Soon after I came in this morning, a woman came into James' room with a tray. On it were three items that immediately caused a cheer to arise in our room: a glass of ice water, a cup of vanilla pudding, and a packet of graham crackers.
The swallow assessment!!
She tentatively, cautiously, carefully offered the ice water towards James. The bendy straw goes toward his lips and she's telling him to take care and not swallow too much too fast. (She does not know that he has been successfully swallowing water for weeks. He was sucking sponges dry for a week before they put an NPO sign on his door the night before his facial surgery- the 15th. Then, they didn't cancel the order! So we had to sneak water to him. Then he valiantly refused water on principle.) He takes huge happy swallows of the ice water.
With that success, she immediately starts peeling the foil lid off the pudding cup. His eye rolls with joy... vanilla pudding he would've scorned at before Christmas, the best flavor ever, now, after a month with nothing but sponges of water.
She offers him a corner of a graham cracker. He maneuvers it into his mouth and carefully minces it to dust, successfully swallows it. It's a PASS! She assigns him a status of "Mechanical Soft" with the official sweep of dry erase marker on his white board.
Soon a dietician or someone comes in- these people wear a laminated apron and a laptop thing on a strap- she says James can have meatloaf, diced spinach, and mashed potatoes for lunch. He is in heaven.
Then the wound care specialist comes in. She says she's here to look at James' right wrist.
|James' right wrist break and setting with pins.|
|These are the heads of the pins extending out of his wrist.|
She casually sets a pair of pliers- the kind from a tool kit- on the bed. "I'm here to remove these pins," she says.
I try to remain calm. They told me they are just going to pull those suckers out with no local and I don't want to panic James with a look of impending doom.
Then another nurse comes in. She's messing with James' c-collar, unbuckling it and talking about how the neurosurgeon said it could come off. We're distracted for a second and the wound care nurse just gets a hold of that pin and ....huu-unh! it's out. We're both a little bug-eyed (James certainly more than I) and the second nurse goes "Hey! I'm trying to distract you!"
|yes, normal pliers!|
|These are the pins- stainless steel, about three inches long.|
First let me complain for a moment about the c-collar. He's had the same nasty thing since New Year's Eve. He has a set of extra padding we wash out in the sink and air dry. It's loose, it's just enough to be uncomfortable. We have to clean and suction his trach around it. He moves his head every direction besides looking up. It's ridiculous that he has to wear it, it is in no way stabilizing his neck. Protocol, Protocol!
The nurse says she approached the neurosurgeon. She said essentially, "Your patient, James Dear, is downsizing his trach... I can't find the occipital fracture on the scan... he's been moving his head... the c-collar has been on for a month... we'd like to remove it."
He's like, "Who?"
She reminds him the last time he saw James was when he drained the hematoma on the right side of his head on January 11. He says: "Him? I thought he was gonna die."
Nonetheless the collar is off now.
He also had PT/OT today. Each floor of the hospital (so far we've been on the first floor, the 6th floor, and now the 8th floor) has a different team of
They helped James sit at the edge of the bed. His body has become accustomed to lying down and needs to regain the ability of pumping blood up to the head and down to the feet. He has to fight light-headedness for a few minutes before he can try to stand up. Then he only stands up for about 10-15 seconds. When Franz helps James balance, James says his left leg is heavy and hurts. He is only allowed "toe-touch" on that leg- the quickest toe to the ground and switch his weight back to the right. Hans tries to slide his hand between the floor and James' left foot, and he can't. They ask him to get the weight off his left leg, but he can't.
They assign leg exercises to strengthen his leg so he can even lift the weight off the ground.
James' left arm gets startlingly purplish as he spends more time sitting or standing. It's the last holdout of swelling.
Hans and Franz are surprised at how well James is moving in the bed, turning himself, pushing his right (good) leg against the foot of the bed or against the mattress to shift himself up. He has a full range of motion in his right arm and although a week or so ago he couldn't lift his left arm more than an inch or two, today he can lift it nearly a foot or more.