Thursday, January 31, 2008
Tuesday, January 29, 2008
Since I got back into Detroit, there haven't been a lot of updates to post. I've notices a bunch of hits on my blog sitemeter that have only lasted a few seconds...Sorry to disappoint if I don't post something on him everyday. It's a good sign if there's nothing to report...no news is good news! He's a pic from him in the ICU a few minutes before they took the trach out. He was acting like a space man with the oxygen mask on his eyes. From what I can tell, the ortho surgery on his knee has been postponed until Friday. He's still having some difficulty swallowing, but he should be able to have food and drink within the next two days. He's in good spirits, and happy to have visitors for short visits.
Saturday, January 26, 2008
Unfortunately, he aspirated on the swallow test, so he has to keep waiting to drink his root beer. When I came in the evening around 7:00, he was peacefully sleeping. I didn't want to disturb him, so I left about 5 minutes later. He had a few visitors from the ward in the evening, but after about 10 minutes, he was lecturing my mom on visiting time limits. He said he likes visitors, but not for longer than a few minutes. From what I've noticed, he's a bit more lucid in the mornings, and less agitated. I think as the week progresses, he'll be requesting more visitors. He realized that there's a phone book by his room phone, and he keeps threatening to call people. So if you get a random, raspy-voiced call from David...be prepared for some silly talk.
Friday, January 25, 2008
Thursday, January 24, 2008
Tomorrow morning the vascular surgeons will complete the "full amputation," which will assess the damaged tissue still there, adjust the length of the bone, and close up the wound. Dr. Goodman was optimistic that the surgery would go well, and only minimal tissue would have to be taken out. But we had to listen to the list of risks, benefits, and alternatives before signing the consent. He had an evaluation with a psychiatrist, had his wounds redressed, reinstalled the feeding tube, and then was transferred up to the 11th floor. He's in room 1116, and is able to have non-family visitors. He will be in surgery for most of the morning, and will probably be out of it for most of the day from the anesthesia. I would venture to guess that he can handle visitors by Sunday, but be prepared for a little psychosis.
He'll have the next surgery to revise the amputation tomorrow. Either tonight or tomorrow he'll be moved out of the ICU and into a step-down unit. His first phone call was to his mom in Oregon. I put my cell phone on speaker phone and they had a short, but emotional talk. He keeps asking for phone books so he can call people when he's bored. But after about two hours of visiting, he started drifting off for a nap. I'll be back over this afternoon, and will report any updates as they come.
Wednesday, January 23, 2008
I could not believe the progress my dad has made since the last time I saw him. His body isn't swollen and bloated, there are less tubes coming out of him, he is able to force-talk through the trach, and he's done with the ventilator. Unfortunately, this morning he pulled out the NG feeding tube out of his nose, which is bad because he's not getting nutrition or a route for medication in pill form. This afternoon they will be doing a swallow test, and if he does okay, he will be able to start eating and drinking. Tomorrow he will have another surgery on his leg to make sure that the tissue is healthy and not infected, bloodflow is good, cut down the bone, and sew it up with plastics. After that surgery, he'll have the trach removed. Next week he'll have surgery on his other leg to repair the knee.
I met with the rehab case manager, who said the doctors have ordered no weight-bearing activity for 6 weeks. She said that acute rehab could be done through the hospital, where willing caregivers would be trained in proper caring and lift techniques. She said the better option would be up to 6 weeks in a rehab facility. He says he really wants to come home, but I am not sure it's a possibility unless we get many, many willing caregivers to take shifts every two hours for 6 weeks. We'll have to play it by ear.
Tuesday, January 22, 2008
"David is stable, he still has some temperature but that is normal. He will go back to surgery in a couple of days & the surgeons will amputate a little above the knee to make sure they got all of the necrosis. He is still on a ventilator, but seems to breathing a little easier. And he still has a feeding tube. He's on a lot of medication so he is still a little confused, but he is not in pain. As soon as he is not in critical condition, he will be moved either to another floor, or to rehab, wherever the family & his case manager & his nurse decide."
I, Nicole, David's eldest daughter am now moved into my apartment in Michigan and can get away to Utah for a few more days. I'm flying back out to Salt Lake tonight and will be able to give more first hand accounts soon.
Monday, January 21, 2008
Elder Dickson of the Quorum of the Seventy came to the Highland Ward today ("for Mary Watson") and spoke. He then went to the hospital to visit David and give him a blessing. He's talking a little bit now, but very labored with the trach. Dad asked Elder Dickson what he should do about consenting for amputation. He lifted up his coatsleeve, and revealed that he himself had an amputated arm. He had bone cancer when he was 19 and required an amputation. He advised David to do what would save his life. What a perfect man to be counseling dad on this life-altering decision.
Sunday, January 20, 2008
Unfortunately, his leg isn't doing so well. Despite the surgery on Thursday, he continues to experience more muscle death. The enzymes from the muscles are very hard on the kidneys...we don't want his kidneys shutting down from this. There's a fairly strong chance he will need his leg amputated from the knee-down this week. We are praying that his leg will recover, but I personally feel that amputation isn't as scary and dramatic as everyone thinks. It will speed up his whole-body recovery by several months, it will make physical therapy much more effective, he won't have life-long chronic pain issues, and prosthetics are so amazing now that he'll be up on his feet/foot in half the time. We should have some answers on this by Tuesday or Wednesday.
Saturday, January 19, 2008
Friday, January 18, 2008
For the most part, David's condition is about the same as yesterday. His fever has decreased slightly, and the blood cultures didn't grow out any bacteria. The trach tube was inserted, so he's got the "Christopher Reeve" neck look going now. His leg is still exposed from the surgery, and the opening is gaping about 3 inches by 7 inches. The leg is packed with gray sponges and the wound vac is still sucking away. He is developing pneumonia, which is scary, but a common condition when you've been on the ventilator for a while. The doctors don't expect any big improvements in the next few days, but we're hopeful that his body will continue to heal and be ready for less sedation soon.
Thursday, January 17, 2008
This evening, David was in surgery for approximately 2 hours with the vascular surgeon. His left leg muscles were assessed for death/damage. Unfortunately, I'm not up on my muscle anatomy these days, nor is my mom who gave the report. Apparently two muscles were okay with no tissue removed, but 50% of the other two muscles was irreparable and removed. The surgeon tried to be conservative and take only was was absolutely necessary at this point. He will have another surgery in a few days.
Tomorrow, he will be having a tracheotomy, which is a surgical procedure to create an opening through the neck into the trachea(windpipe). A tube is inserted through the opening to allow passage of air and removal of secretions. Instead of breathing through the nose and mouth, he will temporarily breathe through the tracheotomy tube. It'll leave a noticeable scar, but will be much better for his body in the long run. Below is a diagram of where the trach incision will be.
1. Gift Cards: Smiths, Harmons, Costco, Shopko, Target, Walmart...to help pay for groceries and other items that may need to be purchased. Mary will be sent out on a lot of shopping assignments (and who can trust a teenager with their parent's credit card??? jk) Cash or checks are also gladly and thankfully accepted for any amount.
2. Ready-to-Eat Meals: We have been blessed with many fully-stocked hot meals so far, but what would also be helpful are ready-made casseroles, lasagnes, meals for the crockpot, etc...that can be refrigerated or frozen, then easily heated up and served. We're big fans of the fruit and veggie trays from Costco too :)
3. Cases of bottled water, juice and other snacks: Since we stand vigil at the hospital for so many hours at a time and all of the vending machines are outside the unit, we've already scraped our stash of bringable snacks at the house. We get thirsty, and Barbara prefers juice over soda. Other snacks like granola bars, fruit, junk food, Orbit Gum and munchies also help us curb our hunger and minimize our trips to the hospital cafeteria.
4. Outside-the-house help: If you happen to drive by, and see that snow has not been shoveled, or garbage cans haven't been taken from the curb, please stop by. We also need our Christmas lights taken down (since David will obviously not be up on a ladder anytime soon...) As the spring comes along, there may need to be some yard work done also.
5. Prayers, Letters, Emails, and Supportive Phone Calls: While David is in the ICU so long, this means that whatever progress he does make will probably come slowly. I know that my nerves have been frazzled after 6-9 hour shifts at the hospital each day. It can be hard to keep spirits up when looking at his swollen, bandaged body with various tubes hanging out.
My email is firstname.lastname@example.org . You can email me with questions or just to let me know that you're thinking of us. Any donations, cards, and meals can be sent or dropped off at their house. If you would like to mail something, and are not in the Salt Lake area, please email me for their home address.
Yesterday, Taylor, Rosie and I flew back to Detroit. We left for the airport around 6:00 am, but due to layovers and a 2-hour delay on the ground in SLC, we didn't arrive back until 5:00 pm. We're pretty exhausted, and Taylor leaves on a 4-day trip this morning. I wish he wasn't going to be gone. We get our apartment keys on Friday, and the moving truck comes Monday.
As for David, his status continues to remain the same. He's had a temperature around 102 degrees for a few days now. They use fans and ice packs to keep him cool. His vital signs have remained steady, but he is heavily sedated. I don't think his lungs are quite as bad as the RT who signed him up for the albuterol protocol led us to believe. There are some crystalized parts of his lungs, but the vent protocols are going as expected. The lady from the wound team looked at his leg and said part of it looks "dusky", which means there hasn't been adequate bloodflow to that area. Thursday he will go into surgery with Dr. Merrill and his resident to work on his leg. They will take out any necrotic tissue, assess his muscles and take out any part that has died. This surgery will give a good idea on what the long-term prognosis of his leg will be. Now the time estimate is for him to be in Shock-Trauma for up to two more weeks.
Tuesday, January 15, 2008
Tuesday proved to be more trying than Monday for David. The temperature that he developed on Sunday night has increased, which is indicative of infection. He's on Kefzol and Gentamycin, which are two great antibiotics, and his blood culture hasn't grown any specific bug...so it's a waiting game to see what is causing the fever. The two murses (male nurses, the metro training the redneck) weren't particularly helpful in explaining his condition today. I got there too late to hear the report on the doctors rounds, and his wounds looked better, so I thought he was showing constant improvement. I talked with the respiratory therapist a lot today, stood at his bedside as she tried to wean him off the ventilator. She said she heard some "crackles" in his lungs and he didn't do very well with the vent weaning. It made his BP increase, his pulse ox go down to 86%, he was very agitated, his body was quivering, and he had to be put on a higher dose of Propofol (sedation) to calm down. His hands were also put in soft restraints to prevent him from pulling at the tubes. I grabbed Taylor's Zune and some headphones so he could listen to Crosby, Stills and Nash to calm him down.
I spoke with the HR and Workers Comp people at the Church. From what I understand, WC will pay 2/3 of his full time wage through a third party administrator. But because of a upper limit cap, he will only get 55%.The remaining 11.66% will come out of his sick time accrual (11 hours a week, I believe). This will be about a $900 a month loss in net pay. Kind of hard to take. Health insurance will continue to be in force for the family, but he will not accrue sick time, 401k deposits, or vacation time. After 45 days, his Long Term Disablility coverage will kick in, and medical insurance premiums will be covered for no cost. Luckily, all medical care for the rest of his long-term recovery will be covered by WC and he will not have to pay a cent for his accident-related injuries. That's a blessing for sure.
Around 5 PM, and 5 hours at his bedside, I gave him a kiss and said my goodbyes until next week. I had plans to go out on a double date with John and April. As we were leaving, my mom got a call from the respiratory therapist asking if David could be enrolled in a research protocol for patients with Acute Lung Injury. Up until this point, the family was under the impression that all of his major injuries were from the pelvis down. Apparently, his lungs have filled with some fluid, the trauma of the accident is exacerbating his decreasing lung function. To find this out freaked me out, because Acute Lung Injury is in the same pulmonary family as ARDS, which I had in 2000. The research protocol will give him doses of Albuterol through his vent tube every four hours until 24 hours post-extubation. The RT came to my parents' house to explain it to mom, and the RT called me on my date to explain the protocols. I thought it was a great idea, and quite ironic because the ventilator protocols used now, with the highest positive outcomes, were the same ones established through the ARDS study in 2000. I gave my approval and mom signed the consent forms.
Due to the increased need for pulmonary care, David was transferred to the Shock-Trauma ICU last night. I was so exhausted that I couldn't wait until 11:00 PM to visit him, which was the time the nurses said he would be ready for visitors post-transfer. If I wasn't leaving for the airport so early on Wednesday, I would have been over to get the details from the horse's mouth.
My blogs will become a little less detailed at this point, since I won't be speaking with the doctors and nurses directly until next Friday 1/25 when I fly back to Utah. Hopefully he'll be out of the ICU and will be able to enjoy my visit and see Rosie too. My blog will probably have a few non-David related posts, but I will put any updates I get on here for your reading fulfillment.
Monday, January 14, 2008
Mom and I talked to a case manager nurse and the HR representative for dad's department. His billing and pay should be figured out over the next few days. Luckily, he has 32 sick days accrued, which will guarantee 2/3rds pay until at least Mid-February. We'll find out the details on his other compensation and benefits sometime Tuesday or Wednesday. In the evening, we had a family council with Bishop France and Jim, our home teacher. We figured out some of the upcoming needs for keeping the household running, such as paying bills, housework, and meal preparation. Jacob knows how to do the Dish installations, so hopefully that stream of income won't dry up during dad's recovery. It's great to have such an amazing support network, especially within our own family.
Sunday, January 13, 2008
At church today, there was a flood of love, support and prayers. I know our family will be taken care of. I was also told by Bishop France that Elder Dixon from the Quorum of the Seventy contacted him, and let us know that the First Presidency is personally praying for David.
I'm heading back over to IMC again. Taylor was released from duty early today, and I'll be picking him at SLC airport around 6:30.
Friday night I received a call from my mom. My dad, David, had been in a serious rollover accident near Fillmore on the way back from a work trip to St. George. He's an audio/visual engineer with the LDS Church, coming back from equipment upgrades on the Temple. He was with two other coworkers, Bruce and Nathan, in the back seat of a van (we still aren't sure if it was a minivan, with lots of heavy A/V equipment that was being transported back to Church Headquarters. I haven't gotten the full story, but here's what I've pieced together.
Around 1:30 PM, Friday January 11, Bruce dozed off while driving, by sign post 143, pretty close to the Meadow/Kanosh exit on I-15. He was startled awake by the sound of the caution grooves on the freeway, and overcorrected right when my dad yelled out his name. There was a slight hill down which the van flew over and tumbled a 2 1/2 times, broke threw 80 feet of fence and landed on its roof, by the side of the frontage road. Matt, a passing motorist from CA on his way to Provo for his daughter's wedding, saw the accident and was the second person on the scene. I've talked with Matt a few times, and this is what he explained to me:
The van was very well crushed and totaled. It had flipped and flown three or four times. Matt saw David's rear end was hanging out the side window of the crushed, upside-down van. It looked like he was crawling in with his left leg squashed under his body. Matt saw that the seatbelt was still attached, so he went to look for a knife and cut him out of the seatbelt to relieve the pressure. By the time he got back, another person had cut him out. Matt and some of the other motorists who stopped to help, set out some blankets, clothes, and other items so David could be laid out on the ground without getting cold and snowy. He was fully conscious through the whole ordeal. They administered consecrated oil and gave him a priesthood blessing.
The paramedics arrived and started triaging and treating David. Nathan was freed from the car fairly easily, and walked away with some minor cuts and abrasions on his forearm and elbow. Bruce was crumpled, not crushed, in the debris of the van and required the Jaws 'o Life to free him. He sustained some lacerations and contusions to the face, and was patched up within a few hours at Fillmore Hospital. My dad was taken by ambulance to Fillmore Hospital, where they diagnosed a pelvic fracture and a completely dislocated knee that had stopped adequate bloodflow to his leg (below the knee). Two hours post-impact, they decided that his condition was way too serious and he'd need to be LifeFlight'ed to Intermountain Medical Center in Murray.
For those who read this blog, and don't know David....he's no lightweight! My guess is that he's somewhere around 6'2" and 315 pounds. Due to weather conditions and the weight and balance on the helicopter, they were unable to chopper him to Murray. They loaded him on a fixed-wing LifeFlight plane, and flew him to Salt Lake International Airport. Then they took him (via helicopter) to IMC. Within an hour of arrival, my dad was taken in for an 8 hour surgery with a vascular surgeon, orthopedic surgeon, and general surgeon.
The pelvic fracture was on the wing of the pelvis, which is a non-essential area for bodily movement, and did not require surgical intervention. He had a pretty massive open wound over the pelvic fracture from the seatbelt, which they cleaned up and took care of. The main concern was his knee and lower leg. In addition to the dislocation/fracture of the knee, he had a significant crush injury to the leg. A saphenous vein graft from his right leg was required to restore bloodflow to his left leg. An external fixator was installed on my dad's lower leg, which elevates the open-wounded leg for drainage. After just over 8 hours in the OR, he was moved to the Thoracic ICU.
By the time I got the call, Taylor was into the 2nd day of his 4-day trip, so I decided to take Rosie out to SLC on the first flight of the morning. After 4 hours of sleep, we woke up at 4:00 am and drove to the airport. The layover in Minneapolis and flight to SLC was pretty uneventful. I knew that Rosie wouldn't be able to go into the ICU, so I arranged for her to stay with the Lewis' family while I stood vigil at the hospital. My mom and Jacob had stayed overnight through the whole surgery until 6 am, and were sleeping, so my job was to be on call for questions and support at the hospital. After taking about 6 condition-calls at my parents' house, I drove over to IMC. The IMC Campus is huge, and I was a little confused because I'd been told he was going to be transferred to Shock-Trauma ICU. After about 15 minutes of going from nurse station to nurse station with no luck (his trauma alias was ZZZIM, ZITI for some reason) I found a doctor who has been briefed on his condition and he showed me where to go.
When I walked into S204, I couldn't believe how swollen and bruised up he was. His neck had swelled so much that it was bigger than his head, but even his ears, eyes, nose, and tongue were swollen. He was sedated on Versed and intubaed. The most gruesome sight was his leg, itself. It was covered in bandages and elevated, but was soaked in blood and fluids from the open wound (to help reduce swelling and edema). Thana, his ICU nurse, was absolutely wonderful. I spent 5 hours with her, as she kept tabs on his vitals, dopplered his feet to verify adequate bloodflow, infused more units of blood, checked labs, glycerine-swabbed his mouth to keep it moist, and other nursing functions. She and I got along really well, and she designated me as the family spokesperson to give updates to anyone who called the ICU with the privacy code. Throughout the afternoon, Mary, Grant, Julie (his sister), Grandpa Jack, Mom, and Bishop France visited him. He was given another priesthood blessing by Jack and Patriarch Sheffield, and was guaranteed a full recovery.
I spoke to all three surgeons over the course of the day. The vascular surgeon said that this was one of the most difficult surgeries he's ever done because my dad's calf was so large. We joke about our "Watson Cankles"...our giant calves and ankles that have no end. The swelling made his calf about the size of a volleyball, and he had to use his deepest instruments. The maneuverability within the leg was darn-near impossible to operate quickly, and the surgery lasted over 8 hours. Unfortunately, from the time of impact to bloodflow restoration was just over 9 hours...and normal function of the leg is only guaranteed within 6-8 hours of blood deficit The orthopedic surgeon said the health of his muscles and nerves will take a few weeks to determine, and he will likely have permanent nerve damage. He could have partial or full muscle loss, which could require amputation. The general surgeon said she'll be rounding once or twice daily to make sure that his other vital systems are functioning normal (i.e. respiratory, urinary, cardiovascular, etc)
For a while, the respiratory therapist tried to wean him from the ventilator to see if he would breathe on his own, but he coughed and gagged irregularly, and it was clear that he would still need to be intubated for a while. We were told that due to the pain medication and sedation, it was necessary to keep him on the vent while his body healed, because he wouldn't be able to adequately breathe on his own (due to trauma and existing asthma and sleep apnea). His Versed dose was weaned from 10 to 2 while I was there, and for part of the early evening he was responding to stimuli. The first response made me laugh...I asked him if he knew that 3 of his 4 favorite girls were next to him, and he smirked and shrugged his shoulders. A few times he tried to open his eyes, but his eyelids were swollen shut and purple, and his eyeballs were completely red. He loved it when I scratched his head, and would lean into it a little. He grabbed my hand a few times, but didn't have much grip (from a bandaged hand with a chunk of flesh missing).
I stayed at the hospital from about 1:30 PM to 6:00 (at shift change) and went back from 8:15 to 10:30 MT. I had been up for 21 hours, after only 4 the night before, so I headed back to Chez Watson and slept on the couch. I will probably go back again this morning around 8, stay till 10:45, go to sacrament meeting at 11, then come back to his bedside. I'd originally planned to fly back to Detroit this afternoon, but in my priesthood blessing from Grant, I felt that the family needs me here for a few more days. I'll have to play it by ear.
Any prayers or positive vibes through the universe would be muchly appreciated. I'll try to keep updates on my blog everytime I'm back home by my computer. You can call my cell for updates also.