Monday September 19, 2005

Monday September 19, 2005 Zack was awake in bed waiting for me to get him up. He ate a quick breakfast, showered, dressed and was ready to start walking. Dr. Mook stopped in with Sarah (our case worker) to discuss discharge plans. Tentatively it looks like Oct 6th we will get to go home. 9:00 Speech with Kathy and she asked Zack what he did this weekend. He told her he went surfing and asked her if she believed him. They looked at the pictures of all his friends taped to the wall and asked discussed with Zack who they were. He got really silly for a while making up names. When Donna arrived he called her his “sitter” because he couldn’t remember her name. Kathy gave him an object and two written words to chose which matched the object. He needed more help than yesterday. He is less impulsive about making the wrong choice but aphasia is still a major roadblock. He tries very hard to figure it out but many times chooses the wrong answer. She showed him several objects and he had to identify them. He struggled and told her the “I stayed up late last night”. She had hidden two objects and he couldn’t find them even though he would go to the exact location and look right at it. When she pointed it out he said, “That was sad. You got me on that one”. P.T. with Amy and she asked him who Donna was. “My sister-in-law”. He worked out on the treadmill for 15 minutes, was stretched and then on the stationary bike for 15 minutes. His stamina has really improved. Check out the cafeteria for a while until its time for O.T. Mary Beth is 5 minutes late and Zack is not patient. She has him write his name, the date and what he did this weekend. He wrote on his own, “I played Texas Hold Em with my train” (it was supposed to be my buddies). Played a memory game on the computer where he was shown a group of 16 pictures. They all went away but three of them, then they all came on. He had to choose the three that stayed on. He got them easily. She did it again with less time. They went to the garage and he did a project that 3 weeks ago frustrated him badly. Today he completed it in record time with no problem. He keeps asking questions like, “How do you know the time?” “How do you know when Mary Beth is coming?”
He said he didn’t know and he wanted to. He is starting to become more aware of his deficits so that is the first step to recognizing aphasia and conquering it. Mary Beth gave him a hammer to use a large carpenter nails and he did great (he couldn’t do it 2 weeks ago). Back in his room for lunch he said, “I’m going to flavor in my room tonight”. Once he was told that only one word was wrong and flavor didn’t make sense he said, “I’m going to stay in my room tonight. I did good”. He wants so badly to get his mixed up words fixed. 2:00 We went to our meeting with Dr. Han. I had to fill out mountains of paperwork and then we waited for 1 ½ hours before we got to see the doctor. Zack was getting tired so I asked if there was somewhere he could lay down and they put us in an exam room. After a long time Zack sat up and looked at me and said, “suspension of this would be good”. I agree. Dr. Han doesn’t know if his bone flap is contaminated but will check into it tomorrow. Regardless, we will not be having surgery until he is released from Frazier Rehab and he is scheduled out for 2 weeks already. He will be in the hospital (either Norton or University depending on if he has to have an acrylic bone flap made) for 3 to 4 days and then go home. He should be able to start speech and O.T. rehab immediately but Dr. Han wants to wait a while before beginning any P.T. He will have his stitches for 10-14 days and once they are out he will no longer need his helmet.
I discussed having a plastic surgeon close the incision so we could close up the gap a little better (where no hair is growing) but Dr Han said he would be closing it. He explained that a plastic surgeon would want to remove too much scalp and create a new wound as a potential infection site. He felt he could do as good of a job while being most concerned with getting a good seal on the bone flap. He said we could always come back when they bone flap had fused together and was completely healed (about 12-18 months) and then a plastic surgeon could tighten it up if we felt it was necessary. Then he would not be concerned about infection. I’m not sure if I agree or like that approach. It seems that a plastic surgeon could take a little more time and is more experienced in a cosmetic closure than a neuro surgeon. We drop in at University Neuro ICU to say hello to the nursing staff that took care of Zack in the beginning. Christy cried when she saw Zack and told us we gave her incentive to keep working in ICU. We saw Yolanda who couldn’t believe it was Zack walking in and Karen (our first Physical therapist who gave us so much hope). We gave them all copies of the pictures I took of Zack with each one of them when he was so badly injured. We left them with big “now & then” pictures for the bulletin board and we took new pictures. We were disappointed that we didn’t get to see Dr Densler, Kim (RN), Dr Muntchnik, Tom, Stephanie and some of the others but we will come back again. As we left the hospital we met Dr. Densler on the sidewalk. He gave me a big hug (this was the surgeon who never hugged anybody) and we took pictures. He was amazed at how well Zack was doing. I told Zack that this was the doctor who removed his scull and he raised his eyebrows and said thank you. Dr. Densler said that he wanted Zack to speak at the Brain Injury Survivor Reunion next year because he was hurt very badly and was doing exceptionally well. As we left and headed back to Frazier Zack told me it was good to meet Dr. Densler again. Of course he didn’t remember anyone. In front of Frazier we ran into Amy from P.T. She talked to Zack and I for a while and when we walked away Zack said, “Who was that lady”. I told him Amy had worked with him every day since he had been here and he said he knew her but he didn’t know her. Short-term memory is still not good. As we walk back to the room he says something and mixes his words up. I tell him I am going to get a tape recorder and record him talking so he can hear himself. He didn’t like that idea and said it would kill him if I taped him. He said he didn’t want to hear himself messing up. Once back in the room he takes a nap before dinner. After he eats dinner several friends arrive and he is dancing again. We all enjoy watching him and he loves the attention. When it is time for them to leave we walk them to the lobby. He is walking down the hall with a girl holding each hand. Any teenage boy would be envious of the parade of female visitors Zack receives. He is exhausted when we settle into his room and falls right to sleep. I am resigned to the fact that after his surgery it will be me tending to his incision at home. I would much rather come back to Frazier and have the nurses fussing over him and Dr. Mook checking things out but insurance doesn’t work that way. I guess I have had enough experience now and God will take over where my knowledge ends. Please continue to pray that Zack will recognize his aphasia so we can conquer it. Pray that our last few weeks here will be marked with great leaps of improvement. Pray for complete recovery.