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 Chattanooga to come here.  She left word with your friends because I did not have any of their numbers.

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:

 

  • Small Sub arachnoids hemorrhage in brain which is stable (not bleeding out) and brain is swollen – Neurologist stated you had a major concussion as you are moving purposefully to pain and commands.
  • Broken jaw in four places and dislocated on right side at joint.
  • Liver laceration that has stopped bleeding.
  • Right collapsed lung (chest tube displaced)
  • Transverse spine fracture
  • Left femur fracture
  • Left tibia/fibula fracture (compound).  Tibia came through the bottom of left foot.  Tibia crushed your ankle bone and heel bone.  All of your bones except two are fractures.
  • Right tibia broke through top of leg

 

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 Vena Cave to act as a “basket”, since you are at high risk for “throwing” clots from your orthopedic injuries.  This “basket” will catch the clots to keep them from going to your lungs.  You could say you have a “catcher” within a catcher.  HA!  You are scheduled, tentatively, to have your jaw fixed on Thurs 7/27/2006.  There is a possibility you may need a “temporary” tracheal tube placed in your heel to continue assisting you with your breathing if you are not strong enough to do it on your own.  We are waiting to see how you do as we reduce your sedation

            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:

  • You continued to “buck” the endotracheal tube last night and you had trouble maintaining your oxygen saturation.
  • So today the Trauma team told us they would need to put the tracheal tube in through your neck.  You would be more comfortable.
  • You also spiked a fever last night to where they needed to put a cooling blanket on your body. 
  • The team needed to start checking where the source of the fever came from.  They did a Bronchoscopy (video into your lungs to find any insult to the lungs) to lavage (clean out) the lungs and send samples for culture.  You had an area in left lower lobe and an area behind your heart that was hazy on your Chest X-Ray.  They also want to do a CT scan of your chest and belly to make sure you don’t have any problems (more) there.
  • Your chest tube in the right lung was pulled last night and you tolerated that well.
  • You are still tolerating your feeding via the tube. 
  • Orthopedic doctor is going to undress your left in your left to make sure the wound on the bottom of your foot is healing and not getting infected.
  • A research team for antibiotics signed you up to be a candidate for a new antibiotic as a test case.  We thought you would like being in research. – Unfortunately after running test your liver enzymes cam back too high and it kicked you out of the research study…oh well!

 

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)

  • You never broke your fever; it stayed around 102 – 103 degrees, despite Tylenol and ibuprofen.  They keep the cooling blankets on all night and are still on.
  • You also are having trouble keeping your oxygenation up so they are adjusting the ventilator to help you keep your oxygenation up.  By doing this they have to increase your sedation again so you won’t fight the ventilation.  The goal for you today s to rest, relax, and cover the focus is your lungs and fever. 

 

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 ESPN Sports Center and you would be really happy! They had to sedate you enough afterward to give you rest. You also spiked your fever again 103.9.  But the biggest success and goal for you and for me was, when Keaton and I were in your room ready to leaver for the night I said “Caleb” and you opened your eyes!  Both Keaton and I saw it.  That was wonderful!  I pray you will have great, healing rest tonight – Tomorrow is a new day full of promise and recovery.

 

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!

  • You “woke up”
  • Sat at the side of the bed in a “Neuro” chair
  • They reduced & changed your ventilator settings
  • Off all sedative medication
  • Only on one antibiotic now instead of three.

 

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 Chattanooga.  Christine will be back next week to see you.  She and I will be keeping up with each other by phone on your progress.  She loves you very much and is worried but keeping a very strong front.

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 Chattanooga for the test!

 

 

 

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: Nashville

           

            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 Chattanooga to summer school and work.

 

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 Dyersburg and frame it so that when you came to visit them they can show you what you did.  They were very impressed with your recovery to this point.

            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 Dyersburg.

            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.  Once you are ready to leave the hospital you will go to a rehab hospital to build your strength and learn to maneuver with your casts on your legs.  Then once you have mastered In-patient Rehab you will be able to come home.  Once home you will continue with Out-patient Rehab.  Whew!  The mantra is: You are in a marathon, not a sprint!

            Right now for tomorrow I want you to get through the TEE; I pray the aorta looks fine with NO clot, leak, or tear and get your jaw wired.

            You have had a couple of good days.  I pray there are no more set backs only more forward.  I pray for God to continue to hold you in his arms as your healer and protector through your journey to completeness in Body and Mind.

            We love you son!

 

8/14/06 Monday 22 Days Post Accident

 

            Wow what a great day thus far.  You had a good night.  Your restraints were off all night and all your restraints are off today.

            Physical Therapy (PT) and Occupational Therapy (OT) were in to work with you.  You did absolutely fabulous.  PT had you working your lower & upper legs – you did each of the exercises (3 in all) 10x each leg.  OT had you working your arms (3 in all) 10x each.  You sat on the edge of the bed without difficulty and did some of the exercises.  They asked you to write what hospital you were in – you wrote Vanderbilt.  They asked you what month it was – you wrote July.  They then asked you what year it was – you wrote 2006!  This is all so awesome. 

            You kept writing if you were going to be able to leave today, tomorrow.  You are definitely itching to get out of here.  You need to use that as your motivator to healing.  We are not sure when you are to have your TEE today.  Hopefully it will be early so you can get your mouth rewired.

 

8/14/06 Monday’s Day End Report

 

            The remainder of the day you were calm, alert, and interactive (you actually played catch with me, using your squish ball, for about 5 min you threw to me and I threw to you and you caught the ball) that was awesome.  You were also throwing trash in the trash can (like basketball).  Your clarity is getting better each day – another answered prayer.

            You finally had your 2D ECHO done in your room around 3pm.  We didn’t find out the results, and really not the entire results, at 9pm.  That was after much persuasion on the Trauma Resident and a couple of phone calls to a friend in Cardiology.  What I do know is your pericardial effusion has decreased.  I don’t know by how much.  The Trauma Resident thinks you have a 75% chance you will be going to surgery tomorrow.  I do know you are on the OR schedule from 7:30 – 11:30am just for the ankle.  I do not know if you are also scheduled for the mouth re-wiring as well.  I do pray the physicians (Cardiologist, Ortho Surgeon, and Oral/Maxillary Surgeon) all talk to each other prior to going to the OR so we al know the plan.  It would be great to have you under general anesthesia once for the two surgeries if at all possible.

            My prayer for you tonight is, continued rest and healing of mind and body, but also for the physicians to coordinate a plan for tomorrows surgeries.  Sleep well, we love you!

 

8/15/06 Tuesday 23 Days Post Accident

 

            Today is the long awaited day to have your ankle repaired.  Dr. Tressler has called me from the OR suite to let me know what he is actually going to do today.  When he took off your splint to the left foot the lateral (outside) aspect of your ankle/heel did not look good (the outside skin tissue was not conducive to opening and exposing bone to, at this time).  Dr. Tressler believes this was caused from pressure on the side of our foot.  He is going ahead and work on the ankle, try and locate the taler body and pin your ankle, then reposition the tibia somewhat.  He also talked about putting a pin in your calcaneous (heel) to help take some of the pressure off of your lateral aspect of the foot to aid in healing that area for future surgery.  I am not sure when your mouth is going to be re-wired as Dr. Tressler was not going to be able to give the Oral/Maxillary surgeons his OR suite when he is done with you as he has two other long cases following you.

            LAMP – Psalm 119:105

Your word is a lamp to my feet and a light for my path.

We have thought of other acronyms for LAMP besides Look At Me Please, Lord Acknowledge My Path, and Lord Answer My Prayers.

                        Dr. Tressler just came out to speak to us at 7:15 pm to give us the summary of your surgery.  He started off saying he could not have been more pleased with the outcome and how the foot looks.  He said he ended up repairing both the ankle and the heel.  The area of the L lateral heel that he thought was pressure was definitely pressure—the heel bone was poking out.  He cleaned the area and the heel bone and went ahead and repaired it.  He also said your surgery was the most difficult case he has done thus far.

            The ankle had to be fused because he could not locate the bony piece he thought might have been imbedded in your foot.  He rebuilt your ankle bone and your heel bone and placed a plate to stabilize the ankle so it won’t collapse.

            He then repaired your L fibula as it was externally rotated which once put back in place allowed your foot to sit right and the tibia did to need to be repositioned.

            Dr. Tressler then called in Dr. Hagan, who is the Chief of Plastics, to take a look at the wound on your heel from where the tibia came through.  Dr. Hagan debrided (cleaned) the wound down to fresh, good blood flow, tissue and placed a wound vac in your heel.  The wound vac will keep the wound free of infection and allow healing from the inside out.  Then the plan is to do a “reverse skin flap” over the wound to close the wound completely.  He will take some skin tissue from the mid aspect of your left sole and lay it over the wound to cover the wound.

            There is no other surgery needed on your ankle or heel, barring no complications, except for the flap.  The flap could take pace in a coupe of weeks to months, we are not sure.  Dr. Tressler did say that you had told him you could feel the bottom of your foot a couple of times.  He also said your screw in your right leg could be seen under your skin as you had lost enough weight.  He said, “It’s nothing a number of cheeseburgers couldn’t fix.”  Evidently you lost approximately 500 cc of blood from your foot.  Dr. Tressler said he never had so much blood come from a foot, usually 100 cc, but not 500 cc.  He went ahead and transfused you with a unit of blood, not so much because you needed it but because it would give you good oxygenation.

            Dr. Tressler asked what color of car you drove, wanted to know if it was blue.  We told him you had a gray jeep, and asked why he wanted to know.  He said he found a blue paint chip in your foot.

            Your surgery lasted a total of 10 hours.

 

8/15/06 Tuesday’s Day End Report

 

Mark 11:24 “Therefore I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours.”

            We thank God for answered prayers.  You came through the surgery beautifully!  You arrived in your room at approximately 8:30pm.  You were awake, alert, NOT on the ventilator, and complaining of pain.  Your right leg had the splint completely off and the leg looked great.  You rose up to look at your leg.

            You had the wrist restraints back on because our nurse told us you pulled your trach out last night.  She found you sitting in bed holding your trach in your hand.  You never dropped your oxygen saturation which is good but they paced a new one in last night.

            I am so excited you are awake, alert, breathing on our own, and remembering what had been done.

            You were asking for something to drink but you could not have anything.  I asked the nurse if you could maybe have some ice ships or suck on a wet washcloth.  The nurse gave you a couple of oral swabs that were wet for you to suck on.  Before we left the nurse informed us you were scheduled for OR tomorrow to get your mouth re-wired.  I am glad that is getting done so there won’t be anymore surgery after the mouth for a while.

            I pray that all healing will be done without complication of infection and the healing is done quickly. 

            This day has been full of answered prayer—Thanks be to God!  AMEN.

 

8/16/06 Wednesday 24 Days Post Accident

 

            This morning when I came to your room you were already sitting in the Neuro chair.  Aunt Kathy was at your bedside and she told I was coming down the hall.  You leaned forward in your chair to look for me.  Aunt Kathy had told me you had asked “Where’s Mom” before I got to your room. 

            Your surgery to re-wire your jaw is scheduled at noon today.  You are getting bored in your room.  I went to my office to pick up your “toys” Daniel, Jonathan, and Thomas brought you.  The “toy” you wanted to play was the hand held poker game.

            You were also asking for water again.  The nurse brought you a small medicine cup, put some water in it, and gave you an oral swab.  We would place the swab in the water and gave it to you to suck on.

            You were asking the nurse when you would be able to eat and drink.  We then asked if you could have some Gatorade.  The nurse agreed and you gave big thumbs up on that.  Aunt Kathy went and bought you a bottle of Powerade.  You could only have the amount that would go on the oral swab—you were very eager and persistent on keeping the oral swab moistened with Powerade.  At one point you motioned with your hand if you could have the bottle to drink.

            The patient care partner was at your bedside emptying the reservoir bag from the humidified air tubing that goes to your trach.  You quickly looked to her to see what she was doing, as you heard the water being emptied. You wrote to me you thought she was pouring out your Powerade.

            You were in surgery for 2 hours to re-wire your jaw. Dr. McKenna had to drill a hole in your cheek bone to pace a “suspension wire” through to hold up your arch bar on your upper jaw.  Dr. McKenna expects you to be wired for at least one more week.  When they remove the wires the “suspension” wire will be removed a well.  Dr. McKenna also stated how amazed he was with the healing of your inside wound on your lower jaw.

 

8/16/06 Wednesday’s Day End Report

 

            You made it back to you room around 6:15pm.  The nurse allowed us to come back and see you for a short while, even though it was after visitation hours.  Your Dad was itching to get back and see you.  He was pacing the halls waiting for you to get back to your room from surgery.

            Again you were awake, alert, and NOT ON the ventilator.  You are officially done with all of your known scheduled surgeries!  Now we need to focus on the other items to conquer (i.e. your trach, the g/j tube, foley catheter, and your abdominal wound).  The frustrating part about all of these items is; none of them come with an exact timeframe.

            So, again, the mantra goes – you are in a marathon not a sprint – all of this is going to take a long time as you are also going to have to go through rehabilitation to strengthen your body, learn how to walk with crutches, not put weight on your left foot until your ankle bones fuse, and doing activities of daily living that you will need to make adjustments to due to your injuries, not to mention rehab your mind.  There may be aspect of your cognition (thinking), memory, etc that you will need to work on for a while.

            There is one thing I know about you that will make this journey a success and that is you are a fighter, you will take this as a challenge, and work hard to get yourself back to completeness.  You have always loved a good challenge and you have got a few!

            For tonight I pray you will have a restful night with as little pain as possible on your ankle or your mouth.  Sleep well; we will be with you in the morning.  We Love You!

 

8/17/06 Thursday 25 Days Post Accident

 

            More progress and success today!  Your foley catheter (the tube in your bladder that was “peeing” for you) was removed last night and you have had no problems “peeing” on your own today.  You are asking the nurse when you need your urinal – No problems there.

            You are asking the nurse for pain medication when you hurt which is mainly your ankle you complain about with pain.

            You have been saying how hungry you are.  The Trauma team has decided it is time to downsize your trach and then have speech therapy come and do a swallow study to test whether you can take liquids with out aspirating into your lungs.  If you pass you will have two wins! 1) You will be able to take in drink through a straw and 2) they could put a valve over your trach so you can talk.

            I have started talking with Case Manager and Liaison from Stallworth In-Patient Rehabilitation hospital for transfer.  We could be transferring you as soon as tomorrow – Friday August 18th - it depends on mainly whether you need to have IV Fentanyl to change your wound vac sponge dressing or if you can use IV Morphine for the dressing change.  Stallworth does not use IV Fentanyl but does use IV Morphine.

            I just walked back to see you and when I walked in the room you “spoke” to me you said, “Hi Mom.”  WOW how beautiful that sounded.  Your trach was downsized and you put your finger over the trach so you could talk.  How great is that?!?!

            The nurse also removed your wrist restraints.  Hopefully you will behave and not pull anything out.  You do not want any set backs.  You are definitely in a forward motion, let’s keep in going!

            Physical and Occupational therapy came to work with you today.  The nurse reported that you did very well and did al the exercises as requested.  She also encouraged you to keep doing your exercises while in bed.

            The Speech Therapist just got done with you swallow study – You passed!!!  You are cleared to drink fluids through a straw.  You also have your pasv muir valve on your trach and you are talking – WHEW what a day so far.

 

8/17/06 Thursday’s Day End Report

 

            What an awesome day.  You have accomplished a great deal.  You have thrilled family and friends with your ability to talk.  Daniel and Michael were so happy when they returned to the waiting room after seeing you for about a minute.  The minute was worth it because – when they said to you, “You look tired”, you responded with “Hell ya I’m tired” – made their day!

            Dr. Tressler called tonight around 9:00 p.m.  He had just looked at the CT scan of your left leg.  He said your left tibia and fibula are externally rotated about 8 degrees off.  He said for most people 8 degrees is not bad, but with the extent of your ankle/heel injury he wants to give you every possible advantage he can and he wants to take you back to the OR to get you in perfect alignment.  He also wants to take you to the OR to change the dressing on the wound vac.  He prefers the wound vac be changed under sterile settings since it is so close to the heel bone.  This would decrease the risk of infection.

            Dr. Tressler is going to speak with Dr. Kregor in the morning to discuss the tibia/fibula issue.  If they are in agreement you could go to the OR tomorrow afternoon.  You would be an “add-on” so I am not sure what time exactly you would go to the OR.

            I have to say I have been very impressed and pleased that both Dr. Tressler and Dr. Kregor have been so detailed and vested in your broken body being  put back together as near to perfection as possible.

            I pray you sleep well tonight-it sounds like you may have another busy day tomorrow. Love you!

 

8/18/06 Friday 26 Days Post Accident

 

            Oh there is not a more wonderful way to start my day than to walk into your room and have you greet me with a “Hi Mom”, a hug, and a kiss.  Thank you son!

            We know today you will be going back to OR to have your tibia and fibula realigned.  You will also have the wound vac dressing changed.

            You were definitely ready and excited to go back to the OR to get the leg right.  This surgery is to last only 2 ˝ hours.  They started your case @1:30 p.m. and you were taken to recovery @3:50 p.m. You went back to your room @ 5:10 p.m.  You were awake, alert, and talking.  Your valve was already placed in your trach.  You were told you could have clear liquids tonight for your diet.

            You were asking questions about your car—so Dad and I showed you the pictures of your Jeep.  You asked when it happened so I told you July 23, gave you today’s date, and let you know you have been here almost 1 full month.

            Today is also the first day you have asked whether you will be able to play baseball.  No one can really answer that right now.  A lot of that answer will be left up to you and your rehabilitation.

 

8/18/06 Friday’s Day End Report

 

            The tube feedings have stopped for now.  Your diet consists of clear liquids.  The Trauma team is going to assess how well you do with a clear liquid diet.   You are doing well with a straw and the nurse has also provided you with a syringe that has a catheter tip to also use for liquids.  The coldness of the fluid bothers your teeth so you are waiting for the liquid drink to get to room temperature.

            For the night you will have your abdominal wound packed before going to bed and you specifically asked the nurse to do the wound packing first then give you your pain medication so you can sleep tonight.

            The next step for you will be transferring to rehabilitation.  I would think by Monday you would be transferring. 

            Sleep well tonight.  We love you.

 

8/19/06 Saturday 27 Days Post Accident

 

            You have been placed on a Fentanyl patch to help with your pain.  When I walked in your room you had a full liquid diet tray on your bedside table.  This is progress.

            The nurse allowed me to change and pack your abdominal dressing today.  The wound looks really good and is healing nicely.  The team has started counting the calorie you are taking in.  This is good because if you can take enough calories in you may be able to get rid of your stomach tube you were getting feedings through.

            Grandma and Grandpa Short arrived today from Kansas.  They both were so glad to see you and be with you.  You spoke with each of them for just a few minutes then you were ready to sleep.  You are taking a lot of pain medication to try and get on top of the pain.  Besides the fentanyl patch, you are still getting oxycodone every four hours and IV Morphine every hour.

            You have been doing great with your full liquid diet.

 

8/19/06 Saturday’s Day End Report

 

            You spent the afternoon and early evening resting as much as possible.  During the late evening visitation hours we put up your basketball hoops and you were shooting hoops with your nerf basketball.  You were doing pretty well.

            The main item the Trauma team is working on for you is to get you off of your IV Morphine.  They placed a second fentanyl patch on you tonight t see if that would assist better with your pain in your left ankle.

            Everything else you are doing quite well with (i.e. full liquid diet and secretions).

            Sleep well again tonight.  We love you.

 

8/20/06 Sunday 28 Days Post Accident

 

            First off the bat the oral/maxillary service called me to make sure I get you a follow up appointment this Thursday or Friday with Dr. McKenna to have your wires removed in his clinic.  The Junior Resident called to give information regarding your oral care while at Stallworth.

It is exciting to know you are ready to be transferred to rehabilitation.  Today marks the 4th week you have been in the Trauma unit at Vanderbilt.

Your mouth is healing, your abdominal wound is closing nicely (it still has a way to go), and your mind is getting sharper.

Today has been a very busy day for the Trauma unit – that is not a good thing.  We have nothing but complete respect for the staff (particularly the nurses and doctors) who have cared for you and all the other patients.  When there are days like today the staff is placed into high gear and are at the top of their game – for every patient we are very thankful.  We know that not all patients have good outcomes – but we do know the staff works hard for the best outcome to occur if at all possible.  Our hearts are always heavy when a new family has to come to the Trauma unit and we pray for that new patient and the family, as we know prayers have been said for you and us.

 

8/20/06 Sunday’s Day End Summary

 

            You were awake and alert for a longer period of time today.  You also lengthened your time in the neuro chair.  This was a very good day for you.  It was also somewhat sad as Christine had to go back to Chattanooga as school starts tomorrow for her.

            The plan tomorrow is to transfer you to Stallworth Rehabilitation hospital.  I do not know when or what time.  Once you are there Stallworth will work you hard – you have to participate in 3 – 4 hours of rehab a day.

            You will also need to work hard on gaining weight as you have lost quite a bit in the 4 weeks you have been here.

            I think you are ready to get started on rehab and gaining weight.  I know you are ready to transfer out of Trauma.

 

8/21/06 Monday 29 Days Post Accident

 

            Well you didn’t transfer to rehab today, not so much because you were not ready but more because Stallworth didn’t have all of the information they needed to get you there.

            I was in your room when Dr. Tressler (Ortho Surgeon who did your ankle/heel) and Dr. Hagan (Vascular Surgeon who will do your skin flap on our foot) were discussing your left foot.  I was able to see your wound on the left bottom heel.  The wound was incredible.  It looked really well, as in no infection, good clean tissue for healing.  The wound is approximately 2 inched in diameter and approximately 1 ˝  inches deep.  Dr Hagan thinks you need the wound vac for one more week and then maybe you will be ready for your skin flap on you heel.

            I watched as Dr. Tressler changed out the wound vac dressing then put dressings on your other incisions from the surgery on your ankle and heel.  He then placed a new metal splint on your foot up to the bend of your knee – “very fancy”.

            You truly amaze me with how much you have been through and your body is healing so nicely.  I thank God every day for the wonderous recovery you are going through.  The two of you work as a great team together.

            There are no BIG plans for today now that we know you are not transferring to Stallworth. You just focus on more rest and more healing!

 

8/21/06 Monday’s Day End Summary

 

            Dad and I went over to Stallworth tonight to take a look at the Rehab facility and an empty hospital room.  It is a very nice facility.

            We found out that each patient is scheduled through out the day starting from 8 in the morning to 4 in the afternoon 3-4 45minute sessions of rehab a day.  They sure will be keeping you busy!  I went back to the hospital around 6 p.m. to see you and tell you good night.  I was going to go home and sleep.  I have come down with either a cold or allergies and feel lousy.  Dad was coming back at 8:30 p.m. for the night visitations.

            I pray that we both get good rest for healing tonight and I will see you in the morning.  Tomorrow marks one full month you have been on the Trauma unit.  WOW!

Love you!

 

8/22/06 Tuesday 30 Days Post Accident

 

            Day 30 is a milestone for you.  Today is the day you will be moving to Stallworth Rehabilitation hospital.  It marks the next trek in this marathon.  I know you are ready to make this move and get started on building strength.

            The nurses on the Trauma unit have all been so wonderful to you and have truly worked hard and diligently to get you to this point.  Your father and I are forever greatful for their healing touch.

            All the physicians/surgeons have also been extremely vested in having the most positive and functional outcome for you.  We are forever thankful for their time and expertise with your healing.

            To date you have had 10 procedures and 11 surgeries with countless dressing changes and splint take downs.  With your jaw fractures and your lower extremity fractures you have literally been put back together unlike Humpty Dumpty all of the Kings horses and all the Kings men did put you back together again!

            From where you started to where you are today you have come a long way and we are ever so thankful and blessed to have you here.

            Thanks go to all the Trauma team, family, and friends.  Through stellar medical care, many thoughts and concerns, and most importantly CONSTANT Prayer we are done with this leg of the journey.

            Let the journey continue….

 

Thanks again Trauma Team for getting us this far.

 

8/22/06 Tuesday’s Day End Report

 

            You arrived at Stallworth around 4pm.  You are in a private room which is quite nice.  It is much quieter at Stallworth.  You are in room 2009. 

            When I made it to your room you were very happy with it.  I think you were glad to have a change of scenery and to not be hooked up to all the wires or have to listen to all the noise of the Trauma unit.

            There was a schedule on your over bed table with the next days activities.  It had the times for when breakfast, lunch, and dinner was served as well as your occupational, physical, and speech therapy was to be done.

            Visiting hours are from 11a – 8:30p and there is no age limit of who can visit.

Sleep well tonight.  We Love you.

 

8/23/06 Wednesday (31) Day 1 of Rehab

 

            And so it begins – the start of your next trek in this journey to recovery.  You have a full day of assessment to be done, occupational therapy for your upper body, physical therapy for your lower body, and speech therapy for your mind.

            When I finally got to your room for the day it was approximately 2:30p.  You had already had your abdominal wound dressing changed, the wound vac dressing on you heel changed, occupational therapy twice, physical therapy and speech therapy once.  You were sitting in a wheelchair when I walked in the room.

            While I was there speech therapy returned and asked you a lot of questions and had you demonstrate your ability to understand direction and understand comprehension of sentences.  You did a great job!  The therapist also tested your short term memory and recall.

            Physical therapy came back as well and had you wheel yourself in the wheelchair around the nurse station – again you did quite well.  Once back in the room she brought you to the bedside, had you raise yourself out of the wheelchair (not putting any weight on your left foot), pivot on your right let and have you sit on the side of the bed.  Fantastic!  Once on the bed, sitting on the side, she had you do some resistance exercises with both legs – then while lying in bed did some passive exercises.

            We found out that you are assigned a team of therapists who will follow you through out your whole stay at Stallworth.  This is great for consistency and continuity.  I would rate your first day a success.  Marvelous!

 

8/24/06 Thursday (32) Day 2 of Rehab

 

            When I arrived at Stallworth today it was approximately 4pm.  You were “cruising” the hallway in your wheelchair with the physical therapist by your side.  This was your second time today with her.  The therapist stated you had stood in-between the parallel bars on your right leg for about 1 minute this morning.  That is a pretty good start, I would say.

            You said you had only done one session today with occupational therapy because you didn’t feel well for the second session.

            You were complaining of feeling nauseated most of the day and were still nauseated this evening.  You actually looked as if you didn’t feel well and were moving quite “sluggish”. 

            When I asked you if you had your abdominal wound dressing changed today.  You told me you did but that the nurse did it wrong.  When I asked Dr. Groomes about the dressing change order he said they use a different solution that what Trauma used.

             I also asked if you had gone to any Dr’s appointments today, you told me NO – when I asked the nurse about your appointments she said you did not have one today but were scheduled tomorrow with Dr. McKenna (oral/maxillary) at 3:30pm.  Hopefully you will be able to get your wires off of your jaw.

            Your mental tracking and memory of today’s activities were right on.  Each question I asked you answered with clarity and was verified with the staff.  Excellent!

            Another positive for today was, even though you did not feel well, you remained in your wheelchair for 5 ˝ hours.  You moved from the wheelchair to the bed, using your right leg, with minima assistance.  Again, excellent progress in a day, I would say.

            You get bored between sessions but by the end of the day you are tired and ready to sleep.  You stated you slept good last night.

            My constant prayer for you is to have God sustain you in his arms and grant you strength, endurance, and continued healing.  We love you!  Mom

 

8/25/06 Friday (33) Day 3 of Rehab

 

            Today was an exciting day for you. You had your follow-up appointment with Dr. McKenna (oral/maxillary) to see if you would get your wires removed.  Dad and I met you at Dr. McKenna’s office.  You had been taken by van to the office from Stallworth.

            When we got to the office you were sitting in the waiting area in your wheelchair signing paperwork.  You told me you did not have a good night.  You said you vomited twice – most of it came through the wires but you had to swallow what remained (gross!).

            While at Dr. McKenna’s office you were given good oral hygiene and had your wires removed!  Another success – bands were put on and you were given instructions on how to exercise your jaw: at each meal, remove bands, brush teeth, then exercise jaw using the stack of tongue blades, finally apply new bands.

            When you returned to your room at Stallworth you had quite a few visitors.

            I was also able to watch the dressing change on your abdomen wound and the incisions on your left ankle.  All looked very good.

            There was some discussion about your trach and whether it was ready to be removed.  It sounds like maybe in a couple of days it could come out.  I know you are ready for that to happen.

            Your neck brace will be the last annoying item for you to have removed.  You have one more week you will wear it.  Before we left you had a temperature.  I pray that will leave you overnight.  Love you!  Mom.

 

8/26/06 Saturday (34) Day 4 of Rehab

 

            Gma and Gpa Short, Uncle Steve and Aunt Kathy, Dad and I arrived for visiting hours around 1pm and you were not in your room.  You were down in the “neuro gym” building what looked like plumbing pipe models.  You were actually involved with your occupational therapy.  The therapist would give you a picture of the model you were to build.  You then had to find the correct pieces and build the model.  We all went down to the “neuro gym” to watch you work.  You did a fantastic job – you built the models without any problem.

            We visited for a while – I showed your nurse how to put on your bands on your teeth correctly.  You were pretty tired from your therapy so we left – to return later for the evening visit.

            When we all returned (Keaton too!) we entered a full room of visitors.  You seemed much more alert with a little more energy.  You shared that you wanted to get a haircut on Wednesday.  You have not lost your WIT as you made a joke of Gpa Short and how much he pay for his haircuts!  Pretty cute, you got a lot of laughs out of it.

            I checked your teeth and the band placement.  The nurses had placed the bands correctly.  Those bands are pretty tricky and it does help by making it much easier if there is a second person helping to place them.

            We brought you some pudding and applesauce for you to eat.  We also brought you an “easy” crossword puzzle book to hopefully help pass the time.

            Gma and Gpa Short are leaving for Kansas tomorrow – they were so happy to spend time with you and talk with you.  Uncle Steve and Aunt Kathy are going back to Georgia tomorrow too.  It was good to have them all here.

 

8/27/06 Sunday (35) Day 5 of Rehab

 

            Today marks 5 weeks post your accident.  We took Caanan to see you today.  He did very will but was scared of the elevator.  I think you were disappointed by how Caanan responded to you.

            Caanan was very still and somewhat afraid – not so much of you but of your room – being in unfamiliar surroundings.  Dogs also are very sensitive to when someone is hurt.  I am not sure but he might have been confused by your c-collar and maybe your voice.  You sound a little different with the trach still in place.

            Dad and I were a little saddened when we left this afternoon as we both felt the visit from Caanan did not go as we had hoped.  Neither one of us wanted you to be disappointed but we felt you were hurt the he did not respond as you had hoped he would.

            During the evening visit Jonathan and Ashely Wage were there to see you.  Dad and I brought you a portable DVD player and some movie DVD’s to watch.  I think you liked it but were getting tired for the night.

            You are slowly decreasing your pain medication use which is good.  Your ankle is really the only area you complain of pain on your body.

            Today at speech therapy you said you worked on word math problems.  You did not have occupational or physical therapy scheduled today.

            Tomorrow will be a full day of all the therapies.  Maybe you will also hear some good news about your trach.

            Have a good night sleep.  We love you! 

 

8/28/06 Monday (36) Day 6 of Rehab

 

            You were very busy today.  It was very clear you had a work-out.  In the morning therapies OT and PT were very good for you.  OT you worked with bands but it was the PT that I was most impressed with.  In PT you walked on your right leg the full length of the parallel bars three times – OUTSTANDING! Speech therapy you worked on word paragraphs.

              In the afternoon therapies for OT I watched you do weights with the pulley.  You did three different sets of 15# each arm.  Then you worked with the bands.  For PT you walked around the nurse station with a walker.

            When I returned to your room in the late afternoon you were eating supper.  I was surprised but very happy to see you were eating spaghetti, broccoli/cheese puree, and chocolate pudding (no more soup).  You definitely worked up an appetite.

            I believe you were pretty pleased with how the day went and you should be you did a great job!

            I think you will sleep well tonight.  We love you!

 

8/29/06 Tuesday (37) Day 7 of Rehab

 

            Hurray! Another success – you had your trach removed today!  They pulled out your trach early today and you have had no problems with it being out.  You do not have to but you know to put your finger over the bandage on your neck to talk clearer.

            OT today you worked with free weights – approximately 3# each.  For PT you again walked with the walker approximately 60ft.  Speech therapy she asked you about certain phrases like “the grass is always greener on the other side” to see what you said about their meaning.  She also would ask you ethical questions to see if you knew right from wrong.

            Tuesdays are the days your whole team gets together (Dr. Groomes, RN, OT, PT, speech, RT, and the Case Manager) to discuss your case and your progress.  During the discussion it was decided that you may be ready for discharge home as soon as Thursday September 7th.  They have been very impressed with your progress.  Your wounds are healing nicely and you are progressing well with all of your therapies.

            Dad and I are equally as impressed, but never doubted that once you were ready for rehab and you knew what you needed to do to get back to an independent function you would get to it!  And boy, have you – We are so very proud of you.

            Tomorrow is going to be a bid day not just because of therapies but because you are going to have your follow up appointment with Dr. Tressler to look at your left ankle.  I am quite sure you will have xrays done and look at the wound on your heel.

            I pray tonight that we will hear encouraging words of forward progress with healing on your left foot.

 

8/30/06 Wednesday (38) Day 8 of Rehab

 

            Today was somewhat frustrating for me.  You were supposed to have your clinic appointment with Dr. Tressler today.  When I went over to the clinic to meet you there, you were not there.  When I called Stallworth to check on you they told me your appointment had been rescheduled for next week.  That was the frustrating part – No one informed me of the change.

            You on the other hand had another very productive day.  You had your sutures removed from your left foot, which allowed you to take a shower.  This was your first shower since your accident.  Even though you had to sit on an “uncomfortable” chair your still enjoyed the shower.       

            Today for OT you were in an “extremity group”.  You stated this group worked with free weights and you did about 15 exercises – 20 reps each.  That is pretty aggressive therapy.  For PT you walked with a walker 60ft in the morning and in the afternoon you did leg exercises.  The afternoon OT therapy you worked with screwing in screws.  Speech was more of the right or wrong questions.

            To top the day off you had quite a few visitors to keep you busy.  Dad was with you for most of the late afternoon and by the time I came your day was almost over and you were tired.

            You are working so hard and making such great progress.

 

8/31/06 Thursday (39) Day 9 of Rehab

 

            Your day was like most of the other days today.  You had OT in the morning and in the afternoon.  You had your Extremity group that worked with free weights and then bands in the afternoon.  For PT you walked again with the walker but this time you went 120ft. so you doubled your distance.  The speech was again having paragraphs of stories read to you with questions regarding the items in the paragraph.  But the best thing that happened today was Christine was here to be with you.  She has taken off from school and work to be with you for the next four days.  You were so happy to see her and to be with her.

            What a joy it was to see the two of you together.  We love you both!

 

9/01/06 Friday (40) Day 10 of Rehab

 

            The rehab continues and you are making such tremendous progress.  The therapist was telling Dad they believe you will be going home next Thursday.  The PT therapist brought in a walker for your use at home.  You went up stairs with your walker today.  We were told you will need to have a second hand rail built on the garage stairs so you can get into the house and we will need to get a toilet commode with handles to place over our bathroom toilet in order for you to get up and down.

            Your second follow-up clinic appointment with Dr. McKenna was today.  He was very pleased with your healing and recovery.  You were given a second rehabilitation devise to assist you with the exercising of your jaw.  He said you could lose the rubber band on the front so now you only have the two bands, one for each side of your jaw.  He said he wants you to start taking off and placing on your own bands.

            Your next appointment with Dr. McKenna is in two weeks by then he thinks you will not need to have your bands and we will discuss when he will remove your arch bars off your teeth.  He also said you can start chewing food. (NOT HARD FOOD).  He stressed the need for aggressive rehab for your jaw so it won’t get stiff.

            While we were waiting for you to see the Doctor you told me you thought your mind was back to where it was before the accident.  Amazing-truly Amazing!

            We also saw one of the patients and his family in the waiting room that had been in the Trauma unit at the same time you were there.  It was the “Newman” family – Tattoo Lady!  He looked great, another testament to answered prayer.  God is good.

 

9/02/06 Saturday (41) Day 11 of Rehab

 

            The weekend is again here and your therapies are reduced.  You only do OT and PT once on Saturday.  Today for OT you did your Extremity group and for PT you walked with your walker around the nurse station.  Christine spent the majority of the day with you.  The two of you watched the UT game together.

            Dad and I visited for a short time, we felt it was good to give you and Christine time alone together since Christine had limited time with you until she has to go back to school.

            We love you.

 

9/03/06 Sunday (42) Day 12 of Rehab

 

            Today was a lousy day for you.  You were sick most of the day.  Your stomach was bothering you.  You had no appetite at all.  You felt it was your medication that made you sick.  It was after the nurse gave you your iron medicine when you threw up you lunch.

            Dawn came to visit before she left to go back to school.  Chuck came too, it was good to see him.           

            You did not have speech therapy today (the only therapy scheduled) because you did not feel well.  Christine stayed until visiting hours were over, you both needed the quality time together.

            I pray you feel better in the morning and you are able to sleep well tonight.  I love you!

 

9/04/06 Monday (43) Day 13 of Rehab

 

            This was a day that was dreaded as Christine had to go back to school, she left around 4pm.  It must have been hard for both of you.  Christine will be back though, this coming Thursday to help get you home if you are discharged.

            Maureen has provided a shower chair and stool that has handles, to place over our toilet at home to assist you getting up and down.

            Coach Oglivie came to visit from Martin Methodist.  He was so impressed with our progress and recovery thus far.  He also brought you and Dad two T-Shirts each from the baseball team.  He stayed for about an hour.

            You felt much better today.  You participated in OT Extremity group and walked with your walker again for PT.  You went farther today with your walker, approximately 180ft.  Outstanding!!

            Keep it up – We love you!

 

9/05/06 Tuesday (44) Day 14 of Rehab

 

            Today you had your follow-up appointment with the Ortho-Spine service.  You had x-rays taken of your neck as well as all of the x-rays Dr. Tressler wanted before seeing you tomorrow in his clinic.

            After your x-rays were taken you were place in an exam room, you were there approximately 15-20 min, a physician came in took your C-collar off asked you if your neck hurt where she was putting pressure – No, asked you to move your head side to side and if there was any pain – No, and asked you to bend your ear to your shoulder (left and right) and if there was any pain – No.  The C-collar was then paced promptly in the trash can.  You were FREE from that valuable annoyance.  You were told you did not need to follow-up with Ortho-Spine service anymore unless you started having problems.  The nurse then brought you a soft C-collar and told you to wear it only if you were to drive where possibly the need to turn your neck suddenly.  Driving at this point won’t be happening and you felt as tough you did not need the transition from soft collar to nothing.  You were very good in allowing the nurse to place it on your neck and you wore it back to Stallworth but once you were in your room at Stallworth off came the soft collar and it has not been worn since.  Congratulations you have another success!

We had the nurses get your weight today – 138#.   You will be going home on tube feedings mainly to get your weight back up.  Since your accident you weight has gone from 185# to 138#.  You have lost 47#.  Most of the weight loss is muscle mass.

No worries!  You will gain and build back your muscle mass – NO DOUBT!

            Again, congratulations on your latest success!  We love you.

 

9/6/06 Wednesday (45) Day 15 of Rehab

 

            Today was the day I think we all have been waiting for, I know I have.  You had your following appointment with Dr. Tressler (Ankle/Heel) to see how your orthopedic injuries are healing especially the left ankle and heel.

            Once again to the physician’s amazement you are healing exceptionally well.  Dr. Tressler was very impressed how much new bone growth you have produced.  He said you are actually growing more bone than you need in some areas, such as your femur site.

            The ankle/heel alignment with the tibula/fibula are perfect and the ankle angle from the dome of he ankle joint to the great toe is also perfect.  Dr. Tressler is an outstanding ortho surgeon and so is Dr Kregor.  The two of them have literally put you back together piece by piece and to as near perfection as they possibly could.

            You have been truly blessed to have had such gifted physicians who have taken you into their hands with a vested interest of making you whole once again.  I believe God was also guiding their hands and it is a God given talent that has been blessed to these two surgeons.

            Dr. Tressler shared with you, he has been awarded one of a selected few in the nation to work alongside others as gifted for approximately 6 months in Seattle, Washington.  He will be leaving October 1, which means Dr. Kregor will be following you for your orthopedic recovery of your ankle/heel.  Although I think Dr. Kregor will be keeping Dr. Tressler up to date with your recovery.  There is much Faith we have in both physicians we are pleased that either one will be following you.  AMEN.

            The wound on your left heel is looking great.  It is reducing in size and had granulated enough that NO bone is showing.

            I love the progress you are making!  You truly are an amazing man.

            Dad and I did not stay long this evening as we needed to finalize the room at home for your homecoming.

 

9/07/06 Thursday (46) Day 16 of Rehab

 

            Oh Happy Day!!!  You have been discharged to go home.  Dad spent most of the morning packing up all of your items and home supplies you are going to need:

  • Wound dressing supplies for your (abdomen, head, and trach)
  • Formula for the tube feedings
  • IV pole and pump for the tube feedings
  • Walker
  • Wheelchair
  • Prescriptions for your continued medications at home (pain, BP, and head injury)

 

When we got home you were so happy and relaxed, much more animated with your friends who came to visit.  Chuck Rowe had built the second handrail for you to get up into the house from the garage (thank you). 

      So far getting around on the first floor is not problematic.  You have settled in quite well.  As Dorothy from the Wizard of Oz said, “There’s no place like home.”

      Welcome home son!  God has granted you new life – there is purpose for you in the world – Thanks be to God!  AMEN and AMEN.