Under Pressure

Jenny here.

First the improvements:  he ate an egg today!  And pushed himself hard in PT (rolling himself down hall in wheelchair).

It was a really hard weekend for our favorite guy. Although the steroids ended last week and liver numbers are not worse, the weakness, slurred speech, disorientation, confusion, and now increasing agitation are wrecking havoc on mood and sleep. He is often begging and pleading and angry about almost everything. He is no longer getting all his mental status questions correct all the time. Today he thought it was 1992. He is still eating very little. He now has a catheter to reduce falls and accidents.  And overnight we hit a new level of care:  he has to have sitter or loved one in the room at all times because in his agitation he won't wait for help out of bed.

The team feels that the liver, along with paradoxical medicinal effects, is the cause and he needs to come off most meds, including a blood pressure med, so we can try to detoxify his system. If his body holds on to the toxins they have an option 2... A drug that will quickly clean him out in the form of diarrhea. We are crossing fingers it won't come to that one, especially since he is not very mobile.

Mood wise, if you know him, just imagine all opposites. Angry. Impatient. Demanding. Overly verbal. Defiant. When he is sleeping I can still see glimpses of the guy I know is still there. But in his awake state he is so very different at times. Like a 4 year old tantruming on a long distance road trip. It's sad and frustrating and sometimes comical. Yes. Comical. He gave his PT a hard time, complaining and saying he was done with her. She replies "I'm a bad therapist, huh?"  Without missing a beat he says, "that's ok.  I'm a bad patient" and smiled a little. He keeps trying to pull out all his charm to get what he wants (usually something dangerous).  When he is told no he does everything but give them (and me) the finger. Just as suddenly he can turn to me and tell me he loves me. He says all this up and down of moods makes him feel so crazy. When he's panicked I have been trying to use anxiety grounding techniques I use with clients. It works. Until he says " hey, I know what you're doing now."  He's too smart for his own good.

There is no discharge plan. The docs said we would give it a few days here to get him off drugs and lower confusion and then reassess safety and a plan to discharge. Wil has alwyas said he was unique.  We just didn't expect that medically he would be SO unique.

Today:  We moved to a new room (812) that is across from the nurses station so they can hear him and his bed alarm if he tries to get up. They are working on his potassium levels and discontinuing meds they think are causing the disorientation. An eval from  psych is scheduled to help address agitation with a med that will have less side effects.