Brandon was moved onto the Physical Therapy Floor this morning. He is loving his new digs! He has been standing up and even took a couple of steps with his old lady walker. His nurse looked at him and said, "Welcome to Boot Camp!" Brandon ate two pudding cups today and drank three cups of juice, but he's looking forward to eating a nice juicy steak real soon.
Brandon got to see Branson for the first time today. He took him for a ride on his lap on the wheel chair coming back from his first therapy session. Branson has been hanging out with his grandma Carlson, and he is really giving her a run for her money. Kassi's parents have been taking care of Kassi and trying to get her to rest so she can heal. She got to see Brandon tonight and he said he wanted to "watch a movie and chill." He asked her to come lay her head on his chest. Brandon says the funniest things. He told Kassi, "Me and you, me and you; The door; We have $#!+ to do."
Kassi got him a stuffed horse a couple of days ago and he's been making it prance around on his bed. We asked him what he wanted to name it and he said, "Disturbia or Kum bi yah". He says it's a wimpy horse.
Brandon also got visits today from his brothers, Brad and Eric, and his sister, Aimee. This accident has given us all a reason to pause and to reflect on our own lives and how we can better live our lives. His brothers are no different. They have made some mighty big promises when Brandon walks out of the hospital. When he does, I am going to have my camera ready!
All of Brandon's nurses and doctors are absolutely astonished by his recovery! He really is an "almost walking" miracle! There is a guy named David that was two doors down that was a hockey coach and had a ground level fall on the ice and is not doing well. We are so lucky and I hope no one ever forgets that miracles really do happen and Heavenly Father had his hands in all things. Thank you for yours prayers and your fasting and for all your love! We love you all and we must tell you that Brandon's recovery is only one of the many miracles that are taking place from all of this. Brandon has changed a countless number of lives for the better! Never take your life for granted! You could close your eyes for just one second and your life can be changed forever!
Family
Tuesday, November 30, 2010
Day Ten - Tuesday - Part Two
November 30, 2010: I had to do one more post before I leave for Hurricane. There have been a lot of joyful tears shed today. The nurse came and got me from the waiting room early today. She brought me back for shift change. She said she had cheated and tried to give Brandon a drink of water. He drank it without problem. She then let me feed him a cup of pudding and a glass of juice. You should have seen him inhale both of them, (figuratively - not literally).
He told me "No more medicine, I'm not in pain." I told him when he gets agitated we assume he is in pain. He said, "I'm not in pain, I'm panicking." We talked about what was being done and why. I placed a O2 saturation probe on his toe. He asked, "What did you do that to my toe for? Get it off." I told him what it was and why and he told me I could leave it on. For the first time in days he is resting comfortably and is not trying to remove the remaining tube, electrodes, or sat monitor.
His room is now a hub of activity as they get him ready to go to the rehab floor. Rehab is excited to receive him. We are hopeful that it is not too much too soon. We are able to work through his panic moments and he calms right down. A good day. He slept, ate, worked out, asked the right questions and acknowledged people. Then back to staring. Increasing lucid moments and physical responsiveness. All great steps in the right direction.
He told me "No more medicine, I'm not in pain." I told him when he gets agitated we assume he is in pain. He said, "I'm not in pain, I'm panicking." We talked about what was being done and why. I placed a O2 saturation probe on his toe. He asked, "What did you do that to my toe for? Get it off." I told him what it was and why and he told me I could leave it on. For the first time in days he is resting comfortably and is not trying to remove the remaining tube, electrodes, or sat monitor.
The tears came as he stood with assistance. The physical therapists were working with him on balance and retraining him to lean, sit straight, look left. He was extremely responsive. Then came stand. He stood with help. They told him to find dad. He looked around, made eye contact, then they said give him a wave with your right hand. He waved. He waved with an arm that has for the most part remained flaccid for ten days, and best of all, he gave me the trade marked Brandon grin.
Day Ten - Tuesday
November 30, 2010: Finally a good, non-sedated night sleep. Brandon remained so agitated last evening that I left a few minutes early hoping it would help calm him down. His agitation increased after I left. The nurse had to place a halter restraint on him to help keep him in bed. With the restraint in place, Brandon became more relaxed then more lucid.
He told the nurse his throat hurt. Brandon seemed confused about what was going on and where he was. They talked about being in the hospital and the treatment he was receiving. Following the conversation, Brandon relaxed and went to sleep for most the night. The nurse was even able to loosen the restraints to allow more movement. When I went in this morning, he was sound asleep, (Brandon - not the nurse), no self induced stridor.
Kassi is adjusting to being bruised, broken and beat up. It is tough for her trying to heal and helping Brandon heal. With all her concern for Brandon, I think she has forgotten she was seriously injured herself and needs rest and time to heal. I hope the change to rehab will allow her the opportunity to rest and heal. The rooms there are more conducive to her needs when she visits. It will also allow Branson the opportunity to see his dad for the first time in ten days. It should provide a great motivation for Brandon.
I will turn the watch over to Leanne this morning and return to Hurricane. She will also take over the blogging this afternoon. We have three children who need to return to school and I have a few things I need to accomplish prior to returning to IMC later this week. I am hopeful they will move Brandon to the rehab floor early this morning. The STICU is slammed (another one of those medical terms) and they really need the bed. If Brandon is moved before we leave, it will allow Matt and Chandler the opportunity to see their brother.
We all have a long journey ahead while we patiently watch Kassi heal and discover who this new Brandon will be. Each great journey begins with a small step. We thank Father daily for all your prayers which help Brandon and Kassi take those little steps everyday.
He told the nurse his throat hurt. Brandon seemed confused about what was going on and where he was. They talked about being in the hospital and the treatment he was receiving. Following the conversation, Brandon relaxed and went to sleep for most the night. The nurse was even able to loosen the restraints to allow more movement. When I went in this morning, he was sound asleep, (Brandon - not the nurse), no self induced stridor.
Kassi is adjusting to being bruised, broken and beat up. It is tough for her trying to heal and helping Brandon heal. With all her concern for Brandon, I think she has forgotten she was seriously injured herself and needs rest and time to heal. I hope the change to rehab will allow her the opportunity to rest and heal. The rooms there are more conducive to her needs when she visits. It will also allow Branson the opportunity to see his dad for the first time in ten days. It should provide a great motivation for Brandon.
I will turn the watch over to Leanne this morning and return to Hurricane. She will also take over the blogging this afternoon. We have three children who need to return to school and I have a few things I need to accomplish prior to returning to IMC later this week. I am hopeful they will move Brandon to the rehab floor early this morning. The STICU is slammed (another one of those medical terms) and they really need the bed. If Brandon is moved before we leave, it will allow Matt and Chandler the opportunity to see their brother.
We all have a long journey ahead while we patiently watch Kassi heal and discover who this new Brandon will be. Each great journey begins with a small step. We thank Father daily for all your prayers which help Brandon and Kassi take those little steps everyday.
Monday, November 29, 2010
Day Nine - Monday - Part Two
November 29, 2010: I forgot to mention earlier today that we awoke to 10.5" of snow outside the motor home. Our poor car was plowing snow whenever we attempted to drive. I thought we had moved to Hurricane to avoid this cold white rain. At least it was what Utah is best known for, light, fluffy powder. It almost made me want to be a skier.
I think our roller coaster has officially gone from unknown to frustration. Brandon continues to have great lucid moments of incoherency, much like his sleep starved father. It is hard to see him go from calm and following commands to agitated and rambling. We are so grateful for the progress he has made. We need to continue reminding ourselves that patience is a virtue and apparently we need more of it.
Brandon had a couple of tests this morning. He had a swallow test. I don't think he studied for it hard enough. Actually, I think it would have been difficult for any of us to pass it. The physical therapist had him sitting up for his first time in eight days. The oxygen had dried out his nose and it was bleeding. He was holding a towel to his nose, pinching it and the speech therapist was asking him to swallow and suck on a straw, all at the same time. Pretty tough for anyone, let alone someone who has been sedated and unresponsive for a week. Needless to say he was able to negotiate the ice chips but failed the water and pudding test. I talked to the physical therapist and nurse and they are going to do a repeat tomorrow before the decision is made about retuning the feeding tube.
His physical therapy session this morning did not have much promise. Of course he was given Haldol and Morphine prior to the session. He was able to stand several times with assistance. He told the therapist he wanted to go home. She told him if he went home she couldn't help him. He replied, "You can go home with me." He would not look to his left and stood giving his best impression of a question mark. It is obvious that stimulation needs to be kept to a minimum. Today we even limited visits by family. I think we will need to keep those limits in place for some time. A great byproduct of the therapy was a decrease in agitation and better breathing. His stridor was gone and he rested more comfortably after the session, at least for awhile.
Rounds were a bit late today. By this afternoon when they made rounds, Brandon was in another physical therapy session. He was able to stand again, put lotion on his hands and with some encouragement, look to his left and sit in a chair with varying degrees of assistance. The trauma doctor looked in his window and was excited. Brandon had a prolonged period of lucidness. The doctor kept saying, "Are you seeing this." "You need to get this on video." "Look at that." The doctor looked at me with a big grin on his face and said how great Brandon was doing. This was the same doctor who heard me tell Brandon that a lot of people were praying and fasting for him, turned to me and said, that the fasting and prayers were responsible for all the progress made by Brandon. His progress and how far he has come can only be explained by prayer, fasting and priesthood blessings. We just need to keep stringing those moments together, moment by moment to eventually arrive back at Brandon. The small victories we see are a far cry from where anyone expected him to be months from now.
Based on his progress, they are holding off on his feeding tube, looking at the potential of removing his urine catheter, and moving him to neuro rehab tomorrow for a prolonged stay. He continues to sustain his oxygen sats on room air and when lucid, complain that he wants to be free of all restraints and tubes. It is the chicken and egg dilemma. Is he agitated because of the restraints or restrained because he is agitated? When I told him I went to see the gym and that he would be able to start working out tomorrow, he said "Sweet!" I am hoping the rehab will help with his agitation. If he can increase his alertness and rid himself of all tubes and workout, perhaps the agitation will decrease.
I am having a hard time convincing myself I can leave his side tomorrow and return to work and family life in Hurricane. It has been hard enough to leave his side for shift change for the last nine days. Leaving him for a few hours today to decrease the stimulus in his room was heart breaking. Leaving him for five days may be unbearable. It is tough to see your little boy struggle and not be able to reach out with a magical cure. It will be even tougher not to be there to catch him when he struggles and falls.
Kassi on the other hand has been pushing herself. I think it is starting to wear on her. She went to the doctor today to confirm that yes it is a broken collar bone and no she should not have been discharged from the hospital without treatment and care instructions. She was also admonished to pace herself.
It is hard for her to not be here with Brandon every moment of every day. She keeps being reminded that she too must heal. The change to neuro rehab will give us some definite scheduling and limited visiting hours. It will be fun and frustrating to watch Brandon's progress. We all pray that he will continue to amaze us and keep his spirits up to override his almost unbearable frustration for one who days ago was very mobile and healthy.
Photos & videos posted to this entry tomorrow.
Photos & videos posted to this entry tomorrow.
Day Nine - Monday
November 29, 2010: Today started much the way it ended. Brandon continues to have lucid moments followed by long periods of incoherency. He does like to talk. I like to think he knows what he is saying. Even if he does I am not so sure his thoughts are relevant at this point. As the doctor says, he is still in a fog and it will take come time to come out of it.
When Brandon is lucid, his thoughts and comments are extremely relevant and they leave us with hope that he is still in there somewhere. It is nice to have most tubes gone and for him to be breathing on his own. He still works hard to breath and remains raspy. They placed him on humidified air overnight and he sounds a little better. His cough is also a little more productive than it was last night. He still has a lot to get out of his lungs.
With all the struggling we don't have to worry about Brandon, the staff, or mom and dad getting their exercise. He will be able to do his own exercise video by the time he is done. "Getting Ripped in a Gown" should become a best seller considering all the hospital patients out there.
We are constantly reminded that with all the improvements, he still has a long way to go. He will get his first physical therapy session today and they are wondering when the neuro rehab that was ordered on Saturday will be here. We are starting to plan for the long term rehabilitation that will be needed.
At first we worried about the hospital bills considering the level of care he has required and the limits of his automobile coverage. Fortunately Kassi had health insurance to help with her costs. Now we wonder how we will be able to transition to the long term care that is required along with Brandon and Kassi both being out of work for what will be a prolonged period.
The physical therapist is here to treatment and they are also here to do his swallow test. Hope he studied for both tests. More later.
When Brandon is lucid, his thoughts and comments are extremely relevant and they leave us with hope that he is still in there somewhere. It is nice to have most tubes gone and for him to be breathing on his own. He still works hard to breath and remains raspy. They placed him on humidified air overnight and he sounds a little better. His cough is also a little more productive than it was last night. He still has a lot to get out of his lungs.
With all the struggling we don't have to worry about Brandon, the staff, or mom and dad getting their exercise. He will be able to do his own exercise video by the time he is done. "Getting Ripped in a Gown" should become a best seller considering all the hospital patients out there.
We are constantly reminded that with all the improvements, he still has a long way to go. He will get his first physical therapy session today and they are wondering when the neuro rehab that was ordered on Saturday will be here. We are starting to plan for the long term rehabilitation that will be needed.
At first we worried about the hospital bills considering the level of care he has required and the limits of his automobile coverage. Fortunately Kassi had health insurance to help with her costs. Now we wonder how we will be able to transition to the long term care that is required along with Brandon and Kassi both being out of work for what will be a prolonged period.
The physical therapist is here to treatment and they are also here to do his swallow test. Hope he studied for both tests. More later.
Sunday, November 28, 2010
Day Eight - Sunday - Part Three
November 28, 2010: Early days, late nights are nothing compared to the day Brandon has experienced. He continues to improve overall with lucid periods mixed with confusion. He is being pretty good at obeying commands. He has spent most of today trying to remove the remaining tubes from his body.
His lucid moments are fairly promising. When Megan came to visit he asked what happened to her arm. He described seeing people when the accident happened. He asked about Kassi and Branson. When Kassi came to visit they spent several moments trying to decide who loves each other the most. These great advancements are offset by his trying to lick his mom's hand or his sister's forehead.
He has been off sedation all day. It has taken Haldol, Momrphine and constant attention to keep him in bed. His temp is normal, he has been able to keep his oxygen sats up on a nasal cannula, (even with significant stridor or wheezing on breathing out), his blood pressure and pulse remain great, and is left with a foley and PICC (IV) line in place. He is scheduled for a swallow test to see if the feeding tube can remain out and physical therapy. We are hoping he has a good nights sleep and that tomorrow will be as good as today.
When the nurse came on tonight he introduced himself to Brandon and told him he was here to take care of him. Brandon said, "You take care of me and I'll take care of you."
(I've added pictures and video to the following posts; Day Five - Thursday - Part Two, Day Six - Friday - Part Two, Day Seven - Saturday - Part Two. Don't tell Brandon, I don't want his to get mad at me because he is embarrassed.)
His lucid moments are fairly promising. When Megan came to visit he asked what happened to her arm. He described seeing people when the accident happened. He asked about Kassi and Branson. When Kassi came to visit they spent several moments trying to decide who loves each other the most. These great advancements are offset by his trying to lick his mom's hand or his sister's forehead.
He has been off sedation all day. It has taken Haldol, Momrphine and constant attention to keep him in bed. His temp is normal, he has been able to keep his oxygen sats up on a nasal cannula, (even with significant stridor or wheezing on breathing out), his blood pressure and pulse remain great, and is left with a foley and PICC (IV) line in place. He is scheduled for a swallow test to see if the feeding tube can remain out and physical therapy. We are hoping he has a good nights sleep and that tomorrow will be as good as today.
When the nurse came on tonight he introduced himself to Brandon and told him he was here to take care of him. Brandon said, "You take care of me and I'll take care of you."
(I've added pictures and video to the following posts; Day Five - Thursday - Part Two, Day Six - Friday - Part Two, Day Seven - Saturday - Part Two. Don't tell Brandon, I don't want his to get mad at me because he is embarrassed.)
Day Eight - Sunday - Part Two
November 28, 2010: Quite an active morning for a Sunday. Brandon no longer has a breathing tube. It was removed as part of the morning shift change. I was allowed into his room with the hopes I could help him remain off sedation and help protect the remaining tubes. The first thing Brandon said to me was, "Get the tubes out, NOW!"
Two more tubes were removed by the staff after rounds; the one going into his stomach and the one taking what goes in his stomach, out the other end. That had some calming effect on him, yet he still wanted the other tubes removed, the feeding and foley (urine) tubes. It has been a battle all morning trying to keep both of them in place. It is amazing what he is able to do with his feet and thrashing with his head.
The feeding tube was impossible to keep taped. It was re-taped multiple times only to fall off. He finally caught the feeding tube on the bed rail and pulled his head back, pulling the tube out. The foley has been a chore as he has used every means possible to try and remove it, including using his toes to try and remove the Velcro straps and then try and use them to grab tube. He still insists that he be allowed to get up. Things must be getting better as two of his favorite words have returned. If you need to know what they are, ask Branson.
They have tried to wean him off the continuous IV pain meds and go to regularly scheduled pain med administration. His temp is down to 37.2, his cough remains productive, and all muscles are present and accounted for as he strains in an attempt to get out of bed. I am amazed that his oxygen sats have remained at 99 with all the struggling and only on 5 liters of oxygen through a cannula. The next attempt is giving a little Haldol to help with the struggles.
He tries to convince everyone within ear shot to let him up. If he would remain calm and use more complete thoughts he would be closer to making it a possibility. Brandon has asked me to tell you something. It is his new favorite phrase, "I want out."
Two more tubes were removed by the staff after rounds; the one going into his stomach and the one taking what goes in his stomach, out the other end. That had some calming effect on him, yet he still wanted the other tubes removed, the feeding and foley (urine) tubes. It has been a battle all morning trying to keep both of them in place. It is amazing what he is able to do with his feet and thrashing with his head.
The feeding tube was impossible to keep taped. It was re-taped multiple times only to fall off. He finally caught the feeding tube on the bed rail and pulled his head back, pulling the tube out. The foley has been a chore as he has used every means possible to try and remove it, including using his toes to try and remove the Velcro straps and then try and use them to grab tube. He still insists that he be allowed to get up. Things must be getting better as two of his favorite words have returned. If you need to know what they are, ask Branson.
They have tried to wean him off the continuous IV pain meds and go to regularly scheduled pain med administration. His temp is down to 37.2, his cough remains productive, and all muscles are present and accounted for as he strains in an attempt to get out of bed. I am amazed that his oxygen sats have remained at 99 with all the struggling and only on 5 liters of oxygen through a cannula. The next attempt is giving a little Haldol to help with the struggles.
He tries to convince everyone within ear shot to let him up. If he would remain calm and use more complete thoughts he would be closer to making it a possibility. Brandon has asked me to tell you something. It is his new favorite phrase, "I want out."
Day Eight - Sunday
November 28, 2010: Finally, one long peaceful night. This is the first time that I have walked into Brandon's room first thing in the morning before shift change and he is in bed, tubes in place resting comfortably with sedation at a lower level. His feeding tube was replaced before we left last night around 10. He is still breathing on his own. All his vital signs are normal and holding steady and his fever appears to be managed by the meds. His breathing is markedly less raspy. I can no longer hear and feel the gurgling or popping (rales and rhonchi) by standing at his bedside and placing my hand on his chest. Deep suctioning was very productive last night and they were able to remove an impressive plug from his lungs.
They just finished drawing an arterial blood gas the old fashion way since Brandon lost his art line in one of his more active moments. His Propofol sedation was at 35. While drawing the ABG, Brandon opened his eyes and turned toward the blood draw and tried to sit up. He calmed right down when asked to do so and remained fairly calm while the sedation was increased slightly. I anxiously await this morning's vacation in hopes of a repeat of yesterday's performance. They begin the tube removals if he is able to provide a repeat. He continues to maintain his own respiratory support on CPAP, (pressure assisted ventilation).
We appreciate all the support and visitors at the hospital. With Brandon's increased awareness we have been asked to limit Brandon's bedside visitors to family. Others are welcome in the waiting room. If we are not there feel free to ask the receptionist to have a family member come to the waiting room to visit with you. Family members are reminded that some well timed stimulation is great, however, with everyone wanting to see him open his eyes, squeeze hands and do a number of other activities, you would think we are trying to train him to be a sideshow performer.
Kassi continues to heal while trying to spend time with Brandon. I am concerned she is doing more than she should. She stands, walks, travels to and from Salt Lake, and tries to heal all at once. She felt some very distinct pops in her left shoulder and she now sports a very prominent bump on her left collar bone.
When you see her and all she is doing, it is hard to believe she is doing it with broken ribs, collar bone, surgically repaired femur, and a lung that is healing. By the time she goes home it is amazing she has any strength left to get in and out of the car let alone into bed.
Megan continues to do well with her hand in a soft cast. She has an appointment with her doctor next week. I continue to be amazed at how she reacted when the accident happened. She must come by it naturally or get it from her dad. Without her and her efforts, there would have been a much different outcome. Her healing will take more than fixing broken bones as she relives a very terrifying experience and continues to ask the dreaded question, why?.
All of those involved are weeks ahead in their healing of where anyone expected them to be. This is a direct result of all your thoughts, prayers, and fasting in their behalf. We are hopeful that the roller coaster is finished with all its major downward spirals.
They just finished drawing an arterial blood gas the old fashion way since Brandon lost his art line in one of his more active moments. His Propofol sedation was at 35. While drawing the ABG, Brandon opened his eyes and turned toward the blood draw and tried to sit up. He calmed right down when asked to do so and remained fairly calm while the sedation was increased slightly. I anxiously await this morning's vacation in hopes of a repeat of yesterday's performance. They begin the tube removals if he is able to provide a repeat. He continues to maintain his own respiratory support on CPAP, (pressure assisted ventilation).
We appreciate all the support and visitors at the hospital. With Brandon's increased awareness we have been asked to limit Brandon's bedside visitors to family. Others are welcome in the waiting room. If we are not there feel free to ask the receptionist to have a family member come to the waiting room to visit with you. Family members are reminded that some well timed stimulation is great, however, with everyone wanting to see him open his eyes, squeeze hands and do a number of other activities, you would think we are trying to train him to be a sideshow performer.
Kassi continues to heal while trying to spend time with Brandon. I am concerned she is doing more than she should. She stands, walks, travels to and from Salt Lake, and tries to heal all at once. She felt some very distinct pops in her left shoulder and she now sports a very prominent bump on her left collar bone.
When you see her and all she is doing, it is hard to believe she is doing it with broken ribs, collar bone, surgically repaired femur, and a lung that is healing. By the time she goes home it is amazing she has any strength left to get in and out of the car let alone into bed.
Megan continues to do well with her hand in a soft cast. She has an appointment with her doctor next week. I continue to be amazed at how she reacted when the accident happened. She must come by it naturally or get it from her dad. Without her and her efforts, there would have been a much different outcome. Her healing will take more than fixing broken bones as she relives a very terrifying experience and continues to ask the dreaded question, why?.
All of those involved are weeks ahead in their healing of where anyone expected them to be. This is a direct result of all your thoughts, prayers, and fasting in their behalf. We are hopeful that the roller coaster is finished with all its major downward spirals.
Saturday, November 27, 2010
Day Seven - Saturday - Part Two
November 27, 2010: Last night was one long lonely night. Up and down, high then low. What a ride this is. The only guarantee we have is that the night eventually ends, and we are not in control.
Brandon's morning sedation vacation had little change. At rounds we discussed replacing the ET (breathing tube) with a tracheotomy and the feeding tube in his nose with a feeding tube in his abdomen. He had little motion and I am sure the resident physician was skeptical when I told him about yesterday's eye opening. Brandon also has strep in his lungs and they are changing his antibiotic to help in eliminating it. His breathing is quite raspy when he breathes in and out.
The Dr.s decided to let Brandon remain on vacation for a little longer to see if he would have any repeat of yesterday's unconfirmed eye opening. Twenty to thirty minutes later Brandon began moving. The doctor returned and asked Brandon to open his eyes. No response. He stimulated with a little pain. No response. He then asked Brandon to give his a thumbs up. Brandon raised his index finger. A bit surprised, the doctor repeated the request. Brandon again raised his finger. The resident drew every body's attention to Brandon's actions. He then responded to the request to open his eyes. The nurse asked him to smile. He did. He was asked if he was in any pain. He shook his head no. I called Kassi and told her to hurry to the hospital. He spent 20 or more minutes responding appropriately. He kept reaching for my hand and rubbing it with his fingers. He then pushed my hand back and then grabbed my finger and interlocked his with mine, rubbed my hand with his thumb and would not let go.
My favorite reaction came after Kassi arrived. She was holding his hand talking to him. She told him she had brought some hunting magazines as was going to read them to him. He laid there as a big grin spread across his face. He acted appropriately until he was placed back on the Propofol for sedation.
Needless to say, as the Propofol started taking effect, the resident commented, "Well based on this new response, I guess we will put the tracheotomy and feeding tube on hold at least until Monday."
The respiratory therapist came to his room a few hours later and changed the ventilator to pressure assist. Brandon did not have much reaction. Slowly he began taking deeper and deeper breaths. He is now breathing on his own at 40% oxygen and he is retaining his oxygen saturation at an acceptable level.
Bad night changes to GREAT day. We now anticipate his next vacation and pray for a repeat performance and antibiotics to successfully rid his lungs of infection. Thank all of you for asking Father to answer your prayers in Brandon's behalf. May he continue to do so.
(I am still trying to attach video and pictures from my phone if I can find a cable.)
Brandon's morning sedation vacation had little change. At rounds we discussed replacing the ET (breathing tube) with a tracheotomy and the feeding tube in his nose with a feeding tube in his abdomen. He had little motion and I am sure the resident physician was skeptical when I told him about yesterday's eye opening. Brandon also has strep in his lungs and they are changing his antibiotic to help in eliminating it. His breathing is quite raspy when he breathes in and out.
The Dr.s decided to let Brandon remain on vacation for a little longer to see if he would have any repeat of yesterday's unconfirmed eye opening. Twenty to thirty minutes later Brandon began moving. The doctor returned and asked Brandon to open his eyes. No response. He stimulated with a little pain. No response. He then asked Brandon to give his a thumbs up. Brandon raised his index finger. A bit surprised, the doctor repeated the request. Brandon again raised his finger. The resident drew every body's attention to Brandon's actions. He then responded to the request to open his eyes. The nurse asked him to smile. He did. He was asked if he was in any pain. He shook his head no. I called Kassi and told her to hurry to the hospital. He spent 20 or more minutes responding appropriately. He kept reaching for my hand and rubbing it with his fingers. He then pushed my hand back and then grabbed my finger and interlocked his with mine, rubbed my hand with his thumb and would not let go.
My favorite reaction came after Kassi arrived. She was holding his hand talking to him. She told him she had brought some hunting magazines as was going to read them to him. He laid there as a big grin spread across his face. He acted appropriately until he was placed back on the Propofol for sedation.
Needless to say, as the Propofol started taking effect, the resident commented, "Well based on this new response, I guess we will put the tracheotomy and feeding tube on hold at least until Monday."
The respiratory therapist came to his room a few hours later and changed the ventilator to pressure assist. Brandon did not have much reaction. Slowly he began taking deeper and deeper breaths. He is now breathing on his own at 40% oxygen and he is retaining his oxygen saturation at an acceptable level.
Bad night changes to GREAT day. We now anticipate his next vacation and pray for a repeat performance and antibiotics to successfully rid his lungs of infection. Thank all of you for asking Father to answer your prayers in Brandon's behalf. May he continue to do so.
(I am still trying to attach video and pictures from my phone if I can find a cable.)
Day Seven - Saturday
November 27, 2010: It's 12:13 AM and I just left Brandon's room. I had gone back to drop off and pick up some things. When Leanne and I left at 7:00 PM - shift change, Brandon was flaccid, on sedation and had been so for some time. Normally I return to the room at 8:30 once shift change is over. However, there were errands to be run and repairs to be done to the motor home and time is getting short when I will have to return to work to help offset the costs of our new financial challenge.
I finally returned just before midnight. I wanted to check on Brandon, drop off some things we had purchased for him and pick up his cd's to put them on a MP3 player in order to provide his room with continual music that he would choose.
When I entered the room I noticed a few changes. Brandon was no longer breathing by himself. He was back on the respirator. The feeding tube was gone and there was an additional blood tinged drain coming from his mouth. The nurse stated that he had extubated himself shortly after she came on and didn't think he had been sedated or given enough pain medication. After the unintentional extubation, they had left Brandon to breathe on his own to see what he could do. She stated he was unsuccessful at sustaining respiration and was place back on the respirator and sedation along with the addition of a Fentanyl (pain med) IV. She also stated that the feeding tube loss was not a significant event due to the fact that it was not in the correct location. Somewhat strange since he spent an hour having the feeding tube replaced and confirmed about eight hours earlier.
What is it about nighttime. I sit with my son for 10 hours of the day shift and normally at least four hours of the night shift and nothing drastic happens. At least nothing that cannot be controlled with reasonable effort. At night when I am out of the room, the staff tells me he beats them to a frazzle. This latest episode leaves us to wonder what insult has now been added to his injury.
It took less than four hours to go from elation and promise to devastation and despair. Welcome to the roller coaster ride. All of us diligently and at times not so patiently wait for Brandon to wake up, to acknowledge and hold his family in his arms, and fulfill his role as husband and father. We don't ask for much, do we?
Why do most of the good advances of the day have to end and suffer set backs with the setting of the sun?
I finally returned just before midnight. I wanted to check on Brandon, drop off some things we had purchased for him and pick up his cd's to put them on a MP3 player in order to provide his room with continual music that he would choose.
When I entered the room I noticed a few changes. Brandon was no longer breathing by himself. He was back on the respirator. The feeding tube was gone and there was an additional blood tinged drain coming from his mouth. The nurse stated that he had extubated himself shortly after she came on and didn't think he had been sedated or given enough pain medication. After the unintentional extubation, they had left Brandon to breathe on his own to see what he could do. She stated he was unsuccessful at sustaining respiration and was place back on the respirator and sedation along with the addition of a Fentanyl (pain med) IV. She also stated that the feeding tube loss was not a significant event due to the fact that it was not in the correct location. Somewhat strange since he spent an hour having the feeding tube replaced and confirmed about eight hours earlier.
What is it about nighttime. I sit with my son for 10 hours of the day shift and normally at least four hours of the night shift and nothing drastic happens. At least nothing that cannot be controlled with reasonable effort. At night when I am out of the room, the staff tells me he beats them to a frazzle. This latest episode leaves us to wonder what insult has now been added to his injury.
It took less than four hours to go from elation and promise to devastation and despair. Welcome to the roller coaster ride. All of us diligently and at times not so patiently wait for Brandon to wake up, to acknowledge and hold his family in his arms, and fulfill his role as husband and father. We don't ask for much, do we?
Why do most of the good advances of the day have to end and suffer set backs with the setting of the sun?
Friday, November 26, 2010
Day Six - Friday - Part Two
November 26, 2010: It has been a good day for Brandon today. Kassi came to visit. She is working through the pain and even though she is trying to heal herself, is here to help Brandon heal. Brandon was on his sedation vacation while she was here. It lasted for three hours this time. That is a new duration record for him. He had a fair amount of movement, mostly left sided, with a markedly decreased level of agitation over previous vacations.
The most exciting part came with several accomplishments. First; more eye openings. We stopped counting at 8. There were several more. Some lasting SECONDS. I thought Kassi would burst. It is fun to hear everyone cheer him on. It is amazing what seeing eyes will do for our spirits. On one of his attempts he opened his eyes, gazed at the person to his left, then turned his head toward them and looked at them. It is the first time he has appeared to have some sense of focus or recognition when he has opened his eyes.
The most exciting part came with several accomplishments. First; more eye openings. We stopped counting at 8. There were several more. Some lasting SECONDS. I thought Kassi would burst. It is fun to hear everyone cheer him on. It is amazing what seeing eyes will do for our spirits. On one of his attempts he opened his eyes, gazed at the person to his left, then turned his head toward them and looked at them. It is the first time he has appeared to have some sense of focus or recognition when he has opened his eyes.
Tomorrow he will have several tubes relocated. His breathing tube will be relocated to his trachea and the feeding tube will be relocated to his abdomen. Based on his teeth grinding against the ET tube and the second repositioning of the tube in two days, he will enjoy the tube replacements much more than where they are currently located. He is currently breathing on his own with pressure assist from the ventilator. He is able to keep his oxygen saturation in a clinical range while on less than 40% oxygen.
We continue to hope for some finger squeezing or toe wiggling. Each day is a new adventure. We hope that each day continues to be better while realizing that this journey is riding a roller coaster not climbing a mountain - good days mixed with not so good days.
Day Six - Friday
November 26, 2010: We are still waiting for morning rounds. We came in the room this morning for what is becoming all too familiar. Brandon was on Propofol was at 45 with active movement - straining against his restraints. The plan today remains much the same as before. Wean off sedation and ventilator by trying to find the magical combination of other meds to reduce the sedation.
His day was full of activity. He had his feeding tube replaced and his caloric requirement evaluated. We are now waiting for rounds and his sedation vacation. I am interested to see if he can repeat his eye opening of yesterday. His fever remains and lungs continue to clear.
Yesterday we had two small world experiences. Brandon's friend Chris and his wife Chelsey came to see Brandon. Chelsey told us how she was at work talking about what had happened to Brandon. One of her co-workers said that her grandparents had told her a story of stopping to help at their accident. We have also been spending many hours in the waiting room with another lady whose husband fell and hit his head on the ice last week. They are also dealing with prolonged head injury issues. Yesterday they had a visitor who turned out to be one of the individuals that stopped to help Brandon and Kassi after their accident. He was able to give a pretty descriptive account of what they saw and were able to accomplish. Their efforts are directly responsible for Kassi being here today. It made us realize just how fortunate we really are for everyone involved to be doing as well as they are.
We remain hopeful and grateful for all the expressions of concern and you prayers. Thank you to everyone for all they are doing.
His day was full of activity. He had his feeding tube replaced and his caloric requirement evaluated. We are now waiting for rounds and his sedation vacation. I am interested to see if he can repeat his eye opening of yesterday. His fever remains and lungs continue to clear.
Yesterday we had two small world experiences. Brandon's friend Chris and his wife Chelsey came to see Brandon. Chelsey told us how she was at work talking about what had happened to Brandon. One of her co-workers said that her grandparents had told her a story of stopping to help at their accident. We have also been spending many hours in the waiting room with another lady whose husband fell and hit his head on the ice last week. They are also dealing with prolonged head injury issues. Yesterday they had a visitor who turned out to be one of the individuals that stopped to help Brandon and Kassi after their accident. He was able to give a pretty descriptive account of what they saw and were able to accomplish. Their efforts are directly responsible for Kassi being here today. It made us realize just how fortunate we really are for everyone involved to be doing as well as they are.
We remain hopeful and grateful for all the expressions of concern and you prayers. Thank you to everyone for all they are doing.
Thursday, November 25, 2010
Day Five - Thursday Part Three
November 25, 2010: Brandon's activity continues to increase today. He became animated enough to require a return of higher doses of Propofol. Most of the day was spent keeping him calm. I may be looking for things that are not there, however, his activity seemed to be much more purposeful. He reaches for his tubes with increased accuracy and defined purpose. Rather than flail hands and arms to try and get out of the restraints he is reaching for the tie downs, grabbing hands, and when he moves my hands in the direction he wants to go and when I do not let him loose, he has started to dig his fingernails into my hand as if to say, "If you don't let me out of this I will hurt you!" My hands still have the marks to back up his actions. Small changes, potentially big steps.
Brandon's fever continues to decrease. His chest x-ray looks much better with the right side markedly improved and the left side getting better. The by product of suctioning his lungs looks much better. They are still playing Jr. Chemist with Brandon trying to find the right combination of pain meds and anti-psychotics in an effort to decrease his sedation.
Kassi, Brandson, and Megan, the other three participants in the accident arrived today along with family members. I'm not sure the hospital was as prepared for the support as they thought they were. Some big steps toward healing for the family members who were stuck miles away trying to heal themselves.
Brandon's fever continues to decrease. His chest x-ray looks much better with the right side markedly improved and the left side getting better. The by product of suctioning his lungs looks much better. They are still playing Jr. Chemist with Brandon trying to find the right combination of pain meds and anti-psychotics in an effort to decrease his sedation.
Kassi, Brandson, and Megan, the other three participants in the accident arrived today along with family members. I'm not sure the hospital was as prepared for the support as they thought they were. Some big steps toward healing for the family members who were stuck miles away trying to heal themselves.
Day Five - Thursday Part Two
He seems to be a little harder to console. I Hoped it was because of heightened awareness. His agitation continued to increase. When the nurse came in to turn the Propofol back on she asked if he would open his eyes for me. I told her no. I tried once again. My heart stopped. He opened BOTH EYES. Praying it was not a coincidence, I asked him twice more. Three times he opened both eyes. A father could not be any prouder of his son. More later.
Day Five - Thanksgiving Thursday
November 25, 2010: Another long restless night. I am not sure what it is about nighttime. When I left his room at about 11:00 last night he had been on 10 mcg/kg/min of Propofol for over 7 hours with only one small episode of activity calmed with touching and talking to him. By this morning he was back on six times the Propofol with a chest restraint.
When I walked into the room he was still fairly active. Like any of us, he wants to remove tubes from all the places they are not meant to be. All it takes is being able to show is he can protect his airway by following basic instructions. Still no hand squeezing, no eye opening, no toe wiggling. Lots of coughing, straining to get free of the restraints and remove the tubes.
On the plus side, his fever is still slowly getting lower. His right lung is sounding better and the suctioning of his lungs remains quite productive. Each small step gets us just that much closer to getting Brandon back.
When I walked into the room he was still fairly active. Like any of us, he wants to remove tubes from all the places they are not meant to be. All it takes is being able to show is he can protect his airway by following basic instructions. Still no hand squeezing, no eye opening, no toe wiggling. Lots of coughing, straining to get free of the restraints and remove the tubes.
On the plus side, his fever is still slowly getting lower. His right lung is sounding better and the suctioning of his lungs remains quite productive. Each small step gets us just that much closer to getting Brandon back.
Wednesday, November 24, 2010
Day Four - Wednesday - Part Three
November 24, 2010: Today has been a good day in several respects. First, Brandon's anesthesia Propofol, has remained at 10 mcg/kg/min since 1:00 this afternoon. The balance of pain meds and decreased Propofol seems to be working. He reached and stretched for awhile when the ET tube was re-secured. We held his hands, talked with him, and allowed him to rest his head on my arm until he calmed down WITHOUT the addition of more meds. A great step in the right direction.
Second, the antibiotic also appears to be working. His fever continues to slowly decrease, the suctioning of his lungs far more productive, and the oxygen level on the respirator decreased by almost one-third.
Third, on his morning rounds sedation vacation the isolated the pain at three locations. When the doctor stimulated by his eyebrow, Brandon squinted and rather than move his hand toward his eyebrow, his hand found the doctors arm and grabbed his hand. If that is not a purposeful movement it is one great coincidence.
Forth, despite listening to old country music all day today, he still seemed to have some small improvements; lower Propofol, lower pulse, lower blood pressure, and lower temperature than this morning.
We continue to receive great care from all the staff. The minor actions we have struggled with are at an amazingly low level for a facility with the volume and autonomy they possess. We remain more and more hopeful each day. While it is hard to wait, the wait is worth it.
Second, the antibiotic also appears to be working. His fever continues to slowly decrease, the suctioning of his lungs far more productive, and the oxygen level on the respirator decreased by almost one-third.
Third, on his morning rounds sedation vacation the isolated the pain at three locations. When the doctor stimulated by his eyebrow, Brandon squinted and rather than move his hand toward his eyebrow, his hand found the doctors arm and grabbed his hand. If that is not a purposeful movement it is one great coincidence.
Forth, despite listening to old country music all day today, he still seemed to have some small improvements; lower Propofol, lower pulse, lower blood pressure, and lower temperature than this morning.
We continue to receive great care from all the staff. The minor actions we have struggled with are at an amazingly low level for a facility with the volume and autonomy they possess. We remain more and more hopeful each day. While it is hard to wait, the wait is worth it.
Day Four - Wednesday - Part Two
November 24, 2010: KASSI gets discharged TODAY! She is so anxious to see Brandon that she pushed through it all and climbed up and down six stairs, used crutches, took a shower and was able to eat some of that great hospital food and better yet, she was able to keep it in her stomach. She is counting the hours until she gets to be with Brandon.
For those of you who say, "What's the big deal?" "Six stairs, crutches, hospital food, I can do that." Remember she is doing it a day after surgery with a brand new 18" metal rod, associated hardware, remnants of a pneumothorax, two broken ribs and a newly discovered broken collar bone.
Her plan is to go home, gather some photos, family reminders, some favorite music, clothes, eat an early Thanksgiving dinner, pray for dry roads and head to SLC Thursday afternoon. I don't know if is so much that she is more eager to get there to see Brandon or eat another Thanksgiving Dinner. Pete's son Tony has kindly agreed to smoke a turkey for us. There is no telling what some people will do for a smoked turkey. (With all the support and love, everyday for the last three days has been Thanksgiving day.)
It appears that the transport team had it right. Brad, one of the team members is also a PA at Shock Trauma, read the films in Cedar and felt Brandon had aspirated. Based on the fever and today's chest x-ray, Brad had it right, aspiration, not contusions. I will avoid the description, out of respect for the holiday cooks, of the fluid they are taking from Brandon's lungs. The antibiotics were started this morning. Hopefully their battle with the bugs will be short lived.
We are currently weaning him off the sedation. He has not shown any signs of cranial pressure. So they are lowering the Propofol slowly while increasing the pain meds. I have volunteered to monitor him for tube security in an effort to increase the duration of his sedation vacation. I am hoping we can keep him off the sedation for several hours. He could use the break from the med and we can use the exercise.
His nurse is a very compassionate total care giver. That may stem from her history of being a paramedic before becoming a nurse. You all know how compassionate those paramedics can be. Speaking of which, I was on my phone this morning outside the unit. The doors opened and Josh Forsythe walked out in his scrubs looking for another patients family. Josh is one of those great Provo Fire paramedics who became a nurse and now works for IMC and Provo. I received more compliments on his patient relationship skills than any other employee I have had the privilege to supervise. It's not unusual to receive a card, letter or email expressing general thanks for a fire crew. One thing that made my experience with the comments about Josh unique is they were not done by a card, letter, or email, they were either by phone or in person. It was not unusual to have someone find out I was the Provo Fire Deputy Chief and start telling how much they appreciated Josh and his compassion.
I need to take a few moments to share my philosophy on medical treatment. In one of my posts I talked about a caregiver who gives Brandon high levels of sedation when he moves and are a little more abrupt focusing on using the skills of nursing rather than applying nursing skill. Medicine is an art which uses science. There are standards of care, not one absolute, scientifically proven method. Just as with photography which combines art with chemistry, there are countless individuals who can take and develop wonderful pictures, few can produce a masterpiece.
Because medicine is an art, there is room for choice of method and interpretation of predicted outcomes. The nurse we had the first night was exceptional and set the tone for our stay. All of them are skillful at the art of nursing. I need to keep better track and write down his caregivers names, my memory is not what it used to be. They are all worth remembering. All the nurses here have great nursing skills. The way they apply those skills creates the art of nursing or the masterpiece. Some choose one path, others a different path. Just because someone prefers blonds, doesn't diminish the value of the Mona Lisa. Most artists can paint well, few are masters. IMC Shock Trauma has many, many masters. That's what makes them good at what they do. And that is why when given a choice of flying North or South of Cedar, North was the ONLY choice. While I may have preferred Mona Lisa as a blond, she is still quite the masterpiece as a brunette.
I really have grown to appreciate those who are masters. Their focus and approach makes a world of difference.
For those of you who say, "What's the big deal?" "Six stairs, crutches, hospital food, I can do that." Remember she is doing it a day after surgery with a brand new 18" metal rod, associated hardware, remnants of a pneumothorax, two broken ribs and a newly discovered broken collar bone.
Her plan is to go home, gather some photos, family reminders, some favorite music, clothes, eat an early Thanksgiving dinner, pray for dry roads and head to SLC Thursday afternoon. I don't know if is so much that she is more eager to get there to see Brandon or eat another Thanksgiving Dinner. Pete's son Tony has kindly agreed to smoke a turkey for us. There is no telling what some people will do for a smoked turkey. (With all the support and love, everyday for the last three days has been Thanksgiving day.)
It appears that the transport team had it right. Brad, one of the team members is also a PA at Shock Trauma, read the films in Cedar and felt Brandon had aspirated. Based on the fever and today's chest x-ray, Brad had it right, aspiration, not contusions. I will avoid the description, out of respect for the holiday cooks, of the fluid they are taking from Brandon's lungs. The antibiotics were started this morning. Hopefully their battle with the bugs will be short lived.
We are currently weaning him off the sedation. He has not shown any signs of cranial pressure. So they are lowering the Propofol slowly while increasing the pain meds. I have volunteered to monitor him for tube security in an effort to increase the duration of his sedation vacation. I am hoping we can keep him off the sedation for several hours. He could use the break from the med and we can use the exercise.
His nurse is a very compassionate total care giver. That may stem from her history of being a paramedic before becoming a nurse. You all know how compassionate those paramedics can be. Speaking of which, I was on my phone this morning outside the unit. The doors opened and Josh Forsythe walked out in his scrubs looking for another patients family. Josh is one of those great Provo Fire paramedics who became a nurse and now works for IMC and Provo. I received more compliments on his patient relationship skills than any other employee I have had the privilege to supervise. It's not unusual to receive a card, letter or email expressing general thanks for a fire crew. One thing that made my experience with the comments about Josh unique is they were not done by a card, letter, or email, they were either by phone or in person. It was not unusual to have someone find out I was the Provo Fire Deputy Chief and start telling how much they appreciated Josh and his compassion.
I need to take a few moments to share my philosophy on medical treatment. In one of my posts I talked about a caregiver who gives Brandon high levels of sedation when he moves and are a little more abrupt focusing on using the skills of nursing rather than applying nursing skill. Medicine is an art which uses science. There are standards of care, not one absolute, scientifically proven method. Just as with photography which combines art with chemistry, there are countless individuals who can take and develop wonderful pictures, few can produce a masterpiece.
Because medicine is an art, there is room for choice of method and interpretation of predicted outcomes. The nurse we had the first night was exceptional and set the tone for our stay. All of them are skillful at the art of nursing. I need to keep better track and write down his caregivers names, my memory is not what it used to be. They are all worth remembering. All the nurses here have great nursing skills. The way they apply those skills creates the art of nursing or the masterpiece. Some choose one path, others a different path. Just because someone prefers blonds, doesn't diminish the value of the Mona Lisa. Most artists can paint well, few are masters. IMC Shock Trauma has many, many masters. That's what makes them good at what they do. And that is why when given a choice of flying North or South of Cedar, North was the ONLY choice. While I may have preferred Mona Lisa as a blond, she is still quite the masterpiece as a brunette.
I really have grown to appreciate those who are masters. Their focus and approach makes a world of difference.
Day Four - Wednesday
November 24, 2010: It was a busy evening in the unit with the addition of more patients. Brandon's room showed signs of an active night when I went in this morning. They placed a feeding tube yesterday. Of course what goes in, must come out. When I told his nighttime nurse that his agitation episode late last evening was triggered by soiling his bed, she gave me that, "right - he's just combative - you're dreaming" look. This morning I think she is a believer. The linen bin and the garbage receptacles were overflowing, glove boxes empty, the bed looking the remnants of a war zone, Brandon all sideways in bed, collection bags bulging, another tube inserted to assist with removal of the processed nutrition, and as is her preference, the Propofol level high to keep him completely flaccid.
It may seem a simple thing, but it is the simple things that keep us hopefully optimistic. If he can have this level of recognition and appropriate response (trying to get out of bed and reaching for the soiled area) with Propofol at 40-50 mcg/kg/min, it gives you hope that he may be even more appropriate when they wean him off the anesthesia. We hold on to one of life's most ignored natural truths, there's always hope.
The fever continues and he is beginning to have additional physical changes that are the expected result of a continuing coma. That is why I continue to pray for staff that are willing to treat the entire patient over treating lab results and beeping monitors. We have had exceptional care from very conscientious practitioners. I just wish all of them would carefully consider their actions on the overall outcome for my son. The physicians are hoping to successfully remove the anesthesia and properly manage the pain with meds in an effort to allow Brandon to eliminate the need for the ventilator and start giving us a more accurate neuro evaluation. Until then we continue to expect the best and rejoice at all the small positive changes.
We are all eagerly awaiting word on Kassi and her highly anticipated discharge from Valley View. I sit here looking over I-15 in Murray and I am reminded why I love Southern Utah. The drivers are hoping for 15 miles per hour and a vehicle should not try doing a 360 on a packed Interstate. The storm continues to move south and we are hoping Kassi's discharge will allow for her trip to be with Brandon will be in time to allow her to travel on on dry roads before another storm decides to move in.
It may seem a simple thing, but it is the simple things that keep us hopefully optimistic. If he can have this level of recognition and appropriate response (trying to get out of bed and reaching for the soiled area) with Propofol at 40-50 mcg/kg/min, it gives you hope that he may be even more appropriate when they wean him off the anesthesia. We hold on to one of life's most ignored natural truths, there's always hope.
The fever continues and he is beginning to have additional physical changes that are the expected result of a continuing coma. That is why I continue to pray for staff that are willing to treat the entire patient over treating lab results and beeping monitors. We have had exceptional care from very conscientious practitioners. I just wish all of them would carefully consider their actions on the overall outcome for my son. The physicians are hoping to successfully remove the anesthesia and properly manage the pain with meds in an effort to allow Brandon to eliminate the need for the ventilator and start giving us a more accurate neuro evaluation. Until then we continue to expect the best and rejoice at all the small positive changes.
We are all eagerly awaiting word on Kassi and her highly anticipated discharge from Valley View. I sit here looking over I-15 in Murray and I am reminded why I love Southern Utah. The drivers are hoping for 15 miles per hour and a vehicle should not try doing a 360 on a packed Interstate. The storm continues to move south and we are hoping Kassi's discharge will allow for her trip to be with Brandon will be in time to allow her to travel on on dry roads before another storm decides to move in.
Tuesday, November 23, 2010
Day Three, Tuesday - Part Three
November 23, 2010:Kassi continues to be hopeful she will be released from the hospital tomorrow. If the doctors allow, the plan is to take her to IHC to see Brandon. We hope to take her there in the motor home. It should give her a more comfortable ride and also provide a place to call home for the next several weeks. IMC has electrical hook-ups for RVs and several have taken advantage of it. It would be nice to have something close and private. It won't take much to beat sleeping in a chair in the waiting room.
Brandon continues with his little accomplishments. The doctor this evening expressed his concerns and optimism at Brandon's condition. He feels Brandon is further along than should be expected and he is progressing at a fairly steep rate for his head injury. We were also visited by the trauma PA who was also a member of the flight team who cared for Brandon in flight. He was also optimistic at Brandon's prognosis. He feels Brandon's fever is most likely a result from aspiration. While it raises concern for pneumonia, it beats several of the alternatives. His white count is up slightly and the initial blood cultures are negative.
His movements would appear to be either extremely coincidental or they are getting more and more purposeful. They are getting more consistent in action and association. This evening he had one of what appears to be a triggering event and he kept trying to get out of bed as any of us would. He has had this same event three times today and his actions were exactly the same each time. They have been trying all day to limit his anesthesia. Tonight's care giver steeply increased his Propofol with one of these events rather than give a small bolus and keep the maintenance dose the same. It is interesting that last night she ended up raising his dose to 60, while others are consistently able to keep it around 20-30.
It gives you a deeper appreciation for the difference of those who do their jobs at an exceptional level and those who are exceptional at delivering excellent patient care. The trauma PA keeps reminding her the goal is to decrease and wean, not continue to increase dosages.
Brandon continues to over breathe the respirator. He does a great job with the lower dosages of anesthesia and even over breathes at the higher dosages. If he continues to improve at his current rate and they will continue to focus on reducing the anesthesia, I am hopeful for an intended extubation by the weekend.
His movements would appear to be either extremely coincidental or they are getting more and more purposeful. They are getting more consistent in action and association. This evening he had one of what appears to be a triggering event and he kept trying to get out of bed as any of us would. He has had this same event three times today and his actions were exactly the same each time. They have been trying all day to limit his anesthesia. Tonight's care giver steeply increased his Propofol with one of these events rather than give a small bolus and keep the maintenance dose the same. It is interesting that last night she ended up raising his dose to 60, while others are consistently able to keep it around 20-30.
It gives you a deeper appreciation for the difference of those who do their jobs at an exceptional level and those who are exceptional at delivering excellent patient care. The trauma PA keeps reminding her the goal is to decrease and wean, not continue to increase dosages.
Brandon continues to over breathe the respirator. He does a great job with the lower dosages of anesthesia and even over breathes at the higher dosages. If he continues to improve at his current rate and they will continue to focus on reducing the anesthesia, I am hopeful for an intended extubation by the weekend.
Day Three, Tuesday - Part Two
Kassi continues to long for Brandon. It is hard for her to be in Cedar City with Brandon in Salt Lake. I believe she used the term, "This sucks." She is trying her best to get ready for the trip to Salk Lake just as soon as the doctor says she is ready. Friends and relatives continue to pour in with offers of housing, food, vehicles, babysitting, and anything else you can imagine. Travelling long hard roads are made easier when supported by such great people. She expresses her love for all of you.
Brandon continues as he has been, heavily sedated with a few minor daily victories. He had several accomplishments on one of his sedation vacations. He opened his left eye, squinted heavily when both eyelids were opened by the PA, and brushed his hand across his forehead. Today's goal is to wean him off the anesthesia and the ventilator while increasing the meds to better control his pain. He has been doing a good job at taking many of his own breaths. His brothers and sisters continue to dote over him. He is getting regular massages to exercise his muscles and tons of expressions of love. I just hope they don't rub all his skin off with all the attention he is getting.
Last night's marathon MRI session confirmed our greatest concern. Brandon has signs of diffuse axonal trauma in his brain. The wait and see game stretches even longer. We continue to hope and pray that the injury will be limited to stretching or swelling rather than disruption or sheering of the axons. He is getting the best of care and we are planning a family fast starting tonight to ask for the extra help Brandon and his family need at this time.
Brandon, Kassi and their families express their appreciation for all the love, support, and prayers everyone continues to offer in their behalf.
Day Three, Tuesday
November 23, 2010: Shift change at IMC. We spent a few minutes with Brandon before shift change. The fever has returned. The Propofol at 55 mcg was raised to 60 overnight. It's hard to see the levels jump all over. You pause and wonder if the staff wants to make their job easier by keeping him as low as he can go. The answer came when we said goodbye for the morning change and rounds. Brandon became very active. Fighting through 60 mcg when most of us would be lying there flaccid without a care in the world. One tough fighter.
We anxiously await word on Kassi this morning and the findings of the all night MRI. More later after rounds.
We anxiously await word on Kassi this morning and the findings of the all night MRI. More later after rounds.
Day Two, Monday - Part Two
Monday, November 22, 2010; Brandon was scheduled for an MRI and potentially an ICP monitor earlier today. An afternoon sedation vacation showed promise and the procedures were cancelled. This evening one of Brandon's relapses made completing the MRI a better decision.
The procedure scheduled for 19:30 and they anticipated that he would be in his room by 20:30. We went to the STICU at 20:30 and were told it would be 22:30 before he would return.
22:30: Brandon is not in his room. The anonymous voice on the intercom told us they have added additional tests and it would be at least another hour to hour and a half to complete. She stated she did not know what the tests were or how long they would take nor any information on Brandon's condition.
23:30: Intercom rang for five minutes without an answer. Team members would look at me through the windows in the door, you could hear ringing in the unit all without an answer. A women from housekeeping came to the STICU and we asked if she would ask someone from inside the unit to come talk to us. A team member finally came to the door, we asked her if we could see Brandon. She went into the unit, spent a few minutes then returned telling us he was "downstairs" getting some tests.
We asked for an update informing her we have not had any communication since 19:00. She stated that she had no further information and did not know how long Brandon would be getting the undefined tests. We politely asked her if someone would come get us as soon as he returned. She assured us she would.
Another team member, from housekeeping, who overheard our conversation with the nursing staff came to the waiting room just before midnight. She asked who we were waiting for. We expressed our frustration at having been without any information since 19:00. She left the room. Went down the elevator and within four minutes, we were provided with the first information in over 5 hours. The housekeeper told us he was doing fine and that the tests they were doing would take about three hours. We thanked Heavenly Father for a good housekeeper.
We appreciate the importance of the care and attention being given Brandon, however, you have to wonder if withholding information is a ploy to get dad admitted to the cardiac ICU and Aimee, Brad, and Eric admitted to the psych ward. Every institution is looking at maximizing profits in troubled times.
00:43 The nursing supervisor came to the waiting room and told us Brandon was just now being brought back to his room. He was in MRI this entire time and everything was fine. The MRI and MRI-A all take time. We told her we didn't want to interfere with getting him settled, it was nice to have some information about his condition and the tests.
01:03 We were finally were able to see Brandon in his room. The MRI wresults come tomorrow. He is paralized by meds and has his highest level of Propofol flowing to date - 55 mcg/kg/min.
The procedure scheduled for 19:30 and they anticipated that he would be in his room by 20:30. We went to the STICU at 20:30 and were told it would be 22:30 before he would return.
22:30: Brandon is not in his room. The anonymous voice on the intercom told us they have added additional tests and it would be at least another hour to hour and a half to complete. She stated she did not know what the tests were or how long they would take nor any information on Brandon's condition.
23:30: Intercom rang for five minutes without an answer. Team members would look at me through the windows in the door, you could hear ringing in the unit all without an answer. A women from housekeeping came to the STICU and we asked if she would ask someone from inside the unit to come talk to us. A team member finally came to the door, we asked her if we could see Brandon. She went into the unit, spent a few minutes then returned telling us he was "downstairs" getting some tests.
We asked for an update informing her we have not had any communication since 19:00. She stated that she had no further information and did not know how long Brandon would be getting the undefined tests. We politely asked her if someone would come get us as soon as he returned. She assured us she would.
Another team member, from housekeeping, who overheard our conversation with the nursing staff came to the waiting room just before midnight. She asked who we were waiting for. We expressed our frustration at having been without any information since 19:00. She left the room. Went down the elevator and within four minutes, we were provided with the first information in over 5 hours. The housekeeper told us he was doing fine and that the tests they were doing would take about three hours. We thanked Heavenly Father for a good housekeeper.
We appreciate the importance of the care and attention being given Brandon, however, you have to wonder if withholding information is a ploy to get dad admitted to the cardiac ICU and Aimee, Brad, and Eric admitted to the psych ward. Every institution is looking at maximizing profits in troubled times.
00:43 The nursing supervisor came to the waiting room and told us Brandon was just now being brought back to his room. He was in MRI this entire time and everything was fine. The MRI and MRI-A all take time. We told her we didn't want to interfere with getting him settled, it was nice to have some information about his condition and the tests.
01:03 We were finally were able to see Brandon in his room. The MRI wresults come tomorrow. He is paralized by meds and has his highest level of Propofol flowing to date - 55 mcg/kg/min.
Monday, November 22, 2010
Day Two, Monday
Monday, November 22, 2010; A long day. The hardest part is having your heart go out to two seriously injured family members separated by 245 miles.
Kassi stayed in Cedar City where she underwent surgery for a broken femur. She now sports some fancy new hardware. The surgeon had hoped to use a block for the surgery to minimize the impact on the pneumothorax. Unfortunately the pre-op blood work would not allow it. She had an open reduction internal fixation of the femur. She seems to have tolerated the surgery well and is eager to be with Brandon. Today also brought mom and daughter together. Thanks to family members, Kim arrived in Cedar City and was able to be with Kassi when she got out of surgery. Chad and Becky have been kind enough to open their home in Cedar,provide cell phones and endless support. Family and friends continue to check on Kassi. Cedar City has learned what it means to have a Kuhlmann - Carlson held captive by their medical condition. The love and support continues to pour in from throughout the state with friends and family north and south offering homes, vehicles and any other support they can offer.
Kassi's interaction with the billing clerk in Cedar City was far from professional. Fresh out of surgery, the clerk noticed this was an auto accident and DEMANDED the vehicle insurance information - NOW! Kassi was in tears. Leanne had to crawl through the car to find what information she could and has been working with the company to verify the policy was active and coverages. Kassi had no idea who held the policy, and as we all know, contrary to our wishes, Brandon the one with all the information is not talking.
Branson has been spoiled by his family in Cedar. He was excited to see his Grandma Kim and now has both Grandmas wrapped around his little finger. He seems to have tolerated his wild ride quite well.
Megan is waiting her appointment with the orthopedic surgeon to find out the final outcome on her injuries. She is concerned about Kassi and Brandon and wants to be with Brandon. She has a new appreciation for seat belts and properly used pain meds.
Brandon continues to provide all of us with his own version of wait and see. His Life Flight ride was exciting. It was a slow start as he waited to get out of Cedar City due to a cold front and limited deicing capabilities at the airport. The flight was uneventful other than a few brief moments of turbulence.
He was met by the trauma team, had repeat CT scans, sedated more and placed under the care of the very competent staff in the Shock Trauma ICU. This roller coaster ride is one of the toughest around.
He was admitted with a coma score of 5. He has shown some minor improvements, followed by slight relapse. He is able to localize pain, but is unable to speak or open his eyes. The staff continues to play junior chemist in an attempt to find the right mix of meds to keep kidney's functioning, ICP (cranial pressures) low, and Brandon non-combative.
He is given several sedation vacations throughout the day, with much of the same results; localizes pain, does not follow commands, does not open eyes. Both dads are very attentive to his every need and wait for ANY sign of change.
The STICU staff are also learning what happens when a Kuhlmann - Carlson is being held captive by their medical condition. There continues to be Standing Room Only as friends and family gather around. Several learned that the floor of the waiting room is not an overly comfortable place to make a bed. No one will budge even though Kelsy literally lives at the end of the parking lot and you can see her apartment from Brandon's room.
We are hopeful that Kassi's condition and the weather will allow her to be with Brandon as soon as she is able. Gathering all the family members to one location will help many aspects of everyone's healing process. Brandon, Kassi and the rest of the family continue to appreciate ALL your thoughts and prayers in their family's behalf. With the best care in the world being provided, our job is to continue to ask for the help and miracles needed when our earthly efforts fall short.
Day One, Sunday afternoon
November 21, 2010: Brandon, Kassi, Branson and Megan were travelling to Hurricane from Pleasant Grove Utah. Brandon wanted to beat the predicted storm and was anxious to get there safely with his family. There had been several accidents on I-15 that morning from Iron to Washington County. They made it South of Cedar to mile marker 44 when for a yet to be determined reason the vehicle rolled several times.
Unfortunately, Brandon was ejected from the vehicle. Kassi was partially ejected with the vehicle landing on top of her. All except Megan's arm remained in the vehicle. Branson remained in his car seat for the most exciting ride of his life.
Branson was determined to be uninjured and was released from the Cedar City ER to grandma.
Megan was examined, placed in a soft cast, referred to an orthopedic surgeon for fractures to the hand and wrist.
Megan got out of the vehicle after it came to a stop and tried her best to call 911 and to lift the vehicle off Kassi. With the help of two bystanders and using her entire 120 pounds, they were able to lift the vehicle enough to pull Kassi out from under the vehicle. Kassi went unconscious for a brief period and then become slightly combative followed by repetitive questioning. Her exam showed broken ribs, a pneumothorax, a fractured femur, and multiple soft tissue injuries. She was admitted to Valley View Hospital for her injuries with surgery scheduled for tomorrow.
Brandon was extremely combative at the scene. The hospital did a rapid sequence intubation to secure his airway and performed a number of tests. He was determined to have a brain injury, bilateral contusions to his lungs, a bilateral fractures to his sacrum, and multiple soft tissue injuries. He was sedated and flown by LifeFlight to the Shock Trauma ICU at Intermountain Medical Center in Salt Lake City.
We appreciate all the concern and prayers in their behalf. They are receiving the best care possible and all we have left to give is our prayers.
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