Day 4 Evening
We've been looking forward to 6 PM as the end of the 72 hours, which would mark the end of the period that the brain swells. Dennis has been "remarkable" (according to the doctor) during this period, and so it's stunning when we meet with the neurosurgeon in the early evening and he tells us the maximum swelling period is "from 3 to 5 days" (72 to 120 hours) I've looked toward this time as the end of an incredible ordeal and am not sure how to handle an extension of 48 hours. Dennis has bulled his way through this and I just hope he isn't feeling somehow the psychological crush of another 2 days of the same effort. I hope that he wasn't aware of all the talk of what we thought was an end, and that he has more gas in the tank than we do to get through two more days. But, the evening isn't without its comic events. At one point during the evening, Dennis rolled onto his side and passed gas in Dad's direction (obviously a closet Monty Python fan), then later told Dad to "duck" while he filled his catheter. And, to share the comedy/humiliation equally, when we walk in at the emergency room security gateway, the attending nurse asks if Shell is "checking in". There really is humor in everything, and maybe this is what's meant by the "God never gives us more than we can handle" axiom. These small events are magnified in their hilarity by the situation, but the laughter keeps us sane. Dennis spends another afternoon/night in Drew and Abbi's care and slowly works his way through another 24 hours, closer now to that magical (now 5 day) terminal point.
Monday, November 24, 2008
Sunday, November 23, 2008
November 7 2008
Day 4
Shell arrived today, her first chance to see Dennis since the accident. Not easy to see your son laid on his back with wires and tubes running out to machines monitoring breathing, heart rate and the ever present cranial pressure. This should be the countdown to 6 PM (and the end of 72 hours), so hopefully she'll see a short period of Dennis at the worst and then be there for him as he improves and becomes more aware. (At least that's the thought process behind suggesting that she delay her arrival until Friday morning) The first visit for her is short, less than an hour, but Dennis acknowledges her presence, though questioningly, as in "What are you doing here?" His pressures remain in the high teens to twenties, with several frightening trips into the thirties. He's made it through the 3rd night, without any calls from the neurosurgeons about surgery, and every hour that goes by is another hour gained. Dennis now has both of the most important people he needs emotionally, and the doctors continue to be impressed by his responsiveness, though limited, considering the pressures he sometimes exhibits. Drew, Dennis' nurse, remains a support throughout, knowing what to say, when to say it and what to watch for. He becomes the one outside the family we come to trust, and since he sometimes seems to hold our son's life in his hands, this is a singular source of comfort in an unbearble situation. As parents, we know that Dennis' support system is complete and now it's up to us to hope, pray and wait for him to come back.
Shell arrived today, her first chance to see Dennis since the accident. Not easy to see your son laid on his back with wires and tubes running out to machines monitoring breathing, heart rate and the ever present cranial pressure. This should be the countdown to 6 PM (and the end of 72 hours), so hopefully she'll see a short period of Dennis at the worst and then be there for him as he improves and becomes more aware. (At least that's the thought process behind suggesting that she delay her arrival until Friday morning) The first visit for her is short, less than an hour, but Dennis acknowledges her presence, though questioningly, as in "What are you doing here?" His pressures remain in the high teens to twenties, with several frightening trips into the thirties. He's made it through the 3rd night, without any calls from the neurosurgeons about surgery, and every hour that goes by is another hour gained. Dennis now has both of the most important people he needs emotionally, and the doctors continue to be impressed by his responsiveness, though limited, considering the pressures he sometimes exhibits. Drew, Dennis' nurse, remains a support throughout, knowing what to say, when to say it and what to watch for. He becomes the one outside the family we come to trust, and since he sometimes seems to hold our son's life in his hands, this is a singular source of comfort in an unbearble situation. As parents, we know that Dennis' support system is complete and now it's up to us to hope, pray and wait for him to come back.
November 6, 2008
Day 3 Evevning
It's been a full 48 hours for Dennis now and we're more tha halfway to the 72 hour mark for maximum swelling. Dennis is definitely more lethargic and less responsive now, a sign of continued swelling. But the doctors continue to remark on his ability to respond to any extent.
The seconds and minutes drag by, Dennis rests quietly and thoughts run wild, about pressure readings, medication options, 24 more hours and possible surgery. One of Dennis' youth ministers arrives and asks if we can see God in this situation. Odd question, since, other than Shell, that's about the only one we've been talking to for the last two days non-stop. That's where Dennis' hope lays right now, so the answer is yes. We think about the one set of footsteps image, in terms of uncertainty, and hope that that's where Dennis is right now. Later in the evening, the neurosurgeon stops by to make sure we have each other's phone numbers and to say that he'll be available immediately. He's fairly certain the surgery option is inevitable, not something we're mentally prepared for, and not a decision we're ready to make alone. There is a young nurse, Jenny, who says there's still more room for the medications to work and that Dennis is young and athletic and that all this will work in his favor, not to worry about the surgery option just yet, but Dennis isn't her son, not her life to decide. The strange thing about watching Dennis is the fact that he's relatively unmarked, no broken bones, no deep cutting wounds, no stitches; just the head injury keeping him in a sleep state. In all honesty, he's amazingly lucky, and we just hope that the luck holds for one more day.
It's been a full 48 hours for Dennis now and we're more tha halfway to the 72 hour mark for maximum swelling. Dennis is definitely more lethargic and less responsive now, a sign of continued swelling. But the doctors continue to remark on his ability to respond to any extent.
The seconds and minutes drag by, Dennis rests quietly and thoughts run wild, about pressure readings, medication options, 24 more hours and possible surgery. One of Dennis' youth ministers arrives and asks if we can see God in this situation. Odd question, since, other than Shell, that's about the only one we've been talking to for the last two days non-stop. That's where Dennis' hope lays right now, so the answer is yes. We think about the one set of footsteps image, in terms of uncertainty, and hope that that's where Dennis is right now. Later in the evening, the neurosurgeon stops by to make sure we have each other's phone numbers and to say that he'll be available immediately. He's fairly certain the surgery option is inevitable, not something we're mentally prepared for, and not a decision we're ready to make alone. There is a young nurse, Jenny, who says there's still more room for the medications to work and that Dennis is young and athletic and that all this will work in his favor, not to worry about the surgery option just yet, but Dennis isn't her son, not her life to decide. The strange thing about watching Dennis is the fact that he's relatively unmarked, no broken bones, no deep cutting wounds, no stitches; just the head injury keeping him in a sleep state. In all honesty, he's amazingly lucky, and we just hope that the luck holds for one more day.
Saturday, November 22, 2008
November 6 2008
Day 3
Dennis slept better overnight, but this is actually a cause for concern, as he seems more lethargic and less responsive. It's also a sign to the neurosurgeons that the swelling in Dennis' brain is continuing and so an additional CAT scan is ordered for early morning. Before the start of mid-morning visiting, Dennis was moved out of his room and into the general Trauma unit area , so that he can be more easily monitored. The neurosurgeons decide to place a monitor and drain in his skull, to control the intracranial pressure that is building due to the swelling. Today at 6 PM will be the end of the second full day after the accident, still looking forward to that magical 72 hour deadline for maximum swelling. The ICP's are ideally supposed to be below 20, hopefully never above 30, because this is the edge of the danger zone foe Dennis. For the first time, the team of doctors begin to talk about options to control the injury, which include medication, activating the drain and removing a section of the left side of Dennis' skull (about 4 inches square). For today, the plan is to use the meds and hope. Again, the nurses, particularly
Drew, are seemingly more positive about his condition than the surgical team, as the team describes the details of the procedure, the effects on recovery and the likelihood of this option. (The family {again that secretive part} decides not to discuss this possibility at this point with anyone, because it is too frightening to contemplate.) During the daytime hours, Dennis' pressure readings fluctuate from low teens to the 30's, causing one of the nurses to comment that watching the numbers constantly will drive you crazy. (She's absolutely right, because we're almost there at this point) Dennis continues through the day, somewhat responsive at times with certain nurses, doing the thumbs up, knowing his name; less so with others, particularly the neurologists. The most difficult parts of the day are updating others on Dennis' condition and prognosis and the drives home.
Dennis slept better overnight, but this is actually a cause for concern, as he seems more lethargic and less responsive. It's also a sign to the neurosurgeons that the swelling in Dennis' brain is continuing and so an additional CAT scan is ordered for early morning. Before the start of mid-morning visiting, Dennis was moved out of his room and into the general Trauma unit area , so that he can be more easily monitored. The neurosurgeons decide to place a monitor and drain in his skull, to control the intracranial pressure that is building due to the swelling. Today at 6 PM will be the end of the second full day after the accident, still looking forward to that magical 72 hour deadline for maximum swelling. The ICP's are ideally supposed to be below 20, hopefully never above 30, because this is the edge of the danger zone foe Dennis. For the first time, the team of doctors begin to talk about options to control the injury, which include medication, activating the drain and removing a section of the left side of Dennis' skull (about 4 inches square). For today, the plan is to use the meds and hope. Again, the nurses, particularly
Drew, are seemingly more positive about his condition than the surgical team, as the team describes the details of the procedure, the effects on recovery and the likelihood of this option. (The family {again that secretive part} decides not to discuss this possibility at this point with anyone, because it is too frightening to contemplate.) During the daytime hours, Dennis' pressure readings fluctuate from low teens to the 30's, causing one of the nurses to comment that watching the numbers constantly will drive you crazy. (She's absolutely right, because we're almost there at this point) Dennis continues through the day, somewhat responsive at times with certain nurses, doing the thumbs up, knowing his name; less so with others, particularly the neurologists. The most difficult parts of the day are updating others on Dennis' condition and prognosis and the drives home.
Friday, November 21, 2008
November 5 2008
Day 2 Evening
Dennis was able to have visitors for an hour or so, and Cody Epps came to watch over him. (this became a nightly visit that Cody never missed) Dennis was pretty tired at this point and spent most of the time sleeping, in and out of being aware of who was with him.The doctors talked of the brain swelling increasing for the first 3 days and that this was the critical period, since in a closed head wound there is only room for blood, cerebro-spinal fluid and the brain itself within the skull, and that the swelling creates pressure that lessens the ability to respond to stimulus and presents the problem of the brain swelling becoming so pronounced that the brain begins to injure itself, perhaps permanently. At just over 24 hours, it was possible to be positive at this point, and see this injury as just much more severe than a concussion (an injury we had sustained when we were young-no matter how many centuries ago that was-it accounts for the personality disorder issues); since many of the symptoms and responses were familiar. This would turn out to be a convenient delusion as the days wore on. The one constant in the day was Dennis' ability to push through hour after hour, on his own in a place no one else could get to. The unique part of this period was the silence that two people shared for hours, one fighting through the pain and confusion, the other struggling to hold onto faith and sanity.
Dennis was able to have visitors for an hour or so, and Cody Epps came to watch over him. (this became a nightly visit that Cody never missed) Dennis was pretty tired at this point and spent most of the time sleeping, in and out of being aware of who was with him.The doctors talked of the brain swelling increasing for the first 3 days and that this was the critical period, since in a closed head wound there is only room for blood, cerebro-spinal fluid and the brain itself within the skull, and that the swelling creates pressure that lessens the ability to respond to stimulus and presents the problem of the brain swelling becoming so pronounced that the brain begins to injure itself, perhaps permanently. At just over 24 hours, it was possible to be positive at this point, and see this injury as just much more severe than a concussion (an injury we had sustained when we were young-no matter how many centuries ago that was-it accounts for the personality disorder issues); since many of the symptoms and responses were familiar. This would turn out to be a convenient delusion as the days wore on. The one constant in the day was Dennis' ability to push through hour after hour, on his own in a place no one else could get to. The unique part of this period was the silence that two people shared for hours, one fighting through the pain and confusion, the other struggling to hold onto faith and sanity.
November 5, 2008
Day 2
Day 2 started a little early, about 1 AM. Dennis was moved to a room of his own, room 19, on the Trauma Unit floor. It was a restless night for Dennis, trying to pull off the monitoring leads and the cervical collar every minute or so, but that seemed to be a good sign, since it showed that he was active, alert and somewhat aware of his surroundings. So most of the night was spent making sure that "stuff" stayed on, waiting for the next CT at 6 AM and praying. There is a tremendous amount of uncertainty that surrounds head injuries, because the damage isn't visible, there is no apparent "wound" that can be used as a gauge of the extent of the injury sustained. The only method at this point is the neuro exams to test responsiveness, like holding thumbs up (not always the thumb in Dennis' case), or sticking out your tongue and telling the nurses and doctors your name and what year it is (Some of us believe, like Dennis, that 1954 was worth mentioning). Dennis did well on these, though there was a distinct difference in the opinions of the nurses and the neurologists/neurosurgeons, and this was the beginning of the anxiety over the prognosis. The second CT was "as expected", there was some additional bleeding into the brain and another CT was planned for later in the day. The rest of the day would be spent with continual periodic neuro exams by the nurses (particularly Elli) and watching and waiting. Dennis would spend the rest of the day in room 19, mostly in a state of light to moderate sleep. The odd part here is that eating and drinking didn't seem to be part of either of our day and night activity.
Day 2 started a little early, about 1 AM. Dennis was moved to a room of his own, room 19, on the Trauma Unit floor. It was a restless night for Dennis, trying to pull off the monitoring leads and the cervical collar every minute or so, but that seemed to be a good sign, since it showed that he was active, alert and somewhat aware of his surroundings. So most of the night was spent making sure that "stuff" stayed on, waiting for the next CT at 6 AM and praying. There is a tremendous amount of uncertainty that surrounds head injuries, because the damage isn't visible, there is no apparent "wound" that can be used as a gauge of the extent of the injury sustained. The only method at this point is the neuro exams to test responsiveness, like holding thumbs up (not always the thumb in Dennis' case), or sticking out your tongue and telling the nurses and doctors your name and what year it is (Some of us believe, like Dennis, that 1954 was worth mentioning). Dennis did well on these, though there was a distinct difference in the opinions of the nurses and the neurologists/neurosurgeons, and this was the beginning of the anxiety over the prognosis. The second CT was "as expected", there was some additional bleeding into the brain and another CT was planned for later in the day. The rest of the day would be spent with continual periodic neuro exams by the nurses (particularly Elli) and watching and waiting. Dennis would spend the rest of the day in room 19, mostly in a state of light to moderate sleep. The odd part here is that eating and drinking didn't seem to be part of either of our day and night activity.
Thursday, November 20, 2008
November 4, 2008
Day 1
All things considered, maybe the whole car-surfing idea didn't work out as planned. Once the EMT's from Sumner County arrived (about 4:15 PM), it was a fairly quick decision to life flight Dennis to Vanderbilt Trauma Unit (Though this wasn't public knowledge for a couple of days, due to a need to know decision by the family {well part of it}). Dennis arrived at about 6:00 PM at Vandy, but was admitted under the pseudonym "Penguin 08", since no family member over 18 was with him. Shortly thereafter, Dad arrived at Vandy, and once the code was cracked (if only he'd worn his Batman cape!) located Dennis and began THE VIGIL. The onset of a brain injury is an event marked by evaluation, scanning, waiting and fear, in approximately that order. Dennis was prepped for a CAT scan to determine the extent of the brain insult and the amount of initial bleeding in the brain. Then he was tested to determine his ability to respond to commands and evaluate his awareness. And then there followed 12 hours of monitoring/re-evaluating and waiting for the next CAT scan, scheduled for 6 AM on Wednesday the 5th. During the night the nurses continued the evaluations and were guardedly optimistic about Dennis' responsiveness.
And so the long first night of waiting began
All things considered, maybe the whole car-surfing idea didn't work out as planned. Once the EMT's from Sumner County arrived (about 4:15 PM), it was a fairly quick decision to life flight Dennis to Vanderbilt Trauma Unit (Though this wasn't public knowledge for a couple of days, due to a need to know decision by the family {well part of it}). Dennis arrived at about 6:00 PM at Vandy, but was admitted under the pseudonym "Penguin 08", since no family member over 18 was with him. Shortly thereafter, Dad arrived at Vandy, and once the code was cracked (if only he'd worn his Batman cape!) located Dennis and began THE VIGIL. The onset of a brain injury is an event marked by evaluation, scanning, waiting and fear, in approximately that order. Dennis was prepped for a CAT scan to determine the extent of the brain insult and the amount of initial bleeding in the brain. Then he was tested to determine his ability to respond to commands and evaluate his awareness. And then there followed 12 hours of monitoring/re-evaluating and waiting for the next CAT scan, scheduled for 6 AM on Wednesday the 5th. During the night the nurses continued the evaluations and were guardedly optimistic about Dennis' responsiveness.
And so the long first night of waiting began
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