Day 6 - Surgery Day #2

By all accounts Daniel had a good day yesterday - Sunday. We were with him most of the day and into the evening.

He went off CVVH dialysis (I think Saturday night - days are running together) and stayed off. His blood pressure has been pretty good and they've been able to keep his pain meds low. Dan is bleeding out of his wounds and that has required a few extra units of blood over the course of the weekend - all a result of the first surgery. This may be a recurring "thing" over the course of the MANY surgeries he will have - what with having no skin to hold in the fluids & blood I suppose. Fluid loss is enormous with burn patients - they lose through exhalation, urine, perspiration and the weeping of his open wounds covering his body.

We learned what the calorie intake is (approximately) each day for Dan - want to guess? It's a lot higher than I would have imagined, but since he's doing that whole marathon thing each and every day I guess I shouldn't be all that surprised... I'll leave you in suspense until the end of today's post... (hehe)

Today (Monday) Dan seemed calm in the morning. We met with his OT again as she worked his fingers, wrists, elbows, shoulders and even got to his neck. Dan seems to favor leaning his head to the left where the airway hoses connect to the breathing machine next to his bed on the left side. He's been laying mostly that way since day one except for when nurses turn him and use pillow wedges to help prevent bed sores. With some help the team got Daniel's head to be more straight for a change. I can't imagine the neck aches and "kinks" a conscious person would feel from such an extended time in a single position so it's a good change to keep adjusting him even if he favors and keeps moving to a preferred position.

After working his joints and doing some simple motion exercises Dan's OT reinserted the large foam arm wedges that will become a common aid in his recovery. He's in a sort of modified airplane pose with both arms (if he can handle it) out at his sides to stretch the skin, tendons, muscles and shoulder joints and prepare for new skin that will want to tighten as it grows back. With burns as bad as his in his armpits and along his arms and sides this is a vital part of therapy even at this early stage. Two hours in this position, then a bit of a rest, then two hours hours back.

I think from all the OT activity he received in this morning his blood pressure dropped a bit so they gave him some medication to force his PB back to an optimal level. They say in burn victims that low pressure is like robbing the heart, kidneys, liver and his body overall of what's vitally needed to help heal so they are always watching it closely. 

Another thing they monitor is his urine output. They've explained that in any patient (elderly especially) if their urine output is good then many other things internally are going to be okay. Low urine output is a signal to the observant caregiver and you need to start looking at what's going wrong or about to go wrong.

Dan has some fluid buildup in his left lung they keep monitoring by x-ray and with cultures. They got a sputum sample from deep in his lungs (which by the way he does not like giving!) and waited for the culture to develop to identify if there was bacteria making for pneumonia - common for burn patients spending days immobile in bed. They have samples from his skin and blood and suspect all will be a similar form of a Staph infection that they are treating with an antibiotic tuned for that strain. With so many wounds across his body it's possible to be bacteria and infections from different strains all at once in different areas. They cover all the burn areas as a matter of course with burn-net (a fine mesh) that is treated with many bug-resistant tools including silver, bacitracin and medi-honey.

Daniel was scheduled for a midday surgery that could last for four hours. He didn't get started until 3pm so as I write this half-way into his surgery I wait for word and to rejoin him in his room. A few more hours to go.

While he was in surgery I walked around the grounds - it's big. There's the innerds of the hospital I have yet to explore, but I got outside today because the sun was out and it's good for the soul. I walked about the campus (it's a medical university after all). So this entire property has some history being a military base originally and I think it's about a square mile on each side. Under construction on the east end is the VA hospital (ya that one that's had cost overruns and been in the news), but I didn't get over that way. 

Instead I weaved through the research buildings, ventured into a few buildings with classrooms and even found a student art gallery. Nearly every classroom, lecture hall, meeting room and study hall had students in it. Away from the hospital this is a busy place. I walked around the research labs and offices fascinated by their areas of study. Office after office of PhDs, Post Docs and lab rats working and doing research. You might call this area of the campus a brain factory and you wouldn't be wrong!

I found a few floors in other buildings that had some really comfy chairs and read a few pages from a book to escape the daily concerns of a worried parent with his boy in surgery.

As I've typed this over the past hour I still wait for Daniel to come out of surgery so I'll end here for today. I'll update with how the surgery went and what's planned beyond in tomorrow's post. But as promised here's the answer to what are Daniel's daily calorie requirements each day while he's here in the burn ward... drum roll... so it's roughly 5,000 Calories!!!! We may fatten him up yet!