Tubes, holes, and pain

[J] If I had a means to quantify Marisa's mental health I'm sure I could come up with an equation to calculate it based on the number of tubes coming out of her, abnormal holes in her body, and level of pain. Her current tube count is four: central venous catheter, urinary catheter, lumbar drain (brain drain), and chest tube (lung drain). Her current extraneous hole count is five: central venous catheter, lumbar drain, chest tube, lung puncture, and brain cavity hole. Notice the correlation between tube and hole count. Her pain fluctuates between a bearable 2 up to an excruciating 9. The chest tube and lumbar drain ensure that she doesn't drop below 2. Headaches cause the 2-9 variation.

As explained in the last post, the brain drain is there to control CSF pressure in an attempt to help seal her head hole. Headaches are a side affect of reduced CSF pressure. If the nurses maintain her CSF drain near 10 cc/hour, as prescribed by the doctor, her headaches are OK. If they let it drain to fast the headaches quickly spiral out of control. The brain drain uses simple physics to control flow rate. Raise the drain reservoir, relative to Marisa's body, to reduce flow rate and lower it to speed things up. I've found that nurses are horrible at collecting good flow data. Once they've gotten their crappy data they're bad at formulating it into a logical plan (raise, lower, stay the same... it's all so complex). This, in part, is due to their inability to understand how that gosh darn contraption works. Fortunately the nurse Marisa has had most of the day today is pretty good at taking data and making good adjustments. He's going to mark the collection burette with time marks so the next shift doesn't have to think so much.

Last night was bad. Her headache pain hit level 9. Before I left, her CSF drain was operating at 10 cc/hr. Based on what I've observed today, I don't believe the nurse maintain a good flow rate. We've learned that small changes in bed elevation and Marisa's body position significantly affect flow. Last night's nurse visits were too infrequent to monitor her effectively. I've talked to the chief nurse. We shouldn't have a problem tonight.

Up until today, Marisa's chest tube has been under a vaccuum; allowing her punctured lung to remain inflated. The thoracic doctor took her off suction this morning. Two X-rays have been taken since then. The first one showed only a slightly deflated lung; indicating that she might be healing. We haven't heard what the second one looked like yet. The doctors should be by soon to let us know. Hopefully the chest tube will be out in a day or two. The morning chest X-ray was definitely the highlight of the day.

Even though Marisa didn't have any holes fixed or tubes removed her attitude has been better today. I guess it's easier to feel better on days when nobody sticks a knife in your back... literally.

Here's how I see the current inputs to the mental health equation:
Tubes: T = 4
Holes: H = 5
Pain: P = 6 (based on a time waited average of values from 2 to 9)
I'm still working on the formula.