Sunday July 23,
2006 Day of the Accident
At 2:50 a.m. I woke up and looked at the clock. I realized Caanan was still on our bed. I thought it odd you had not come home yet, but thought you were having a late time out with friends and went back to sleep. The next thing I knew I heard your Dad say, “He’s at Vanderbilt?” “We are on our way.” I got out of bed and the first thing I did was look at my trauma pager to find your trauma. Your trauma was paged out at 2:48 a.m., it read: 20-25 y/o m, head on mx, multi.fractures, head injury, 80p, snoring resp.
When we arrived to the ED no one was saying much and the Administrative Coordinator escorted us up to the Trauma unit. The first place they took us was to the “Family Conference room” then told us the Resident would be out to talk with us. Dad and I were scared and in shock. I kept thinking this is what is done when there is bad news. Dr. Carpenter came in and started going over all of your injuries. He was very kind and caring but he kept referring to your injuries in the past tense. I finally had to stop him to ask if you were still alive, he said yes, he didn’t realize he was presenting you in the past tense. We were able to go back and see you for just a few seconds. You were still having trouble keeping your blood pressure up. The Trauma team was still aggressively resuscitating you with – fluids, blood, and fresh frozen plasma to replenish the volume you lost with your femur and tibia/fibula fractures along with the liver laceration. The next concern was your left foot.
Dr. Kregor, the orthopedic surgeon,
came and talked to us about your fractures.
He showed us the films of your fractures – the first one he showed us
was your right tibia, it looked bad but Dr. Kregor said this one was the least
from the other two – the second one he showed was your femur, Dr. Kregor was
right, the femur looked worse – then he showed us your left tibia, you had an
approximate 2” gap from the fracture point to the top of the other end of the
tibia. Dr. Kregor was concerned about
the left tibia because your left foot was dusky in color and had intermittent
pulses. The discussion at this point was
whether Dr. Kregor would be able to save your foot. You went into surgery to start the repair of
your two lower legs at 7:10 a.m. The
surgery lasted approximately 4 hours.
Your friends started to arrive as soon as they got word of your
accident. I had called Christine around
6:00 a.m. and she left immediately from
After the surgery, Dr. Kregor spoke with Dad, Keaton, and me about the outcome. Dr. Kregor was amazed and encouraged about the repairs. Your right leg was completely repaired. He nailed the two segmental ends of the tibia and got it approximately 3-4 degrees off from perfect alignment. The left leg he stated that after he cleaned the wound on the bottom of your foot and cleaned the bone you tibia slid back into place with relative ease. Blood flow went immediately to your foot and it was warm/pink to touch with a strong pulse. He did say your ankle bone and your heel were crushed by the tibia coming through and that he would work on them later.
The seriousness of your condition hit us when we were told that the dispatch about the accident went out as a fatality at the scene and we were told they were talking about you.
I thank the Lord, my God and yours
that He was with you and has kept you in his arms as your protector and healer.
7/24/2006 – Day
One after Accident
You are sedated for pain; you are going to the operating room to fix your femur fracture later today.
Here is the rundown from head to toe what your injuries are:
Yesterday 7/23/3006 you were taken to the OR to have the lower legs realigned and splinted after cleaning and debridement.
Rev. Mike Ripski prayed over you before you want to the OR at 6pm to fix your femur. While you were n surgery Daniel, Thomas, Jonathan, Clarence, Adam Gregory, Dawn, Deb and Christy were sitting and waiting with your dad ad me for you to get our of surgery. They all hung out in the surgery waiting area until 11:45pm and then left. You were still in the OR when they left. Your dad and I waited until your back on the trauma unit, which was 12:30am, to come in and see you after the surgery. Your femur was fixed and they also put a pin in your left ankle. You looked very peaceful and comfortable and your color was good (not pale). You received a couple of units of blood (not unusual).
The next item to conquer is weaning you off of the vent then fixing your jaw. You also had a tube placed in your stomach, through your nose to start giving you nutrition to help you heal.
7/25/2006 Day 2
past accident
The plan is to decrease your sedation, the neurologists
wants to get a good idea of your brain function. The trauma team needs you to start coughing
and breathing on you own so they can take the tube out of your lungs and take
you off the ventilators. The trauma team
is going to place a catheter in your
You were responding to commands on both sides – This was very good news! I called Christine to update her on this good news. You went for an MRI of your heel to make sure it was clear to take your C-Collar off.
It is the end of a good day. They have discontinued the sedation medication. You have done bilateral responses to commands by the nurse and physical therapist. You gave a “thumps up” with you right hand and you squeezed the hand of the therapist with your right. They placed your IVC catheter to catch your clots. Your ventilation was decreased to the lowest setting and you are holding your oxygen saturation well through out the day.
In the evening during visiting hours your friends, went back to see you and you were moving a whole lot more which got them very encouraged and excited about your progress.
The last time I went back to see you before the end of visiting hours (Aunt Kathy was with me); you were “bucking” your endotracheal tube. This was a good and bad thing to happen. It was good because it told us you were aware enough of its presence and you didn’t like it. But then it was bad because you started to drop your oxygen saturation. Respiratory therapy checked to make sure you did not have a “mucus plug” obstructing the tube. Then gave you a breathing treatment to get our lungs cleared out You are having minimal drainage out of your chest tube, so possibly, you will be able to get rid of it tomorrow. Your progress is very encouraging and hopeful for everyone. You have had many prayers said over you and many friends at your bedside. You are very much loved! The next goal for you is to open your eyes when your name is said. You are coming back to us – just keep coming we are here for you! We love you so very much!
7/26/2006 Wednesday
Day #3 Past Accident
Dad, Aunt Kathy and I are on our way to the hospital. Last night was the first night was the first night I went home since you have been in the hospital. I was comfortable enough that you were stable, not going to have any surgeries, or major procedures done so I went home.
Every morning the Trauma team has “walking rounds” and invites the family to be at the bedside while the team discusses your case. I am praying for another good day. Today’s report your condition is:
7/26/2006 End of Day Report
Well…today was a rough day.
· You had your tracheal tube placed in your neck.
· Had a Bronchoscopy to check your lungs they lavaged (cleaned) out your lungs and sent samples of the washings to the lab for culture. You had an area on the left lower lobe so they started you on three antibiotics
o Vancomycin
o Tobraycin
o Imipenim
· After the bronch they took you down for a CT of your chest and abdomen to rule out any other source of infection.
· They tried to reduce and discontinue the sedation again but you became very agitated and then would not maintain your oxygen saturation it would hover around 88% - 90% and they want you at 92% or above so they started you back on the sedative and increased your ventilation oxygen %.
· They remover your Nasal gastric tube (tube in your nose that went into your stomach) because they weren’t getting anymore out your stomach. When you first came in they were getting out old blood from what you swallowed at the scene of the accident to the hospital. We can check that off as a success.
· By late afternoon you spiked a fever again 103 degrees. They placed cooling blankets on you, both under and over you to get your temperature down, since Tylenol suppository and ibuprofen weren’t brining it done.
· You also had your esophagus probed to make sure you did not have a tear as the team saw air around your chest bone. That procedure showed you did not have a tear or leak in the esophagus. We spoke to your orthopedic/trauma physician who indicated he thought we could fuse your ankle and heel bones and ask you when you were alert and oriented if you could feel the bottom of your left foot in about 10 days. The deciding factor it should like is whether you keep your foot is whether you have feeling on the bottom or not. Your right foot does not have any broken bones, which is good news because that means you can bear weight on that foot and won’t need to have a wheelchair when you leave the hospital. You can use crutches. This is very exciting! I have to say I am weary tonight. It is so hard watching you struggle to breath or move or come out of sedation. As a parent if I could take that struggle on for you, if I could take the pain away, and if I could suffer for you I would do it instantly. I know you will come back to us and I know you will do it on your own time! I love you!
7/27/2006 Thursday
Day #4 Past Accident
I am sitting in the Trauma waiting room with Aunt Kathy and Dad, it is 7:30am and we are waiting to go back to your bedside for bedside report with the Trauma Team. I pray you are doing much better and that you have broken your temperature during the night.
Well here is the rundown:
(Basically you had a bad night)
Family and friends can still come to see you today but they will be asked not to speak to you or touch because you don’t need the stimulus.
The fever is somewhat perplexing because it has sustained for so long at the degree it has without breaking. The doctors are suggesting that the subarachnoid hemorrhage in your brain could be located around your thermal regulator, which got irritated when you were agitated yesterday which is now responding telling you body “enough”!
7/27/2006 Day #4 End
of Day Report
Today was a day of rest and some recovery for you. You had no procedures done they focused on trying to get your fever to break and keep it down plus allow your lungs to recover and heal. The team started your day by changing your ventilator setting and has the ventilator do most of the work. They sedated you enough so you would not fight the ventilator and to keep your oxygenation. % in the 90’s. As the day went on the team would reduce the oxygen percentage from the machine to ascertain if you would be ale to maintain on your own, your oxygen level n the 90%. By the end of the day you were providing 60% of the effort! Great Job!
Your fever broke at about 10AM and they began giving your scheduled dose of ibuprofen/Tylenol. The cooling blankets were removed. The orthopedic doctors cam and removed your splints on your lower leap to make sure your incisions were clean and healing well. (no signs of infection)! The replaced the splints with new ones and our left foot was back to pick and warm! Good Sign!
The nurses would suction out your lungs to get the “gunk” out. You then had begun to start coughing on your own, to also get the “gunk” out. Also a good sign! You also started to have movement of your eyelashes another good sign. The nurses also gave you a shave and a bath, changed your sheets and got you al “spiffy” for they day. I teased Christine that they were getting you ready for your date with her.
Your fever returned at about 7pm. They put the cooling blankets back on for assistance in getting your fever down along with the education. I pray you have a peaceful, restful might. We love you so very much!
7/28/2006 Day #5 after
Accident
You still had your fever this morning; the highest it got last night was 102.4. You had an uneventful night otherwise. You kept your oxygenation up in the high 90’s -98-99% (Wonderful).
Today the plan is to slowly wan you from the ventilation. They are going to ever so slowly decrease your support to see how you do on your own and maintain your oxygenation. They also are slowly reducing the amount of sedation to see how well you do to see if you get agitated. We need you to come back to us mentally and you are but it slow. That is alright – take your time. We all know you will do it when you are ready! They are going to change your central line (important line) to a smaller bore.
7/28/2006 Day #5
End of Day Report
I think you had a successful day, even though you had fever 102-103 degrees most of the day. You were able to tolerate coming down off of the sedative, you weren’t as agitated, and you were moving a lot more and more responsive to the nurses. Your nurse today, Amy, was so good to you. She was so sweet, caring, and kind. She asked you to give her a thumb’s up, you gave her a weak one, she then asked you to give her a big thumb’s up which you did! Success! I’ve been telling you, you are at Vanderbilt, in the trauma unit, and that you are in a safe place. You are hearing a lot of “bells and whistles” and strange voices but they are your nurses and doctors taking great care of you. Your fever did break late in the afternoon after you had your bath, Deb Rowe and I were at your bedside and while I was looking at you toes talking to you Deb said you opened your eyes twice again success!
When you dad and I went back to see you for the 8:30pm visiting hrs they had moved you to a private room in the ICU. They call the room an isolation room and told us that since you have pneumonia they needed the ICU bed you were in is why they moved you. It kinda freaked your dad and me out because they did not tell us they were moving you and when we turned the corner to see you and you were gone, well….
Moving you
was also a success! The private room was
much quieter and they could lower the light.
You even have a T.V. Abby said we
could turn it on to
7/29/2006 Day # 6
Post Accident
You did very well overnight. You are much more alert, opening your eyes following voices, and following commands. While Aunt Kathy and I were at your bedside the nurse asked you to stick your tongue out at hi and you did, he also asked you about to squeeze his hand and you did. You are trying to sit up in bed, pulling at tubes, coughing on your own, wanting your tube out of your nose. Abby came into the room and started talking to you and you opened your eyes and moved your head towards her.
You want to keep coming up off the bed like you want to sit up. You were telling me with your hand that something was wrong on your right side as if you were sitting on something you were wanting removed. We got you up in a chair tat the bedside. You were trying to pull on your tube in your room, when I asked you what was wrong your raised your hand and pointed to your nose. I told you what it was there for and then scratched around it thinking you might have had an itch. When you heard my voice you opened your eyes and you moved towards me. It looked as though you were trying to move your moth like you were saying “Mom”.
When we called Grandpa Short he started to cry and said “This is the day that the Lord has and, rejoice and be glad in it.” Amen!
7/29/2006 Days End
Report
Oh my gosh! What a day you have had. You “woke up”, came out of the sedative state in typical Caleb Kedigh fashion. You were agitated, confused, trying to get out of bed most of the day. You kept trying to pull out the tube in your nose so they put mitts on your hands. Of you really didn’t like that. You were getting so worked up. You would tell me “off”, I would tell you I couldn’t take them off, you would ask “why”, and I would tell you, “Because you are trying to pull your tube out of your nose”.
I have been telling you, you have been in the Trauma Unit at Vanderbilt, but yesterday I told you, you had been in the Trauma unit for 6 days. Your eyes got real big and you responded with “What?” , like you couldn’t believe it. Today has been a day of success!
The plan for the night is to give you good rest, remove your arterial line and start
switching you over from Fentanyl for pain to methadone. Hopefully the methadone will help your mind be clearer. They also may trail you on a “trach collar” (remove the ventilator and place oxygen over your trach for you to breathe in and see if you maintain your oxygenation).
Sleep well, have a restful night, let God hold you in his arms to heal you and we will see you in the morning. I love you, we love you and you are loved!
7/30/2006 Day #7
After Accident
One full week has passed. You are still quite agitated, you have a panicked look when you arouse. The team is trying to adjust medication so you are not so panicked.
· Your arterial line was pulled
· You are completely off of the ventilation for support. They put you on a T-collar for oxygen support but will switch you to a Trach collar today.
· You are completely off the Fentanyl and moved Methadone and Loritab Elixir
· You got out of bed and in the Neuro chair
· Adjust your medication especially the insulin
Today is going to be a great day! Your oral surgeon spoke to dad and me about your surgery tomorrow. They are going to go ahead and fix your jaw. You are scheduled for 12 noon.
7/30/2006 Days End
Report
All in all you did very well today. You were still somewhat agitated, still wanting to pull out your tube in your nose, so you had to wear your mitts all day. You again sat up at the bedside in a “Neuro” chair for 3 hours or so and were more alert but not quite tracking. It clearly seemed as though you were trying to seek clarity but would get frustrated or confused.
You knew when your nose itched or you were irritated with the tube in your nose. You knew when you wanted to get your mitts off. You would shake your hands, ask people to “pull”, to get them off, or even would put them in your mouth to try and pull them off with your mouth. You knew when you had to “crap” and would try to get out of bed to go to the bathroom but couldn’t. That is when you would get most frustrated and agitated. These are all successes! You remained off of the ventilator and you did very well with the “Trach Collar” which provided you with extra oxygen.
The Fentanyl is completely discontinued and they switched you to Methadone and Lortab. I pray you get plenty of restful sleep tonight and save your energy as you are going to have surgery to fix your broken jaw tomorrow. They will be giving you a sleep aid tonight to assist you in restful night. We love you and are praying every single minute for your full recovery.
7/31/2006 Day #8 After Accident
Today will be a busy day. You will be getting a “PEG” tube placed in your stomach to assist with your nutrition. You will also get your jaw fixed today. Both of these (procedure/surgery) will make you more comfortable and heal. Your surgery today is suppose to last approximately 3-4 hours.
We also heard today the orthopedic doctors are looking at August 8 for your left ankle to be repaired. I am not sure exactly what they are going to do, but when I do find out I will let you know. The nurse told us your had a very restful night. I am so happy you did have a peaceful night since you are having such a busy day today. Aunt Kathy found out yesterday she is going to be a grandma. Megan is pregnant and due to have the baby in May.
You tolerated your PEG procedure
fine. Christine was able to come back
and see you before you went to surgery and she had to leave for
You went to surgery approximately 11:45 am. I would expect you to be out of surgery around 5 pm.
It is 7 pm. And you are done with surgery but you are not back in your room yet. The Oral Surgeon came to talk to us and said you had the worse fractured jaw he has ever worked on. He is some what disappointed because he felt as though he did not get you completely aligned with your teeth. He is going to get a CT of your jaw to check the alignment. There may be a need to take you back to surgery to get better alignment. This was disappointing news but not hopeless!
Christine called and was very
positive about the news. She said what I
needed to hear. She also told us she
made a 94% on her test she had to go back to last Wednesday. I was very proud of her – going through the
shock and stress of your accident, being tired from emotional ups and downs,
then having to drive back to
7/31/06 Day’s End
Report
After arriving to the Trauma unit at 7:30 pm you were still quite sedated. The Trauma resident and your nurse started a couple of IV’s in your hand and arm so they could remove your central line. This was done to reduce your risk of infection at the site of your central line. It also was a step towards getting better as they felt you did not need your central line anymore.
When dad and I went back to see you, you were awake and your eyes had a clarity to them you hadn’t had before. There was some focus in them. You were also quite calm, not so agitated as before. You were attempting to talk but couldn’t because your jaw was wired. When I told you you had your surgery to fix your jaw, you seemed to comprehend what I was telling you. Your nurse is going to keep you comfortable tonight. Sleep well, heal your mind and body. I love you!
8/1/2006 Tuesday
Day #9 After Accident
You look great. You definitely are starting to focus more and get clarity on what has happened. You are communicating what you need. You get extremely frustrated and agitated still. You work yourself up and get your heart rate pretty high. You got to moving around so much they had to put you in a 4 point restraints and a posey vest (i.e. restraints on your arms/legs/and around your chest) to keep you down. Boy! You do not like that. You get mad!
You have had physical therapy come in and work your lower legs, but actually you did most of the work. You followed all of her commands. She also worked on your upper arms to keep them from getting stiff. She had you swab your teeth and mouth which you did, on your own, quite well. You kept asking for “water” but we can’t give it to you since your jaw was just wired shut and you’re not yet strong enough to clear your airway if you have the water go down the wrong way.
We also had you try and write on a piece of paper what you needed or were asking for – to maybe communicate easier – you started to write a word, scribbled out, write again, scribbled out, then you wrote “Agua”. That is so typical of you! What a great moment. We spoke with Dr. Kregor (orthopedic doctor) he had asked our permission to use your case in a textbook he is writing. We said he could. We thought you would appreciate being a part of teaching physicians in their studies. He is going to provide us with all your pictures (x-rays, CT, etc) and the textbook when it is done.
You are to have a CT of your jaw to take a look at what was done yesterday and what may need to be done in the future to get you completely aligned.
Surgery is schedule for tomorrow at 7:30 am.
8/1/2006 Tuesday
Day’s End Report
The CT of your jaw showed you still had fragments of bone that needed alignment, particularly at the angle of your jaw. The TM joint also was not quite looking right so … you are going back to surgery in the morning. You are scheduled at 7:30 am. We will be back in the morning bright and early. You were somewhat subdued tonight but a lot of that had to do with medication. They started you on Clonidine for your head and the agitation, plus jaridon to also help with agitation.
You had been tachycardic (fast heart rate) most of the day, 135 beats per minute, normal is 80. By this evening you were in the low 100’s. You were also off the ventilator and breathing on your own. You were also beginning to take deep breaths when instructed followed by cough which is good. This helps you clear out your lungs. You remained in 4 point restraints and a posey vest even though you were less agitated, you still had the tendency to move about quite a bit.
Your friends have not let you down. They continue to keep a diligent vigil of coming to see you. You get a little more communicative with them. It only takes a look, nod, hand squeeze, etc. to make a difference for them. They love you very much.
As we were leaving you tonight your nurse was starting a medication to help you sleep tonight. I am praying your night is once again peaceful and restful. You have another big day tomorrow with a three hour surgery. I pray God’s arms hold you in comfort and healing. We love you.
8/2/2006 Wednesday
Day #10 After Accident
You went to surgery first thing this morning to finish getting the jaw aligned appropriately. It is going to take 2 doctors to work on you because you break was so bad.
The surgery is done. It took approximately 3 hours to complete. You are good to go. You are in complete alignment. The oral surgeon who specializes in jaws, and was brought in to assist with your surgery, said your joint dislocation was fairly substantial. He said you took a major blow to the left side of your face to have the ball pop completely out of its socket. He said it will be extremely important for you to be diligent in your exercising that joint. He expects you to be wired shut for four weeks, and then he wants to put rubber bands on in place of the wires, so you can start exercising your jaw. You now have two plates holding your chin together. You will more than likely lose three more teeth in the front lower mouth. You also broke off some teeth on the right upper jaw. Our dentist will be very happy in the near future.
This surgery checks off one more success and road to complete recovery. Barring any complications you should be experiencing 6 more days of healing and recovery before you are due back into surgery. The last item of business to correct is your left lower leg.
I am amazed at how strong you are and how resilient you have been through all of this. You being here is nothing more than a miracle; aside from your body, soul, and will, prayers are being and have been heard.
8/2/2006 Day’s End
Report
You came through great, but were nauseous before and after surgery. The orthopedic tech and female nurse practitioner changed out your plaster splints on both of your lower legs. I was able to look at your wounds on your lower legs and the bottom of your left foot. Your left foot and ankle were still swollen but all your wounds looked cleaned and dry. This is good news. You did very, by holding each leg still, while they changed out the splints. You were still medicated from surgery plus they gave you pain medication prior to replacing the splints.
While the splints were being replaced the nurse practitioner was assisting by holding your legs while the ortho tech wrapped your legs and placed the plaster splints. The nurse practitioner had her back to you and you started to pick at her backside; it was a cheap thrill for her but you got absolutely nothing out of it as you were sedated. During the late evening into the night you were struggling with belly pain and having a great deal of trouble getting comfortable.
I wasn’t happy with your night nurse so we had you moved to another room with another nurse. Now I am comfortable enough to go home knowing you are in good hands. I pray once again for a restful night.
8/3/2006 Thursday
11 Days Past Accident
So much for having 6 days of recovery and healing without procedures or surgery. You pulled out your PEG tube this morning. Your belly pain last night may have been your indicator that something wasn’t right and by pulling out the PEG was bringing it to the attention of the physicians. They need to do something and explore more into what may be the problem.
It may be that your PEG was leaking into your peritonea causing inflammation. You were taken to surgery to take a look, possibly do a lavage (cleaning out) of the peritonea then placing a new PEG. You are scheduled for 12 noon. This is a setback but not anything you cannot overcome.
You got back to your room at approximately 5pm, breathing on your own (not on the ventilation), but again you were out of it (sedated) and with a fever.
8/3/2006 Thursday
Day’s End Report
The remainder of the evening and night were uneventful for you, thank goodness. You had broken your fever by the end of the visiting hours 10pm. You rested during the evening/night visitations yet your friends remained faithful and went in to be with you anyway.
Your heart rate most of the evening remained steady at 105-107 which is down from 125-135 and your breathing was slow and steady at 20-25 which was also down from 30-40. You are keeping your oxygen saturation at 96-100% which is fabulous. All of these numbers are post surgery today.
You have a nasal gastric (NG) tube to help keep your stomach decompressed and be of aid if you were to get nauseated and vomit the NG would suck all that up without compromising you with your mouth wired shut. I pray you continue through the night peacefully.
8/4/2006 Friday 12
Days Past Accident
Today is not just a good day it is a great day!
You have been calm this morning after having some Fentanyl for pain. You are more alert and communicating with us. You are using you hands to tell us what you need (i.e. you will pat the bed we then ask if you want the head up or down). You wave your hand to get our attention. We will ask you questions of a yes or no nature and you nod your head in response. You definitely know what you want and are getting more focused.
While Dad and Deb were at your bedside, Dad was telling you about Aunt Kathy staying in your room, Caanan taking Aunt Kathy’s sandal, and chewing it to bits. You got a big smile on your face.
While Dad and I were at your side you wanted to ask about someone so we were asking you “is it…” Christine, NO – Dawn, NO – you started to get frustrated so I told you we would narrow it down – I asked if it was a high school friend, NO – college friend, NO – family, NO – Baseball player, NO – work, YES – Stan, YES – we then told you Stan was aware you were in the hospital and had been to see you and that you did not need to worry about work.
As Dad and I were leaving the room, because visitation was over, you held up your hand and pointed to the T.V. I asked if you wanted me to turn the T.V. on – YES. I asked if you wanted ESPN on-YES.
They began your tube feedings today and are slowly increasing you throughout the day. Your NG (nasal/gastric) tube was removed. Your heart rate is down in to the 80’s (wonderful). Your respirations are in the 20’s (fantastic) and your oxygen saturation remains in the high 90’s (fabulous). I couldn’t ask for better “numbers”.
The plan for the day is to keep you comfortable, have NO unforeseen events, increase your tube feedings, and allow for recovery and healing along with mental awareness/focus.
So far you are accomplishing your goal for the day!
You are still in four point restraints, mainly so you won’t pull any more tubes out, and the Posey vest because you still want to try and get out of bed. I think your nurse is going to want to put you in the Neuro chair today.
8/4/206 Day’s End
Report
Yesterday was very full for your recovery. You had quite a busy day with many guests and your own activity. You did very well with clearing your lungs, by taking deep breaths and coughing up the thick secretions “gunk” out. You reached your goal of tube feedings and tolerated the advancement well.
You sat in the Neuro chair for a couple of hours and even indicated to the nurse when you were ready to get back in bed. It is very clear you know what you want or need; the frustration comes when communicating the want or need is difficult to the ones trying to figure it out. That is okay; we will get it worked out.
As the day progressed, you tired and the frustration intensified. As evening came round you were exhausted and somewhat agitated. Your nurse ended up giving you some Fentanyl to relax and calm you. The goal for the staff with you is to not have to give you Fentanyl as it clouds your mind and they want you to work on clearing your mind.
I believe with each day you will become a little stronger in both body and mind building up your stamina.
Everyone who visited today said to you how much better you looked. A couple times you shook your head NO, but they knew better because they had watched you each day for the past 11 days.
Today was not just a Good day; it was a GREAT day! I pray for you a restful and peaceful night with better clarity in the morning. I LOVE YOU!
P.S. As I let this afternoon I learned over and kissed you on your cheek – you leaned over and kissed me too!!
8/5/2006 Saturday
13 Days Past Accident
The nurse said you had a fairly restful night. You needed to be suctioned a couple of times but that was all.
Today you are much more alert and calmer. When I went into your room first thing today the nurses were giving you trach care. They cleaned around your trach to make sure you do not get any skin breakdown, removed your stitches around the trach, changed your trach collar, then replaced the padding in your C-Collar (neck brace). You cooperated very well and held perfectly still for them.
Next the speech therapist came in and assessed your cognitive ability. She provided you with a pen and paper, while she asked you specific questions, you wrote down the answers:
Q: Where are we?
A:
Q: What building are we in?
A: Hospital
Q: What kind of hospital?
A: Comprehensive
Q: What year is it?
A: 2007
Q: What’s your B-day?
A: 10/05/84
Q: What month is it?
A: June
Q: How old are you?
A: 21
Q: What school do you attend?
A: Martin Methodist
The therapist then talked to you about being able to speak once she can put a Pasv muir Valve in the trach – you wanted to know when.
The next thing you asked about was when you could have your C-Collar off. We asked if the physician could come and assess the possibility of removing it. First the resident came in and said she didn’t think you were clear enough mentally yet, I said I thought you were, she then asked you – Caleb give me two fingers. You lifted up your left hand and gave her two fingers. She then said give me two fingers with your other hand. You lifted up your right hand and gave her two fingers. She then said well I think I will ask the attending to come check out his neck to get this removed (C-Collar) and you gave her big thumbs up!
You also had your mitts off and we released your wrist restraints while we were in the room with you. I hope you don’t pull out or pull of any tubes or wires that will put you back in the mitts and wrist restraints.
8/5/2006 Day’s End
Report
Today truly was a day of rest for you. After a very busy and productive morning, with the speech therapist, you were able to rest fully during the afternoon visitation. Friends did not come until later close to the end of the afternoon hours. This gave you much needed rest for your recovery
During the evening visitation you were sleepy but responsive to visitors. When Keaton was at your bedside he was telling you he got you an Xbox 360. Your eyes got real big as you looked directly at Keaton. Then he told you he was going to get you the Tiger Woods golf game. You responded by putting your fist in the air, as to say “Alright!”
You asked
about Christine, by writing Christine – coming – today. We told you she would not be coming until
Monday night, but that she had been with you most of the first week you were
here and that she had to go back to
8/6/2006 Sunday 14
Days Past Accident
You tried to get out of bed after we left last night so they had to put the posey vest back on you. Regardless you had a fairly restful night.
This
morning you were pretty groggy and tired.
You slept most of the morning.
For the afternoon visitation you had been placed in the Neuro chair. Both Coach Whites (Robert & George) came
to see you. They were with you for about
45 minutes. You communicated with them
by writing responses to them. They kept
the paper you wrote on and were going to take it back to
After being in the Neuro chair for approximately 4 hours you were asking to be put back in bed.
You were given a bath when the nurse noticed some drainage from your incision on your abdominal plus your wound was slightly gapping. The Trauma Attending came to assess your incision and thought maybe they could keep it clean with dressing changes and just keep an eye on it. Your white count in your blood was slightly elevated from 12 to 15.
The attending also said they were not going to remove your C-Collar today. They want to get another MRI of your neck on Tuesday to see if the swelling has gone down. They are still concerned about a ligamentous injury.
8/6/2006 Day’s End
Report
Today was
another good day despite your incision opening/drainage. You got more good rest during the day/evening
and had a great visitation with your coaches from
Going into the night you were having problems with your secretions. They were getting thick and difficult for you to cough up. You had a slight fever and were sweating terribly. You took off your tube to your Trach Collar that was providing humidified air and was holding it to your face to cool yourself off. Very ingenious! The respiratory therapist gave you a breathing treatment to loosen and breakup your secretions. I hope that helps you through the night.
With cold compresses and the humidified air you were not as warm and stopped sweating by the time we left. You at one point wrote to me that the “heat is unbearable right now.”
You have come such a long way from where you were 14 days ago. I am so proud of you! Dad has captured some of your actions on video. He has you holding the tube up to your face to cool yourself and he captured you smiling when he told you the story of Caanan chewing Aunt Kathy’s shoes to bits.
Dad and I spoke with Dr. Tressler today. Dr. Tressler is the orthopedic surgeon who is going to do your ankle/heel on Tuesday. We were very impressed with the detail he went into to tell us what he planned on doing to repair and fix your ankle. He was very optimistic about the potential of pinning your ankle instead of fusing it, if he can locate a piece of the ankle bone that is missing. He believes/hopes the piece he needs is imbedded in your ankle. He has studied your case and the multitude of CT scans of your left ankle to prepare for the surgery. He has booked the OR for early Tuesday 8/8/06 for 4 hours but is mentally prepared for 8 hours. Our prayers will go out to you and also to him for that day.
I pray tonight you have an uneventful night and for more rest for recovery and healing. We love you!
8/7/2006 Monday –
Day 15 Post Accident
You had an uneventful night. When we went back to see you, your nurse Ken was shaving you after giving you a bath. Today’s plan for you:
· MRI of the neck to check and assess if your C-Collar can be removed
· You are going to have a CT with contrast of your belly and pelvis to make sure nothing is leaking
· Take a look at your left ankle to assess whether they will be able to do surgery tomorrow
You are pretty tired today – you have already been busy with your bath and neck X-rays. Activity exhausts you.
Your white blood count is still going up from 15 – 16.8 the Trauma team is quite concerned about an infection. You also have a low grade fever. The Trauma Surgeon came to the waiting room to tell us your abdominal incision has opened up more and is now involving the faschia and some of the bowel is coming through so they are going to have to take you back to surgery to clean you out again and sew you back up.
Dr. Tressler has already called and stated he is going to cancel your ankle surgery tomorrow and will reschedule you for this Friday. This is a moderate set back but again nothing you can not overcome.
You went into surgery at 5:10pm and were in surgery for an hour. The surgeons said they did not find any pus or signs of true infection which was very good news. The surgeon went ahead and debrided your facshia and irrigated the peritoneum; then sutured you back up. The trauma team said they are going to keep you “sleepy” for the next couple days just so you won’t split a gut again.
8/7/2006 Monday’s
Day’s End Report
You were back in you room for the evening visitation hours but you were sedated. Your friends remained true to form and went in to see you anyway. They all care about you and love you very much. You were on the ventilator for pressure support only. All your vital signs were good HR 108 Resp. 20 Pulse Oxygenation 99-100% - couldn’t be any better!
Another prayer was answered tonight as the team found no infection.
My understanding from your nurse, Adam, was orthopedic service might come by and take down your splints to make sure there is no source of infection coming from your orthopedic wounds. I will pray they find none.
Continue to heal. We love
8/8/2006 Tuesday
16 Days Post Accident
7:30am Dr. Tressler called to discuss taking you to the OR today and take down your plaster splints to look at your wounds on your legs. He and Dr Kregor want to assess them and make sure they are not the source of your infection. Both of them preferred to take you to the OR to do this as the OR is a sterile environment as opposed to the Trauma unit which has many contaminants. They also wanted to do this with you under anesthesia as they will be manipulating your legs somewhat and it would be painful to you if you were awake.
You have a fever again, 102. You seem to get them every time you have surgery. Good news – your white blood count has come down 16.8 – 13. The Trauma tem is keeping you in a “sleepy” state to keep your activity to a minimum. They have released your leg restraints which you seem to enjoy.
Your heart rate is around 120-130, most likely from your high fever. Respirations are 20-24, and your pulse oxygenation is at 96-99%. You are still being supported by the ventilator. They have you on CPAP (pressure support).
We still have not heard about the result of your neck X-Rays. You still have your C-Collar on. The Ortho-Spine physicians have to speak with the Trauma team to discuss the neck films. They will then need to get another MRI to completely clear your neck if the neck X-Rays look good.
You went down to the OR @ 5pm to have your lower legs examined under anesthesia. Dr. Tressler called me @ 7pm to give me the Good News report! Dr. Tressler said he could not have been more pleased with how your legs looked and your wounds were clean, dry, and healing nicely. He said he was very pleased at how your legs/wounds looked. He also said the reason it took a while was that Dr. Kregor wanted to see your legs and assess them himself. “He has a vested interest” in the outcome of your legs, and Dr. Kregor was tied up in another surgery so they had to wait till he could break away to come see your legs. Dr. Tressler said Dr. Kregor was also pleased with how your legs/wounds looked. This is all fabulous news and definitely another answered prayer.
8/8/2006 Tuesday
Day’s End Report
Since you came back from the OR your night has been fairly restful. The nurse tonight is Matt and he broke down the plan for the night:
· Keep you lightly sedated
· The ventilator is on pressure support only – you are breathing on your own
· Take some X-Rays of your left foot
· See about starting your tube feedings back up
· Abdominal dosage changes
You were arousable to your visitors. Christine got two big thumbs up from you. There was a time or two where you started to rise to leave but were easily coaxed back down.
The day has been very positive and encouraging for your future surgery on your ankle. I pray you have a peaceful and restful night.
8/9/2006 Wednesday
17 Days Post Accident
You had a restful and uneventful night. They took you off your ventilator support and you are breathing on your own without any problems.
You are still pretty sleepy this morning as you are still on some sedation, however, the nurse says they are going to take you off the sedation sometime today.
You still have a fever – 101 but you are comfortable and not sweating like you do when you have fevers. Hopefully when you do come out of the sedation you will do it calmly.
When I came in today I gave you a kiss on you cheek and told you I loved you. You then put your lips together to give me a kiss too. What a joy that was for me.
This afternoon the nurse heard a heart murmur, so the Trauma team ordered an ECHO of your heart – this is a test to look at the blood flow through your heart and to look at each valve/chamber of your heart. Then you will be getting an EKG – which is a tracing of the beating of your heat looking at each chamber.
The ECHO of your heart showed you have a bicuspid (two) valve where there should be a tricuspid (three) valve which is evidently something you were born with. You also have a pericardial effusion (fluid around the heart). It also showed a “thickening” in the aortic wall which could possibly be a clot so the Trauma team has consulted Cardio/Thoracic surgery. Dr. Byrne (Dept. Chair) will be coming to see you. I’ll let you know what he finds.
Dr. Byrne gave us two scenarios of what this could be without seeing the CT angiogram (which has not been done yet):
1. This finding, the thickening on the aortic wall, is a fluke and the management would be a medical management.
2. The thickening is a clot in the aorta which means there is a tear in the aorta which would require surgical intervention (open heart surgery) requiring you to be placed on a heart/lung machine. This type of surgery also can cause some swelling of the brain so they would also do a CT of the brain to assess the possible risks to the brain.
Dr. Byrne’s “gut feeling” is this is a fluke finding as most aortic injuries present themselves with in hours to days after an accident. We pray Dr. Byrne’s “gut feeling” is correct.
8/9/2006 Day’s End
Report
The CT angiogram did not show any tear or leak of the aorta and no clot. The other CT’s you have had in review did not show any tears or leak of the aorta. Your pericardial effusion has increased over the last couple of weeks so they are going to watch and monitor you for any signs of a pericardial tamponade (too much fluid in the pericardial sac around the heart) that would hinder the adequate pumping of the heart. If that were to happen they would need to place a catheter into the pericardial sac to drain the fluid around the heart or the fluid could just dissipate.
We will pray for healing of the heart and for the fluid to decrease. We love you!
8/10/06 Thursday
Day 18 Post Accident
You had an uneventful night, thank goodness! You did get agitated at one point but medication settled you back down.
You had no fever this morning. You seemed somewhat rested. The occupational therapist and the physical therapist came by to work with you. You did very well. You did exactly what they asked you to do with both your upper and lower extremities.
Today’s plan for you is to rest. PLEASE! No new issues for a couple of days. We would like at least two steps forward.
8/10/06 Thursday’s
Days End Report
There is not much to report, which is a good thing, you mainly slept most of the day. You would barely open your eyes for anyone, let alone squeeze a hand. The most activity you did was in the morning with occupational and physical therapy.
You had a hoard of friends come in tonight to see you.
Dad and I left early tonight to go home and go to bed. After your heart issues yesterday, and not sleeping last night, we were both exhausted. Christine and Deb stayed to close out the visiting hours with you.
I am still overwhelmed by the faithfulness of your friends.
The one true faithful friend that has been with you throughout your entire life is still with you today and will be with you forever is Lord God. You will be forever loved.
Have a restful night as your body continues to heal.
8/11/06 Friday Day
19 Post Accident
The report today is you had a very good night. You have nothing planned for today but another day of rest and healing. The oral surgeon gave a report that your wound inside your mouth is starting to heal.
You are still coughing up “gunk” from your lungs but it seems to be getting less and less.
You are starting to ask great questions. Today you asked when you were getting your ankle done and when you were going to be “done”, specifically when you were going to leave the hospital.
You also were quite clear on your communication with your father as he told you he was taking pictures of you to share with family and friends you provided a very clear hand gesture to the camera on how you felt about the pictures being taken.
It is mid afternoon and you have been taken out of all your restraints, been out of them since 11 a.m., and have done very well.
The nurse has clamped your foley catheter – the tube going into your bladder – to see if you will tell the nurses to “pee” they will take your foley out. You had your foley clamped for a couple of hours and you did not have sensation to “pee” so they unclamped your foley and will trial you again tomorrow.
8/11/06 Friday’s
Day End Report
This has been a remarkable day for you. I would call this a break-through day.
You have been asking great questions via written communication. You have asked – what the date is, - what day you are getting your ankle fixed, - when you were told the date of your surgery then the date for today you then asked if your surgery was in 4 days, - the answer was yes.
The nurse was cleaning your abdominal incision and you asked if you could see it. We got a mirror for you to look. You were quite surprised at how it looked. We told you the incision was not due to your accident but due to you pulling out your PEG tube. I asked if you remembered anything about the accident – you didn’t. I let you know you were the only one in your car and told you the two in the other car are okay. You then asked me how the other car hit you – and I shared with you the mechanism of impact on the cars.
You have been completely restraint free since 11 a.m. today and have done fabulous.
Tonight the nurse placed you on a trach collar. He also gave you the nurse call button which also changes the channels on the television.
You played catch with Dad and me with your squish ball and Dad got it on video for your Website journal.
Caleb today is the day the Lord hath made and we have all rejoiced in it! You have made tremendous progress. God has been very good and will continue to be ever faithful to you in this healing journey. You are so very loved! Mom
8/12/06 Saturday
20 Days Post Accident
Well you have started off with issues today. Evidently your wires on your upper bracket of your teeth were loose. The Oral/Maxillary surgeon went ahead and cut the wires. The reasoning for this is to allow the Cardio/Thoracic surgeons to do a transesophageal ECHO (TEE) of your heart and aorta on Monday. The TEE will definitively tell us if you have a clot or not in the aorta plus assess the pericardial effusion. If all of this is negative then the Oral/Maxillary service will take you to surgery on Monday to tighten your brackets and wire you shut again.
You are once again very sleepy, not very interactive and that’s okay. You need good rest for healing. I have been able to stay in you room today between visitation hours. This has allowed you to be loose from your arm and leg restraints. The problem you are faced with when you are loose is your first instinct when you have to go to the bathroom is to get up and head to the bathroom. You also still have moments of confusion and have the tendency to still pull on cords and wires.
The other problem facing you, which doesn’t have anything to do with restraints, is your abdominal incision. The incision is having difficult healing (closing) due to your strong coughing spells and you lifting up your bottom to move in bed. Each of these movements/activities uses your abdominal muscles, which causes your incision to stretch open. You are learning to try and support your abdomen with a pillow but you don’t use it consistently.
8/12/06 Saturday
Days End Report
The day started out slow for your confusion was present. But as the day went on your clarity emerged.
You were placed in the neuro chair for about an hour or so as you were pretty insistent on being put back in bed.
The day gave you opportunity for good rest.
At one point you had a revealing conversation (in writing) with Christine. You asked her is she had found a place for the two of you to live – she responded with no, remember we are going back to school and you have a place already? You asked her when you were going to have children – she responded with, not for a long time we need to be married first – and you responded with a hand gesture signaling alright. When dad asked you later if you proposed to Christine you responded with a hand gesture signaling “sort of”.
Dad, Christine, and I are all in an agreement – we will wait until you are completely coherent – for that question to be asked again. You have got a wonderful gal!
My prayer for you is to again reach a restful sleep, allow your body and mind to heal and recover. I pray you reach more clarity each day. I also pray with great fervor the TEE on Monday will give us a definite answer regarding the aorta and that the answer is NO to a clot/leak/tear.
We love you! MOM
8/13/06 Sunday 21
Days Post Accident
Today marks the 3rd week of being in the Trauma unit. You are remembering pieces of information that has been given to you, or so you say.
You had an uneventful night, I am very thankful for that. You have already had your bath today, trach care, and morning medication. You are sleepy, quiet, and seem comfortable.
This is turning out to be a great day for rest. You are getting some really good and needed sleep. There have not been a lot of visitors this afternoon which has given you a break.
You have been able to stay wrist and leg restraint free today. You are turning yourself over on your side for more comfort. You are also using the remote control to change channels on your television. In the early evening you were much more interactive with Staff, Christine, and me.
My greatest thrill was when I was getting ready to leave for dinner and you raised your arm and rolled over to hug me. Oh what a wonderful feeling that was for me. It brought tears of joy to my eyes.
8/13/06 Sunday’s
Days End Report
This was another good day for you. The rest you are receiving has been much needed. You seem to be getting more clarity and are remembering bits of previous conversations. This is progress. This evening you had a number of visitors of friends to which you had conversations with (written) or hand gestures. Again more progress.
You asked a number of times today when you were going home. The answer to this question is not yet known. You still have a procedure tomorrow (TEE) and your jaw needs to be re-wired. I pray this happens tomorrow. You then will have your ankle surgery on Tuesday.
Even after your ankle surgery on Tuesday we may find out you will need to have additional surgery on your ankle/foot and we won’t know when as it will depend on a number of variables. It is the variables we are unsure of at this time. Then there is your abdominal incision that still needs to heal.