In and Out of the Fire: The Time Line of a Refinary

This post is intentionally backdated and will be updated a day or two after the most current events.

Please note that some of these may seem to contradict each other, this is a time line of what we knew at the time. Occasionally diagnostics showed different things (especially on the mitral valve).

If I am missing anything please let me know. (And yes, I know I change voices, sorry)

Finally, the dates are also links to all the posts for that day.

Tuesday, December 4th: TJ is admitted to United Hospital ER with chest pains and difficulty breathing. An MRI showed pneumonia in the lungs, and TJ is transferred to the ICU.

Day 1 in hospital, day 1 in ICU

Wednesday, December 5th: Blog started, TJ starts to look a little bit better.

Day 2 in hospital, day 2 in ICU

Thursday, December 6th: Significant pneumonia in the left lung is confirmed as is a plural effusion. However TJ says he feels a little bit better and he is starting to look better. We are actually hoping he'll move out of the ICU by the 7th.

Day 3 in hospital, day 3 in ICU

Friday, December 7th: 650 ccs are drained from the plural effusion on TJ's left side, which makes him feel a little bit better. But the overall assessment is that he is about as sick as when he came in and the cause of the pneumonia is uncertain.

Day 4 in hospital, day 4 in ICU

Saturday, December 8th: TJ is put on a ventilator and put into an induced coma after his condition worsened overnight. The doctors are highly suspicious that he has a fungal infection from cutting trees in Wisconsin, but it will take 3 to 5 days for the cultures to return.

His NG tube is put back in, and after a chest X-Ray has a brush with death.

Day 5 in hospital, day 5 in ICU, day 1 in coma, day 1 intubated

Sunday, December 9th: 300 more ccs are drained from TJ's plural cavity, the doctors start to suspect that he has an antibiotic-resistant infection. A heart murmur is found during an echo cardiogram.

Day 6 in hospital, day 6 in ICU, day 2 in coma, day 2 intubated

Monday, December 10th: It is confirmed that TJ has MRSA, not a fungal infection. His fever rises past 102', and a TEE shows that he has a mitral valve that is leaking badly. The family publicly asks people to pray for miraculously healing of the valve. Finally, another 550 ccs are drained from the plural effusion.

Day 7 in hospital, day 7 in ICU, day 3 in coma, day 3 intubated

Tuesday, December 11th: The doctors talk about extubating TJ, then delay. A new chest tube is put in to drain the plural effusion, except this time almost nothing comes out. TJ's blood pressure starts to dip. Finally, a swan line (aka a catheter) is inserted into his sub clavein vein.

Day 8 in hospital, day 8 in ICU, day 4 in coma, day 4 intubated

Wednesday, December 12th: A chest X-Ray shows the pneumonia starting to spread to the upper right lobe, his sedation is increased, and his temperature starts to fluctuate more. His blood pressure is still low so he is put on a drug to help keep it up.

Day 9 in hospital, day 9 in ICU, day 5 in coma, day 5 intubated

Thursday, December 13th: The doctor's worst fears start to develop, TJ is put on 100% oxygen with the vent pressure turned up (e.g., no margin left), his breathing becomes more difficult, he go into septic shock, and his blood pressure continues to be troublesome. By the end of the day, however, his vitals are in less dangerous places (but still quite bad).

Day 10 in hospital, day 10 in ICU, day 6 in coma, day 6 intubated

Friday, December 14th: More antibiotics are added, as TJ is not responding quickly to what he is on. Vitals get bad, then better (better compared to really really bad).

Day 11 in hospital, day 11 in ICU, day 7 in coma, day 7 intubated

Saturday, December 15th: It is unclear whether TJ is responding to antibiotics, no major crisis for the day, but he is probably the sickest man in the hospital. His temperature is still a significant concern.

Day 12 in hospital, day 12 in ICU, day 8 in coma, day 8 intubated

Sunday, December 16th: The previous night went well and the vent settings are lowered, but TJ starts to have pre-atrial contractions and his heart rate hits an impressive 235 bpm. Shocking him doesn't work, medication is given and the heart rate comes back down, but the doctor says he honestly doesn't know whether the drop was from prayer or the medication. Finally, he fever fluctuated between 99.7' and 102.8' during the day.

Day 13 in hospital, day 13 in ICU, day 9 in coma, day 9 intubated

Monday, December 17th: A new TEE shows the mitral valve leak to be moderate instead of severe now, the O2 was lowered to 60% during the night, giving TJ some margin. Both lungs are significantly inflamed, TJ has ARDS, and the doctors are looking hard for the source of the secondary infection.

Day 14 in hospital, day 14 in ICU, day 10 in coma, day 10 intubated

Tuesday, December 18th: A new TEE shows the mitral valve to be practically just fine [ed: a later one would fall in between "dramatically" leaking and "just fine"], temperature is better than it has been, and sats are ok, although the vent settings are still pretty high. Highlight of the day: no major crisis.

Day 15 in hospital, day 15 in ICU, day 11 in coma, day 11 intubated

Wednesday, December 19th: Nothing major changes, the chest tube is removed because nothing is draining, the medication to control the heart rate is cut in half and things stay ok. Highlight of the day: another day without a crisis.

Day 16 in hospital, day 16 in ICU, day 12 in coma, day 12 intubated

Thursday, December 20th: The vent settings are turned down, the doctors say he is making progress in the right direction but is still very sick, his lungs still have major infiltrate but it is not increasing. His temperature is better, but this is with Tylenol and a cooling blanket. The doctors start to talk about extubating.

Day 17 in hospital, day 17 in ICU, day 13 in coma, day 13 intubated

Friday, December 21st: TJ's chest starts to look better, still slow progress in the right direction. His sedation is lightened but he isn't waking up quickly. He is weaning off the vent quite well.

Day 18 in hospital, day 18 in ICU, (not in coma, but not really awake day 1) day 14 intubated

Saturday, December 22nd: While TJ is still weaning well, his slowness in waking up becomes a concern. Moreover, it is discovered that he has a massive blood clot covering three veins, including his jugular, sub clavien, and one in his right arm. These are all places where the PIC line (aka catheter, swan line) were put in.

Day 19 in hospital, day 19 in ICU, (not in coma, but not really awake day 2), day 15 intubated

Sunday, December 23rd: TJ's vitals are still ok, he is looking responsive, but nothing that would qualify clinically as responsive (e.g., following commands, speaking, etc.) The cardiologist says he isn't too concerned about the blood clot; they are seeing more of these with the catheter lines. By the end of the night the fever is under control for the time being.

Day 20 in hospital, day 20 in ICU, (not in coma, but not really awake day 3), day 16 intubated

Monday, December 24th: TJ's fever rises again, he has a spinal tap done, but his other vitals are ok. After taking him off all pain meds he becomes more alert, but soon has to be put back on one of them.

Day 21 in hospital, day 21 in ICU, (not in coma, but not really awake day 4), day 17 intubated

Tuesday, December 25th: Still slowly getting better and appearing more alert, but not following any commands. Spinal tap results were negative as expected, ENT doctor doesn't find anything, vital signs are good expect that his blood pressure is still being maintained by medication.

Day 22 in hospital, day 22 in ICU, (not in coma, but not really awake day 5), day 18 intubated

Wednesday, December 26th: TJ is finally extubated. Again, looking more alert (half smiles, many eyebrow raises, even more dirty looks at medical staff that keep bugging him), the doctors think that the fever (which is still a problem) is due to the blood clot.

Day 23 in hospital, day 23 in ICU

Thursday, December 27th: TJ won't follow commands for the doctors, but will occasionally for Mary Ann. He appears to understand the news on CNN, and is on a small amount of O2. Finally, he can sit up by himself -- for 15 seconds.

Day 24 in hospital, day 24 in ICU

Friday, December 28th: The speech pathologist is afraid that TJ has apraxia, he still isn't becoming alert as quickly as he ought to be. However, it looks like TJ has "ICU jet lag" (Jon's term), as he is staying awake during the night and either sleeping or groggy during the day as a result, making it more difficult to judge his mental status .

Day 25 in hospital, day 25 in ICU

Saturday, December 29th: TJ slept part of the previous night, and actually nodded to a nurse's question. His sats remain pretty good, despite being on a low amount of O2 during the day and a CPAP at night.

Day 26 in hospital, day 26 in ICU

Sunday, December 30th: TJ barely slept Saturday night, but the doctors were optimistic and he focused very intently on some pictures he had taken in Hong Kong as a child. Vitals remained good, and temperature more or less under control.

Day 27 in hospital, day 27 in ICU

Monday, December 31st: TJ is very tired but is finally able to croak out "Mary Ann," as well as non-verbally communicate. The doctors make plans to move him out of the ICU the next day.

Day 28 in hospital, day 28 in ICU

Tuesday, January 1st, 2008: TJ slept poorly, but his sats and blood pressure dropped over night and he was put back on oxygen for awhile, effectively postponing the move out of the ICU. His white count was elevated, and midnight spiked his repository rate and heart rate, but came back down on their own.

Day 29 in hospital, day 29 in ICU

Wednesday, January 2nd: TJ was able to sit up on the edge of his bed for ten minutes on his own, and stand for twenty seconds. He successfully managed to say four words ("I love you too"). Finally, his white count started to come back down.

Day 30 in hospital, day 30 in ICU