July 29, 2009

Today was a "team meeting" for Gene at Kindred.

This is a weekly meeting of all the care providers who work at Kindred on Gene's case. They get together to discuss what is going on with him and family members are invited to attend. Not all of the doctors are in this meeting because they are not all actually Kindred staff, but have privileges to practice at Kindred just like many of our family physicians practice at a hospital but have a private practice as well. But all of the caregivers who have day to day responsibility for him are represented in the meeting to discuss his progress and future plans. This is a great practice!

Emily, Joyce, and Lynn attended this meeting. The wound care nurse addressed the pressure sore and the steps that will be taken to heal it. Dr. Brice who is the wound care doctor had been in earlier in the day and wanted to debride the wound again. This time it will be able to be done at bedside with a local anesthesia. Once a wound has dead tissue, that prevents healthy tissue from generating, so it must be kept clean. It is a really nasty wound, but they assured us that it can heal. That debriding procedure has been scheduled for Friday morning or early afternoon. One of the care givers also explained to us that when a person is really sick the body uses all its resources to take care of the heart, the lungs, and other vital processes, and that in the "body's priorities" a skin wound is a very low priority. The nutritionist reported that they will continue to increase the amount of his feeding. They have added a nutritional supplement called Juven which is specifically for wound healing. In addition, he is on a bed which inflates and turns him automatically; has heel boots to protect that portion of his skin; and is being watched very carefully by the nurses, but even more importantly by Emily.

Gene's vent pressure has been increased from the CPAP setting which is him breathing all on his own with just the support of pressure and oxygen to a setting that measures his breaths per minute and gives him additional breaths if he does not meet the standard. The respiratory nurse indicated that it is to be expected to have some variation in his breathing. In addition they will continue to work with him on swallowing. He will have ice, which produces a very small and slow stream of water to swallow, then later sips of water, then he can graduate to something with texture such as applesauce or pudding. He is quite eager to graduate to a cup of coffee in the mornings!

The pharmacist reported on the medications Gene is receiving. He is back on a daily Levaquin IV for infection and is on the anticoagulant Heparin. The family reminded them of his hemorrhagic stroke 6 years ago and they assured that they are watching his clotting factors very closely.

The director of infectious disease control is a Master Gardener and knows Gene from the Master Gardeners of Hamilton County where he has been active since the move to Chattanooga. It's nice to think that he has touched so many lives in such a positive way here in Chattanooga even though he has not been here very long.