Tuesday August 2, 2005

Tuesday August 2, 2005 Zack had to be restrained on his left arm through the night to keep him from picking at his head wound with his arm splint on. We really have to watch him cause his head itches so he wants to pick at those stitches. His Linezolid antibiotic treatment was over yesterday so he was started on a new antibiotic called Bactrim. Because they suspect a urinary track infection and they are still waiting on his head wound culture, they want to keep him on some antibiotic. At 9:00 Joan Hhh h Hardin the wound care nurse comes by for a consult. She agrees the best treatment would be to clean it three times a day with saline. This will dry it out so the stitches can be removed. We move him to his wheel chair for our first morning trip down to the gym and he is holding his head up very strong. I take him into the elevator and suddenly he starts throwing up. Not once but several times (it is 9:50 AM). It scares both of us. There is puke coming out around his Trach. When the elevator doors open I start screaming for help. Zack is upset that there is puke on his hands, baseball and lap. We have to go back to the room and I get his shirt changed and clean up him up. I ask his therapist (both O.T. and P.T.) if they would come upstairs. When they arrive we work with Zack on a mat down the hall from his room. They get him up on his knees holding onto a windowsill. He does really well until he starts throwing up again (it is 10:30). We have to stop and go back to his room. We discuss what the problem might be and I am concerned that he might be catching some kind of stomach bug. The nurse pages the doctor and I am left alone to wait. Again Zack starts to throw up (it is 11:15). Jennifer (day nurse) comes in and thinks she has figured out the problem. The new antibiotic Bactrim frequently makes people sick. The order for Bactrim is stopped because now all our cultures are back and Zack’s white count is under 10. He only has a mild urinary track infection that his body will fight off on it’s own. The head wound culture grows only yeast, which will be handled with the saline. They give him Phenegran at 12:30 to stop him from throwing up. They decide to introduce Bolus feedings, which means they will feed him through a syringe directly into his G tube (into the stomach) three times a day. It is a more natural digestive rhythm. Fill the belly up, digest, stomach is empty, fill it up again. This will happen at 8:00, 12:00 and 5:00 and still be tube fed at night (9:00 PM – 5:00 AM). This will help to start putting the weight back on him. We get an unexpected visit at 12:00 from Dr. Kraft, Director of the Brain Injury Program (his son dates Lindsey, a friend of Zack’s). We could have talked with him for hours. He had reviewed Zack’s case file and gave us a lot of information. What stands out in my mind are his comment that “working memory” begins at Racho Level 6. This is when Zack will have an awareness of time. Right now when someone walks into the room (no matter how many times he has seen them that day) to him it is the first time he has seen them. He lives only in this moment. Dr Kraft also explained that they know a whole lot about brain injury but only recently discovered why some people recover more completely. You can take two 15 year old, athletic, smart boys with the same brain injury and they will recover differently. In the last few years they have discovered that the difference is the level and type of “family support”. Patients that have a family member involved in their therapy are the greatest assets to recovery. Speed of recovery is not the issue. It doesn’t matter how fast he is getting through a particular phase but rather how “complete” his recovery is. Whether it takes 6 months or 2 years is irrelevant…what is important is complete recovery. It was great information and the very reason that I am here all the time. At 1:30 we go to speech therapy but Zack is out of it. The Phenegran stops you from throwing up but it also makes you sleepy. Zack’s midline (keeping his head and eyes straight forward) is better but we get very little out of him. Instead we talk to Kathy our speech therapist. She explains why they always offer water 1st (Frazier Water Protocol) which is to insure that he is swallowing properly. They need to make sure it goes down correctly and not into his lungs where he could aspirate. We go on to P.T. and O.T. where Zack still does very little because he can hardly stay awake. They stretch him and show us how to do exercises with him in his room. We return to the room and he sleeps until 6:00. He is very relaxed and his eyes and head are turned to the right (very good…remember he has right side neglect). He starts to get visits from his friends. He is alert and making eye contact. Then at 9:00 P.M. our biggest gift. Andrew, Taylor, Trey and Allie are talking to him. Suddenly we get the biggest smile…full teeth. It was a joyous occasion. Several nurses heard the commotion and ran into the room. I grabbed my camera and got the remnants of his smile. God is so good. Knowing what a stressful day we had he gave me what I have been waiting for…to see that smile. What a blessing! There’s not much more I can say.