My final days in ICU were spent readying me for the rehabilitation Ward. I hadn’t been approved for rehab yet, but that was my hope and the plan of my medical team.
The rehab Ward won’t accept patients with tracheostomies. The nurses in rehab are not experienced enough with the care of tracheostomies, nor do they have time. The patient:nurse ratio is far greater than the 1:1 ratio in ICU. Getting my trache out was a priority.
My swallow reflex was greatly affected by my stroke. This meant I couldn’t be trusted to get my saliva to my stomach and not to my lungs. Saliva is full of bacteria so if it gets into the lungs it can cause aspiration pneumonia. Pneumonia is potentially dangerous and being immobile and unable to cough adds to the risk.
For patients like me, a cuff is placed around the trache tube. The cuff is filled with air so the trachea is completely blocked off, stopping any saliva from getting down into the lungs.
You can see in the diagram above that there is a pilot tube attached to the cuff. This stays outside the body and is used to inflate or deflate the cuff.
To prove you are ready to have your trache removed, you need to prove you can swallow your saliva effectively and protect your airway. To do this, the nurses deflate the cuff. This opens up space around the trache tube. If any saliva goes the wrong way, the patient coughs like crazy. This tells the staff that the patient isn’t able to protect their airway and some saliva is getting into the lungs through the space around the trache tube.
Each day the cuff on my trache was partially deflated for a couple of hours at a time. Overall this went quite smoothly. The cuff plays a second role as well. By closing off the trachea completely, it ensures all the air goes to the lungs. This keeps the patient well oxygenated. When the cuff is deflated, air is able to escape up around the trache, affecting the amount of oxygen getting to the lungs. A couple of times my body wasn’t happy with the amount of oxygen it was getting. I was so dizzy and sweaty and generally feeling unwell. On one of these occasions my monitor had been turned onto silent, so the nurse wasn’t alerted. It took a while for me to blink out my concerns. The cuff was reinflated and everything returned to normal.
I continued to be taken to the Stroke Ward gym a few times a week. I’ve mentioned before that my limbs were put in slings hanging from the roof to effectively remove the force of gravity on my limbs, making it ‘easier’ to move them. The amount of effort and concentration needed to focus my brain on the appropriate muscles and initiate movement was insane.
Overall, my movements were improving. Only by centimetres, but improving none the less. My Dad wrote, “Steph has also had more movement in her right arm and leg. Whilst the increments are slow progress, to Steph they are sometimes dramatic. Yesterday for the first time Steph was able to move her right arm further than any time before and she was able to wiggle a couple of right toes. Everything is heading in the right direction and we remain positive that Steph will ultimately have a positive outcome.”
I haven’t written a lot about pain. In my memory it only lasted a short time. Reading over the journal my family kept for me, I’ve just realised that I was, in fact, in significant pain for about 6 weeks.
I can remember times that family members spent hours trying to find a position that gave me some relief from the pain in my back. They had my very cool bed moving in all sorts of ways (it was one of those beds that could move in 3 different places), there were pillows going everywhere, yet there were times there was no relief to be found.
“Steph has had a few good days since my last update. The ICU team seem to have now controlled her pain after trying various mixes and as a result Steph’s last few nights have been much more comfortable, only generally being woken to move her position which they do once or twice a night.”
In ICU I had a family member with me 24/7 who could communicate my needs to staff. I also had my own nurse in ICU so I always had help at hand. As I moved on to other wards, this would not be the case. I couldn’t move any finger well enough to press a regular hospital buzzer. I couldn’t make a sound – not a grunt – nothing. One of the ICU doctors I had seen early on, had a husband that was a Biomedical Engineer (I think). She made it her mission to have her husband come up with something I could ring/press to attract attention. This was yet another example of staff going above and beyond the call of duty in an attempt to make my life a little easier.
They tried several options. Buttons to activate with the head movement I had, call buttons strapped to my hand etc. They never did come up with a solution. I simply didn’t have enough strength to activate any type of switch/button. That’s not important- they tried.
There are a thousand little things that made my ICU stay an incredible experience. There are simply too many to write about, and many of them would seem insignificant as words on paper. While many of them were medical experiences I could never have imagined I’d go through, the large majority of what I remember most, relates to the staff. Healthcare worker who gave that little extra to make my life better. So if you work in Healthcare, never underestimate the power you have to make someone’s life better. And if your patients can’t or don’t thank you (there are so many reasons why that may be the case), never stop giving that little extra human touch. It does matter.
As my last 2 days in ICU rolled around, I became quite emotional. I had spent my entire ‘new’ life here. I knew and trusted the staff, I had a routine I knew,I felt safe. I was sad to leave the staff I had grown to love, and scared of what life in a new Ward would look like.