Tuesday, June 30, 2009

Spontaneous breathing trial, June 30

Dad was very restless today. He tried to ask all sorts of questions, but due to the ventilator tube and the drugs, we had a very difficult time understanding him. It must be incredibly frustrating for him. When he is able to get his point across, though, he lets everyone know how happy he is. At one point he kept lifting his arms, which were fastened to the bed to prevent him from tugging at the ventilator tube. After a few minutes of trying to decipher his hand gestures, we finally guessed that he just wanted us to unfasten the ties on his arms. As soon as we did, he lifted both arms as high as he could and stretched them out. He smiled, gave his signature thumbs-up sign, and then he even did a little dance with his hands!

The respiratory specialist did a spontaneous breathing trial with him today. Essentially, they remove all ventilator support for thirty minutes and they observe how well he breathes on his own. He performed wonderfully. It won't be long before they can permanently remove the breathing tube.

During the breathing trial, Dad's mom (we call her 'Gabby') started singing old-timey love songs to him. In that moment, I saw my father as a son. I doubt I'll ever forget the sacred feeling of perceiving the connection between them as she sang her encouragement to her son, and I knew from his eyes that it was working. It reminded me of many times with my own mother, and the thought that I'll never have that experience again was replaced with the thought that, yes, I will have that experience again, but in a very different way.

I apologize if I'm getting too sentimental. I try to stick to the facts, but sometimes the facts are pretty beautiful.

Morning update, June 30

Another good morning for Dad. His white blood cell count is going down, his blood pressure and heart rate are at safe levels, and he seems to be relatively comfortable. He still has a slight fever at 38.2 C. His breathing continues to improve, and the PEEP has been lowered to 8.0, which is the lowest that we've seen it so far. His lungs are getting stronger. They are still removing a good amount of secretion from his lungs, but this is hopefully the tail end of the infection.
The primary goals right now are (1) pain control, (2) weaning off the ventilator, and (3) getting rid of the lung infection.

We brought in some music for him. First, I put on Faure's Requiem, which is one of his favorite pieces of music. His heart rate immediately started to decrease, and he raised his eyebrows, smiled, and gave a big thumbs-up. The last piece on this particular recording is the Pie Jesu, which is a soft soprano aria. Because this piece ends so quietly, I had the volume up pretty high. Unfortunately, the next song on the play-list was a bluegrass song, and it came blaring out for a few seconds before we could lower the volume on the iPod. Dad didn't like this very much. So we're on a break from music for a little while, and in the meantime we're going to work on our play-lists.

Monday, June 29, 2009

Morning update, June 29

Dad's condition is steadily improving. Here are some of the important stats this morning:

Heart rate is 120

Temp is 37.8 C

PEEP is at 10.0

Oxygen is at 35%

These are very encouraging stats, especially in light of the fact that the nurses have dramatically reduced the amount of pain killer he's getting. Last night, Kristen and I figured out that he is much more comfortable when we stuff pillows under his knees -- having his legs elevated takes the pressure off of his lower back, which must be a significant source of discomfort due to the broken transverse processes.
He's still fighting the infection in his lungs, but that seems to be going well. He has a bad contusion on his left eye (and what looks like strabismus in the right eye), but the ophthalmologist seemed to think everything was satisfactory after an examination yesterday.

Late last night there was a brawl outside the ICU. We had momentarily stepped outside to give the nurses some room while they repositioned Dad, when a group of distraught people entered the waiting room. From their conversations, we gathered that their son had just drowned. The boy's mother was fainting every few minutes. More and more friends and family arrived until the waiting room was completely packed. After a few minutes an argument broke out. Following some harsh words, there was an altercation, which unfortunately caught some innocent bystanders by surprise. We tried our best to diffuse the situation by expressing our sorrow and acknowledging their loss. Two good friends who were visiting at the time went and spoke with the instigators of the fight and helped them calm down. It was around this time that the boy's mother went into cardiac arrest. This caused even more confusion. Everyone was sobbing, and a few people were throwing up. I felt so incredibly sad for this family. After the emergency team came and wheeled away the mother, we were able to make our way past the police, who were also pretty agitated. It was nice to be back with Dad. He has a way of comforting people even when he's the one in critical condition.

Sunday, June 28, 2009

Morning update, June 28

Elisabeth stayed the night with Dad last night, and she gave us some good news this morning:

Heart rate is down to 114.

Temperature is down to 37.4 C.

The nurses have been removing congestion from his lungs every four hours, and it looks like the amount of congestion is tapering off.

He seems to be both responsive and relatively comfortable, and that is a combination that hasn't been possible until now. Today is going to be a good day!

Saturday, June 27, 2009

Update on Kent #4

I just finished speaking with his primary day nurse, who gave me a good summary of his condition. Currently, the most urgent issue is the lung infection and the resultant fever. Based on early images of his lungs, they are convinced that he had community-acquired pneumonia when he was admitted into the emergency room on Saturday morning. If not for the accident, the infection probably would have been killed off by the body's endogenous defenses, but the trauma to his body has given this infection the opportunity to flourish. The good news is that the infection hasn't spread to other parts of his body yet. They are treating it with two different antibiotics, and they are hopeful that it will be eradicated within the next two days.

They recently discovered two blood clots in his lungs. This isn't too much of a problem (according to the nurse), but it does explain the recent setbacks in his breathing. They are treating the clots (in his lungs, as well as some in his arm) with a blood-thinner.

On the bright side, the medical team has been giving him much more appropriate levels of pain medication. This brings his heart rate down and allows him to sleep a little.

With regards to his breathing, there are two crucial numbers with which we have become well-acquainted. First, there is the PEEP. It stands for Positive End-Expiratory Pressure, and it is indicative of the amount of pressure that the respirator maintains in his airway after he exhales. This positive pressure keeps the alveoli open and prevents the lungs from collapsing. Currently, his PEEP reading is 14.0, which is the highest that it has been, and this is primarily to address the clotting in his lung.

Another important number is the oxygen content of the air being pumped into him by the ventilator. This number is an indirect measure of the efficiency of his breathing. The air that we normally breathe has an oxygen content of roughly 21%, but the oxygen content of the air Dad is breathing has been as high as 70%. Right now he's at 40%, which is very good, given his current situation.

His temperature is currently 38.5 Celsius, which is 101.3 Farenheit. This is down from his temperature last night, which was 39.5 C (or 103.1 F).

His heart rate is 126. I can see his chest pounding through his hospital gown. In spite of this, he is sleeping peacefully now. Occasionally, he'll raise his eyebrows as if he just heard some surprising bit of news, or he'll start to lift his hand like he wants to scratch an itch, but his arm only gets so far before it falls back down to the bed. I miss him and I want him to wake up.

Friday, June 26, 2009

Update on Kent #3

It is my hope that this blog will give hope and comfort. It was in the spirit of that hope that I focused only on the positive aspects of Dad's health in the last update. I still want to keep this focus, but I think I should have mentioned some of the more difficult issues Dad is facing. He is still in critical condition: he hasn't made very much progress with his ventilator in the last day or two, the doctors think he has group acquired pneumonia (which they think is the cause of his fever), and he has been in a constant state of tachycardia (average heart rate of 130) since Friday. If you pray, please continue to pray for our father.
We love and appreciate all of you.

Thursday, June 25, 2009

Update on Kent #2

Great news: the tube in Dad's chest was removed today. He also slept much more today than he did yesterday, thanks to a more merciful dosage of pain medication. He is able to write out messages on a pad of paper, and this allows us to do a better job at keeping him comfortable (although his handwriting is now even worse than his pre-accident undecipherable scribbles). He keeps the nurses in line, asking things like, "How many CC's of saline am I getting?"

One hand, one heart

Walnut Creek, circa 1984

Wednesday, June 24, 2009

Services for Mom

Because we can't predict exactly when Dad will be out of the hospital, we haven't set a date for the memorial services for our mother. When we are able to set a date and time, we'll let everyone know through this blog and other outlets. We anticipate that it will be held between mid-July to early-August.

Tuesday, June 23, 2009

media coverage


moved to ICU

Dad was moved to ICU late last night. It is a much better atmosphere than the emergency room (he was there for 70 hours). They cleaned him up, gave him a new bed and some new sheets, and replaced his bandages. His temperature has been spiking periodically, but Tylenol and antibiotics have kept the fever at bay. There were moments during all of the moving around last night where it was clear that he was very uncomfortable, but he would simply respond to the requests of the nurses by giving a "thumbs-up". It was hard not to be proud of him.

Monday, June 22, 2009

Our gratitude

We have been so incredibly overwhelmed by the outpouring of love, help, and condolences. We can't possibly begin to give thanks on an individual basis. Please know that all the food, flowers, service, and words of comfort have not only helped us in this difficult time, but also given us a certain kind of joy that those who love Mom have been able to mourn her passing in their own way. We know that many are hoping and praying for the continued recuperation of our father. We love you for it.

Update on Kent

Here are the details concerning Dad's condition as of today (June 22):

* He had a collapsed lung and a half-dozen broken ribs on his left side. His lung was punctured, so they are draining blood from it, and also removing the air that is escaping from his lung into his chest and abdomen. He is currently on a ventilator.

* There was a gash on the back of his head. This has been stitched, and there is no sign of any related brain damage.

* There was some swelling and bleeding behind his eye, and there was some initial concern for Dad's vision, but this has been ruled out. His vision seems fine so far.

* Generally, he is in and out of consciousness. The pain medication keeps him asleep most of the time. When he is most alert, he responds to questions with smiles, nods, and squeezing our hands. He occasionally asks questions by mouthing one or two words.

* Contrary to early reports, there is no apparent damage to his neck vertebrae. Some external elements of his lower vertebrae were chipped off, but this will not require any intervention.

* We have been touched by the many offers to visit and stay with him. Arrangements have already been made to have someone with him in the event that an immediate family member can't be there. Until his condition is more stable, we ask that people refrain from visiting him.

The accident

[Updated on Mon. June 29]

There are a few versions of the accident floating around, so it might be useful to have a more official account given here. Of course, the details of the event are still gradually coming into focus for us, so I'll just stick to what we know for sure. We know that Dad and Mom were driving home from Girl's Camp, and that it was about midnight on Friday, June 19th. Near the Folsom Prairie City off-ramp on I-50, their car fishtailed, ran up an incline, and flipped a number of times. Mom's death was instantaneous. The first officer on the scene informed us that when he arrived, he found that Dad was conscious, but disoriented until they were able to sedate him.