Day 45 - 45 days, just wow

45 days in ICU: That's like a month and a half. We're about to change seasons. Time passes quickly as the days have blurred from one to the next. When did all that time pass? In some ways I can totally feel each one of those 45 days, in other ways it feels like both decades and a mere few hours since the accident on January 25th.

Daniel completed a lot of activity yesterday - I think we took him over a point of being comfortable into a place where he could not get real restful and it might have even effected his sleep last night. We discussed during rounds that his heart rate goes up when he's not resting  (I've talked a lot about that the past two days). The team postulated that his pain meds may be a bit less than what he needs to function and be comfortable now that we've ramped up our demands for him. Rather than just limiting him to little boosts when he's working we decided to increase his baseline so that he can do all that we are asking of him. Then still boost pain meds if needed. We'll know in a few days time if that's the right solution.

Every day we eat in the lunch room cafeteria at the hospital. We've started to notice some trends that are like every other lunch room in America; whether it's at a middle school, large corporate office, or any other lunch place, it's all the same. We bring our lunch daily because our friends and coworkers have been so awesome and generous and supportive with providing meals. Thanks everyone!

Some things I've observed about our cafeteria is that:

• A LOT of people buy and eat their lunch here in the main cafeteria. It has a rush hour that goes from 11:30 to 1:30 when most tables are occupied. Mornings are busy too for breakfast foods.
• Patients in gowns will eat here too. Sometimes they even have IV carts in tow. A topic in one of the burn survivor meetings was about the stares you'll get from people when they see your burn scars (if visible) out in public. The burn survivors explained that they had to get over that initial feeling of being stared at and had to have a quick story to explain what happened because they learned they get asked that a lot after the blank/frightened looks from random people. Luckily Daniel doesn't seem to care or be aware of what other people think AND he doesn't talk so there ya' go. No worries.
• When the weather is bad outside, the cafeteria is PACKED.
• Not many visitors bring their lunch regularly that we've seen. I believe there aren't all that many visitors that have been here as long as us and coming every day. Perhaps they eat lunch at other times than we do or go out to get away from the hospital for awhile. I might be missing them as they don't stick out as much as scrub-wearing staff.
• Lots of hospital staff DO eat in the lunch room - they are easy to spot because they are all wearing some color of scrubs: dark green, blue, lime, maroon, lab coats, doctor coats, some with hair nets, some with stethoscopes, lots of old-school pagers.
• Caste system - among the staff, it's rare to see people of different colored scrubs eating together. Is this some kind of twisted self-imposed segregation? It's not too different from the preppy kids sitting apart from the jocks, who aren't hanging out with the drama nerds, or the chess club members. 
• Timing your arrival to use the precious microwave oven is key. With only two microwaves accessible in the cafeteria the kitchen makes it harder (on purpose) if you do need to heat your food. (I think the middle school where I work has at least two microwave ovens in it for many fewer people).
• The menu in the cafeteria is quite varied. You might think there would be ONLY bland and boring healthy food, but you can get pretty much anything there. French fries, soda pop, chips, ice cream, donuts - yup! Of course there are foods one considers to be more healthy too like a grilled chicken breast, salad bar, sushi, vegetable side dishes and such.

Moving on... Daniel ate some breakfast this morning, but Dawn did the feeding this time instead of encouraging Daniel do it since it was right after wound care and he seemed pretty out of it. He ate everything we gave him and drank a lot of juice and water too. Daniel has started to move his arms IN like the skin on his chest is tightening. The OTs will begin to do some scapula stretching to help with this.

After a nice break Daniel's OT came in and made some adjustments. She wants to keep Daniel's arms spread so that he doesn't hunch up and pull his arms into his chest. We will need to "Remind" Dan to keep him from pulling his arms in, which won't be easy - he's wanting to do this all the time now. I hope the pain meds help him to relax through this. He is also bending his elbow too much so they want him in splints at night to keep the elbow unbent.

Right after her visit the ST's came in and tested his swallowing and deemed him worthy of advancing to level 3 - which opens up the menu of foods he can have and he can drink any fluids without thickening. They are also concerned and want to keep his mouth/lips to be stretched due to the grafting around his chin/throat. They brought in a middle-age torture-like device (think Clockwork Orange sort of on the mouth not eyes) that spreads and keeps his lips wide and stretches the skin around his mouth. Luckily or not depending on who you are, they couldn't get the device to attach to his head without harming is burned ears so they ordered something different that is also a lip spreader, but it just pulls the corners open. It's called an MPA. You can make up your own definition for that acronym where P might stand for "pain".

Just after the ST's left it was time for the PTs to do their own form of torture on him. We got Daniel standing. He got up from the bed on his own, stood up and did a little shifting then we started walking without little support from us. We walked to a new place on the burn unit - the gym!

In the gym we sat for a few minutes to catch our breath and bring the heart rate down. Then Daniel went up a set of stairs and back down to practice stair walking. After that we set up some pedals and had Dan practice some pedaling with his feet. Then a short break and then we had him pedal with his arms. All the while he was looking really wiped, but he did it all! Then we walked back to his room and landed in his chair. We sat for a bit then began to eat lunch. He was super thirsty and drank down some water and a pepsi. He sat in his chair for a total of 30 minutes or more and finished his food. Then we finally got him back to his bed to some well-earned rest.

Big day. There's more ahead this evening, but I'm done with today's post!

Bike ride home, then a massage then maybe a drink!