on.  Rich's funeral arrangements are for this Saturday, April 11th.  Visitation is from 10:00-1200.  Service at 12:00 and burial to follow.  All will be at the Heritage Gardens Funeral Home and Cemetery in Niceville, FL   Address:  2201 Partin Dr N, Niceville, FL. 32578.   Phone, 850-729-1955.   If anyone wants to say a few words about Rich at his funeral, please feel free to when the Chaplin asks.  The out pouring of love, prayers, hugs, kisses, and the kindest emails, texts, and phone calls has been staggering, loving, and something I will always cherish forever.  I knew what a special man I married, I just never guessed how special he was to all of you.  For those of you who are able to attend his funeral please join us for some comradriere following the burial, at the American Legion in Niceville.  Address:  444 E John Sims Parkway,
I love you all so much throughout this painful journey.  I will have to spend the rest of my life being  "a Mother Theresa"  to pay forward all of the love, and kindness you have bestowed on Rich and I.  For those of you who only started the blog during the bad times, if you are ever bored and want to read the good times please do at Nicevilleyc.org  
All my Love and Gratitude to all of you who helped carry me through the absolute worse time of my life, I will be forever grateful.
Love,
Kathy

Monday Morning, April 6th

Time of Death 6:16 am.  Rich maxed out on his vasopressors to keep his blood pressure and went into asystole (no heart beat) as expected.  Funeral arrangements pending.

Easter Sunday, April 5th

Well today they increased his Levophed to 52 mcg to maintain his blood pressure and that was only keeping it in the 80-90 range.  The fellow re-inserted the dialysis catheter and dialysis was started.  I was able to visit this afternoon with my nephew Jason, niece Caroline, met their 2 adorable children Emma and Jake, and Caroline's parents who were visiting from Puerto Rico.  Later, when I was in Rich's room tonight reading emails to him that came in today, his nurse rushed in and started trying to get a pulse in his wrist and a carotid pulse.  This was around 7:15 I think.  Got the Doppler and called for the medical team.  She could not get a pulse, and so the crash cart appeared, and I was asked to leave the room.  He was in Pulseless Electrical Activity (PEA), which was caused by acidosis.  They got him back with epinephrine and sodium bicarbonate and CPR.  You cannot shock PEA.   When I returned to the room, he was now on 100 mcg of  Levophed .  After calling family and speaking with the doctor who ran the code, I was in direct conflict with myself as the nurse and as the wife.  We had talked about giving Rich the benefit of the doubt by allowing him to code one more time and then changing code status to medication only.  Easier said than done.  I decided to watch and see how he was doing, when around 9:15 I looked at the monitor and now his heart rate was 59 and some weird rhythm.  I called his nurse in the room.  He checked for pulses, but they were extremely weak.  Next thing I know the medical team and crash cart are in the room, and I am out in the hall again.  They brought him back again, with CPR and meds.  Now in his atrial fib.  Blood pressure still extremely low.  Eyes reacting very slow and pupils dilated in a well lit room, although they are wandering.  I then decided that it would be so unfair to Rich to keep coding him through the night, in light of all of his other horrific issues, so told the doctor that I wanted a medicine code only.  With his previous brain injuries, this coding was just adding fuel to the fire.  Right now it is 11:45 pm,  his blood pressure is 69/43 on 94 mcg of Levophed.  Believe it or not he is in Normal Sinus Rhythm  at a rate of 70, so for now the 2 meds to decrease heart rate have been discontinued.   The doctor said they would continue to increase the Levophed up to the max of 160.

Saturday, April 4th

A day of major setbacks.   Arrived to find that the vasopressor Levophed was up from 8 mcg to 25 mcg/min to maintain his blood pressure.  Pretty high.  Heart rate high too.   By the end of the day Rich was on 2 IV meds to lower heart rate, and 2 to maintain his blood pressure.  Apparently earlier in the day he had a fever.  When I felt his head I thought he seemed warm, but by this time he was down to 99.9 temp.  So the doctors ordered more blood cultures to see if he has a new infection that is not coverd by the antibiotics he is on.  It is like going through the sepsis drill all over again.  Kidneys starting to fail again.  Creatinine up to 3.4 and BUN 97, both bad.  Signed a consent tonight to insert another catheter for dialysis.  They did an ultrasound of kidneys looking for more clots/dead tissue, don't know results yet.  The weekend pulmonary fellow and ICU resident were absolutely awesome, they get A+ for family skills.   They know the gravity of the situation, but willing to do whatever the family wants.  They are not sure if Rich's heart can take another assault, and feel that the clot by his mitral valve may still be showering his organs with debris (clots).  Just don't know what to say.  The only good thing that happened was a friend of ours (we are the godparents of his twin daughters) and his wife stopped in to see Rich tonight and we had a nice visit.  They are just now moving to Miami.   I hope Rich knew Terry was here,  and how much Terry loves him.  I tell Rich each day about all of your emails and well wishes.  And I tell him often, not knowing his mental status.  Have to say today he was in sleep cycle, but when one eye open and he was staring straight ahead, I asked him to look at me and he did, and appeared to focus on me, followed  my voice etc.  So not sure about anything.  When his eyes are wandering, I am pretty sure that is really just reflex.

Friday, April 3rd

Up and down today with the blood pressure and the Levophed .  Rich was in his awake phase most of the day.  Told him how many friends he has that have been sending hugs and well wishes.  Went over where he is, what happened, where the boat and dogs are.  Reviewed how we met, every place we have ever lived and what adventures and people we met at those locations.  Went over the fun we had on this past cruising trip.  Although the doctors would argue with me, I think he did focus when I was talking to him.  Yes his eyes would wander in between, but he seemed to try.  The doctors are there for a few minutes, I am there for hours.
One of our really good friends, Marcee Cook, did something very nice for Rich and I.  She asked me to pass it along to you.  She opened an account on  Gofundme.com/qs7yrzc       I am strong, independent, and have a hard time accepting the generosity of family and friends.  However, that being said, my Rich is Dutch and very tight as many of you know, so he would probably appreciate every penny.  I also know that for some of you who feel helpless, it feels like you are doing something, and you are.   So thank you so very much, but do not feel obligated to contribute.  We love you all the same and prayers are worth millions to me.  Also, for those of you who have sent comments on the blog, I have received them, I just can't figure out how to answer back, so if you want an answer please use our email.  Rikava2@aol.com    
I feel like a little girl who needs her Mom to make it all better.  Unfortunately my Mom does not have the mental capacity to help me anymore.   Thank you all for being there for Rich and I.

Thursday, April 2nd

Still on the Levophed today, but decreasing the dosage, maintaining blood pressure 96/58 on 6.6 mcg.  Changed antibiotics to Meropenem based on blood cultures.  Changed PICC (peripherally inserted central catheter) from right to left arm, just to prevent infection.  Seemed to be in sleep cycle until about 2:00 pm today.  At 6:30 pm back to sleep cycle.  Nurses say he does respond when getting moved or ointment in eyes, and they can tell he does not like it.  All in all a quiet day, and that is alright to me.