Many folks have heard of the auto accident that occurred when 1998 Western V.P. Bob Gravance and family were returning from the 1-26 Championships in Elmira. Bob's son, Jack has been sending updates on the family's condition via email. Since some you you out there aren't registered with the email List Server, I've decided to try and keep this page up to date with the latest information. If anyone has anything to contribute, please email it to me. Our thoughts and prayers for a speedy recovery go to the Gravance family.
Here's the latest...
February 16, 1999
Well, this past week has been a big one for the Gravance Family! As we mentioned Bob got his cast removed last
Tuesday. He is hobbling around quite well just after a few days, using his crutches and his walker mostly. He
gets to and from the car and around the house regularly and is pretty steady. Bob’s older brother, Gene, and
his wife Ginne are here visiting from Pennsylvania, as well as his mother Esther from San Jose area. Martha,
daughter of Gene and Ginnie, will be here today. A good friend, Vern Hutchinson, was kind enough to give Aunt
Ginne her first glider ride Sunday, they stayed up 40 minutes, and landed with her wanting more! Then…Vern
landed the glider at the other end, and sent me to get Dad for his first glider ride since the accident. Dad
expressed concern about getting into the cockpit, but didn’t complain about being too tired, so Dad and Vern got
a 1 hour and 10 minute flight on the shearline. Additionally, Dad flew most of the flight himself, though he
insisted that Vern do the takeoff. Dad’s first comment on landing, with a great big grin on his face, was
MARVELOUS! Dad’s right foot was rather sore from using the rudder pedal. He can’t fit a shoe on that foot yet,
it is swollen and still has some wounds that need to heal, and the rudder pedal is a series of horizontal tubes
connected by vertical tubes. Not too comfy! The other great news, that Dad shared with us on the way home, was
that he was seeing with single vision, as opposed to double vision, for about half of the flight, especially
when he focused at a distance. We think that this is a good sign towards his eyes getting back to normal. We
are keeping our fingers crossed.
With respect to Dad’s cognitive abilities, about two weeks ago he gave me a refresher on how a constant speed
turb-prop would operate for different performance settings. I also have to be careful how I word this because
Dad is fully up and running on his own e-mail now and he gets a copy of this, and he is starting to get feisty
again! He reads his e-mail regularly and shares them with Mom, they appreciate everyone’s kind notes. Mom is
doing well and getting around great.
Happy Skies!
Daughter Elise
Here's the history...
July 17, 1998
Bob, Lee and grandson Brian Gravance were in a vehicle
accident on 10 July 1998. Brian received minor injuries, Lee has a broken bone
in the shoulder, Bob is in critical but stable condition. The accident
occurred in Nebraska, while they were returning to California from the 1-26
Nationals (a glider contest) in New York.
Brian was treated in the emergency room, receiving
stitches for some cuts, and later crutches for a twisted ankle. He was not
admitted to the hospital and has returned to California.
It was initially thought that Lee's shoulder would
require surgery. Later cat scans revealed the socket was not broken, so they
have decided to allow the arm bone to heal with immobilization. She has her
full faculties and is in as good of spirits as can be expected. Other health
conditions had led her to the use of a walker in recent months. Now with the
broken humurus she can't get around. She is currently undergoing multiple
sessions daily of physical therapy.
Bob suffered two broken legs, a bad concussion, tissue
and ligament damage to the right hand/arm and various lesser injuries. He is
also ill with pneumonia, which he had contracted several days before the
accident. The right leg was a compound fracture, and Bob had three surgeries
on it in the first five days. His vital signs are solid and he weathered the
surgeries well. He has been under heavy sedation and has not regained his
consciousness since the accident. They have reduced the sedation and we are
trying to get him awake.
We can be reached at:
-
Good Samaritan Hospital
10 E. 31st
Kearney, Nebraska, 68848
(308) 865-7100
If you have e-mail and would like to receive periodic
updates, send us your address at Gravance_central@yahoo.com.
July 20, 1998
Bob is still in the ICU in critical but stable
condition. Late last week they started lowering the sedation level and trying
to awaken him. On Saturday there was an episode where he "fought"
with the respirator. They took another x-ray of the lungs, which was similar
to the previous one taken. Based on the above and other indicators to them,
the doctors have made a new diagnosis of Acute Respiratory Distress Syndrome
(ARDS). It means the lungs are damaged; it could have been caused by several
factors (trauma, pneumonia) all of which Bob has experienced recently. No
matter the cause, the therapy is rest and hope for the lungs to heal. So they
have re-sedated him for 1-2 weeks. Lee was moved to sub-acute care over the
weekend. The fracture in her arm will require 6-8 weeks to heal. She is doing
well at her several sessions of therapy each day, and has a new walker that
requires only one hand for use.
July 21, 1998
Bob's condition is the same, which is good. We don't
expect to have anything to report on him for at least a week. He is sedated
and sleeping. We are hoping for the lungs to heal.
Lee is making excellent progress. She is taking her
physical therapies seriously and doing more than the therapists are asking
for. Yesterday she walked 130 feet with the new walker. She has been walking
from her room to the dining room each meal. She spends the day up and out of
her room, rather than lying in bed. I am really proud of her.
July 22, 1998
Status remains the same. Thanks to everyone for the
thoughts, phone calls, cards, emails, offers to help, etc. It is truly
appreciated. I am staying in the hospital hotel, room 5. You can direct dial
there, saving long distance charges if I'm not there to pick up. (308)
865-7865. We expect Mom to start staying there early next week. Currently she
is in room 347, but she in not there much during the day, so try in the
evenings if you want to get her (same for me in room 5).
July 23, 1998
Bob's status remains the same.
Lee is getting better every day. Today she, Jack and
Val (hospital staff) went shopping. The primary purpose was to get her shoes,
and pull over style dresses. The shoes are required because her feet are quite
swollen from the accident and Dr McGowen (her and Bob's orthopedic surgeon)
has diagnosed that she has a pre-accident condition of drooping left foot when
she walks. He has prescribed a plastic brace (an L shaped thing) that supports
the foot; the shoe is required to hold the brace in place. One of the
therapies Lee receives is "dressing" which means learning how to get
you clothes on and off. She can currently pull blouses over her head, but
can't pull pants/skirts up. Thus the need for pullover dresses.
Lee also has been diagnosed with another pre-accident
condition.
Several days before leaving on vacation, her neck
started hurting. Dr. McGowen has diagnosed it as arthritis and has prescribed
a set of neck exercises. We are going to get this 68 year old woman in shape
yet! I'm surprised nobody has asked about HOW the accident occurred. I'm sure
at least one person is curious. I presume everyone was polite and assumed we
didn't have time to report (which is accurate!). But today I have time. They
were westbound on I-80, a four lane (two each way) divided highway. It was 45
minutes past midnight. They were in the motorhome, with the glider and trailer
in tow behind. A semi- truck was closing from the rear, and by his report, he
didn't see the glider/trailer. As he looked in his rearview mirror to clear
himself to pass, he ran up and onto the glider/trailer. The semi, glider and
trailer broke loose from the motorhome, and slid to a stop on the right side
of the highway, with the semi on top of the glider/trailer. The motorhome
exited the roadway to the right and ended upside down. The top shattered,
Brian was thrown clear, Mom and Dad were seatbelted in the front seats,
underneath. The trucker was not physically injured (I am glad of that, his
being injured would not make my family better).
July 24, 1998
Yesterday I gave you a brief description of the
accident, everything in it factual as far as I know. I have heard/read a few
times that the motorhome rolled 2 or 3 times. I don't know if that is factual.
It did end up inverted.
I give you the above paragraph as a set up to further
describing Lee's injuries. In addition to the fractured arm, she is bruised
everywhere. I have never seen anyone with as many, or as large. Although Bob's
injuries were much worse, he is not bruised as much.
All week I have told you that Bob's condition is the
same, critical but stable. Some of you have interpreted that no negative
complications over two weeks is a good sign. That is accurate, but negative
complications could occur at anytime. One of the doctors told us several days
ago that it was a good sign, and that if he didn't have kidney or liver
failure, the doctor thinks he will make it. I interpret this as his letting us
know that these are possible complications for a patient in this condition, so
we will be prepared.
Today I can report to you several positive things,
within the framework of critical but stable. Yesterday I spoke with Dr.
Cantrell (Pulmonologist) for the first time. He is encouraged that no negative
complications have come up, he specifically mentioned the liver, kidneys and
other organs are all doing well, Bob's vital signs are solid, and the
pneumonia is gone or nearly gone. I may have used the term respirator in
previous correspondence, but I have since noted the machine that helps him
breathe is called a ventilator, I don't yet know if that is the same thing. I
have been learning how to read the ventilator, Driprivan (sedative) and other
monitors. The last two days, all of the readings I monitor have been
improving. I confirmed this with nurse Julie today. Despite my engineering
background, I submit the following numbers without the units. Sedative (an
input) reduced from 65 to 60 then 55. Oxygen percentage (another input)
reduced from 50, to 45, to 40, to 35%. PEEP (another input) reduced from 10 to
7. The fact the can reduce these inputs and his respiratory system tolerates
it is an improvement over last Saturday. Peak airway pressures (an outcome)
were 40 when I arrived, 50 on Saturday, 40 earlier this week, then two days
ago 30, then that afternoon/evening 24, yesterday high teens, today mid teens.
SPO2 (an outcome) which earlier this week would drop below the desired 90
minimum without sedation/morphine are no running mid to high 90's (on the
lower inputs). Mean airway pressure has dropped along with the peak.
July 25, 1998
Status today is pretty much the same as yesterday. I
don't have internet access on Sunday, so you will next hear from me on Monday.
I don't expect them to try and awaken Bob this weekend.
Lee gets stronger each day. Although there is no
therapy on the weekend, she continues to do her exercises. Sons Mark and Jack
stood by to make sure she didn't lose her balance on the exercise set that
requires her to stand. She also walked a circuit which she had done the
previous day with the physical therapist.
I know you want to hear all these details; the other
day when I told you about Lee's briuses, I forgot to mention her swelling.
Both feet are swollen, and the left arm from the shoulder to the fingers. When
first measured in my presence (about four days ago) the left arm was 4 inches
larger in circumference than the right. One of the therapies she receives is
lotion and rubbing the fluid towards the shoulder. The following day the
swelling was reduced by two inches. (The first day I was on station I noticed
how tight her wedding rings/bands were; they removed two with soap and water,
had to cut the third one off).
July 27, 1998
Amateur doctor Jack noted that Bob's respiratory
system was showing definite signs of improvement late last week, then seemed
to plateau over the weekend. Professional doctor Cantal confirmed this Monday
morning and said it is not unusual in patients of this type. The progress from
here is typically slow. Bob has not re-gained consciousness, but has opened
his eyes several time today. A nurse was vacuuming his mouth this afternoon
and asked him to open his mouth; the nurse and son Mark noted that he followed
the command. This is the first time that son Jack knows of that he followed a
command.
Bob has been intubated (tube through the mouth to the
lungs for ventilator assisted breathing, tube through the nose to the stomach
for feeding and drinking) for over two weeks now. They are planning a
trach-xxxx for tomorrow to replace the mouth tube, and a peg (entry through
the abdomen to the stomach) for the nose tube.
Lee is doing well and may check out of the hospital on
Tuesday or Wednesday. If so, she will take over the hospital hotel room 5 that
Jack has been occupying. You can direct dial it at
(308) 865-7865.
July 28, 1998
I was in a hurry yesterday, and didn't complete a
thought. The procedures to move the tubes will make Bob more comfortable. In
particular, his lips have taken a beating, so they can begin recovering after
the trachxxxx.
The reason I was in a hurry yesterday was because I
was concerned about Bob's breathing when I left the hospital to come to the
library (where I use the internet). I had gone by to see him, and his
breathing was very labored and the airway pressure was going negative as he
struggled to inhale. It appeared the machine wasn't putting out any air
(though it indicated it was assisting) and he was having to draw the air
through the tube. I pointed it out to the nurse and she called the doctor. I
explained to my brother Mark what my concern was, and left for the library.
The doctor arrived after I left and Mark later explained to me that the had
vacuumed quite a lot of material from his lungs, and increased the volume on
the venitlator. When I looked in the nurse pointed out to me they had also
lowered the PEEP to 5 (from 7 the last 3 or 4 days) which is a good thing. I
observed his respiration rate to be mid teens, the lowest yet (never before
below 20). So in an hours time, he went from a big struggle to the most
relaxed breathing yet.
Nurse Jeff related to me this morning that he had
awakened Bob first thing this morning, and that Bob had looked around trying
to figure out where he was. This is the first instance I know of that Bob has
been conscious enough to look around. The news does indeed seem to be getting
better.
July 29, 1998
Lee Gravance is checking out of the hospital as this
is being written. She will be staying in hospital hotel room 5 (the one Jack
and Mark have been in). Jack is returning to his home in Atlanta, Georgia
tomorrow. Son Mark will remain with Lee through Saturday. Son Paul is driving
to Kearney at this time. Daughter Elise will be flying to Kearney on Friday.
So there may not be an update for a day or two.
We continue to see improvement in Bob's condition.
Nurse Jeff today told Jack that the night nurse was bathing Bob last night.
Bob's eyes were open for 3 or 4 minutes and tracking her, trying to figure out
what was going on. The Driprivan (sedative) had been discontinued this morning
and Bob's eyes were open when Jack arrived. He was more awake than he had been
recently. However his breathing soon became labored and his blood pressure
went over 200, so the nurse started the Driprivan again.
A bronchoscopy (or something like that, a look into
the lungs with a scope) was scheduled and performed this afternoon. They
vacuumed some fluids, but there was no infection. Dr. Cantral was upset that
the Driprivan had been started again, without his consent. After the
bronchoscopy he talked with us. Bob's breathing is strong, even if the
respiration rate is high, he wants him to remain unsedated for observation.
They have a way of telling if the breathing muscles are tired, and Bob's
aren't. If the blood pressure goes up again, he want to handle that separately
with anti-hypertension medicines so he can evaluate Bob's respiration
system.
You may be interested to know of the bed Bob is in. It
is an airbed, with multiple tubes. The air pressure is controlled by the
computerized bed in one of several different modes. The one used the most
rolls him slowly left to right, providing motion and changing the pressure
points so no "hot spots" occur. Another mode vibrates the upper part
of the bed to shake loose the stuff that is not supposed to be in his lungs.
I'm told the bed cost $60,000!! My first house cost $50,000.
July 30, 1998
This is being written in Atlanta, Georgia. I (Jack)
stopped by Bob's room last night after dinner and again this morning. Last
night Bob's nurse came running in from the adjacent room, very excited about
his improving condition. I had met her only once before, I think her name was
Susan. She animatedly told me that she had been trying to catch us as we came
in, she was Bob's nurse that night, and the two previous, had seen us coming
and going, but was caught up in other duties at the time. She is the one that,
as reported yesterday, observed Bob's eyes tracking her as she attended to
him. She spent several minutes updating me, even though that pulled her away
from a doctor attending to her other ICU patient. The level of personal
concern that the nurses here take for their patients, and the patients
families, is truly astounding.
The reports on Bob continue to improve, though I don't
have anything from a doctor saying "he is out of the woods". This
morning when I arrived, his eyes were wide open. As I talked to him his eyes
turned toward me. I wouldn't use the term that his eyes were tracking, but his
eyes definitely moved to different targets (compared to the first time I saw
his eyelids open, when the eyeballs didn't move).
The "gravance_central" address list is now
70+. Jo Shaw is one of those on the list. She one of the "soaring
fraternity" and an RN, and has sent us several emails with much
appreciated advice. I am very impressed with the staff at Good Samaritan, and
we have previously received from them much of the same advice that Jo sends,
but I am an engineer, so I need to hear new things several times before I can
comprehend them, so thanks Jo.
What prompted yesterdays note about Bob's air bed was
a note from Jo. Already the family is getting a hard time about it
(engineering jokes) from a source who will remain nameless (Arnie W.). But I
must also admit, I was planning on writing about it and other technical things
as time permitted, so go ahead and make fun, if you must!
The following paragraph is also prompted from a Jo
email. Jack, Elise, Lee, and Mark all talk to Bob even though, by all
appearances, he is unconscious. We have been advised that studies show people
recall a great deal of what they hear when in this state. Of course we say all
the "gushy" stuff like we love you, but we also tell him that Brian
received only four stitches and a twisted ankle, that Lee has "only"
a broken arm and (as of yesterday) has been checked out of the hospital. We
tell Bob that he was in an accident, that a trucker ran them over from behind,
that he suffered the worst injururies, but he has all of his body parts. We
tell him he had pneumonia, but has now recovered from it, but that his lungs
have to heal. We tell him that he is getting better each day, that he is on a
ventilator to help him breathe, that it is like pressure breathing (an airmans
term that he would understand) and to not fight it, let it fill his lungs. We
tell him that both legs are broken and in casts, that his right wrist had
surgery to repair tendons and that it is casted also. We tell him that the
right leg was a compound fracture, and that he went through several operations
on it (but no more detail than that, again, as an engineer I find some of it
interesting, and will tell him when he is stronger, and you if you dare read!
By the way, his orthopedic surgeon started adult life as an engineer designing
avionics shock mounted racks, went on to an advanced engineering degree with a
study on bio-medical devices, got more interested in the bio part and ended up
as a surgeon).
Another part of Jo's email today talked about how
Bob's blood pressure could be affected by worry about Brian and Lee, but if
relieved of that, his frustration about his own condition could lead to
tension, high blood pressure and maybe he will vent verbally. The doctors and
nurses had prepared us for this, but he has yet to regain enough consciousness
that we have experienced it. Last week Mom (Lee) said to me (Jack) that she
was glad that if Bob survived he would, after a long rehab, probably have
all/most of his function. I quipped that if that weren't the case, I would be
in there right now pulling tubes out; a recovering Bob Gravance is something I
can live with, complaints and all; an immobilized Bob Gravance is something I
wouldn't want to contemplate, little less live with! I said in an earlier
email that I was glad the trucker was not injured.... It is true, I harbor no
anger at him, he made a mistake. But if I had two broken legs, a bad
concussion, lung damage, tendon damage on my right wrist, and had spent three
weeks and counting in ICU, I might be angry at something/someone. Life is not
fair.
If, as now it seems reasonable to hope, Bob survives,
the rehab will be a long and difficult journey, but in my opinion, he is more
capable of it than most 67 year olds.
July 31, 1998
Mark (Son of Bob and Lee) called with status at lunch
time today. Bob is conscious and argumentative. When Mark told him of his
situation and said he is doing O.K. Bob vigorously shook his head no. Bob is
responding to commands to squeeze his right hand. Later when Mark told Bob he
was leaving for a while and leaving Lee in the room he shook his head yes.
Mark said they have put Bob back on the ventilator,
and that it may be for a long term. They said he may need to be moved to a
different hospital when he is released from the ICU, because their hospital is
not set up for long term ventilator care in the sub-acute section.
August 1, 1998
Elise arrived in Kearney late last night. Mark is
flying back to California now, arrives Saturday evening. Paul and the twins
arrived this afternoon, driving from California.
Lee is doing well. Her bruises and cuts are improving
and fading over time. She looks perky as is getting around better each day.
Bob is doing well. His respiratory numbers are good.
They are running PEEP at 5 (4.9 actually), the respiratory pressure is running
20-25, which is slightly higher, but he is not on morphine anymore. the oxygen
concentration is at 35 with a saturation of 91. They hope to be able to keep
it at that.
He had a slight fever, last night and today, they did
an ultrasound on his abdomen and are checking the gall bladder more closely.
They are thinking it may be trauma to the gall bladder. I don't know much
about this yet as it is hard to get to doctors on Saturday. Dr. Mansur is here
for Cantrell this weekend, pulmonologist, she has not seen Dad for 2 weeks so
she hesitated to give any long term answers about the respiratory issues.
His responsiveness is good. Today he is awake most of
the time, responding with facial gestures, some limited lip movement, and
squeezing our hands quite consistenly. He seems to focus on us most of the
time. He only had morphine prior to cleaning of the tubes, which is
uncomfortable.
I was mistaken about him being able to talk with this
trachea tube, evidently they have to vent this one to allow for the secretions
of the lungs, and that keeps him from being able to pass air through the vocal
chords. Later when that clears up more they can insert a valve that will allow
him to close it off and talk through the mouth. He is able to shake his head
yes or no, he doesn't always, but most of the time.
August 3, 1998
Lee is doing well, getting around with the new walker
and looking better, less bruised and more color, every day. The burn on the
right leg has gotten some infection so she is starting an antibiotic today.
She is also attending physical and occupational therapy each day as well as
visiting Dad for several hours. Busy schedule.
Bob is coming along well. We talked briefly to the
doctor today, he got called away but the respiratory therapist, fiesty gal,
Rhonda, filled us in on the next step. For the last 4 days he has been
responsive. The use of pain killers is mostly stopped except when a procedure
is necessary, the oxygen numbers were doing so well, they say he is improving
so much, that today they took him from "assisted breathing" and
tried him with him breathing on his own! He is doing all the work himself with
the exception of a slight amount of pressure being applied by the ventilator
because of the trachea valves. All of the driving in and out he is doing on
his own. So far he has handled it well for 4 hours. The respiratory therapist
explained that they try it until he tires, kind of a checkout run, and see how
it goes. It appears that it is a little hard for him but not too bad.
About the responsiveness, Dad is awake part of the
time and asleep partly. He wakes when they move him around a lot. We let him
sleep when he seems sleepy and when he is more awake we work with him, ask him
questions and check his responsiveness. When he is awake he seems to get
across his messages, he can let the nurse know he is in pain or not with
nods/head shakes. He squeezes his right hand a lot and stronger for
"yes." Saturday, several times when Mom was talking to him and
squeezing his hand he shook his head sideways and acted irritated. I
immediately asked different things were hurting, on his hand. He responded no!
Paul asked if "Mom was being too mushy?" and he squeezed his hand
hard. He was getting embarrassed.
We aren't sure how long Bob will need the ventilator.
Today when he while he is breathing on his own they are letting him go until
the respiratory rate gets above 35 breaths per minute (bpm). He is hovering
about 25-32 after 4 hours. It is odd to see the number missing that shows the
pressure provided by the machine, as it is not forcing oxygen. The doctors
aren't sure if he will be off of the ventilator when he gets released from
ICU, but it is nice that they are now discussing that step, (leaving ICU).
Saturday they were looking at his gall bladder, an
ultrasound, it seems that everything there was O.K. and his temperature is
back to normal. They say various things could cause it, fighting infection,
the foreign bodies in his legs (the pins), the healing. Otherwise, the legs,
hands, cheekbone, etc are all doing well. He indicates, most of the time, that
he is not in too much pain.
August 4, 1998
Tuesday - Steve here today (Elise doing more mundane
correspondence - don't blame her for any of my interpretations or grammar and
punctuation) . . .
Really Good News!! Because of his progress, Bob was
removed from active ventilator assist yesterday (Mon, 8:00AM). This means that
as of now (Tue, 4:00 PM) he is breathing on his own with only a slight
sustaining pressure necessary to keep lungs inflated when he fully exhales.
Yesterday, this pressure was set at 12 cm H2O, he held steady so this AM they
reduced to 8 cm. Still holding steady, they will likely reduce pressure to 4
cm sometime soon. If all continues OK at 4, they will likely take him off
entirely with ventilator on standby until they are pretty sure he is doing his
breathing entirely on his own. This means that there is reason for optimism
with respect to his being off the ventilator entirely. Like anything else
however, there is no schedule or guarantee but the feeling here is that if he
continues to progress at this rate, we are talking somewhere in the range of a
week to a few weeks, not months.
Today they moved him to what they refer to as the
"Cadillac" chair. This is a rolling chair with adjustments for
height, tilt, angle, foot height, etc. Kind of like a medical version of a
deluxe lounge chair. He is started into it with it parallel to his bed, then
slid over to it, strapped in and then when lowered, they reconfigure the thing
into a lounge chair position (semi-reclined). This has the immediate effect of
loosening more "junk" from his lungs (good news). This is the first
time since the accident that he has been in a position other than horizontal
for other than momentary movements. For this exercise, the total time in
semi-reclined/semi-sitting position approximately 1 hr. He was pretty tired
after about 45 min., and was moved back to his bed.
Yesterday Dr. McGowan (orthopedic surgeon) told us
that all the staff is impressed with his strength and rate of recovery to this
point and said that a lesser man would have not made it.
Most significant at this time is Bob's responsiveness.
He is responding more to direct requests and this is significant to both
family and staff. This response is typically in the form of nodding and some
times hand squeezing. (Elise and Lee seem to think so about the hand squeezing
- They're women, what can I say. I'm not so sure but the head shaking and
nodding is definite). For example yesterday after a difficult time in which we
were moving him around and then suctioning his lungs again - he was asked,
"are you tired, Bob?" He clearly nodded. He is much more physically
active, moving arms and legs around - obviously uncomfortable.
There is still a long way to go. His most alert days
were Friday and Saturday. Since then he has been off most of the pain
medicine. With the breathing on his own and awake time wearing him out he is
not able to focus on his surroundings for any longer than a few seconds, so if
you need to get his attention, you really have to force the issue. With the
tracheotomy and all the hoses in place in his airway, he wouldn't be able to
speak even if he were up to it. We are all hoping that this excess respiratory
plumbing can be done away with in a week or so if his progress keeps up at
this rate but we all are aware that with somebody in his condition, there can
be setbacks.
August 5, 1998
Steve again (with Elise providing editing support)
Good news again!! Bob was taken entirely off of the
ventilator this morning. He's now breathing entirely on his own. He is being
supplied 40% oxygen through the tracheal collar (no more pressure assist).
Normal atmospheric oxygen is ~ 20%. If he can be brought down to 20% from 40%,
he'll be ready to have the tracheal collar removed. The reason that he may
keep the collar and tracheal gizmo in place, for awhile, is that it allows
easy suctioning of his lungs, although he is coughing pretty well on his own
now. Wish him well there. Best news of all, as of 1:30 PM today, they have
removed the ventilator and associated monitors entirely from the room. These
had been there on a standby basis until Bob appeared to be stable. We were
told that they wouldn't have removed them unless they had confidence in his
recovery and ability to stay off the machine. If he is not under respiratory
therapeutic care when he leaves the ICU, he can stay in this facility to begin
rehab.
We are still seeing positive signs of Bob's progress
with respect to higher mental functioning. He is definitely nodding his head
in response to specific questions and appears to be moving around in bed much
more - he's obviously uncomfortable but the movement is a good sign. Again, he
can't talk until a change is made with the trachea tube.
Bob is completely off of the sedative and only takes
morphine if there are definite signs of pain during changing of dressings on
his "bad" leg, the external braced leg,(the leg with 2 breaks is the
"good" leg). With all the damage, apparatus, etc., this is
understandable.
Through Ruth Swalley, we have heard that there are
three prayer circles in town now (Lutheran, Methodist and Presbyterian)
praying for Bob and Lee. We still find ourselves being amazed at the level of
local support and encouragement.
While we were out walking, Ruth's daughter and her
husband pulled over to the side of the road so they could ask us how everybody
was doing and made sure that we knew that they would help out in any way they
could. Even offering to let Paul's twins come over to play with their kids to
give Paul a break.
Lee's progress continues steadily. She is getting more
mobile although there is a slight infection in the burn in her lower leg which
the doctor will be looking at today in a couple of hours. She protests the way
her kids are pushing her to walk instead of getting pushed in the wheelchair,
but she does what she's told (her kids are as stubborn as her husband –
and certainly more stubborn than she is).
We continue to hope that progress will continue to be
as steady as it has been to date.
August 6, 1998
Bob is out of intensive care at last!! He has been
moved to room 222, bed 2. Bob's progress is holding steady. He is laboring a
little when he is put into the "cadillac chair." We are cautioned
that this is what will be required to strengthen his respiratory system after
nearly a month of artificial respiration.
Lee has seen the doctor about the infection and has a
"uniboot" (not sure if I got it right) which is a lot like an ace
bandage to wrap the affected area and provide compression for swelling. She
also has to have some exercise to ensure good circulation, elevate the leg 3
times per day to allow fluid drainage and continue antibiotic. Otherwise,
things continue to improve steadily for her as well.
August 7, 1998
The last few days, after coming off of the ventilator,
has worn Bob out, but he is holding steady in his new surroundings in the
progressive care unit. His breathing had been slightly higher than when on the
ventilator but we are told that this is normal when someone in his condition
is regaining his lung strength and function. This is starting to improve today
and as he continues to gain strength, his alertness is again improving. He
still is awake, off and on, and responds to requests and answers with shaking
of the head, but since he is so exhausted we don't push him too much and are
letting him get back above the curve.
We won't know much about Lee's infection until Monday when the "unaboot" is removed. Otherwise, she is doing well.>br>
One other note, which I relayed to my cousin-in-law
(the orthopedic surgeon in Atlanta)is that Dad's orthopedic surgeon, Dr.
McGowan, has been especially attentive to Dad and the family. He spends extra
time with us, not just answering all of our questions but asking if there is
anything else he can do for us. I even heard that he came by at 1:00 in the
morning to change Dad's dressing on his fractured leg. The nurse asked him
about it and he just said that it needed to be done. Incredible huh? It sure
makes it easy on us knowing that they are in good hands. By the way, all of
Dad's wounds and skin grafted areas are healing cleanly.
Some of the ICU nurses also work the floor when they
have time and have been stopping in to see Bob and saying hello to us.
August 8, 1998
Elise here, Steve is busy talking materials with the
system admin here at the library.
Things are going as well as can be expected. The plan
is to get Bob stabilized, work on getting him off of all of the supplied
oxygen and strengthen him so that he can handle his own coughing/trachea prior
to moving to rehabilitation. They say he has a strong cough and we are seeing
him start to get rested some and is a little more awake than the past two
days. He sits up in the Cadillac chair twice a day now. Yesterday they didn't
get back to him, as another patient needed assistance, and he spent 3.5 hours
sitting up. That tired him quite a bit. As I mentioned to Uncle John, I think
I am just starting to realize just how slowwww this whole process is going to
be. But, keeping our chin up, he would be mad if we didn't.
Mom's swelling in her leg has gone down. We will know
more when they take the unaboot off Monday. She is holding up pretty well but
I think the whole trauma has been hard on her.
Steve and Elise are traveling back Sunday, August 9th.
Jack should be here late Saturday or early Sunday. Paul and company will
probably be heading home, driving, Saturday or Sunday.
August 10, 1998
Horses sweat, men perspire and women glow. This is a
truism as is real men don't cry. Saturday this 45 year old boy had tears in
his eyes, but this time over a happy event. Bob was in the Cadillac chair. In
the room with him were Lee, Jack, Elise, Steve, Paul and Paul's 5 year old
twins, Michael and Sarah. The twins had seen Grandpa for the first time since
the accident about an hour earlier, when he was in the air bed. In the air bed
he looked much better than 9 days ago when I had last seen him, but he still
looks pretty bad. In the Cadillac chair he looked even better, more awake and
alert. I think it was Paul who first asked if Michael and Sarah wanted to kiss
Grandpa, they both did, and when Bob heard he beamed, perked up, eyes shining
and looking and a smile too! First Michael, then Sarah were dutifully held up
and Bob leaned forward and pooched his lips for the kisses. This scene was
repeated the on Sunday afternoon as Paul and the twins said their goodbyes and
started their long drive to California.
Prior to the above Jack had been visiting with Lee in
her room. Her improvement during Jack's 9 day absence was very noticeable. She
was moving around in the wheel chair, had the left arm out of the wrist
restraint and was moving it with abandon. When she stood up it was with little
effort. The swelling in the left leg is almost gone. The swelling in the left
arm is still substantial, but much less than 9 days ago. The right leg is
still badly swollen, but much less than 9 days ago. Lee has been in
continously good spirits, and is taking this ordeal as well as anyone should
expect.
This morning they changed Lee's Unaboot. I can't tell
you (or won't try, we don't need that kind of graphics here) how ugly the
unhealed, infected wound is. The RN (Marlene) says because of the swelling,
underlying poor circulation, diabetes, age, etc. that the wound has not done
any significant healing. The first step is to get the swelling down, which the
Unaboot has helped with, and Lee elevates the foot above her heart several
times per day, and when she sleeps at night. Marlene thinks the healing could
take another month at least.
As I reported during my last trip out here, Lee has
been doing great with her occupational and physical therapies, and with
exercising on her own. She now does the therapies three times per week on an
outpatient basis. Exercising was never Lee's forte, and Jack has been
educating her on aerobic exercise, building stamina, that it is not only O.K.
but desirable to exercise muscles to the point of tiring yourself and soreness
the following day. Two weeks ago Lee was walking 130 feet to and from her
meals. Now she is walking 250 feet those six times, and other walks as
well.
There is more good news about Bob today also. The
doctor has written orders to move Bob to the skilled nursing section. This is
an area for patients that need less care than the progressive care section he
has been in recently. The move hasn't occurred yet because they don't
currently have an open bed in that section.
Bob also started therapies in his bed today. He work
the left hand on command, squeezing a ball when asked. He wiped his chin with
a washcloth. He had speech therapy also. In this case, he can't talk because
of the trach collar, so the nurse does the talking, and Bob answers the yes or
no question with his head movement. He reportedly got 75% correct, which is
good for now.
And a final piece of good news. The orders haven't
been written yet, but Bob's social worker had heard that the doctor thinks Bob
will be ready for transportation back to California in about a week.
The reason I have been sending the entire file each
day is that we are still adding to the address list almost daily. I hear that
some AOL users can't get the file because it is too big, and today I ran into
a limitation on Yahoo. My solution will be to send two files each day, the
July letter, and the August letter. Delete to your hearts content!!
August 11, 1998
Bob's move to the skilled nursing section was
scheduled for 3 PM today.
Dr. Cantral is Bob's pulmonologist, Dr. McGowan the
orthopedic surgeon, Dr. Salulman the Chief of the rehabilitation section, and
RN Deb is the social worker (I would describe her job as case manager). Deb
confirmed that Cantral says Bob will be medically ready for transportation in
one week. Deb said McGowan wants to keep him for two weeks so he can at that
time remove the external fixator from the right leg and replace it with a
cast. He would also at that time remove the cast from the left leg and replace
it with the plastic brace it originally had (this allow the leg to bend for
and aft at the knee). Deb is working toward a transportation date of Friday,
August 21. Jack and Lee ran into Salulman in the hallway, and he was initially
concerned we were going to move him immediately. When he heard two weeks he
was happier, but he really wants us to keep him here for three weeks so
Salulman's rehab department can jump start him.
The speech therapy I reported to you yesterday was
reported to me by Deb. Today Lee and I were in the room while the speech
therapy was going on. She asks paired yes and no questions. Are you Mr.
Johnson? A five to ten second delay and Bob shakes his head no. Are you Mr.
Gravance? A five to ten second delay and he shakes his head yes. I only saw
him miss one, and he got that right on a second try. She also would hold up
two pictures, like a banana and a cow and have him point to the cow. Sometimes
he was able to, other times not. It may be that his vision is blanked on the
left side. At one point I moved to just right of his center of vision and he
saw and recognized me and beamed just as he did on the two occasions with the
twins.
Now that I know he has this 5-10 second processing
delay, I suspect we have mis-interpreted some of his early nods. We have to
keep the statements short, and wait for a response.
Later I was in the room alone with him, while he was
sitting up in the Cadillac chair. He moved his right arm (it is the one casted
after the tendon repairs) fore and aft several inches many times. This is the
first movement of that arm that I have witnessed.
Yesterday while taking a walk by myself I found
Serenity Trail right across the street from the hospital. It is a cement trail
surrounded by multiple types of flowers, shrubs, grasses, etc. I found that
from the start to a midway exit was 100 of my paces, the same Lee has been
walking to and from her meals. It was too hot yesterday, but this morning I
took Lee to the start of the trail. She walked the 100 paces, rested standing
on her feet, then continued another 50 paces. It has gentle ups and downs, so
she did more than 150% of what she has been doing lately.
August 12, 1998
Another amusing and amazing hospital personnel story.
The house keeping lady who cleans the hospital hotel rooms leaves a small
handful of candies each day. She also is found roaming the hallways upstairs,
and she knows who the Gravance family members are. She will float into Bob's
room and reach into her pocket and hand one of us several pieces of candy. Of
course she does this for other patients and there family members as well, and
her knickname is the Candy Lady.
I realized as I was doing it yesterday that I was
switching back and forth from writing in the third person to the first person.
I is shorter to type, so today I means Jack.
Yesterday afternoon I presented Lee with a new
challenge, walk from her hospital hotel room, to the cafeteria, rest standing
when she wanted, then continue to go find Dad (who we presumed had been moved
to the third floor since our previous visit). I allowed Lee to be the one to
determine when she had enough. So we did the 100 paces (my normal step) to the
cafeteria, then back to the elevator, to the second floor, verified Bob was
not in Room 222, back to the elevator, to the third floor, down the hall to a
nursing station, determined Bob was in Room 351 (at the other end of the
floor), and then part of the way towards Bob's room before choosing to ride
the wheelchair the remainder of the distance. Jack later paced off the
distance as 230 paces! This morning Lee walked 236 paces on the Serenity
Trail. Add physical therapist to my resume.
Today I learned another trick to communicating with
Bob. I first asked him if he knew he was in a hospital in Kearney, Nebraska. I
got no response. I then stated to him that he was in a hospital in Kearney,
Nebraska and asked him if he knew that to shake his head in the affirmative,
and after a short pause he did shake his head. He seemed to need the reminder
to communicate by shaking his head (I later confirmed this with the speech
therapist). I stated to him that the truck ran over the motorhome and it was
the truckers fault, and asked if he understood that and he shook his head yes.
Bob was pretty tired at that time, so I let him go to sleep. Later I tried to
tell him Brian was O.K, had only four stitches on his arm and a sprained
ankle. I did not get a response, so I shortened it up to Brian is O.K, do you
understand that, Bob registered yes. After lunch Bob was as attentive as I
have seen him, so I told him what time it was and the date and he shook his
head affirmative. I told him the accident was on July 10th and he had been in
the ICU for a month (four weeks) and he made a very astonished look and
movement of the head. The speech therapist said she saw a nurse come into the
room and say hi to Bob. Bob turned his eyes to her and made a small wave with
the fingers of his left hand. Add occupational and speech therapist to my
resume.
It is my intent to send this message only 3 or 4 times
per week in the future, so please don't be alarmed if you don't hear from me
on any given day.
August 13, 1998
Who was I kidding when I said I wasn't going to
continue the updates daily? This is therapy for me!
Today the I in this message is Jack (son of Bob and
Lee)
I had, until yesterday, been taking the approach that
Bob's physical needs were being met by the hospital, and that I only need to
spend a short time each day with him. I used the bulk of my time getting Lee
around to meals, therapies, visits to Bob, and being her cheering section for
exercising. This has paid off in getting Lee less and less dependent on me, as
Bob is getting more and more cognizant and can use more of my time. Yesterday
I made a conscious decision to try and be at Bobs room as much as possible
today, to get a better understanding of what all is going on, and it has paid
off with much additional information (the late Frank Batchen used to use the
term "management by walking around". In this case it is
"management by standing around and letting all the doctors and nurses
come to you."). It turns out Lee was thinking along the same lines. We
agreed she would use her home health care to get her to the cafeteria this
morning, and that I would come get her at 8:30.
This morning I set my alarm for one hour earlier and
arrived at the hospital at 7:30. After bringing Lee up to Bob's room I
challenged her to walk 320 of my paces. The funny number arises from 4 laps of
the hallway that Bobs room is on, so I could watch Bob and Lee at the same
time. On her previous walks I have followed along with the wheelchair, this
morning I made no attempt to do so. Her stability is not an issue, and when
she gets winded she can rest while standing. Lee met the challenge. We then
discussed her walking from her hotel room to Bob's room unassisted. Her two
initial fears were (1) the elevator door running into her and knocking her off
balance, and (2) the door to the hotel room has a quite heavy spring on it. We
discussed techniques on how to overcome these obstacles and came to agreement
on them. Then Lee demonstrated and unassisted trip from Bob's room to hers.
Bob's speech pathologist is Diane Carranza. As most of
you know, one of Bobs' injuries was a bad concussion and a bruise on the
brain. We don't know yet what Bob's neurological condition is, they are
currently evaluating it. The things he is having problems with now are not
unexpected. He may regain full function, we just don't know yet. Some of you
thought my previous report about the possible sight problem was an eye
problem. It is not. If (IF!!!!) there is a sight problem, it is from the brain
trauma. If (IF!!!!) there is a sight problem, he might recover from it. He can
barely communicate on very simple questions. This evaluation will take some
time.
I learned today that Bob has a cuff installed. It is a
plastic tube with an inflatable bubble in the throat to keep fluids from going
down the throat. Today the suctioned his lungs, then Diane closed off the hole
to the trach, and asked Bob to say hi. Bob was able to make sounds with his
vocal cords, though it didn't sound much like hi to me.
Diane called Bob my name several times today. About
the third time she did, he laughed heartily!! No sound because of the cuff,
but laughed for 4 or 5 seconds. Diane asked him if the woman in the room was
his wife. He turned his head, looked at Lee and shook his head yes. Diane
asked if her name was Mary and he shook his head no. Diane reported that in an
earlier session she asked Bob how many grandchildren he has and he held up
four fingers on the left hand (the correct number).
Bob's IV has been removed from his left hand. He
receives two shots daily of a blood thinner (these are in the belly).
Bob's arm cast is coming off tomorrow morning.
Dr. Cantral is having the plastic trach replaced with
a metal one. I think the purpose is so they can put a valve on it that Bob
will close to talk.
August 14, 1998
Two minor negative complications to report today, one
each for Bob and Lee. Yesterday Lee complained of indigestion several times.
This morning she was worse. Her nurse Mona was said it is hopefully the same
intestinal bug going around that her husband gave to her mother. Hope, because
they had trouble for only 24 hours, not flu like symptoms.
Yesterday I (Jack, son of Bob and Lee) was present at
Bob's morning occupational therapy. Michelle exercises all of the non-casted
joints by moving them slowly through their entire range of motion, if
possible. Some of these motions are, of course, mildly painful, and Bob shows
this with his facial expressions. I suspect some are actually pleasurable, at
least on most he shows no expression. But on the right elbow motion he
expressed great pain. I arrived at the hospital at 7:30 this morning to watch
orthopedic surgeon Dr. McGowan remove the right arm cast. I told him what I
had observed and he duplicated Dad's reaction to the arm bending. It concerned
him and he examined the elbow and found nothing. He ordered an x-ray and it
showed that Bob has developed a heterotopic ossification. This is a growth of
bone in the joint that sometimes occurs in these kinds of situations. He said
that for now, they will treat it by continuing the occupational therapy,
hoping that dissolves it. I believe he told me of several other possible
treatments, but I didn't retain that part of the conversation, because I was
back trying to remember the words heterotopic ossification. He did say that if
the other things don't work, surgery can remove it (Bob will be delighted
about that!).
Bob's arm cast was removed and the tendon surgery was
successful with no complications. McGowan examined the right leg and it is
continuing to heal well, no infection, the skin grafts are taking, the muscle
flap is healing, the scabs are coming off where the underlying skin is
healing, etc.
Yesterday I also was present for Bob's physical
therapy. On these the therapist moves the limb through it's normal motion,
asking Bob to help or resist. She reported that he was providing the requested
inputs. This morning McGowan gave Bob 10 units of morphine so the leg
inspection wouldn't be so painful to him. Knowing that speech therapy was
coming up, I asked how long for the morphine to wear off, and McGowan said 3
to 4 hours. The morning therapies and the 1:30 speech therapy had to be
aborted because Bob could not be awakened. Just like Christmas mornings when I
was a kid. I think McGowan does the leg inspection twice a week, so we are
going to ask him if a lower dose of morphine can be administered, or the
inspection scheduled for late afternoon.
Lee has home health care each morning. Lisa comes in
and helps Mom with some personal thing she can't do with her arm in the sling,
such as getting dressed and bathing. Monday, Wednesday and Friday nurse Mona
comes in immediately thereafter to change Lee's dressing on her left leg. Mona
and Lisa, I'm not making this up.
Some have wandered about the caretakers health, and I
appreciate the thoughts. Anxiety set in shortly after my arrival on the first
trip. I was not functioning at 100%, as can be exemplified by my spending 10
to 15 minutes trying to find the Gothenburg phone number in our notes, before
simply picking up the phone book and looking it up. There were more examples,
but I'll spare you the boredom and me the embarrasment. When Bob got out of
the ICU the anxiety started to ebb. The anxiety was completely gone within a
few days of my return to Nebraska. Seeing how much progress had occurred in my
nine day absence helped immensly. It is good to be able to perform every day
tasks in an efficient manner again. I hope other family members emotions are
improving also.
Dr. Cantral says the purpose of the metal trach is two
fold 1) it is smaller in diameter and will let the healing begin and 2) it can
be capped, allowing a one day evaluation. If all goes well he thinks the metal
trach will be removed in three or four days.
We are striving for a return to California on Friday,
August 21.
August 15, 1998
Lee's indigestion and nausea are no better or worse
today than yesterday. Many others have confirmed to me that something is going
around. In Lee's case the 24 hour bug may take longer because of her other
injuries.
Morphine is great stuff. Yesterday when Dr. McGowan
asked the nurse to give Bob 10 units I volunteered that I could use 10 units
also. This got a reasonable amount of laughter from the half a dozen people
within earshot.
Bob was still extremely groggy this morning, I could
only get one small yes response out of him. About 1:30 PM I went into his room
and he had his eyes open (this doesn't always mean he will be responsive). I
told him I was there and he nodded yes. I told him what day it was, followed
by do you understand? No response to that. I said do you remember that Brian,
Mom and you were in the motorhome and he shook his head no. Then I re-phrased
it to what I wanted to say the first time, do you understand that Brian, Mom
and you were in the motorhome, to which he nodded yes. Both of these responses
are correct, he doesn't remember but he does understand.
I then ran through a long series of statements and he
nodded yes to understanding them. I shortened up the description of Brian's
injuries to 1) Brian had four stitches 2) Stitches in his arm 3) Brian had a
sprained ankle 4) Brian didn't have any other injuries 5) Brian is O.K. Bob
nodded yes to all of these. Mom had a broken bone. In her arm. No other injury
(I thought it too ambitious to get him to understand a burn that had gotten
infected, etc). In short sentences I got him to understand the truck had run
into the glider. This evening I'm going to see what his response is too memory
of and understanding the glider contest he was at the previous week.
Jack's therapy on Thursday consisted of one hour on
the internet, a haircut, and changing the oil in his 1993 Nissan 300ZX. Also
that day, a 17 year old lad with a broken leg and speech problem asked Jack to
by him a Dr. Pepper. I said I would later, but I would have to ask the nurse
if it was O.K. I continued on my way to see Bob. Later, Chad again asked me to
by him a Dr. Pepper and I repeated my promise to do so. The third time he
caught me in the hallway it was 11:30 AM, a time of day I normally go to the
cafeteria and get me a large diet Dr. Pepper. The nurse confirmed he was
allowed soda, so I said I'd go get him one. He said he would go with me if I
would push the wheelchair. So Chad and I went and drank our sodas in the
cafeteria. I assumed the speech problem and broken leg was from an accident.
He said he broke his leg falling down in the driveway. I later checked with
the nurse, Chad is and outgoing, mentally retarded nice kid.
August 17, 1998
For those of you who worry, now would be a good time
to start. I'm not naming names (Elise). But by the time you get through the
next few paragraphs you will be able to relax. I started my day at Bob's room
at 07:30, trying to intercept doctors, etc. As I looked into the hallway a
nurse was approaching and asked if I was Lee's son. I replied yes. She said
Lee was in ER and they needed me there. Coffee in one hand and fruitcake in
the other, I expedited to the ER waiting room. The receptionist had me sit
down and called into the ER to see if they wanted to come out or send me in. I
decided I would set down my coffee. Soon I was told to go into the ER. Lee was
on a bed and conscious. The Unaboot extends from the upper calf to the toes.
If you are squemish skip from here to after the **********. The Unaboot was
covered about 50% with blood. They were preparing to remove it. When they did,
my assessment was that the wound was certainly no worse than a week ago, and
probably somewhat better. Last week it was about the size of my palm. Today it
was about the size of my four fingers. The necrotic (dead) tissue was pulled
away from the new live pink tissue along the bottom edge and a portion of the
inside edge of the wound. The blood was oozing out from this area. Over the
next ten minutes or so it made a spot about an inch big on the dressing they
laid the leg on.
*****************************************************************
Lee was scheduled to see Marlene RN CETN at 10:30
today anyhow. They went and got her, and when she examined the wound she was
delighted with the progress. They took a blood sample to check Lee's sugar
levels for her diabetes (143) and white blood cell count (normal) which shows
if infection is present (it is not).
Marlene's speciality is a relatively new one. She
deals exclusively with healing wounds. She was delighted that Dr. Sokolowski
made the correct diagnosis and prescribed a Unaboot. As we previously
mentioned, the purpose of the Unaboot is to reduce the swelling. Healing will
not occur when there is swelling. The swelling below the knee is mostly gone.
There is still some very noticeable swelling above the knee.
Marlene removed some of the necrotic tissue that was
loosening from the new skin, telling Lee that she didn't need to hurt her to
the intolerable level. As Marlene worked, Lee grimaced, and Marlene would ask
tolerable or intolerable? Lee would say through gritted teeth tolerable. Even
if I didn't like my parents, I wouldn't want them to endure the pain they
have. I left the room until Marlene was done.
So Lee's leg is healing, what a relief.
Bob's progress is amazing. I knew when he got to the
rehab point he would be a great patient. The physical therapist was very
excited about his progress since Friday. He didn't receive any official
therapy this weekend, but I worked his left arm, hand and fingers. I didn't
exercise his right arm because it is the one with the calcium deposits in the
elbow. On his own Bob was moving the arm around, wiggling fingers, and tightly
gripping the bed rail. I would hand him his blue squeeze ball and he
reflexively would squeeze it some. He is moving legs on his own. He turns his
head, reaches his left hand up and picks at the scab on his chin, or rests his
head against the palm of the hand.
Bob's responsiveness is noticeably better each day. On
Saturday I got mostly correct answers to short questions about the family,
etc. It took about 5 or 6 tries, but he remembers being in New York for the
glider contest. It went something like this. Dad, do yo remember the 1-26
contest? Nodded no. Dad, the 1-26 nationals. In New York. Nodded no. Dad you
flew. C note (the nick name of the glider). Do you remember flying the 1-26
nationals. A nod yes! Dad do you remember I was here yesterday, talking to
you. A nod no. I then ran through the whole list of statements I've previously
told you about, phrasing them as "Do you understand..."to which he
would respond yes. So he doesn't remember day to day, but he understands the
things we are telling him. Later that day I realized that the 5 to 10 second
processing delay was shortened or gone completely. I believe what is happening
is that the short term memory is starting to load the longer term memory.
On Sunday Bob was even more responsive. I asked him if
he remembered me talking to him the prior day. Nodded yes! A ran through the
list of questions phrased as "Do you remember me telling
you…" and got immediate positive responses! Around mid day I
returned to his room for a brief visit before heading to lunch. One of the
Environmental Services staff was there and said he was smiling a lot today (he
was in the Cadillac chair). I said that he had been a lot more awake today
than previously and Bob grinned. After a short visit, I told him I was going
back to my motel for a cheese sandwich and a beer. He mouthed something. I
didn't get it, but the Environmental Services staffer did. She said that Bob
mouthed "Sounds good to me". And she was right. I can now say that
my Dad is going to have a full recovery.
Today we put Bob in a standard chair.
The metal trach that I wrote about last week didn't
get done. On Thursday Dr. Cantral told me it is an easy procedure, he could do
it himself, but was leaving it to Dr. Bragg as a professional courtesy, since
Bragg did the original plastic one. It turns out Bragg was out of town, so on
Friday, they assigned it to Dr. J. T. Johnson. He didn't get to it, probably
had an emergency surgery. Today, Cantral wrote new orders for Bragg.
It is not firm yet, but Bob will be air ambulanced to
a facility TBD in California, probably on Friday, August 21. Lee will be on
the small jet with him.
The gravance_central mailing list is now 88.
August 18, 1998
If your squeamish, skip the first paragraph and start
past the
While brushing my teeth at 7:06 today, the phone rang.
It didn’t seem likely to me that it would be somebody calling with good
news. It was Lisa and she put Lee on. She had again bled through the Unaboot
and had an 8:30 appointment with Marlene. When I arrived at Lee’s room
there was a six inch diameter spot of blood in the bathroom, and a light trail
back to the bed from the legs of the walker. Lee had awakened at 3:00 AM,
found the blood, attempted to contact Marlene and when that failed, talked to
admissions, got a medical person on the phone and was advised it would be
O.K.to wait until the morning, and set up the appointment
One of Lee’s pre-accident conditions is
arthritis. She had been taking six aspirin per day for the pain. Aspirin thins
the blood. Today we got a new prescription for Daypro and Cytotec for the
arthritis pain.
Lee is determined to be rehabilitated enough so that
when Bob is released from the hospital she can care for him. If I have been
guilty of underestimating her strength before, I am not now.
Lee’s therapy for the day was a trip to Randy
and Brian’s wrecking yard in Lexington to see the glider, trailer and
motorhome. We have a good set of pictures of the wreckage, which she has seen.
She had to walk around a pickup to see the glider and trailer, and when she
caught first sight of it she exclaimed "Oh my God!" It really is
more insightful to see it in 3D.
When I went into Bob’s room after lunch I said
"Hi, Dad". He responded with a wave of the right hand, a first!
The plastic trach is still in. I suppose the hospital
has just been to busy to get to it. It consist of two parts, the base which is
stitched in, and a removable tube that snap into the base. Yesterday a nurse
told me that to remove the tube, it is necessary to grab it on both sides and
squeeze, like a childproof cap. Dad is not a child and he removed the tube
yesterday! I said to him "Dad, the tube removal is supposed to be a
doctors’ job, not an engineers". Bob chuckled.
Lee’s intestinal bug is gone. I started to
suspect on Sunday that the bug was gone, and her queasy feelings were caused
by not enough to eat. Yesterday she ate normal portions and felt good all
day.
August 19, 1998
Jack didn’t have time to handle the e-mail so he
called me and I will give a brief update on my lunch hour.
The only new news I have on Mom is that there was no
bleeding in the una-boot on her leg today. Glad for that.
We have sort of mixed news on Dad. As was the case
when Dad was originally diagnosed with the acute respiratory distress syndrome
(ARDS), about 2 weeks after the accident, it had been a condition that was
ongoing for those two weeks, they just formally diagnosed it at that time.
Similarly, we now understand that Dad has a staff infection in his lungs,
called MRSA (don’t know yet what it stands for). This explains the
mucous (hereafter referred to as stuff) in his lungs and the need for the
regular suctioning. Previously, we had been given mixed explanations, we were
told that the pneumonia was all gone and that he still had bronchitis, and a
different nurse called the remaining infection pneumonia. This MRSA, evidently
is what he has had for awhile now, it is just that now it is diagnosed. It is
an infection that is resistant to normal anitbiotics, but now that they know
what it is they have a different antibiotic to handle it. Evidently, as in
viruses such as herpes, it can go dormant and crop up later.
They did remove the plastic trachea tube and replace
it with a metal one, sometime since yesterday’s e-mail. Mom said Dad was
talking some, in short phrases, but was not terribly cooperative with the
speech therapist today. She asked him if he was getting tired of all of the
silly questions, and he answered “yes.” Sounds like Dad is getting
back to his old self.
We don’t know how the infection will affect the
transporting back to a hospital in California yet.
August 20, 1998
Nothing to add from Elise’s report yesterday
about Bob and Lees condition.
Lee is flying to Los Angeles International on
Saturday. She will spend the night with her sister, Helene, and family in
nearby Manhatten Beach. TBD family member will then drive her to her home in
Palmdale. Their home phone number is (805) 947-6913.
Next Monday Bob will be air ambulanced to Antelope
Valley Hospital in Lancaster, California. They will take him with the staph
infection. He will start out in acute care so they can do their own
evaluation.
Jack will start the two day drive back to Atlanta on
Sunday afternoon, arriving Atlanta late Monday.
Lee’s flight information is:
United Flt 1909 Leave Lincoln 1:40 PM, Arrive Denver
1:58 PM
United Flt 1619 Leave Denver 2:45 PM, Arrive
Los Angeles 4:05 PM
Wheel chairs are arranged.
August 21, 1998
Yesterday afternoon xrays were taken of Lee’s
left shoulder and right elbow. Yesterday evening we saw her orthopedic
surgeon, Dr. McGowan. The shoulder has healed enough that she is now free of
the sling which has restricted motion for the last six weeks. The right elbow
had been giving Lee occasional sharp pains. The xray showed a small
protrustion on the radial surface, probably from a prior injury. McGowan was
certain this was not the cause of the pain she reported. He examined her and
determined it is pinching of the ulna nerve (funny bone). With the left arm
restrained she has probably been resting on the right one more than usual.
McGowan also said that excessive use of the phone can contribute to the
condition. Mom confirmed that during some long conversations her elbow would
tingle. I mention this here only so that all of you well wishers can enjoy a
small dose of quilt.
As we were leaving McGowans’ office, I noticed,
and Lee also later noticed, that even though the sling was removed, she had
walked to the car with it in the position it had been restrained for 6
weeks!
When we got back to the hospital, I retrieved
Lee’s two handed, wheeled walker. She took off like a scalded cat. I had
never seen my Mom walk with a walker before arriving in Nebraska. She had been
telling me how much more difficult the one handed walker was, but the
difference was truly startling. I had been concerned about her endurance,
since she hadn’t done any walking for exercise since coming down with
the intestinal bug, then the leg bleeding. But she covered the distance from
the front door to the hospital hotel room in good time.
Today Dr. McGowan removed the dressing from
Bob’s right leg and the cast from the left. Xrays were taken, and showed
that significant healing (callousing) has taken place at most of the break
sites. The alignment of the bones is good, as it has always been. The wound
sights and skin grafts are healing nicely. The external fixator was removed
and a cast applied to the right leg. The left leg is to have the plastic brace
re-installed. This allows the knee to bend.
Today I have come to understand the MRSA staph
infection is not as serious as I first assumed by watching all the hospital
personnel put on gowns, masks with face shields and gloves before entering the
room. That first day two larged containers were placed in the room, one with a
yellow lid for the gowns 9 (which they wash) and one with a red lid for the
gloves and masks (which they discard as bio-waste. The next morning the
warning sign on the door was changed, requiring only masks. Today the old sign
was up again, but a nurse went up to Bob to arrange his oxygen mask without
any of the gear. She used to work in a nursing home and says that this
hospital is very aggressive in their approach to MRSA, other don’t use
any protective gear, simply wash hands after working with the patient. McGowan
echoed this to me. He did not wear a mask while working on Bob, stating it is
not airborne, but fluid borne. He told me it is not that serious and there are
worse things to have. I don’t remember who told me, but this was
probably already colonized in Bob’s system.
August 24, 1998
Lee was met at Los Angeles Airport on Saturday, 8/22,
by her sister and brother-in-law, and taken to Manhattan Beach, CA for the
weekend. Since she has stayed with us many times before, she has what has
become designated "her bed" in our home, so needless to say, she was
quite happy to be in a house and be able to sleep in a bed that she was
familiar with - the first time since late June (almost two months ago to the
day).
She endured the flights quite well from Lincoln, NE,
with a lay over/plane change in Denver, but got off the plane in LA quite
tired and hungry. Both of those conditions were quickly rectified.
Saturday and Sunday, 8/22 and 23, were both R&R
type days - lots of rest, home cooking, and pampering from her brother-in-law
Larry, nieces Jenn and Kris, and ‘little’ sister (although I am
taller!). Niece Lauren felt left out since she’s away at school in San
Luis Obispo, so she called her aunt "to talk". After dinner Sunday
evening, we drove Lee to her home in Palmdale. Before we left, neighbors had
stopped by to let her know how happy they were to have her back home and how
much she had been missed! We felt more comfortable leaving, knowing that there
were such caring people so close by, in addition to her children who have been
magnificent! Let me take a minute to publicly acknowledge the outstanding
attentiveness, care and support Lee and Bob’s children have given their
parents throughout this whole ordeal. This aunt is very proud of them!! Also,
I want you all to know that Lee expressed to me how overwhelmed and pleased
she has been with all of you keeping in touch - calling, writing, sending
e-mails, etc., etc.
I have mixed emotions about Lee’s status. On one
hand, I am glad to see how well she is coming along since the accident, based
on all the detailed reports we’ve had from Elise and Jack. However, I
realize that she still has a ways to go to reach pre-accident mobility and
stamina. I do see a strong determination in her to do the prescribed exercises
to regain her strength and capabilities. Determination, yet patience, seem to
be two key words we will all need to keep in our vocabularies.
Best regards to you all.
Helene Grik (Sister to Lee; Sister-in-Law to Bob)
*******************************************************
A brief update. Bob was transported by air from
Nebraska to Lancaster today. Lee got the call that he was at the hospital
about noon. Roy and Gerry Mills gave Lee a ride to the doctor and then on to
visit Bob at the hospital. Elise stopped by to visit in the evening, feeling
somewhat better after a stomach flu (using a mask and staying several feet
away). After not seeing Dad for two weeks, it was surprising just how much
better he looked. He was only able to whisper as the trachea tube was not
closed off, but he was using coherent phrases and definite head shakes. He
even smiled and asked for a cup of coffee!! He is in acute care now as he is
being evaluated. We aren’t sure how long he will be here. For now he is
in room 446.
Jack called on his way to Georgia yesterday relaying
the information that the pulmonologist, in Nebraska, Dr. Cantral, said that
his breathing was better and the antibiotic was kicking in, with respect to
the staph infection.
Not much more new information, just wanted to let
everyone know he is here. Aunt Helene, Lee’s sister put out a note and
Mom is home and doing well also.
August 26, 1998
Hello to everyone from Jack in Smyrna, Georgia.
This information is from phone calls from Lee and
Elise Gravance today. Lee was seen by an orthopedic surgeon in California. He
is not satisfied with the healing on her right leg. While on a hike several
years ago with three female veterinarians, I learned that medicine has some
art as well as science to it. The vets spent a good part of the day discussing
different "courses of treatment" they would consider for actual
cases they had recently seen. The nurse who had been applying the Unaboot had
suggested to us that the doctors/nurses in California might seek a different
course of treatment, indeed she suggested the one that the California surgeon
and Lee have decided to follow. That is, debris the necrotic tissue (by saline
soaking for five days) followed by a skin graft. Lee will enter a new facility
tomorrow for the saline part of treatment. The operation and recovery will be
at Antelope Valley Hospital. The phone number for Lee starting tomorrow is
(805) 942-8463.
The news on Bob is anectodal. I will report when I
have something more to say.
Jack (son of Bob and Lee)
August 27, 1998
Elise here. Jack gave a good rundown on Lee’s
condition yesterday, she is checking in to the hospital today at 11AM.
Just a few brief notes about Bob’s condition. He
seems to have stabilized, at Antelope Valley Hospital, after the transport
Monday. He seemed worn out after the transport but is looking much better as
of Wednesday evening. Generally his condition is the same. They are keeping
him somewhat isolated because of the staff infection. The amount of isolation
varies depending on the day/nurse/etc. I haven’t been able to connect
with his doctors yet and don’t have much official to report. Bob’s
communications vary greatly according to how tired he is. They vary from
mouthing words or sentences to whispering sentences and sometimes, with much
effort, he can make clear sounding words.
I would imagine that if things continue to progress in
the right direction that there will be only small changes and therefore will
probably only make an update every couple of days. Bob’s mother, Esther,
(101 years young), yes I did say mother, will be driving down from San Jose to
Lancaster to stay with us for awhile. I believe she will be arriving Friday,
August 28th. She is a firecracker and it will be so nice to have her here, for
us and I am sure for Bob. I know it has been hard for her waiting in
California for his return.
Elise (daughter of Bob and Lee)
September 2, 1998
This message brought to you from Jack Gravance, who
doesn’t have a home, so is using Steve and Elise’s home computer,
in California.
Lee has been receiving saline treatment on her leg.
This consists of a wrap around the affected portion of the leg and saline drip
into the wrap. The purpose is to loosen and remove the necrotic (dead) tissue.
It has worked very well and the orthopedic surgeon, Dr. Lawrence, was ready to
do the skin graft today. However the O.K. has not yet been received from the
HMO, so the graft is delayed until Friday or Saturday. Medically this is O.K.,
the leg will just be that much cleaner and healed. Lee will continue with the
saline treatment at the facility she is in. So it is an example of the
HMO’s slow response will end up costing them more. Lee is not excited
about the extra several days of bed rest, but her spirits are, as usual,
excellent.
I would say to you that Bob’s progress is
unbelievable, except that I believe it. You can see his progress each day, but
when you go away for over a week, the result is dramatic.
Yesterday I spent an hour with him. Today his 101 year
young mother and I spent several hours with him. He was awake the entire time,
responsive, checking out his leg brace, wiping out his mouth, answering
questions with no delay.
Yesterday I told him I wanted to talk to him about the
property settlement. He nodded yes. I told him C-note (the nickname for the
glider, which was serial number 100) was totally destroyed. His response was a
mouthed "Oh, (expletive deleted)". I told him they were offering
$10,000 for it and the trailer, that I thought that was a very fair offer, and
he nodded agreement. I told him the motorhome was totally destroyed and he
shook his head in disgust. He agreed the $4,000 offering for it was fair. I
told him that most of the electronic equipment had been retrieved by the
wrecker, but that about half of it was not working. I told him that Steve,
Elise, Mom and I had put together a list of missing or destroyed personal
stuff and that they were willing to pay us the asked for price of about $4300.
He understood and agreed.
I later learned that the occupational therapist has
started Bob writing. He can make straight lines, circles and happy faces. This
morning he wrote out his last name. It is not legible if you look at it after
written, but the therapist says you can make out the letters as he writes
them, if you know what he is writing.
Today I asked Bob if he remembered yesterdays
conversation on the property settlement and he indicated he did. I told him I
had pictures of the wreckage and asked if he would like to see them. He
responded yes. When I showed them to him he was incredulous, as are many who
see them. At a later date I’ll get them scanned and attach them to the
email.
They have gone back to the plastic trach, perhaps
because he tore the other one out several times last week. Even with the trach
installed Bob sometimes speaks forcefully enough to get an audible and
understandable word or two out.
Bob’s mother and I were fortunate enough to
observe his occupational and physical therapies today, as well as meet his
lung doctor, Dr. Krishna.
September 6, 1998
I don't think we had yet thought to give you the
address where Bob is;
Bob Gravance
Antelope Valley
Hospital
1600 W. Ave J
Lancaster, CA
93936
Lee's skin graft from right thigh to right calf was
accomplished on Friday. It was done on an outpatient basis and she returned
home that day.
I have had little time to spend with Bob the last
three days. On the short visits I made he was either tired or asleep, so I
don't have anything to report to you.
September 10th, 1998
Things are progressing slowly, but they are
progressing.
Lee saw the orthopedic surgeon, Dr. Lawrence, today
about the wound that was skin grafted last Friday. He said that her leg is
healing nicely. She seems to be in good spirits. Paul and Salina are doing a
great job helping her get around.
Bob is doing well. The doctor said that he had seen
some slight improvement the last few days up through Tuesday. Since then it
seems that the lung secretions have diminished. The speech therapist, Bethany
was in Tuesday evening while I was visiting. She worked with Dad for awhile,
after just waking him up. She said that she can notice an improvement since
the week before and he is able to answer more of the complicated questions.
For now, with the plastic trachea tube, he answers with nods, whispers and
thumbs up or down.
They also have Bob scheduled to have the right leg
re-straightened. This is the leg that had the compound fracture. I guess it
was growing slightly crooked, as I understand this can happen with this type
of break. From the way it was explained we aren’t sure if surgery is
required to fix it. My impression from the description was that it
wouldn’t. Dad also seems to be in good spirits.
Elise and Steve
September 14, 1998
Bob had a complication Friday. He had a small part of
the lung collapse. They have put him back on the respirator to keep it
inflated and to give it time to heal. They think it may heal without a
surgical procedure. The doctor’s think that he is starting to get ahead
of the infections in the lungs and they are now keeping his door open.
He is also getting stronger and trying to get out of bed,
by himself! He got two cards Saturday and it appeared that he was able to read
them by himself.
Lee’s leg is healing and she is now allowed in
to see Bob again.
Elise (Daughter)
September 17, 1998
To elaborate on Bobs leg procedure, I was told within
a couple of days after the accident that this would likely be necessary. When
both the tibia (the "shin bone) and the fibia (the smaller bone behind
the tibia) are broken, the fibia will heal the fastest. This has a tendency to
force the tibia into a crooked stance, as the body will always try to
"over repair" an injury.
The procedure to be done today is called a
"closed reduction of the fibia". In plain talk, it means they will
re-break the bone without opening it. (That’s why they call it a
procedure rather than a surgery.)
On a lighter note, Lee said that Bob managed to say
"what?" three times yesterday without any plugging of his trach. How
this is possible, I don’t know!
Paul
(youngest son of Bob and Lee)
Several days ago the doctors decided to go forth with
the procedure on Bob’s chest to drain the fluid.
I (Jack) arrived safely in Lancaster on Monday. I now
have access to the internet at work, so if you want to contact me my address
is
-
jack_gravance@yahoo.com.
My work phone is (805) 275-4754.
For one month I will be staying at:
The Essex House, Suite 403
44916 North 10th Street West
Lancaster, CA, 93534
(805) 948-0961
September 18, 1998
Last night when I (Jack) arrived at Bob’s room,
Lee was in visiting. She had seen her orthopedic surgeon for a look at the
graft site. It is doing well. Lee now has a daily regimen to unwrap the site
and perform a saline soak.
I visited with Bob for over an hour and he was alert
the whole time. At 7:45 PM Dr. Choudhary (Bob’s lead physician) came
into the room and gave me a complete rundown on Bob. He had spoken with Dr.
Krishna (lung doctor) that day, as he does every day, and Krishna was
satisfied with the progress. Dr. Choudhary explained to me that the lung
collapse is like a puncture and that will have to heal. They expect that will
take some time, so again our family will just have to be patient. The staph
infection still exists and Bob is still getting antibiotics for it. As I
understood it, Bob does not have pneumonia, the secretions from the lungs are
of a bronchitis type, around the wind pipe, not down in a lobe of the lung. I
was very impressed with Dr. Choudhary’s bedside manner.
September 21, 1998
On Saturday I (Jack) spoke with Dr. Hahn (surgeon). He
had just inspected the chest tube, and it is fine. He said that Bob’s
lung has re-inflated. The chest tube is doing some good removing fluids, so
they will leave it in until Tuesday or Wednesday.
Yesterday Albert (respiratory) told me that they had
reduced the setting on the ventilator from 6 to 4 (sorry, bad engineering, I
don’t know the units!). Bob’s numbers were holding up well on the
new setting and Albert was guessing another lowering of ventilator setting
would soon come.
September 22, 1998
More good news on Bob’s progress. Yesterday they
removed the plastic splint from his left leg. Bob was enjoying his new found
freedom by bending his foot up and down, left and right. Even though the right
leg is still in the cast, he has regained enough strength to lift it.
Jack (youngest son of Bob and Lee)
September 25, 1998
The chest tube was removed from Bob on Tuesday. The
lung has remained inflated. Also on Tuesday took Bob off of the ventilator for
evaluation. After two hours his oxygenation number had dropped enough to
indicate the ventilator is still required, but at a lower level than
previously.
A good friend of Bob’s from many years ago is Ed
Minghelli. Ed was also a glider pilot and owned a tow place Prue IIA which he
had built himself. Bob and Ed set several national (and I believe World)
records in Ed’s glider. About 3 weeks ago as I approached Bob’s
hospital room there was a hospital employee outside the door. I introduced
myself as Bob’s son and the employee said his Dad was a friend of my
Dad. A short exchange revealed the man in front of me to be Ed’s son Ron
Minghelli. Ron had other duties to attend to then, but came back for a visit
later. Last night Ron came into the room again, but not to visit this time, he
is a respiratory therapist and had been assigned to Bob’s section that
night. It is indeed a small world.
Ron informed me they have been weaning Bob from the
ventilator. During the day they run it in CPAP mode (he told me what the
acronym meant but I’ve forgotten). In this mode Bob does all the work of
breathing himself, the ventilator supplies only enough pressure to overcome
the tubing. At night the ventilator is put in another mode which supplies some
pressure; this is so he can rest and to provide extra security.
The procedure to re-straighten Bob’s right leg
is scheduled for today.
Jack (oldest son of Bob and Lee)
September 28, 1998
Lee reported good news and bad news on Bob’s
right leg. They removed the cast on Friday and x-rayed. The alignment is good,
but not enough healing of the bone has taken place to leave it un-casted. Lee
learned today that Dr. Lameer, the orthopedic surgeon, believes they may need
to do something else, ie. install a pin. If so, that will wait until his lungs
are better. The right leg was re-casted, but this time with a lightweight
fiberglass.
Lee also got some good news on Bob’s lungs. The
preliminary results, from the first culture they took, show no staph. The way
she understands it, they need to get negative results on two more cultures
before the results are official.
September 30, 1998
Today when I approached Bob’s room the door was
wide open. A check at the nurses’ station confirmed there is no longer a
need to wear protective clothing while visiting, Bob’s staph infection
is gone! Furthermore he was sitting up in a hospital chair facing the door and
sipping coffee through a straw, holding the cup himself! He was taken off the
ventilator Monday and has been receiving un-pressurized oxygen since then.
Shortly after my arrival they brought in a tray of
food, milk, cranberry juice, ice cream, custard, applesauce, soup and water.
The respiratory nurse, Kathy, then showed up for his periodic treatment.
Following that his RN asked if he was hungry and he indicated no. She told me
he had eaten jello about an hour before. Then his speech therapist, Diane,
showed up. She told me that yesterday they had put blue dye in applesauce and
fed Bob several bites. This was followed by suctioning of the lungs 5 minutes,
30 minutes and some hours later. The results were negative (no dye) so he is
handling soft foods satisfactorily. Diane mentioned this test is not a great
test, but one indicator they use. Today she fed him most of the custard, a
glass of water, then mixed the blue dye with his melted ice cream and fed him
a few bites. The five minute suctioning indicated a trace of blue, the 30
minute suctioning had noticeable blue. So Bob will receive his liquids
thickened for the time being. Diane said she will order x-ray of the chest
where the valve is.
I noted four or five days ago that the restraint on
Bob’s arm had been purposefully tied much looser, and would have allowed
him to pull out the trach if he was so inclined. I gathered he has finally
been trained not to do so. Today his restraints were untied, and not only did
he not try to remove the trach, but at one point when the oxygen hose came
loose of its’ own accord, he motioned to me to put it back on!
The occupational therapist (whose name I’ve
forgotten, Kathy?) was also in today. This was her first visit in about a
month, since all the lung problems had been higher priority. Because of the
time lapse, she did an evaluation of Bob as if it were her first visit.
Jack (oldest son of Bob and Lee)
October 01, 1998
Lee drove herself to her appointment with her
orthopedic surgeon today. He is mostly happy with the skin graft. There is a
possibility a second smaller graft will be required. Some of the skin has died
where it is on an exposed tendon; but, there is granulation at the site, so it
may fill in without another surgery. She no longer has to do the daily saline
treatment and is encouraged to leave the site open when she is at home,
wrapping it only when she goes out or goes to bed.
Have I used the term good news - bad news concerning
Bob’s health before? Many times you say!! How about his condition
hasn’t worsened, but we have a new diagnosis? You’ve heard that
too?! Look, I’m an engineer, so those of you with better writing talents
than I (that should be a majority of you) send me some new prose.
Yesterday the occupational therapist determined Bob
has some adhesion in his right hand where the surgery on the tendons was done.
She said she would bring some new exercise charts for that problem, and today
when I arrived they were there. I helped Bob do a set of them. He then dozed
off, and the nurse brought in his lunch.
The nurse added three teaspoons of the thickener to
Bob’s glass of water. It quickly turned the consistency of cream of
wheat, though more translucent. I usually am willing to try something new, so
I put a little in a clean cup and ate a bite. It pours, but barely. It adds a
little flavor that is not terrible, but plain water is better. It kind of lays
there on your tongue, wetter than nothing, but not as refreshing as liquid. I
wouldn’t choose to add it to my beer.
The good news is: Bob awoke and I fed him most of his
beef stroganoff, peas with baby onions, lettuce, tomato, green pepper salad,
and bread roll with margarine. I think he would have finished it all,
including the two oatmeal cookies, but we were interrupted when they came to
take him away for the x-ray procedure of his swallowing function.
The bad news is: Bob’s swallowing is weak. The
food lies in the esophagus and is subject to aspiration (entering the lungs).
He does better with the soft foods than liquids, but neither is good enough.
So no more meals for now. I am not ashamed of asking stupid questions,
especially when I can’t word them to make me look intelligent. So I
asked Bethany (the speech pathologist who performed the test and informed me
of the results) “How can you build the strength of the swallowing
muscles without eating”? The answer is, Bob will get another exercise
regimen, basically singing through the scales. He is going to love that
one!
Jack (oldest son of Bob and Lee)
October 07, 1998
Yesterday Dr. Choudhary (Bob’s overall doctor) entered the room while I (Jack) was there. He was guardedly optimistic about Bob’s recovery. He is doing well, as long as something doesn’t crop up. He left the room, and shortly returned with a much better outlook. He had just run into Dr. Krishna (lung doctor). Krishna said the lungs are healed well enough that the are the secondary concern (they will continue to monitor them) and the primary concern is getting Bob into a good, intensive rehab facility. They had already contacted the HMO and are awaiting what the HMO comes up with as alternatives for the doctor’s to evaluate.
Several days ago I came up with the idea that maybe
the family could help with Bob’s swallow muscle rehab. I contacted
Diane, the speech therapist, and she was delighted. She left a card and a
sheet of paper with the instructions. The exercises are sticking your tongue
straight out, puckering, smiling, opening your mouth wide, pressing lips
together firmly, sticking tongue out and moving to the corners of the mouth,
scrapping the roof of the mouth like it had peanut butter on it, form a
suction of the tongue to the roof of the mouth then pull it down to make a
popping sound, move a toothbrush from the center of the mouth to the right and
left chewing areas, put the tongue between teeth and cheek and move it around
to the right and left, stick the tongue out and try to touch the chin, and
hold mouth wide open and try to pucker. I probably missed a few.
Jack (oldest son of Bob and Lee)
October 12, 1998
Hello all, Paul here. (Youngest son of Bob and Lee.)
Great news today! Bob has been transferred to the Acute Rehab Center in
Valencia, CA. It’s about a 30 minute drive South of Palmdale.
I received a call on Friday at about 2:00 PM from
Elise. (Daughter of Bob and Lee.) She brought to my attention the answering
machine message that had just been left by Lee while I was out doing yard
work. Lee was on her way to a scheduled doctors appointment and had just
received a call from Bob’s nurse informing us of the transfer (and the
destination!)It was scheduled to occur at 3:30! I managed to arrive in time to
see Bob and explain to him what was going on before he left. He had been told
he was being transferred to Henry Mayo Memorial Hospital but not why, and he
didn’t know what city the new hospital was in. (Nor did I until I asked
Elise during the phone call.)After receiving this information, Bob’s
spirits rose noticeably and have remained high ever since. I then followed the
ambulance down to Valencia and followed Bob, who was on a gurney into the
Rehab unit. I didn’t ride in the ambulance with him because they said
I’d have to ride up front and wouldn’t be able to communicate with
him anyways.
His progress lately has been very noticeable on a day
to day basis, even over the weekend with no therapists coming in. (Other than
the part-time therapists, re: Jack and Elise.) Yesterday he scooted himself
over in bed and lifted his head up over the bed rail to give my twins (Michael
and Sarah) a kiss without anyone holding the kids up to him. Sarah went for
the first kiss, and I wish I could fully describe the excited, wide eyed look
that Michael gave me after Grandpa did that!
Today Bob starts his therapy regimen, which will be
posted on a board in his room each evening. Monday through Friday will begin
at 8:00 AM and go straight through until 4:00 or 4:30 with various therapist.
(Occupational, Physical, Speech and Respiratory are the ones I remember.)
The one bit of dissapointing news to report is that
due to a sinus infection, Lee is once again under Doctors orders to stay away
from Bob. I can’t imagine how hard this must be for her! On a brighter
note, her leg is healing well, and she’s getting along (and around)
pretty well by herself.
Bobs new address is:
-
Henry Mayo Newhall Memorial Hospital
Nursing Pavilion
Acute Rehabilitation Unit, Room 310
25727 North McBean Parkway
Valencia, CA 91355
(805) 253-8992
-
Directions:
From I-5 exit McBean Parkway and proceed east. As you approach the street of Avenida Navarre you’ll note the signs indicate only to the right, and you’ll note the hospital is on the left. Avenida Navarre essentially dead ends into McBean, but you can turn left there onto the hospital roads. Then the building on your left is the Acute Rehab Unit. As you enter the breezeway the Adult day care center will be on one shoulder and Acute Rehab on the other. Follow the signs to the nursing station, introduce yourself and they’ll tell you to go right on in.
From Hwy 14 exit San Fernando Road/ Hwy 126, and proceed west about a mile. Where the road bends right, turn left on Lyon Ave., right onto Orchard Village Parkway, right onto McBean and finally a left at Avenida Navarre, then the building on your left is the Acute Rehab Unit.
If anyone going to see Bob happens to need directions after getting to the Hospital grounds, be sure to specify "Acute" rehab, or you will surely be sent to the drug rehab unit!
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