Thursday, January 31, 2013

Wed Jan 30- Adventure

Bleergh, I am tiiired!

Lots of excitement today... JAMES LEFT HIS ROOM!

First they put him in a wheelchair. He whacked or put weight on his bad (left) leg and whoo it was no good. He tried to use his hands to push the wheels and we all yelled at once "No wrists!!" So he used his right foot to pull himself forward. Once he got rolling he just rolled right out the door.

I felt totally unqualified to be "in charge" of James. They just put the man in a wheelchair and said "Why don't you take him for a spin, go on down to the first floor in the employee elevator and go outside in the Tranquility Garden for a minute."

What? Hike Everest in my pjs?! Sure, ok... let's go...?

I roll him to the employee elevator lobby. I push the button. We wait. The doors open. I begin to carefully push him toward them, envisioning what would happen if I jabbed his right foot into the doorjamb. (Not imagining it maliciously, but like with sheer terror in my heart of the possibility.)

The doors close. We are nowhere near them.

I push the button again, but evidently the elevator is already gone off to whisk someone else away to an unknown fate. We wait again.

Finally we get to the first floor, together, un-jabbed.

We follow the advice of the dude who held the elevator open and start down the hall. Almost right away a woman in OR scrubs - her booties and hair net- gets a "look" on her face and stops us. "I was your date in surgery! You look fabulous! Do you remember me?! I was your anesthesiologist! You look GREAT! I can't believe you're up! Look at you!" and she rushes over to his good side and says she'll escort us to the Tranquility Garden.

Of course she doesn't expect James to remember her. She was present for the entire 11-hour surgery on January 16 to repair his eye bones and sinuses. She chatters on about the joy she gets from seeing a patient after such a surgery, and how unusual it is for her to get to see anyone she works for (patients).

She is looking at James and he is looking at her, blindly trusting me to not run him into a wall. I look ahead for obstacles and who do I see? The neurologist who so bluntly told the nurse the other day that he thought James was going to die. He reminds me of Texas- of Cotton from King of the Hill.



He seems to be a Texan's Texan- he wears scrubs but with a black felted blazer over it. He's literally a brain surgeon. He has horn-rimmed glasses and no lips. He walks like he has cowboy boots with spurs on but I've never looked at his feet.

I say, "Dr (Cotton)! Look whose up and about!" And what does the man say?

"Wow, you look awful! I told the facial surgery team you were gonna die!" All three of us just stared blankly at his incapability to talk to others. (As Michelle, my main handler, would say, "Ass hat!") We proceeded down the hall.

We make it to the garden. The air is moving. Stand up comic Jim Gaffigan said "You ever go outside after being inside all day? It's like being on another planet. Oooh, the air is moving!" I think that's what it was like for James. It was a nice enough garden, we identified a lot of the Texas native plants. James was already exhausted and a little nauseous and was ready to go back upstairs. But a nurse had seen us through the glass walls of windows and came outside. It was one of James' male nurses from Seton!! He had taken care of James for two days when he was in bad shape. I told him I'd bring James back one day to say hi, but he was getting transferred to Hays and probably wouldn't get to see him. Well, he was at Brackenridge getting training and saw us and came out to express his astonishment and joy at seeing James so improved. It was awesome pushing a rockstar around for 15 minutes.

James is tired and beginning to be nauseous. We head back upstairs. The nurses have switched us to a new room and put all our stuff- James' posters of cards and pictures, the Lego creations from the boys, our bags, all the technology- all of it in the exact same place it was originally. The lengths they go to for their patients is impressive.

Under James in the wheelchair is a fabric stretcher. They hook this to the lift in the ceiling and pull him up and over the bed where they lower him. My baby orca, I call him.

"The worst Sea World exhibit ever" he says.

not James, obviously, but looks like his good eye on the monitor
As James is about to lapse into sleep, a curly-haired male opthalmologist(sp?) comes in with an assistant and a few briefcases. He is here to do an ultrasound of James' left (bad) eye. First, however, he puts a crazy instrument on his head and inspects James' eye. By the time he's done, the assistant has set up a little machine on the side table. It's an ultrasound machine specific to opthalmologists. I'm expecting that he'll put the goo IN James' eye but he puts it on his eyelid. He takes 3 pictures.

Then he does the same to James' right (good) eye. He takes one picture. This is not the DR nor James in the photo above, but it has the same ultrasound wand and a picture that looks like James' right eye. He also tests the bad (eye) with a penlight. James' left eye can register direct light, but not room light.

He shows James his good eye, how it resembles a large open space, a black ball. Then he has the assistant show him the same angle of the left eye. In James' words, "It looks like a wad of chewed-up gum."

This is the first time James is hearing straight from a DR the state of his eye. It is somber.

The DR says that since the eye can register direct light, they don't like to remove it if possible. He says, God forbid, if something happened to his good eye, at least he could see light with the other. He also, to my delight, says that instead of removing the eye and replacing it with a ball attached to the eye muscles, they can leave the eye and put the shield over the eye. That is the thing that looks like an eye and moves because of either the real, damaged eye or the ball moving behind it. Here's a decent website.


So it seems that like with most things, it's wait and see. See if the eye is holding a static volume. See if it continues to hurt. See. He wants to see James in a month to see if the eye is keeping its (smaller, damaged) size consistent. If it is, and it doesn't hurt worse or stops hurting, it seems that at that time a shield prosthetic will be discussed.

Someone suggested a family picture this fall with all of us wearing eye patches. James said "No way- y'all haven't earned your eye patches."


Stages Of Tracheotomy

First it was a size 8 (installed with the neck collar, getting humid air laced with oxygen.

Downsized to a size 6 (Jan. 24), then a size 4 (Jan. 26)! Red cap means he's talking!
Just a healing scar after removal of trach January 29. Great fart noises from the neck.
You can see his clavicle surgery stitches.

Wednesday, January 30, 2013

Summary of January 2013

A quick summary of what happened in January- a phrase or two a day.
  1. femur, humerus, L radius & ulna, R radius set with rods and plates
  2. rest- trying to stabilize blood pressure, blood transfusion
  3. pelvis and acetabulum set with rods; bad "wake-up"
  4. failed ambulance transport to Brackenridge
  5. good reaction wake-up
  6. rest
  7. Starflight to Brackenridge
  8. rest
  9. facial surgery to set bones and sinuses- cancelled
  10. rest
  11. tracheotomy and PEG (feeding tube) installed; burr hole to drain cranial hematoma; great wake-up reactions; pneumonia developing possibly
  12. looking around, moving R arm
  13. angry, upset
  14. rest
  15. 1st PT/OT
  16. wrote correctly! facial surgery- sinuses and facial bones set (11 hrs)
  17. rest
  18. nose repair (broken on 16th); very upset
  19. very agitated- later, first good rest; 6 hrs!
  20. saw kids first time
  21. rest. Beginning to remember day before/what is said
  22. clavicle set with plate
  23. rest
  24. catheter out, trach downsized (6)
  25. applied to VA rehab
  26. rest
  27. trach downsized (4), talked! passed swallow eval- ate food
  28. rest
  29. trach removed!
  30. rest 

Tuesday, January 29, 2013

Mon Jan 28- Big Day From a Big God

Today was a big day...

 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.

But.

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!

Well we are no longer distracted. James' good eye is about as big and as round as a kid's drawing. The second nurse just sighs and holds the collar. We watch her get a grip on the second pin and James' eyebrow just goes up, up as she pulls the pin out, out. ((shudder))

These are the pins- stainless steel, about three inches long.
Wound care collects her unsanitary pliers and leaves with dignity. The second nurse is telling us how she got permission from the neurosurgeon to remove the c-collar. We haven't seen the neurosurgeon for at least a week or more. He is the one that approves the removal of the thing.


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 torturers PT/OT professionals. The team for the 8th floor came in and introduced themselves. I have no idea what their real names are; James immediately dubbed them Hans and Franz.

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.

Jan 23-27 Quick Update

Wednesday, January 23

Yesterday James had his clavicle set and he is tired and has more pain. He has the nurse call Tracy early to find out when she is coming in. (Tracy has no laundry of any variety and is waiting for the clothes to dry.) She stops at the store and gets a radio and some nail clippers and shaving cream.

 Someone from plastics comes and takes 16 stitches out of his left eyebrow.

They x ray his clavicle to see how the repair went and also took a picture of his knee to see what exactly happened there, as no xray has tried to look specifically at it yet.

Thursday, January 24

The plastic surgeon comes in. He instructs James to smile, growl, raise his eyebrows, furrow them, and suddenly exclaims "Damn! have you got a great plastic surgeon!" and walks out. Later James gets his ratty ace bandage off his right wrist (pins) and gets a molded plastic one that straps on and off. He has lost 25 pounds. His biceps and calves feel "baggy" I think the weight is muscle mass.

After I leave for the day, four nurses attack and traumatize him. He gets the trach downsized to a size 6. They seem unorganized, thoughtless, and inept. He is vulnerable with his collar off, his head being stabilized, and they don't seem to know what they are doing.

In addition, they had been doing this elaborate rotation of the catheter tube, clipping it to a sticker on each thigh and then on his stomach. They have to keep it moving to protect his skin from breaking down from the pressure of the tube. We are discussing the rotation and suddenly I'm like, "He's not sedated, he's been awake, he's remembering- why do we still even have the catheter?!" and the nurse says to me "Sometimes the DRs forget to cancel the order." So we remind them and they take it out in a too-quick and thoughtless way right after they do the trach downsize. Rough day.

Friday, January 25

The plastics person comes and takes out a single stitch- through James' septum (divider in the nose)! which holds two splints in place. (James' nose had been broken when they fixed the facial bones and these were holding it in place.)

The other driver's insurance offers us a great price for the totalled van, even better than what our insurance offered. An answered prayer!!

We faxed an application to the VA requesting a transfer to the rehab facility in either Temple or San Antonio. I do not want San Antonio but we have to apply, the case worker says. We get moved to a new room on the eighth floor- OFFICIALLY OUT OF INTENSIVE CARE!!!! Now James can see the kids any time!



Saturday, January 26

The weekend at a hospital is quiet. James has a good day of rest. He thanks God for saving him from death. He and Tracy talk alot about God's plan and grace. I read James some Psalms (all the ones ending in a zero are so good!) and we listen to KLOVE radio. I am so happy. He has a few visitors.

Of course when I say we talk it really means we lip-read, and sometimes try to convince James to write with a Sharpie or on the iPad we're borrowing. My newest technique is to say what he's NOT saying. He says something and I say, "uhhh, you're NOT saying you hear turnips, right?" Geez.

Sunday, January 27

James and Tracy listen to the latest sermon in a series on marriage that our church is doing. There is a "text in your question" phone number. James is so touched as he has heard details of how we (the kids, his mom and sister, and I) have been cared for when he has been hospitalized, that he has me text in a big thank you to the church.

A prayer request went out that the next trach downsize would be less traumatic. The nurse comes in and has a big intro and says they're ready to downsize again, to the size 4. This is the size where James can talk and try a swallow evaluation to see if he can eat.

He gets very anxious and talks the nurse into doing in Monday morning. She compromises by saying she wants to cap the size 6 and see if he can talk with the cap. As the RT sets out all the supplies and tells James what he is going to do, James is seeing what a big deal it is, so he decides to go ahead and knock out the downsize right then. They give him something to help him calm down and say they'll be back in 20 minutes.

I settle in on the bed on his right side and lean against him and we talk together. He says how hard of a time he was having in November and December, how he was done with life and tired of trying and failing. We talked about God's plan and how all the nurses and DRs are so amazed by his healing and his recovery. He says again and again that it's not him that is so amazing, but God. I tell him it's nice to be near a vessel God is using. I feel like all my Christmases have come at once.

The nurse and some help come in to downsize. One holds his head, another takes off the collar. They set up all the gear and I'm standing there holding his left hand. She prepares the size four, takes out the six, and literally a few seconds later the size 4 is settled in place. It was flawless and simple. Answered prayer!!


He puts the cap on, snap! and James coughs. It's the first noise he's made in 27 days. You have to understand, when he was intubated (till the 11th) he was utterly silent. Violent coughing looked like a seizure- huge chest movements, up and down, with no sound. With the trach he's made some angry hissing noises, and phlegmy ripping noises, but still has been silent. That first tiny cough noise was so beautiful. It was like when I saw his foot and leg in the ER- I knew that noise.

Of course I have stood faithfully by James for 27 days and I expected wanted James to go into a long monologue (like Zechariah) about my awesomeness but instead the nurse asked how the cap felt and James' first words were "It sucks."


Arbonne Fundraiser

Please consider helping the Dear family! All profits plus my commission are going directly to the family. You don't have to buy for yourself, but you might know someone who can benefit from any of these products while helping Tracy and her family out. Have your husband take it to work, ask your neighbor, or anyone you know that is wanting to offer their support. I do have other products I can offer. I am looking to place one huge order so we can save on shipping. The Dear fundraiser thanks you for your support!


Help The Dear Family    

Dear Family Fundraiser
Is something everyone will LOVE!

From now until January 30th, purchase an item from Arbonne’s ABC line for $18ea!
(price includes tax & shipping!)
 For every 50 items sold, we will raise $450 for our friends
Tracy and James Dear.

Arbonne Baby Care
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Diaper Rash: A light, water-repelling ointment that gently relieves baby from sore, dry, chapped skin. Rich in antioxidants, herbs and botanicals, it helps prevent diaper redness and irritation. Excellent for minor burns, cuts, scrapes and sunburn also. Recommended for all skin types. ( 4.7 oz/113.3 g )
Baby Lotion: A gentle lotion formulated for delicate skin that soothes, softens and conditions skin, while helping to reduce redness and irritation. ( 8.5 fl oz./251 ml )


Arbonne International offers Pure, Safe, Beneficial™ products that are formulated in Switzerland to European Standards but made in the USA!! Arbonne products are vegan-certified, botanically based and formulated without harmful chemicals/toxins, or gluten.
Our products are earth friendly & beneficial to you.

To place an order, contact Jamie Finch? at (512) 799-6964 or


Cash or Check only!
The Dear fundraiser
thanks you for your support!
      


Saturday, January 26, 2013

When you visit...


Be sure to add your thumb print to the tree the kids made. It's on James' door, and as he gets more visitors the trees will get more leaves. Their little arms are the trunk and their hands are the branches. There is a green inkpad in his room.

The eighth floor has no time no age rules. You have to check in with  the nurse to make sure he's not sleeping. The nurses' station is just a few feet past his door.

And check out this great article about marriage.

Also my church HCBCRR is doing a series on marriage, it rocks.


Lip Reader, I am Not


If you look carefully at the top of that picture, you can find the phrase "worst linguist ever." Which would be me.

James is much more willing to write now that his fingers are less swollen and more flexible. Also, I trimmed his nails and he is having more success with typing on the borrowed iPad.

Ironically, when he is upset I understand more than when he is enunciating. Of course, the purpose of enunciating is to clarify SOUND, and actually makes it harder to lip read.

" Jenni," James tells me, "she never needs the pen and pad."

"Humph." Is all I have to say to that.

Let me thrill you all with the news that James wants to write a blog post soon! He is a fabulous writer, and did you know once we were in the NY Times for writing?

http://www.nytimes.com/2009/10/13/movies/13veterans.html?hpw&_r=0