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.