Saturday, March 7, 2009

It's about time

Dad is out of the hospital, and out of that blasted gown that prohibits any kind of modesty. I understand that your health is priority one, but I really wonder how much of that recovery is inhibited when they strip away your pride and self-respect.

Mom went shopping yesterday and Dad landed some fancy new "comfy" clothes. I offered up my sweatpants, but we both realized that they would be woefully too short. And that's still a little irritating. Aren't you supposed to grow taller than your father? I surrendered that fantasy some time ago, and settled on reaching 6'0". At my peak (yes, I seem to be shrinking) I reached 5' 11 3/4". I believe that our creator has a sense of humor.

Back to Dad. I don't think it was really that clear to me until today, but the hospital really does force a sense of surrender. My youngest and I had taken to dropping in on him around 7:30. This was on the way to her school, so we could both visit Dad at the hospital, and still get her dropped off before the first bell. It just so happens that this seems to be around the time of shift change, so there is a flurry of activity.

But it was this one nursing assistant that really stuck with me. Determinedly focused on completing her duties, her patient, and his wishes or preferences were really a distant second thought. Her attempt to check his blood sugar accurately was hampered by her constant fumbling with the equipment and struggles to follow the precise steps of the morning routine. Dad complied with every request, and although she did talk to him, I noticed she never made eye contact. It was the cotton ball, dangling from his recently pricked finger after she finished and walked away, that I can't get out of my mind.

It was kind of like static. You've opened a present, or container and a piece of the plastic covering sticks to your hand. So you reach over with the other hand, and you successfully achieve it's release, only to find that it's now stuck to the other hand. This goes on for a little bit, while you look like some silly dog chasing it's tail. Dad's attempts to remove the cotton ball, stuck to his finger, by using only the fingers of that same hand. I can't take it very long before I reach over and help him with it.

...

I would encourage anyone that wants to visit him to feel comfortable doing so. I think he needs all of the positive energy that we can send his way. His schedule for the weekdays are rather full, between all of his therapy sessions and a few naps in between. Weekends are better, but he may be whisked away at any moment for more rehab. If you do want to stop by, his rehab is normally complete by 4:00 in the afternoon. I don't know how long it will take him to get into any kind of routine, but I'd assume that he'll be fairly sleepy by sometime in the evening.

We saw his room at the rehab center early this afternoon. His window is huge, and actually has a view that extends beyond the roof of an adjacent building. The room is spacious and feels much warmer and intended for comfort. Even on the way in, it felt good. We were greeted by smiling faces and warm greetings. This really does feel like a place for healing.

He was asleep when we arrived, and his right arm had fallen down between the mattress and the side rail. The process of releasing his arm from it's captive state woke him up. He immediately made me laugh. When I suggested that we slide him over so his arm didn't once again fall into the crevice, he sort of shrugged and indicated a general state of indifference on the whole issue.

He brightened up when he saw his grandaughters and tried diligently to talk to them. For the first time, I understood a few of the words. The words weren't an immediate response to a question, but the beginning of a sentence that was thought through. Words like "I" or "Well". Simple, but certainly something good to hear after the last two weeks of silence and frustration.

Unfortunately, our visit was cut short by the physical therapists. Okay, it's unfortunate that it was cut short, but I have no complaints. The fact that he's getting rehabilitation is wonderful, and the therapists were warm, kind and gentle with him. They made eye contact, and showed him the respect that he's earned through a lifetime of accomplishment and caring for those around him.

Thursday, March 5, 2009

The fog is lifting

While this might have been an appropriate title for yesterday, I feel more comfortable using it today. I've talked about moments of clarity overshadowed by hours of confusion in previous posts. Keeping in mind that he still sleeps most of the time. But we were getting glimpses here and there that he was still in there, just not able to get through to us.

Within the last 48 to 72 hours, I believe that he's finally broken through that fog of confusion and is able to more fully understand what is happening. Within the last 24 hours, his attempts to speak have seemed much more purpose driven. I still can't understand what he's saying, but it's much less of what we took to calling the "charlie brown speech" and more variety in the tone and variety of sound.

Charlie brown speech? During almost any of those old Charlie Brown "made for TV" animated shorts, somebody would end up on the phone with an adult. While we could hear Charlie, or Lucy or whoever it was on our end, all we heard from the other was "mwaaa mwa mwa mwaaaa." That's the best I can do to explain what he has sounded like prior to the last day or so.

Progress. Baby steps.

His emotions are also more in keeping with what you'd expect. Sadness, frustration and a determination to communicate on the level that he wants. That last part is good to see. Just one more reminder that he's still here and still fighting to regain himself.

This is also his last scheduled night at the hospital. Arrangements have been made to transport him to the rehabilitation center tomorrow. Selfishly, I'm certainly going to miss the ease with which I could visit him. It was just too easy to stop by as I drive the girls to school each morning, and simply say "hi." But I remain optimistic that we are sending him where he needs to be at this stage in his recovery.

Wednesday, March 4, 2009

Tears of Joy

Okay, they weren't my tears this time. And he wasn't crying out of joy. But seeing his response to what I was saying made me joyful.

Let me explain. Due to the PEG procedure I mentioned yesterday, I was unable to visit with Dad this morning. They took him from his room around 6:30 AM. Mom was up at the crack of dawn and able to see him beforehand. The procedure was scheduled for 8:00 AM and didn't take any longer than the 20-30 minutes the doctor estimated previously. Mom called to assure me that he was fine before lunch.

In keeping with my attempt to "normalize" my life again, I didn't visit him at lunch.

I had a rather eventful day. Sort of along the lines of that saying "be careful what you wish for, you just might get it." On the way out the door, I had that familiar urge. Nothing out of the ordinary, something I've done on many occasions previously. I wanted to call Dad and talk about my day.

That served as a quick reminder of my next destination. I needed to stop by and see him on the way home. Awake or asleep, I decided to talk with him anyway.

I was pleasantly surprised to find him awake when I arrived. Awake, alert and watching me enter the room. He had the sheet and blanket pulled up to his chin and was still clearly cold. I searched around the room until I noticed the wall unit blowing cold air into the room. I turned it down, talking with him the entire time.

I was even more surprised to gauge his obvious understanding of what I was doing. I seized the opportunity and proceeded to talk about my day. So, let's put this in perspective; he's recovering from a massive stroke and subsequent brain surgery, and he's still playing Dad. He's focusing intently on what I'm saying, smiling where appropriate, obviously understanding the story as I relay it to him.

Not wanting to waste any of this time, I continued to talk. I told him about the blog. About my initial attempts to reconcile my feelings with what was happening and how it migrated into a tool to communicate his condition with all those that are following his story. I went on to talk about an email from a cousin. An email that offered prayers and love, and confidence that he would be back with us soon.

That's when he cried.

I was prepared for almost anything, but I wasn't prepared for that. In hindsight, I feel terribly inconsiderate. How else should he feel? Why shouldn't he be sad, or frustrated or depressed? But that's just it. He hasn't shown any of that emotion until now. He hasn't shown that level of comprehension as it relates to his situation or the seriousness of his condition until now.

I know it sounds bad, but his tears of sadness were my tears of joy. Joy to know that he's aware, joy to know that he's understanding, joy to know that he won't accept his situation as it is.

Tuesday, March 3, 2009

Lose the battle, win the war?

Dad's status hasn't changed much the last few days. He still sleeps most of the time. When he's awake and alert, he'll make facial gestures indicating some level of understanding to what is happening around him. Including who is talking to him at the time, and even the subject of the conversation. But he won't respond to direct questions. At least not in any definitive means towards communication.

He's still pulling out his feeding tube. And while I can't honestly say that I blame him, it isn't helping matters. I'm not exactly sure how you put a tube through the nose and it ends up in the stomach. Seems to me that it's just as likely that it'd end up in the lungs. Maybe that's why they x-ray him every time they have to put the tube back in place? Needless to say, the hospital staff are worried that the constant removal and replacement of the tube is hurting more than it is helping.

He wouldn't need the feeding tube if he were able to eat. And while nobody can say with any certainty that he can't eat, they don't want to risk him aspirating his dinner into his lungs. If I understand things correctly, when he lost almost all function on the right side of his body, he lost the functionality of the right side of his esophagus as well. Or so we think. Something of a catch-22. He needs to eat, but we can't feed him while he's at risk. The only way to tell if he's not a risk is to feed him.

I mentioned the port in an earlier post. It's officially called Percutaneous Endoscopic Gastrostomy (PEG). Mom approved it today, after we all discussed it. I have reservations, but I understand why it is being done at this time.

I didn't mention that they tested his swallowing ability. It looks like he's swallowing normally. During our visit today, I was told that he actually ate pudding today. So, he can swallow after all. Which leads to the earlier question, why are we still doing the PEG tomorrow? Unfortunately, he isn't awake or alert long enough to actually eat a meal. No meal equals no energy equals no recovery.

When this title popped into my head, I was thinking in terms of losing the battle on the PEG procedure, but winning the war against his disability. And it struck me how much a part of daily life this really is. More a constant state of compromise than losing battles and winning wars, but you get the idea. Small things we do when we don't want to in the effort for a better day or a better life. I'll eat the salad instead of the hamburger in the hopes of lowering my cholesterol. I'll make the bed (even though she got out of the bed last) in the hopes that she will forgive me turning up the volume during the basketball game.

And there it is Dad. I'm compromising on the PEG in the hopes that you will be better energized, more comfortable, and continue down the long road towards recovery. But hurry up, the basketball season is coming to an end.

Monday, March 2, 2009

Knock Knock

"Who's there?" you ask. Unfortunately, I don't know.

And so it is with Dad at this point in his recovery. As I've mentioned previously, he has his high moments and his low moments. After several interactions where I get essentially no response from him, he surprises me, and the Dad I know shows as brightly as ever.

He was exhausted this morning when I stopped by. Apparently, he had just had another MRI. Or catscan, or whatever means they used to poke inside his head this time. Funny, I didn't think to ask again about the results. Anyway, he had once again removed his feeding tube and was attempting to do the same to various other tubes when I arrived. I can't say that I blame him, but he was clearly very confused. It is for these reasons that I hear rumors of restraints being used again.

After a lunchtime visit with the hospital rehabilitation representatives, I tried talking to him briefly. He was awake, and coherent. I told him that the hospital was wanting to remove the feeding tube and surgically move it directly to his stomach. He frowned and made a comically sad face. He was playing it up, the same guy I knew just a few days ago. I winked at him during this visit, and he raised both eyebrows in response. Moments later I asked him to squeeze my hand in response to a question, but I got nothing in return.

Now, I have to be honest here. Dad's hearing isn't what it used to be. He's far from deaf, but if pressed, he'd admit to "some" hearing loss. And for those that don't already know, he's also fighting macular degeneration. It's worse in his left eye than his right. The surgery that saved some vision in his left eye, also left him with a rather large blank spot in the center of his vision. The day before his stroke, he mentioned eye surgery similar to what Mom recently went through. I don't remember the details, but he was excited that it would improve his vision.

Go through the list with me:

Hearing loss
Vision impairment
Unable to speak, and possibly interpret everything he hears
Can't move the right side of his body
Unknown other limitations due to the clot and subsequent bleeding
Unknown other limitations due to the residual swelling inside his head

And yet, he's still finding ways to communicate as he can during those brief moments of clarity of thought. So, upon further thought, I think I can answer your earlier question.

It's still Dad.

Sunday, March 1, 2009

Holes

Dad used to sing this song when I was young. Almost always in the car. I don't know the title, but it goes something like this...

There's a hole, there's a hole.
There's a hole in the bottom of the sea.
There's a log in the hole in the bottom of the sea.
There's a log in the hole in the bottom of the sea.
There's a hole, there's a hole.
There's a hole in the bottom of the sea.

You continue to add to it, until you eventually end up with:
There's a speck on the flea on the hair on the fly on the wart on the frog on the knot on the log in the hole in the bottom of the sea.

This is something that I felt obligated to pass onto my children. Who now think I'm crazy.

...


The doctor wants to put another hole in my father. This time into his stomach, presumable from somewhere in his belly. They want to remove the feeding tube, which is presently reaching his stomach via the hole in his nose. This would allow them to remove the feeding tube, something I'm sure he would appreciate. I'm worried about more procedures and the risk of infection, but I'll defer to those more medically gifted than myself to advise us on what is best for his health and longevity.

At the same time, there is some level of concern, or at least caution, as it relates to bowel movements. Since he hasn't had one for the last 8 days. In his defense, I'm not sure anyone would, if they had to subsist on the brown liquid that fits down the feeding tube. Regardless, they are working to make sure that all of the plumbing is still functioning as it should.

Obviously, Dad is still on the catheter as well. But this is sort of funny. I don't know how, I wasn't privy to that part of the story, but the catheter bag fell from the bed. My oldest daughter (the one that plans on being a doctor) made "icky" noises, and was thoroughly grossed out. My youngest daughter gave her a dirty look, reached over and picked up the bag and hooked it back on the bed.

Finally, the incision in his scalp continues to heal. But it does continue to bleed a little. Something about the sight of blood on his pillow or hand (he rests his head on his left hand a lot) is still disconcerting. Nobody panics, and the nurses reassure us that this is normal, it just needs more time to fully heal and close up.

...

My oldest insisted on reading jokes to Dad for a while earlier today. Now, I'm the first to admit that I'm not very tolerant when it comes to 12 year old humor. But Dad was fairly alert and seemed to be listening to both her and my youngest as they took turns reading from their magazines. Long after I would have asked her to stop, he gently reached up and took the magazine from her. She cooperated, wanting to see what he was interested in. He closed the magazine and layed it on his chest.

I have a new respect for barbers. It's much harder to shave a face that isn't your own. But I'm getting better. Some time after our return from Disney last June, Dad gave in and bought the same electric razor that I use. Had it been any other razor, I wouldn't have known how to keep it charged, or clean. For that matter, I wouldn't have understood how to get the closest shave by moving it this way, or the other along the jaw line. He looks better cleanly shaven, and I like to think that it makes him a little more comfortable.

Milestones

Day 7, end of week one. Hard to believe that much time has gone by already. I'm sure that I'll say the same thing at the end of the first month, year, etc. Then again, it's hard to believe that my children are growing so fast, that I've been married so long (love you dear) and that I'm getting so blasted old. But those are all topics for a different blog.

Dad was transferred from ICU to a different wing. He'll still be monitored by telemetry, and receive more guarded care from the nursing staff than a "normal" room. But really, what is normal in hospital terms? I've been told that we're in the "stroke wing" and I've also been told that the hospital doesn't have a stroke wing. Whatever it is, we're in it. He has a phone, more freedom of movement, more privacy and much less restrictive visiting hours.

My nine year old daughter got to visit with Dad for the first time since this journey began. I hope it was a healing experience for them both. She did well at first, and then began to tear up as she struggled to talk to him. I couldn't help but notice that he was doing the same thing. I'm extremely proud of both of my daughters. The level of compassion and maturity that they have shown through this whole thing has been inspirational. I think they're teaching me more than I'm teaching them.

Dad said a word. Mom and one of my cousins were visiting, she said something about leaving and out of habit finished with, "alright?" He responded in like manner, "alright." Word began to spread quickly, and most everyone was thrilled that he was progressing. Had I been there I would likely have experienced the same enthusiasm that my mother and cousin did. But I was skeptical. After talking with the speech therapist, I understand better what happened. She explained that automatic responses are generated in a different part of the brain, and what he did is completely normal. It's certainly good insofar as it's clear that he understood what he was hearing. Unfortunately, it doesn't show progress in his ability to formulate sentences or even words, at will. On that note, he is mumbling more, and trying very hard to be coherent. I believe that he will talk again.

We visited with that rehabilitation center I mentioned previously. It's amazing. We have an appointment to visit with the rehab people at his current hospital. I just don't see how they can compete with what we saw today. Swimming pool, greenhouse, transitional apartments, spacious rooms, etc. We'll see tomorrow. While I'd hate the 30 minute drive, he needs the best opportunity for recovery that we can provide.

How close are (or were) you to your parents? I consider it to be a blessing to be a part of a large extended family, and most of these nuclear families are still extremely close. Many of them work (or worked) together, further strengthening the bond. Some vacation together, live in the same neighborhoods, etc. The week spent living in the ICU waiting room was eye opening. The other large families, loud and happy together, the mother sitting alone crying over her daughter, the strong silent types and the couples wringing their hands as they tried to busy themselves between newspapers and magazines. I count myself very fortunate that I'm still close to my parents as well as my brother, sister, cousins, uncles and aunts.

Enough for now, this post, and the month are coming to an end.