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.