September 30

Kirk did fine overnight and indicates to me with a head nod that his care is OK. That is what I have been most worried about with the transition. He also indicates to me that he is not in pain. He is pretty awake this morning which is good because there is a lot going on. Since he is new at the LTAC he needs to be seen by every specialty. So this will keep him busy but also help the staff get a plan together to move him forward. He will stay in the ICU at the LTAC facility until they have proven to themselves he is stable. They will also try to wean the vent here. So he shouldn't move to a regular room for at least a few days, which makes me feel better.

Visiting hours are strict though. They are 9 am to 11 am, 12:30 pm to 2:30 pm, 4:30 pm to 6:30 pm and 8 pm to 9 pm. So I am going to work my schedule around these hours as much as possible but will need help in the afternoons. The 4:30 to 6:30 pm hours might be good times for his co-workers to visit. I will of course leave the guest book and would ask you call me at the number listed in it when you visit and provide any medical feed back.

All visitors need to use hand sanitizer before they enter the room or wash hands immediately upon entering. Kirk does not need to get sick and we are entering flu season.

I would guess my posts will get less technical and more about his physical condition. He should finish the last antibiotic today and hopefully be off the heparin soon and just on the Coumadin which is oral. They also may not continue to happen every day. This should be the only post today. Of course if something drastic changes I will post.

He will nod to some yes or no questions and he is looking around a lot. He is trying to move all his limbs but it isn't coordinated yet. Hopefully getting more time along with physical therapy will get him moving.

Thank you for all of your contiued support. Kirk has some serious work to do now.

September 29 Update 2

So we finally got moved. Kirk was supposed to move at 2 pm but the move didn't actually start until 7:30 pm. We lost one more piece of hard wear on our way out. Kirk no longer needs the arterial line. He us stable enough on the vent to not need constant blood gasses. And hopefully he won't be on the vent much longer. We didn't get the CPAP test today because of the move. He is at LifeCare Hospital at 8902 Floyd Curl Dr., San Antinio, TX 78240. He is currently in ICU Bed 8.

Walking one last time from his room, saying good by to the staff, walking out of the waiting room where I sometimes waited in fear was so much harder than I could ever have imagined. I could not stop the tears. The nurses, doctors and other staff have been beyond amazing. I can't wait for the day we can walk in as a family and tell them thank you. They will all forever hold a special place in my heart. Because we didn't leave until after 7 pm I got to say a goodbye to the night staff. Every nurse is excited to see us leave, not because they don't love us, but because they are thrilled this day came.

He made the trip fairly well. It took some time before I could see him but he was cleaned up and in a dapper blue gown. He was very asleep when I did get to see him but woke up for several minutes and was very focused. He would turn his head and eyes towards me when I asked and would answer yes or no questions my moving his head. I didn't get a kiss tonight but I got some earlier. I told him he needed to sleep tonight because he starts working tomorrow. One question I asked him was if visitors were OK and he said yes. But let's give a few days to adjust, work a schedule and get settled please.

Four weeks ago today I thought I was going to loose my wonderful husband. Somehow he hung on and we are starting a new chapter in his recovery. He graduated today as the ICU nurses say. A day I wasn't sure would come arrived today.

Thank you for your prayers, your thoughts, your words, and support which he have felt in so many ways. We will walk together on this next part of our journey. I know we are held, loved, carried and occasionally pushed. My supporting angels were behind me today. I can't be in two places at once so my wonderful friends stepped in and took care of Sidney tonight. Bless them.

September 29 Update 1

So today could be a huge day of change. We are moving to the Long Term Acute Care facility today.  He does a little more every day although sometimes doesn't repeat what he was doing. He hasn't given me a kiss today but he is trying to move his arms more and even his legs some. He also continues to improve on localizing to pain. He turned his head to look at me today and is trying to lift his knees. If the day's activities allow he will get a CPAP trial today as the next step to get him off the vent. Otherwise we are staying level. I will put up a post this evening with all of the new bed and location information. 

So this isn't the best picture ever but Sidney and I finished our Lego model of Marathon's Brae Alpha Platform.  We will take a short break to work on the pop-up book before we start East Brae.  The only one that will be missing from our collection is Brae Bravo.  There weren't anymore of those models when I bought the other two.

September 28

I sure didn't think these days would come. I was afraid to think Kirk would start to get better because what if it didn't happen? So he now tries to kiss everyone, doctors and nurses included. It is pretty funny. I think that he thinks if I kiss you, you will go away and I can go back to sleep.

He also yawns a lot which I think is hysterical. It is something you take for granted until your loved one doesn't move for weeks.

When Kirk arrived in the ER on Labor Day his Glascow Coma Score (measure of mental status) was a 3 of 15. This has been his score for almost a month. This is the lowest score you can have. Yesterday morning he was a 7 and yesterday afternoon he was 11. He varies from 9 to 11 right now. What an amazing difference.

His pneumonia is improving. His chest X-Ray looks better and he is coughing wonderfully on his own. His secretions are thinner and he is generally breathing easier. He is still on the vent but we have taken the first step to weaning him off. It will be a multiple step process with some setbacks likely. He will also start Coumadin, the stronger clot busting drug today. He will be on this for many months. But it is an oral medication.

We have decided not to start another central line. The only IV drug he really needs right now is the antibiotic which will finish on Tuesday.

In addition to kisses he can mouth good morning, I love you, yes and no. He does want to sleep a lot still so it can be difficult to keep his attention for very long. He still won't move his arms or legs on command but I think some of that is they haven't moved in a month. He will react with his arms to pain. I really think I see glimpses of my beautiful husband and Sidney's loving father. It is so wonderful.

The next step is scary to me and it is where I am going to need help. Kirk may move to the long term acute care facility as early as tomorrow. He is going to graduate from the ICU. The LTAC can adjust the Coumadin, wean him off the vent, provide all the medications he needs and start his rehab.

What is scary to me is that he has had a full time nurse for four weeks. He will go to sharing a nurse with 3 to 5 other patients. And there is only one of me. I would like to put together a plan of help to be able to have folks who can sit with him for a few hours each day to help me monitor his care and start to provide him social contact, conversation, thinking and challenge. He still will need periods of quiet rest so we will need to respect that too. Please visit with me if you would like to help when we make our move.

Thank you again for the cards, thoughts, prayers and support. They mean so much to us and we are so blessed to have you in our lives. We love you all so much. Thank you.

September 27 Update 2

Oh I am so excited I could dance. Kirk kisses me and Sidney. We tell him we need a kiss and he puckers up and gives us a real kiss with the noise and everything. He is so much more awake today. He looks around and tracks with his eyes and sometimes moves his head. I think he was watching football until he needed a nap. He knew Sidney was there and chatting with him and he was listening. This afternoon he has been trying to lift his arms. I am sure he is after the tracheostomy but I will take it. He just looks alive and like Kirk.

He is coughing up a lot of mucus still from his lungs. That makes him uncomfortable and drops his saturation sometimes but it is good he is coughing it out. Please continue to pray for healthy lungs.

We are debating whether he will need another central line. He is off IV sedation, at least until we need to move him like for a bath. He is getting heparin but can move to the next medicine anytime which will be oral. So really the only thing he needs right now by IV is the single antibiotic he is still on. So the central line may not be worth it.

September 27

Kirk had a very quiet night and so did I on my night with him. He hasn't had any serious heart rate issues since about 9 pm last night. The nurses are being more careful about how they suction him to try not to irritate him as much. He didn't seem to have a problem with the chest x-Ray this morning either.

Here comes the exciting bit. He opens his eyes much more now and looks around. Sometimes he will even track me or the nurses. He doesn't respond to commands right now. But during his neurological exam when he was pinched, he moved both arms towards the pinch and got good and mad. He also moved his legs some. I know it isn't that nice to be excited about him getting mad but it is a really good sign and we are excited.

We are going to try to get more water off of him today and decrease IV sedation.  His fever is under control and he is coughing up stuff to get it out of his lungs.

He won't get his new central line until Monday. So he will keep all his IVs until then. If we can get him off IV sedation, all he will get in his IVs are antibiotics and heparin. As much as possible we will move to oral drugs.

We will see what the day brings as to whether I put up another post.

September 26 Update 2

Another short update for the evening. The first thing I noticed this evening is that Kirk had 3 IVs and no central line when I arrived. Poor guy has an IV in the top of his foot. So when I got the story I was surprised. The doctors had come in mid-afternoon to pull his central line back about an inch to make sure that wasn't contributing to his heart rate irregularities. Later when the nurses came back to bathe him, the central line was out and laying on the bed. Fortunately that even with the heparin drip he didn't really bleed. They are investigating what happened because Kirk isn't moving so he could not have moved it. He will likely get a new central line tomorrow but they will have to stop the heparin for that time.

He has been off the propofol all day and our next goal is to get off the fentanyl. We may wait until tomorrow but he is really comfortable right now. There is nothing planned for the night so hopefully we will both sleep tonight.

The day nurse just left and it is nearly 9 pm. All of the nurses have been so incredible but today's nurse takes the torch in providing encouraging and touching feedback to me. We are so blessed to be in such caring skilled hands.

September 26

Kirk gave me quite a scare today. When I arrived at his room, all the doctors were standing out side of his room and the nurses were placing paddles on his chest. They were getting an EKG and giving him some medications. 

He had been having periods of tachycardia, or super high heart rate, when he was aggravated, say by moving, getting suctioned, getting a chest x-ray or getting a bath. This doesn't really indicate there is anything wrong with his heart. But is is disconcerting and not ideal. He has had several EKGs and an echo cardiogram. All of these have been fine and previously, before the accident, he would occasionally have an episode.  But is is scary and not something we want when he is so sick. So they started a medicine to try to control those. Because of the medicine, this time when he was aggravated he dropped his heart rate into the 30s.  Causing another scare. Cardiology has been to see him and will try to adjust his medications to avoid going too fare in either direction.  And of course we will continue to walk our fine line of sedation and trying to minimize drugs.  The cardiologist says his heart is healthy.

He is still fighting the pneumonia.  We continue antibiotics and Tylenol. His temperature is back around 100, lower than the 101 yesterday. His chest x-ray still looks bad but it is getting better.

He has reached a therapeutic level of heparin.  So he will stay with heparin the next three days and then we will start a stronger clot busting drug.  He did have a CT this morning to make sure there have been no changes in his brain since starting the heparin at a higher dose and everything looks fine. 

They are going to try moving his central line just a bit to ensure it isn't the cause of his heart rate irregularities.  Sometimes the line can be in far enough to aggravate the heart so they will move it just to be sure.

We are trying to wake him up again today but keep him comfortable. I may put up another post tonight but we will see.

Sidney and I swam last night. She still thinks dragging behind me by hanging onto my feet is still fun.  But she ends up working pretty hard in her class and started to learn a flip turn last night.

September 25 Update

There has not been a real change in Kirk's condition in the last 24 hours.  He is still fevering but not quite as high as before. No other cultures have grown anything besides his lungs. His oxygen saturation still fluctuates based on position and how much he gets irritated.  He doesn't like to be suctioned or laid flat so those things cause him to de-saturate a bit.  The antibiotics continue but they are going to further test the lung cultures for resistivity to the antibiotic to make sure the bugs aren't resisting.  His chest x-ray did look better again today.

He is on fairly low sedation through his IV but is receiving plenty of sedation orally.  (And if you are Sidney you question how he is receiving oral medication through a feeding tube that goes straight to his stomach.  The practicality of a child.)  Regardless he is pretty out so he really isn't doing anything on command.  We are trying to walk a line of minimal sedation but not making him work hard to breathe.

The MRI of his bed sore shows that no surgical intervention is needed for the sore.  It isn't deep enough to cause his fever. So our holding pattern continues. 

If there is no significant change tonight I won't put up another post. 

September 24 Update 2

This will be quick. Kirk had a quiet day. He hasn't been to MRI so he has been able to rest. He might go tonight but this is to look at the bed sore so it isn't a super high priority. He is still well sedated. His temperature just creeped above 100F, the highest it has been today, so they will watch that.

Some wonderful person sent Sidney a Build Your Own Pop Up Book. Please "pop" me a note so she and I can thank you!

I hope tomorrow is a fever free day where we can start to wean off the ventilator. Will keep you posted and thanks for keeping up with us.

September 24 Update

Kirk's temperature is much better this morning. They were able to test the dose of antibiotic in his body and there wasn't enough to fight infection so they increased his dose. So hopefully we are now ahead of this infection. His lungs are still have some frothy stuff that they are trying to work out with special treatments, sedation and ventilator settings.  We aren't having to cool him to control his temperature right now. He is still on IV Tylenol to help control his temperature so the real test will be tomorrow when he is off of that.

He will go to MRI today to see how deep his bed sore is and to see if it needs surgical intervention. After his trip to MRI, sedation will be reduced to try waking him up again. The higher dose of anticoagulant will start today also. This doesn't break the clot but will keep it from progressing. After several days of this, we will try a clot breaking drug. He will be on that drug for many months. His neurological exams will be very important now to make sure nothing bad is happening in his head.

As he wakes up and breathes more on his own, we will be able to start sitting him up and getting him moving again. That is still two or more weeks away.

September 23 Update 2

Kirk did get the new central line today. They will culture the femoral line they removed. Otherwise focus has been on temperature control and getting his lungs cleared. He is heavily sedated tonight to allow him to rest and to allow the ventilator to work his lungs more open. He is more acceptable to gentle turning to his left and right to help keep his bed sores from getting worse. Tomorrow we may be able to start more aggressive anti coagulation. But we will see how he is.

Sidney and I had a really nice evening. Homework and chores got done with a minimal amount of disagreement. We went to piano lessons and then had a nice bowl of left over soup for dinner. We took Stormy for a walk and sat outside before endeavoring to start building the Brae Alpha platform out of Legos. She is showing what comes from her dad in this endeavor. She is trying to build from the overall picture. I am an engineer and building from the instructions. With any luck we will meet in the middle.

September 23 Update 1

Well I have to say I made an oops. Nothing serious but if Kirk wakes up anytime soon and sees himself he might not be happy. He is bald. I though a buzz cut would leave home with at least a quarter inch or so. Um, no his hair is all gone except for the occasional stray that got missed. It will be easy to keep clean now.

He had CTs of his head, chest and abdomen yesterday. His head is consistent with his last CT. His chest shows only the pneumonia, and his abdomen is clear. He should get his new central line today and the femoral line removed. So we continue to look for another source of infection and to verify through cultures that we are treating his lungs with the right meds. His temperature is more under control this morning and his oxygen saturation is good.  We are on hold to treat the clot until the central line is in so it will be at least tomorrow before we make progress there. The doctor did show me the head CT and I looked at some of the others over time and there are remarkable differences. The swelling is way down and the bruises are resolving.

The other thing the doctor said was as soon as his fever is controlled we will start weaning him off the ventilator. As we get his fever under control he will be awake enough to start breathing on his own. That is so exciting to me. We still haven't seen discrete movement if arms or legs but it is difficult with the level of sedation.  Getting him off the ventilator will mean better health for his lungs and less possibility for pneumonia.

I will put up a short post tonight with any new news. (That's bad grammar.). I am hopping it is only central line in and fever under control.

September 22 Update 2

Although the day started out with the positive of removing the ICP monitor, it was a rough day for Kirk. He is really fighting one or more infections. We know about the pneumonia and are treating that but we also think there is something else somewhere that we aren't treating. He is very feverish and then has high and low heart rates and breathing rates. He is heavily sedated right now because he is so miserable with fever. He had a CT of his head, chest and abdomen but we don't yet have the results. We are re-culturing everything but those take days to grow. He is already on the maximum dose of Tylenol. This is our big and serious fight right now. We can't move forward again until we win this battle.

The ophthalmologist was also in to look at his eyes again. His right eye looks pretty good but his left eye ball has kept what looks like a very large blood blister on the eye ball. Apparently they punctured that today to drain it and now want his eyes to be taped closed with lubricant in them to keep them moist and help them heal. Right now he is so sedated that he really isn't opening them.

In other news Sidney had a lockdown drill at school. When I was in school we only had tornado and fire drills. It breaks my heart that our kids have to learn how to respond to dangerous man made emergencies in elementary school. But I am also glad that the school is trying to be prepared. I did get lots of questions about the drill and our safety.

Please pray tonight for the infection source to be found and treated. Pray for non feverful rest for Kirk so that we can start to try to let him out of his coma.

September 22 Update 1

Kirk's biggest fight right now is infection and the fever associated with that. They are treating his staph based pneumonia but trying to find if there is something else going on. They continue to take samples to culture of all his bodily fluids. They also continue to treat with Tylenol and cooling.

The big event of the day is that the ICP catheter has been removed. We are no longer monitoring his ICP. We have lived by the little white number in parenthesis (his inter cranial pressure) for three weeks. And now it is gone. And he is off the EEG so we can give him a proper wash of his head. I may go ahead and have his hair cut to a buzz cut. It will be easier to keep clean and it will grow back. Sorry Honey.

Intensive anticoagulation therapy for the clot may start as early as tomorrow. Neurological exams will be vitally important now because the ICP  monitor is gone. Neurological exams are the only picture we will have of what is happening in his head.

He is going to start a more intensive nebulizer routine to try to clear his lungs. He is also going to get a new central line and the femoral line removed. The doctors want to eliminate the femoral line as an infection possibility.  He will have to go to a surgical suite for that.

I will likely put up another short post this evening just because it has been a busy day so far. Thank you for your continued support and prayers. Sidney and I are truly touched to be so well supported right now.

September 21 Update

Kirk is fighting a lung infection this morning. It is pneumonia with staph. He is really working hard to get enough air.

We had to unclamp his drain at about 5 pm last night because his ICP went above 20 and stayed there. So we are trying to clamp it again today. He is also more sedated today in part due to the difficulty breathing and fever and also due to ICP. He is receiving oral sedatives so we are going to try to work down IV sedation again while trying to keep him comfortable.

Kirk is going to receive a unit of blood because his hemoglobin is low. That should also help his oxygenation. For right now, the fever and lung infection are the highest concern. Until we get the infection under control and fever down, he isn't going to be comfortable enough to lower sedation and try further neurological exams.

Sidney and our friend from Houston made buckeyes last night for the nurses. The nurses are now good and sugared up. Sidney and our friend are going to Natural Bridge Caverns this morning. Sidney will come by and visit her dad after the cavern visit.

Again I don't think there will be another post today. We are just in a holding pattern right now. Tomorrow starts week 4 since the accident. Sidney and I are hanging on as best we can and appreciating the support we are getting. We really do need it. Thank you.

September 20 Happy Birthday Kirk

Today is Kirk's birthday. Sidney and I will store away our birthdays wishes for him and we will celebrate when he is able.

He is doing well this morning. He had a bump at about 4 am when he was cleaned up and put more on his side. I think that mostly has to do with his lungs and infection. But because of that, everything went high for a little while, ICP, heart rate and blood pressure. I think he was also mad.

Today's goal is to clamp the ICP and leave it that way, even if it approaches 20. The doctor really wants to get that out tomorrow. We will likely also take him off the EEG tomorrow as well. The other goal is to get to minimum sedation and as much on oral meds as possible. These are longer acting but also provide less sedation so we can really see what he can start to do.

We did have him breath on his own for several minutes and he took nice strong and regular breaths. But those muscles are weak also so we will allow him to breathe when he wants but keep the ventilator doing most of the work.

The doctor also ordered that he gets 6 hours of minimally disturbed sleep at night. He needs that solid rest. We can mess with at other times.

We will have another friend from Houston here this weekend. It will be good to see her and have another adult in the house for a couple of days. And she has an SUV which I hope she is counting on using.

I may not put up another post today if he stays good and stable. If something changes, good or bad, I will get another post up.

Thank you again for your continued support for us as we make this difficult journey.

September 19 Update 2

Kirk had a really good day. Everything looks really good on him today. ICPs have been good and he is breathing well through the tracheostomy on the ventilator. He is over breathing the ventilator some and we are continuing wean the settings on the ventilator. We aren't trying to wean him off of it yet. This was a day we needed after yesterday.

Sidney came to see him this afternoon. She did a fantastic job taking everything she saw in stride. We have been talking about her visit and the things she would see for a while. So she was well prepared. She was so excited to see him she was nearly dancing. She held his hand and talked to him. I am so proud of her. We sat in his room chatting to him a bit and playing games for a while. I hope we will be able to do this more and eventually get him involved more.

Tonight is date night so I will be at the hospital with him all night. I hope he sleeps and heals tonight.

This time I think is very hard for him. He is smart and kind and full of life. But I don't know what is happening in his head. We are so excited that he simply opens his eyes or sticks out his tongue but at the same time I wonder what is going on in his brain. Is he in there thinking like Kirk or not? Is he frustrated that he can't get out or simply trying to figure out new life. I love him so much and I want to magically make him better.

September 19 Update 1

Well for the big slide back yesterday afternoon, we seem to be back to at least where we were yesterday morning. He hasn't done it for me but the nurse said he stuck his tongue out. He does open his eyes and move his head yo painful stimuli even though he is very sedated. He also moves his right foot ever so slightly. His temperature is better and he is breathing good so we will work the vent today.

He won't take a sedation holiday today as he needs a rest. Maybe tomorrow. He looks much more comfortable today and his pupils are equal. He does show some abnormalities on his EEG but they aren't super obvious as seizures. He is getting the lowest grade seizure meds just to be safe.

All of the reactions we are seeing are good considering the sedation he is on. I am excited to see what he will do on his first holiday. Especially now that he has the tracheostomy.

This is the worst roller coaster ride ever and I hate roller coasters. No theme park will have this one. Thanks for riding with me and helping me hang on. There will be an update tonight.

September 18 Update 2

I wish this post had better news. Kirk ended up having a really bad day. He did get his tracheostomy and permanent feeding tube, PEG at about 2 pm. However he had some trouble after that. First we suspected based on difficulties maintaining his oxygen saturation in his blood, that he had something happening in his lungs. When they did his tracheostomy they took a good look and tried to clean out his lungs. He had a lot of secretions and they have sent off cultures. However he already has a fever so they have started antibiotics for pneumonia again.

After his tracheostomy the nurse noticed his right pupil was much larger than his left pupil and not reactive. His pupils have not been equal since the accident but they weren't this different so it was a change. The doctors tried to send him down to CT but his ICPs spiked too high and he had low oxygen saturation. They did get a CT from the mobile unit. The CT doesn't show anything significantly different from his previous CT and certainly didn't show anything that would cause the pupil and ICP issues.

They have added another short acting sedative as needed to control the ICP and when I checked in at 8:30 pm he was under control and finally breathing OK. But still had the same pupil issue. They are going to get an EEG to make sure he isn't having seizures. He is also back on temperature control to try to get his fever down.

Your prayers were answered the other night when he came off pentobarbital. Please pray for the doctors and their decisions and Kirk and his body and comfort. He was uncomfortable today and that breaks my heart. Pray for rest for his brain so it can heal and peace within the confusion and discomfort he is feeling.

September 18 Update 1

So this is another busy day for Kirk. We finally got his MRI early this morning. He was just getting settled back in when I got here this morning. There were no surprises on his MRI so that is good. I was able to look at it and you can clearly see where the clot is and how large it is. The vein that is blocked is the largest in the brain.  They were also able to clear his neck with the MRI. There is no impact to the spinal cord. I could also clearly see the contusions in his brain that we already knew about.

Kirk has been up and down today. As we reduce sedation and move him more his heart rate goes up and down and so does his comfort. He has also been vomiting some but his abdominal X-Ray is still clear. It is very difficult to see him uncomfortable but these are all the things that are going to get him better.

He is opening his eyes more but still not on command, only either spontaneously or to pain. He does also move his head around but also not toward sound or command. He is producing a lot of secretions through his breathing tube which makes him uncomfortable. A wound care specialist is going to come look at his bed sores to make sure they don't need any surgical intervention. We are trying to clamp his ICP monitor again to see if we can get 24 stable low hours to get that out. Only after it is removed can we treat the clot.

So something else will happen today that we have been waiting for. And it could seem like a step in the wrong direction and I never imagined I could want this to happen. But Kirk will get the tracheostomy and permanent feeding tube today at 1 pm. This absolutely will make him more comfortable over the long run and allow him to be healthier. It will protect his airway, protect his vocal chords, and allow better access to suctioning and caring for his lungs. When they do this they will take another good look at his lungs, suction everything out and get cultures. The two procedures together will take about an hour and I will put another update up when they are done.

September 17 Update 2

Just a short update. Kirk continues to wake up very slowly. It will take many more days for some of the drugs to wear off. His nurse this evening said he is opening his eyes, not on command, but opening them some. He is not moving any extremities but he does open his eyes to pain. His nurse says he does relax when she talks to him and tells him Sidney and I are ok. He is scheduled for MRI tonight. They may have to sedate him with a short acting sedative to control the shivers. But it will be good to see what else is happening in his head.

We hope tomorrow brings more steps forward. Thank you for your prayers, support and love. Oh and I have a new short proof reader who should be asleep.

September 17 Update 1

So there is still a lot going on today. The central sub clavicle line has been pulled.  It looked like it was compromised on the X-ray and it isn't as needed with the reduced number of medications. Also Kirk will start to get some meds through his gastric tube.  He also gets to start receiving all his nutrition that way rather than by IV. His X-ray yesterday did not show any other concerns with his abdomen. Feeding through his gastric tube will allow him to receive much better nutrition.

His temperature is near normal but he continues to shiver.  This is a fairly normal response to head injuries and the drugs being used to control his ICP.

His pupils are more equal today and he sometimes opens his eyes a little. It isn't anything concerted but it is something. He still responds only slightly to pain.

He is off the ketamine and it is a short acting drug so that is out of his system already. There is still pentobarbital in his system for at least two more days. The only pain medication/sedative he is getting is fentanyl. However as a drip, fentanyl acts as a sedative as well. So it is still impossible to tell the effects of drugs from the effects of his injury.  The doctor is going to start having him take a "sedation holiday" everyday where all the sedative like drugs, including the fentanyl are turned off so he can have a proper neurological exam. The first holiday will happen tomorrow.

He will have an MRI today if he can tolerate laying flat. This is something we have wanted for a while so we can see everything happening inside his brain more clearly. They will also do his spine to clear his neck for the tracheostomy.

I am spending more time talking to him now, trying to catch him up on what is happening in our lives. I have no idea how much he hears but I miss talking to him. He also got all cleaned up last night and his hair washed. He needs another shave though.

I don't know if there will be another update today. He is stable so we will see what the day brings.

September 16 Update 2

Things are changing so much more quickly now that I am afraid of the speed. They are weaning Kirk off of the Ketamine slowly with the goal of having him off before noon tomorrow. He has been off the pentobarbital for more than 24 hours. He is on a pain medicine drip now so hopefully he is more comfortable than when I left the hospital earlier today. He is also on a different, more normal ventilator setting and seems to be doing fine handling that. The only thing that didn't work today is clamping his ICP outlet. He just didn't tolerate that and his ICPs worked up over the morning. So he was opened up to drain again. I am sure we will try again tomorrow.

Kirk still has a lot of work to do to get better and we can help him but he has to do the most work. There will be still a lot of pain to endure and changes to adjust to. Sidney and I will walk beside him all that we can.

In other news, I took Sidney to an eye specialist this afternoon. Both of her eyes drift significantly and she can't consistently control them. The result is that she isn't using both of them all of the time both straining her and causing her to not have good depth perception. I have been expecting to hear the news we got today which is that she will require very minor surgery to fix them. At her age patching and other treatments aren't effective. Bless her sweet heart, braces and eye surgery in one month. But it will be wonderful to see her using both eyes in a way that is healthy.

Please continue your prayers tonight for guidance to the doctors and me in the decisions we will make in the coming days and for strength in Kirk's mind and body.

September 16 Update 1

Kirk has been off pentobarbital for 18 hours. The full effects will take 5 days to go away. However his ICP has been under (sometimes barely) since taking him off. He is on ketamine as his sedation right now. His ICP monitor is clamped meaning it isn't draining. It is being measured continuously. This is a step towards getting the monitor removed. And then moving on to other treatments. We need stable ICPs while clamped and off pentobarbital to get the ICP monitor removed.

We are also raising his temperature to just barely below normal and he is off the EEG, yeah. He has shown no signs of seizure activity. Everything is indicating he is coming off the pentobarbital, like his blood pressure and pulse coming up. 

Yesterday's ultrasound shows several blockages in various veins, probably from being unable to be moved for so long. These could affect his central line so they will be watched.  They are going to do ultrasounds of his lower extremities to make sure his femoral line is protected. 

The doctors are going to data mine all the information they have about his reaction to the anticoagulant. Hopefully they will have an answer tomorrow. The surgeons were also here to look at placing his tracheostomy and PEG (feeding tube directly into his stomach). His vent settings may prevent placing a tracheostomy right now. They are also going to get an X-ray of his belly to make sure everything looks good there because he is distended. 

So the news we have waited for. We need to start to wake him up. I am terrified and excited. He is already showing respiratory effort and reacts ever so slightly to painful stimuli. They will try to get the ketamine off as they can, and replace it with pain medicine. We will likely be walking a tight rope of comfort versus treatment trying to balance taking care of his mind and body. 

I will put up another post later today or tonight. Your prayers are moving us all forward. Thank you so much. 

I also can't wait to tell Kirk how many students have learned things from him and he didn't even know it.

September 15 Update 2

This is a cautious update tonight. The pentobarbital was turned off at 5 pm, 4 hours ago. Kirk's ICPs are holding steady at around 10 on just Ketamine. We need to stay here in order to move on with treatment. They are going to try to mostly leave him be tonight. He is back on blood pressure medicine to bring his blood pressure back down. Everything needs to be optimized to strain his body and brain the least. Please, please pray tonight that we can stay off the pentobarbital and start stepping forward toward getting Kirk better.

September 15 Update 1

This is likely to be a 2 update day. There is a lot going on today. Kirk's ICPs have been stable with one exception. He had a high spike when his breathing tube had to be moved. He briefly de-saturated at the same time so the annoyance of the tube moving, the position of his body and the de-saturation all worked against him but he did recover quickly.

They also got the ultrasound of his neck this morning but I do not know the results of that. The wound care specialist visited him this morning also. He is going to be moved to a higher tech bed to try to keep his bed sore from getting worse. He does seem to tolerate being on his side more so being able to move him will help.

Kirk is down to 0.25 mg/Kg/hr of pentobarbital which is a nice low dose. He is also warmed up to near normal and is shivering so he is being treated according to a shiver protocol to reduce that. Since he is of the low dose of pentobarbital his blood pressure has come up so he is now getting blood pressure medicine as well.

Our ultimate goal in addition to getting him off of the pentobarbital is to get good stable and low ICPs for 24 hours so that we can get the ICP monitor out and try to break up that clot. It is such a fine line we are walking around the ICP and the drugs as well as taking care of his physical needs.

Sidney and I are I think close to on our new cruise control setting. She has been helpful most of the time in picking up some of the things she can do. We have a morning and evening system and a plan for the week on activities and meals. Stormy, the new dog is settling in more also and we are learning her signals and needs as well. My parents left today to go over to New Orleans. They may pass back through on their way back to Colorado but we will see.

Sidney spent all day yesterday with friends from Houston. They took her to the zoo and hung out with her for the afternoon. I visited Kirk for a while and then got the groceries and gas. So we should be set for the week.

I will put at least a short update up later since so much is going on today. Thank you for your continued prayers and support. You are buoying Sidney and I up so we can support Kirk and each other.

September 14

So right now we are focused on rewarding Kirk. He should be back to normal temperature tomorrow. His ICPs are stable on the 0.5 mg/Kg/hr of pentobarbital. We did try to lower it earlier but his ICPs came up just above 20. We are also trying to get some water out of his body. This is done with a dose of albumin followed by lasix. I can already see some reduced swelling in his hands and feet. He is wearing boots now to force his ankles to 90 degrees as they were dropping and stiff. He has not had the neck ultrasound yet. That is scheduled for tomorrow. The last thing really happening today is checking to make sure he does not have a reaction to heparin. He is showing signs in his blood work that he might be so they will verify that before they increase his dosage. If he does show a reaction, there are other drug they can use for the anticoagulantion.

If there aren't any significant changes I won't put up another update until tomorrow.

September 13 Update 2

There really wasn't much excitement for Kirk this afternoon. No significant change in medications today. Leaving his ICP open to measure versus drain did not work. His ICPs increased above 20 but decreased immediately with opening the drain. There is very little drainage but he needs just that little bit to maintain ICP. He is still getting warmed very slowly. Pentobarbital is still at 0.5 mg/Kg/hr. He has not had the ultrasound yet. Other than continuing to warm him, nothing should change tonight.

I stopped at a Long Term Acute Care facility on my way home this afternoon. It is the first one I have looked at and it seemed fine. It is very close to my office and on the edge of the medical center closest to home. I think I would be fine with Kirk going there but I am going to look at one more facility if not two. This type of facility can provide near ICU type care once Kirk is stable. He will not go there with pentobarbital or anything like that so we are probably a week or more away from a move, pending getting controlled ICPs without pentobarbital and possibly getting this clot dissolved. This facility bridges the gap between ICU and an intensive rehab facility.

After my visit I came home and ran. That is very self serving but I needed 35 minutes of high heart rate and fast breathing to recharge my batteries. It was cool and windy today so I had a strong head wind going out but a nice tail wind coming back.

My folks joined us for dinner. My dad took care of a couple of to do's and then grilled some steaks. They also brought my four potatoes that would have rotted without our big eater, back as potato soup in containers and my spaghetti squash all ready to spaghetti. Tomorrow they need to take all but 3 of my eggs. I don't eat eggs and Sidney can't eat 10.  This may seem nonsense but I hate to waste food and had just gone to the store buying for three the day before the accident. Kirk eats as much as Sidney and I combined.

I have a plan for next week which is a big step for me. I am finally moving from just hanging on to moving our little family back forward. I can't do it alone though and I thank all of you for your continuing support in the many ways I feel it and the ways that I don't even realize.  I even have our meals planned and a very short and manageable grocery list.

I won't be going to church again tomorrow. I am very sad about that but I still need to meet with the doctors every morning to discuss and understand what the day will bring. Although Kirk is stable, he isn't far enough along for me to not be involved in a significant way each day.

September 13 Update 1

The CT that was done the other night shows that the contusions in Kirk's brain are resolving and the swelling is decreasing. That is good news.

We are holding steady on ICP with a low dose of pentobarbital 0.5 mg/Kg/hr. The goal now is to see what his ICP is when he is warmed up. So his temperature will be taken slowly back to normal. 0.1C over 2 hours. However the nurses are calling him an over achiever on his temperature. He meets his temperature goals and then exceeds them. This means it is hard to control and not ideal swinging high to low and back.

We are stopping the constantly open cranial fluid drain and just monitoring his ICP constantly. We can always open the drain if needed. His pupils are equal and reactive but sluggish. He will also get an ultrasound of his neck veins today so we can see the clot and verify normal flow in all the other veins.  Finally we are increasing his heparin, or blood thinner to try to start attacking that clot. We are doing so gradually to make sure we don't have an unwanted effect.

He had a nice bath this morning and lost the remaining wiskers he was holding on to. So he is nice and clean shaven now. We redid some towel wraps and I got to use my good engineering self. Each of the three pieces of tape on each of the three towel rols has five squares of tape. The tape is awesome, it is perforated every two inches, so you don't need scissors. And you can be exact.

We had a quiet night last night. He had only routine monitoring and no drug changes. We didn't drop the pentobarbital until this morning. Future activities will include eventually doing a tracheostomy and inserting a PEG, which is a line into his stomach, unless we can get him breathing on his own by mid week. Honestly I would sing and dance if we got there.

I have placed a guest book in his room. It will usually be on the table or bench. It is a small blue book and if you come to visit I would love for you to sign it and maybe leave a short note.

September 12 Update 2

There is no change tonight. Kirk is stable at 0.75 mg/kg/hr pentobarbital. He will stay at that dose tonight. Hopefully he can have a restful night. I will discuss options with the doctors again tomorrow and we will see what the next step is. For now I am calling it a night and having a date with my husband. Hopefully this one if more restful for us both than last Friday. Good night.

September 12 Update 1

I apologize for this update being so late in the day. We needed to consider a decision about what to do next for Kirk. We have the results of his CT which was done with contrast. That shows that the blockage in the vein leading from his brain out of the right side is enlarging. Because spinal fluid enters the blood stream from the brain, the reduced exit flow is likely what is causing his ICP. So the choice we had to make was to try drugs to break up the clot or wait.

Risks of trying to break up the clot include bleeding elsewhere in the brain. This is a high risk on Kirk because we can't do a neurological exam on him which means we would not know until he had a bleed in his brain until it was very large. The only way to check for bleeds on him is using a CT every 24 hours. On someone not as deeply sedated, regular neurological exams can be performed to detect the effects of other bleeds. Another risk is his ICP monitor in his head. It is inserted through his scalp and skull into a ventricle in his brain. It alone can cause a significant issue on a strong anti-coagulant. One more risk, which exists anyway is that part of the clot can break off and migrate to somewhere else it isn't wanted like the lungs or elsewhere in the brain.

Risks of waiting include the continuing possibility of high ICP and the fact that the clot continues to increase in size down his neck. Also the vein on the right is usually the larger vein taking more flow than the left so the left is really being overworked.

So we have decided to wait at least 24 hours to see if we can get him off of the pentobarbital and controlled by other drugs. I don't know if that will be enough for us to do neurological exams. I also don't know about the ICP monitor. So we will talk about it again on rounds tomorrow and see where we are.

Otherwise Kirk is stable. His ICPs have been low today. He got another clean up and fresh sheets. We did another round of blood cultures just for monitoring because he still might have a fever even though he is only 91F. We are going to raise his temperature slowly while removing the pentobarbital. His femoral line is still good and he is able to get all the meds he needs right now easily.

Please pray for the doctors to have foresight and knowledge to guide me in making the next critical decision on Kirk's part.

Tonight is my night at the hospital. I hope it is quite for him and we can both rest quietly as close together as we can get for now.

September 11 Update 2

Kirk was stable this afternoon on the pentobarbital with no ICP spikes. He did have a busy afternoon though. First he got a sponge bath and new sheets. This is the first chance we have had to look at his back sconce he has been unstable for eight days. He dies have some significant bed sores so we are going to push the docs about letting us at least tilt the bad to move his weight around. He tolerated the bath and sheets well. It really is a lot of moving and stimulation for someone with such a severe brain injury. He also got a shave of both his beard (sorry honey) and his 11 day growth. The tape around his tube would no longer stick to his face.  He got a new c-collar and we were able to look at his road rash which is healing nicely.

After a short break they set back to work. Kirk needed another central line because of the number of medications. Some are incompatible requiring chooses to be made on which medication could be used when. It was a serious juggling act that can result in an unintentional mistake.

First they tried to put a line in his left arm in the bicep area. They could thread the wire in but not the catheter. However, while preparing for this the practitioner found that the IV in his left arm was not actually in a vein. So when he pulled that out a large volume of fluid drained out of the hole onto the bed, pillow, sheets and floor. Everything at least recently that had been put in to that line came back out. This includes all the individual doses of ketamine they gave him last night to try to bring his ICP down. So the meds were of limited value. The funny part, and it is really, is that ketamine vapors are enough to knock you out. The practitioner was wearing a mask. I wasn't. I got very dizzy and had to walk out before I knocked out until everything was cleaned up.

He still needed his line so they tried for a femoral vein on his left side and in the second try got that. It is a good three ported line giving them tons of flexibility now. His other central line is nearing the end of its life span so it will have to be replaced in the next few days.

He is going to get a CT tonight but this time with contrast. I an anxious to hear the results in the morning.

Our beloved pastor from Houston's wife visited us at home and shared dinner with us. I cherish these moments of normalcy and sharing a meal. She brought a lovely and generous gift from the choir in Katy. It included a new owl for Sidney's collection. But her visit recharged me fully drained batteries. I was on the end of my ability to cope. Sidney also had swim lessons tonight. She has been in them since school started but she was in a class at too low of level. She got moved and she was forced to swim her tail off tonight. She was beat. But she was challenged. She is claiming it is too hard but she is very capable. It is super funny though because the class only has two students. The other is a boy who is at least 1 foot taller and out weighs her three to one. They are a funny looking pair.

I was able to swim laps while Sidney took lessons. It was good for me to worry about kicking, moving my arms and breathing and nothing else for 30 minutes.

Thank you all again for your continued support, prayers and love. I really do appreciate it more than my words can say.

September 11 Update 1

Kirk had a rough night with high ICPs resulting in him halving to be put back on pentobarbital. He is back on at 1 mg/Kg/hour and that is controlling his ICP below 10 with a nice wave form.

There are other things happening in his body due to the amount of time he has been on sedatives and other drugs.  He is needing insulin regularly and has been put on an insulin pump.  This is common for traumatic injuries or major surgeries.  He needs the pump now because he is getting nutrition via IV resulting in his blood sugar staying high. 

He is also getting synthroid, thyroid hormone replacement, because his thyroid is either injured or sleeping soundly now.  This really isn't a big deal overall but it is something that needs to be controlled to not put any more strain on his body.

And he is likely to start a medication I actually take and which is very uncommon.  It is called Desmopressin Acetate (or DDAVP) and is used to control the sodium content of the blood.  His sodium is high, which to some degree we want to pull water from his cells, but he is also dumping water which indicates he needs that drug. Normally the pituitary, a small gland inside the head under the brain, secretes the required hormone based upon its own sodium test, telling the kidneys to hold or release water.  Again because of the sedation or injury that may not be happening for him.

His face looks better every day. His eyes are much less swollen, even his whole face is less swollen, and his raccoon eyes are fading.  And he is about to get a shave, at least of his mustache.  He has so much facial growth that the tape around his air tube won't stick anymore. 

I have not watched the news or been on-line in 11 days now.  I generally don't have any idea about what is happening in the world.  But I do know today is 9/11 and I hold in my prayers all the families who have been down the road I am on or who lost loved ones so many years ago today.

September 10 Update 2

This is a short update. Kirk is still having ICPs into the 40's, much higher than desired. The other meds aren't lowering the ICP so he is receiving doses of pentobarbital every few hours. Doing the math it is about the same amount over time as he was getting at the 0.25 mg/Kg/Hr he was on before. It is a low dose but I sure want it to go away. I am going ask again about a CT tomorrow to see what is happening in there.

I hope and pray tomorrow is better. Good night.

September 10

It has been a more up and down day today. Kirk is off of the pentobarbital and back on ketamine and fentanyl. His ICP was good when he was still on the low does of pentobarbital but it shot up to 40, twice the maximum desired pressure, and with a really bad wave form (high middle peak) as soon as the pentobarbital was turned off. The middle peak was so high you couldn't see the other peaks. It gave me quite a scare. They raised the ketamine and the ICP was back to 10 but not the best wave form ever. At about mid-afternoon the ICP went back up to 26 and still a high middle peak. That is where I can leave off. I will put up another short post tonight with details of where we are in control of the ICP.

Everything else on Kirk is about the same. His primary care is working the ICP. They are still controlling his temperature low and have him positioned to try to lower the ICP. So we haven't gotten off the roller coaster quite yet but I am really hoping we can get control with the ketamine and stay off the pentobarbital.

Sidney and I are doing fine. We need a mediator from time to time. We did piano lessons last night and then had dinner at home with my folks. This morning we found a little toad on the door step when we went to put out the flag. I am going to the store tonight on the way home and we will have dinner with my parents again. I need to sort out smoke detectors tonight, or better put get help with that task. I think one started beeping low battery in the middle of the night but I don't know which one.

September 9 Update

Today is a day of more pleasant waiting.  Kirk's ICP was high, 22, when I arrived at the hospital but he was getting hooked up to the EEG so his head was at a odd angle, his breathing tube was bent and they were gluing stuff to his head.  All those things would make my ICP high too. Once they finished up his ICP dropped to a nice 4 with beautiful waves.

Kirk was on 1.2 mg/Kg/hr of pentobarbital this morning. His lowest dose ever.  They have lowered it to 0.75 and his ICP has stayed less than 5.  They may lower it more if his ICP stays good but they have to manage his temperature as well alongside the removal of the pentobarbital. And being a hot body he doesn't like his temperature managed.

His CO2 was high again this morning so more vent changes happened.  This is manageable.  His sodium is actually higher than desired so he is getting a drink of plain water to dilute him out a bit.

As I mentioned above he is hooked up to the EEG again.  This is mostly to verify that there is no seizure activity as he comes off the pentobarbital.

The nurses and staff here are beyond spectacular. The nurses don't know him but they all want him as their patient.  And everyone is rooting for him. They may change their mind if he is too rowdy when he wakes up.

Tonight is piano lessons for Sidney. Her favorite activity (just after getting a tooth pulled).  I hope I will also get to see my parents tonight. 

September 8 Update

We are on the important day 8. We have made it one week past the accident and if Kirk is consistent with other severe traumatic brain injury patients we will start to see improvement. It will be an arduous long road though.

This update is late because there is a new doctor today and I never actually got to see a doc and it has just been hectic for me. The Neurological Intensivists change each week between 3 doctors. So rounds took longer today. Kirk has been stable though with the pentobarbital. Now we just need to wean that off. That is a baby step process right now. He has been lowered from 2.75 mg of pentobarbital per Kilogram of body weight per hour back to 1.5 through the day. ICP is still good with nice wave forms. He will likely stay at 1.5 overnight. All of the other treatments I mentioned previously are also continuing like cooling, etc. he is also trying to over breathe then ventilator meaning he is trying at least some to breathe on his own. Yeah!

His heart rate is rather low but it is probably nothing to worry about. Our goal over the next few days will be to transition from pentobarbital to a pain management and sedation strategy from this one. When we get there we will start to get a picture of what recovery will look like.

Kirk's parents made it safely home and my parents are safely in San Antonio. I caught up with them this afternoon. They will be here for a week.

I have set myself up a little office in the corner of Kirk's room. I can keep my eye on him and fill the hours with work. Last week felt like an eternity watching the clock tick off each hour. I also took care of a lot of business with his insurance and benefits today. One thing I learned is his new plan year started September 1. So at least the timing on that is good.

Sidney and I are settling into a routine. We don't see eye to eye on everything (like getting up in the morning and practicing piano) but that is normal.

If Kirk stays stable we will go to one post a day. I will try to get it closer to mid-day though.

Kimber

September 7 Update 2

This is a short update. I have been with Sidney and some friends trying to take care of home this afternoon and evening so my update is based mostly on phone conversations with his nurses. Kirk's ICP rose over the afternoon and so they increased the pentobarbital from the 1.75 mg/Kg/hr (the Kg is body weight) to 2.75 to try to get his ICP below 20. However they did find that he had high arterial CO2 and they have adjusted his ventilator settings to try to help lower that. It seems to be working and his ICP has lowered so they will try to lower the pentobarbital some over night along with watching his arterial CO2.

Several members of the team Kirk worked with in Houston came for a visit this afternoon. I wish I was able to meet the people of his away from home life under better circumstances but I thank you for your support.

Sidney and I ate dinner at our table this evening with our dear and supportive friends who have been by our side since the first hour. It was good. Not to mention it was a well balanced real meal with meat, veggies, carbs, and desert (which did have fruit). It is difficult for me to feel like I am in the right place if I am with Sidney or with Kirk. But my husband is in the best hands anywhere and our daughter needs my hands.

We also got Stormy, the sweet young dog we adopted just three days before the accident, back home. She was visiting our dear friends until I could get my feet on the ground. She is super sweet and I am happy to have her home.

Kimber

September 7 Update 1

Kirk had a very stable night. His ICP stayed under control all night.  There have been no significant changes during the night or this morning.  They are now trying to lower the pentobarbital while controlling his ICP. He was at 2 mg/Kg/hour over night and this morning.  He had been lowered to 1.5 and his ICP came up so we are going back up. We are dancing on a balance beam. I visited with the doctors this morning and we are just in the waiting game. This is day seven so hopefully the next few days are less of a roller coaster and more of a slow moving log flume ride. Not the same level of excite but slow and steady movement.

The doctor explained more about the healthier ICP pressure wave and that Kirk's wave more matches that wave form now than it had.  If I can figure out how to get it in here, the drawing I mean, I will do that.

He is still on a cocktail of drugs. He is on the pentobarbital, fentanyl, norepinephrine, tylenol, potassium, hepra, antibiotic, anti-seizure and antacid. The goal is to manage what needs to be managed with the minimum amount of drugs.  So they get adjusted regularly to find a good spot. His temperature is still being maintained low, around 90F, although he still also has a fever.

His nurse to today is Mesha. His nurse last night was Allison.  They are as fabulous as all the other nurses have been.  I have to admit that the pumps and pipes are cool to me. I like to see the different ways the nurses manage the pipes or the tubes. Each has their own system to keep the tubes, of which there are 10 or so at any one time, under control. Yesterday a small cup, like you would take cough syrup with, was taped to the bed rail above Kirks head to make sure the tubes stayed up there. Today a tough depressor is taped vertically to the bed rail to contain all the tubes. We will see what the next nurse does.

So Kirk isn't the only patient here.  Although I am obviously centered on Kirk I see the other families waiting and wondering just the same way I am.  There are also patients that don't have the support we are blessed with. Please will you hold them in your heart and prayer also.  All of these people are experiencing one of the worst events of their lives.

I will be spending the afternoon at home today. I need to get a few things done around the house, get Sidney ready for the week and just breathe. My stalwart friends are coming over to help me get a few things that are harder to do as one done.  I will never be able to thank them enough for their help.

Kirks parents are leaving at noon. I know that is a hard decision but we will need help later. Right now we are in a holding pattern and they have things they need to take care of. My folks will be here tomorrow.

Some Answers, Some Questions

I spent a good deal of time this evening after things calmed down trying to understand more of what is/has happened in Kirk's head and working on refutes for some things we have previously heard.

First, it appears that Kirk just crashed. That's it. We had been told that maybe he had an aneurism or a stroke which made him fall. He didn't. We won't know how or why he crashed. It just happened. I did go back to the scene and there was nothing to tell me more. I didn't think to ask the one witness. I was too busy keeping my husband alive.

I also learned what is happening in his head and a bit about why. First he has significant bruising, just like on another body part, in two parts of his head. The right rear at the base of his skull where there is also a fracture, and the top, above and left of his eye. There are also many other small bruises. The brain really doesn't like to be exposed to blood outside of vessels so it swells, causing an increase in pressure. The more you can make the person rest, hence the drugs, the less other work the brain does, so it can swell but not cause as much of a pressure increase.

Both of these bruises developed nearly immediately after impact. They existed when he was admitted and he never regained consciousness, he did react to pain and had reactive pupils.

There does remain a question. A major vein on the right rear of Kirk's brain was damaged by the fracture. This however took time to show and did so by forming a clot, no longer allowing blood to leave that side of the brain. Blood now all gas to exit the left side. As this took time to occur it happened after he was sedated and we have no idea the effect. We won't know until the drug weaning starts.

The last ditch drug is last ditch in part due to side effects and due to its irreversibility. The other drugs have lets say reversal drugs. You can give a drug to relatively quickly reverse them. Pentobarbital does not. It can only be reduced and allowed to work out if the system. It will be at least a week before it is out of his system and that's if it is stopped in 48 hours.

To the CT. I am a simple engineer but I have looked at every CT he has had except the first one in the ER. This one was vastly different. I could clearly see the difference in the swelling. The doctors I talked to today said there was a significant decrease in swelling at the base of the skull and it appears he is not in danger any longer of herniating his brain through the spinal column hole at the base of his skull.

We are a week at a minimum from having the smallest clue of what the future is. I pray and hope that we are past the point of questioning if there is a future. We are far for out of the woods.

Thank you again for hanging with us. My words will never express my thanks but I can try.

Kimber

September 6 Update 2

Kirk's family came up to the ICU at about noon and since I had been here all day and night I needed food and a Sidney refill. A friend from Houston is visiting for the weekend so we stopped and ate and then headed home for a few hours. When I left Kirk appeared to be in the same shape as he had been once the ICP was controlled overnight. They also had started some nourishment into his stomach. Which the nourishment smells foul and contains maybe 40 ingredients including sardine and anchovy oil. Nasty!

And then the scariest moment since Monday occurred. Kirk's family called me and told me to come back to the hospital immediately. Of course I panicked. There were no details, just to come.

Our friend drove me back and the doctor met with me to fill me in. Kirk's ICP spiked higher than it ever had to a very dangerous level and it did not respond to any of the treatments he had responded to before. We had reached the last possible medical intervention, pentobarbital. All of us were terrified. We talked again about the possibility of a surgical intervention while they were preparing Kirk for a CT. It just isn't a viable option that could be successful.

Our first good news came though. The doctor came and told us that his CT was better. Much of the swelling of his brain had diminished.  I asked to see the CT and I could see a difference immediately in the ventricles in the center of the brain. I could also clearly see the two lobes which was not possible before.

I can't tell you how scary those two hours were. I was afraid again that we were at the end. This drug has to continue working. They are still cooling him, giving him some of the other drugs and Tylenol. They are now having to raise his blood pressure because the pentobarbital.they are using norepinephrine.

I am going home tonight. I needed last night but I also need to sleep. Sidney and I have to make it through a 5 day week this time so I need to stock my reserves.

Tomorrow is Sunday. I will spend the morning with Kirk and the afternoon with Sidney if everything is stable. I am counting on those compacted prayers, one on top of the other starting in Norway and working around the globe tomorrow. Bless you all. Thank you all.

Kirk's family will leave tomorrow. Mine have made it to San Angelo from Colorado Springs and should arrive tomorrow. I am anxious for them to get here safely.

Kimber

September 6 Update 1

I spent the night at the hospital with Kirk. It has nothing to do with the care he is being given or a worry that I won't be contacted as needed.  It was only for me to have one night close to my husband. I am trying to balance my time between Kirk and Sidney and last night Sidney was well taken care of and I needed to be with the other love of my life.

It was another difficult night. Controlling Kirk's ICP (cranial pressure) still defeats the doctors. They had started cooling him last night to 95 and now they are taking him to 91.5F.  He is tolerating that but it is mostly because they have added paralytics to his medicine regime.  So he is on sedatives, pain killers and now a paralytic.  This also means he is even less responsive than he was.  His pupils are larger and less responsive now also. He still has a fever so they will bring Tylenol back in to help control that and did another X-ray of his lungs just to make sure that all looks OK.

We did wash his face last night and replaced AT&T the tape on his tubes. The swelling in his face reduces every day. His black eyes are slow to fade and even his eyeballs are swollen. These simple physical problems will heal with time.

He continues to be one of the sickest patients in the hospital. He is still in a critical phase of the affects from his injury. There is one more medicine if needed to try to control the cranial pressure but then we will be out of medicine options.

His nurse again today is Jessie and he has a student, which if he was his normal self, he would appreciate.  His nurse last night was Crystal and the past several nights he has had Jakob.  He is getting super care from everyone here and they consider him as one of their own.

I will put up another update later today if anything changes. Thank you again for your continuing support and prayers.

Kimber

September 5 Update 2

Kirk had about the same type of afternoon as a morning. We are really fighting swelling in his brain and high ICP. Those are the highest concern right now. We are trying to not stimulate him at all to keep his stress to a minimum. He has been on an EEG (electrical scan of the brain) several times to look for seizure activity. He still isn't stable enough for an MRI. They are also chilling him down to 95 degrees to try to reduce the brain swelling.

The format of this post isn't super. I am trying to do it from my IPad but I wanted to include pictures of his helmet and bike. His helmet is obviously damaged but there is almost no damage to his bike. Only a little damage to the right handle bar and shifter. I just can't wrap my head around this.

Sidney is spending the night with a friend. Same family who has been by our side since the first hour. They took Stormy, the dog we adopted one week ago to the vet to verify she is in good shape. Stormy has been visiting them since the accident and Sidney and I are going to try to bring her home Sunday.

I am spending the night at the hospital. I need a night with my husband.

I want to say thank you to everyone for everything. The prayers, the food, flowers, offers of help, support and on. I apologize if I don't return a call, message, or email. I do get them and I thank you for them. They are helping to keep me going. I won't lie that each day is hard. Your support is so appreciated even if I forget to tell you.

September 5 Update 1

Kirk was too unstable to go to MRI last night. He can't lay flat for any length of time, certainly not the hour needed to do the MRI. When he lays flat his ICP spikes. It spiked several times last night and he gets more medications every time. He is also still on the alternate vent setting to keep his O2 saturation up. He is down to 50% O2 mixed with air to maintain his saturation. I hope maybe they can change the settings later today. He also had a CT this morning. They brought a portable machine to his room. It took 4 people to turn his bed to get the machine in the room with all the lines, monitors and ventilator. They did not feed him last night because of the continued concerns of aspirating stuff into his lungs. He is staying on strong antibiotics. His nurse this morning is Analisa. He is starting to look more like my Kirk. The swelling in his face is reduced and his black eyes are showing a hint of fading.

I saw the doctors this morning. The cultures on the infection in his lungs came back and it is a staph infection. It is improving. His fever is down and his shivers are gone so it is responding to the antibiotic. His arterial blood gases also show his saturation is improving. The doctors also said that between day 3 and 5 we should be at the peak of the brain swelling. They are considering doing surgery to remove part of the back of the skull to relieve pressure. The specialists are discussing that now. He has what appear to be two large clots on the back of his brain, kind of behind his ears, from fractures there. He has two fractures at the base of the skull on the back I addition to facial fractures. They still really want to do an MRI and MR Angio but can't until his ICP is stable. He will remain in a drug induced coma until the ICP is stable and acceptable and then there will be the long process of trying to wake him up.

Even though when I am at the hospital if feels like the world has ground to a halt, it hasn't outside. Our beautiful daughter continues to live her fairly normal life. Many of you have asked how she is doing and she is doing fine. She has not seen Kirk so I don't think she fully understands what is happening. She realizes dad isn't here but she is also getting tons of goodies. Visit from Grandma, spending several nights at some ones house with a pool. Unfortunately at some point this will become reality. She will eventually have to see him and we can't predict when that will happen, what he will be like or how she will react.

She does love her mom a lot. She is as concerned about me as anything. She quizzes me on what I eat and rubs my back with love.

Last night when I was tucking her into bed she told me about her dream. She starts with the fact that she has this dream about 2 times per year. She calls it her Madagascar dream. It is about the animals from the movie. They are on rafts and they trade the rafts for a bigger boat and continue trading up. In a big storm the boat is destroyed and they end up with rafts again. Then they meet a baby seal who takes them home. But the Madagascar animals are to big to fit in the small ice house of the mother seal. Then Sidney says that the dream is so long she has never gotten to the end before she wakes up. I needed that love and laugh in my life. What a sweet and wonderful baby girl we have.

September 4 Update 2

The afternoon has been better, more stable than last night and this morning. Kirk had an echocardiogram late this morning to look for signs of infection in his heart on the heart valves. We don't have the results of that yet. He also had the second bronchoscopy and they cleaned his lungs out more with that. We are also turning him more to keep his lungs and body shifting.

He is back on the cooling blanket to try to control his temperature. He was also given ketamine to reduce the ICP.  He is much more deeply sedated now than before.  An ophthalmologist came to look at his eyes but can't give a full report until she can dilate his eyes. They look OK so far except for the fractures around his eyes. He will go for MRI tonight. He also remains on the alternate respirator setting which works by inflating his lungs and then holding pressure for a couple of seconds before allowing him to exhale. This keeps oxygen in his lungs longer. It isn't a preferred setting but he is staying more saturated that way. They will have to change the settings when he he goes for MRI so it will be a chance to see how he reacts.

He will get some liquid food tonight. We have to keep my big man going.

I am operating by lists. I have figured out that I need to write everything down and to ask people to remind me to do things. I did sleep more last night and am starting to feel like I have a grip. Every set back makes me question that.

When I left the hospital this afternoon to take Sidney to the orthodontist, my low tire pressure light was on. I managed to get air in and all seems fine but all I need is a nail in my tire.

On a normal note, I took Sidney to the orthodontist. She has to get a small set if braces, brackets on her four front teeth and brackets on the back molars only on top. She is not happy but she did pick star shaped brackets so she is "settling" for those. She has piano tonight but I have managed a quick visit to Kirk before that.

The angels keep coming to me. Someone sent Sidney a beautiful unicorn pillow pet and provided us with more meals.

September 4 Update 1

I had to leave Kirk's room immediately after I arrived this morning. They need to look in his lungs and take a sample of the secretions that have developed. His O2 saturation dropped over night and he is still feverish. He has a lot of secretions from his lungs. We have worried since day one that he aspirated vomit before his air way was controlled. His temperature is being controlled with a water blanket. The EEG has been removed so I am guessing they will try to get an MRI sooner today. His ICP or inter cranial pressure was high over night.

So I was told in the ER that he might have had a stroke but that isn't correct based upon what I am hearing now. It is more likely that if there was an event before the crash it was an aneurism. I do not think he just crashed. I could of course be wrong but he has never crashed as an adult and we have ridden many thousands of miles.

The bronchoscopy showed secretions and that the temperature monitor which should be in his esophagus was in his lungs. He has aspirated quite a bit. They are starting him on strong antibiotics to fight the pneumonia he has developed. They have also changed his vent setting and will do another bronchoscopy later today.

Some of Kirk's family and friends are wondering what he looks like right now. I will do my best to describe him. His face is swollen and bruised and he has the worst black eyes ever. He has the ICP catheter in the top of his head. He is wearing a C-collar on his neck because even without broken bones there could still be spinal injuries. He also has a breathing tube and nasal gastric tube into his stomach.

He has a central line in his chest and an arterial line in his right arm along with a standard IV. The arterial line provides blood for blood work and real time blood pressure. His O2 sensor is on his right hand. He is also having his heart rate monitored.

He has compression cuffs on his legs and he is right now covered from neck to toe in blankets and temperature controllers. He does have road rash, mostly on the right side and back. Most of that is healing well.

His blood pressure is much more under control now. They got him on his home medications. Today is the first time someone has said he can recover (assuming we fight the pneumonia) and I want to believe it. I do but I am afraid to.

My day starts with getting Sidney fed and delivered to school. Then I go spend the day with Kirk. I pick her up and we take care of our afternoon and evening commitments. I try to sleep and we start over. Sidney is currently sleeping in our room. Her room is too far away.

I will post again later today. Thank you for your unwavering support. We are not alone. The people around us are stacked so deep we couldn't get out if we tried.

Today's nurse is Jessie. His doctor continues to be Dr. Specific and his coworkers continue to visit and support us also.

September 3 Update 2

I was able to go back and see Kirk this evening and unfortunately I was shocked. They were re-setting up his EEG and he was under a warming blanket and there was a higher stress level that I could feel immediately. After I left this afternoon his blood pressure went up, his pulse went up and his cranial pressure went up. These changes were significant enough to warrant another CAT scan. He also developed shivers. Fortunately there doesn't appear to be a significant change to the CAT scan. It still shows a significant bleed.

They have increased his sedation and increased the medications for the shivering as well as maxing out his blood pressure medicine. They are doing cultures to diagnose the fever and are treating that to start with gentle cooling and Tylenol. They will do more aggressive cooling if needed.

For Kirk's nurse friends I tried to write down at least some of his meds. This is a learning test for me and I am trying to get sharper. I struggle to remember anything so I am learning to travel with eon and paper and to write everything down, including what I need to do in the next hour. Kirk is on Midazolam, Magnesium, high percent saline, Fentanyl, and Cardipene (maybe got those right) at least via IV. He gets some other things through his NG tube and also insulin right now.

They will finish the EEG tomorrow but thus far there are no indications of seizure activity. After the EEG is complete they will send him for an MRI as well as a MRA. They promise to call me if anything significant happens.

I had a very good conversation with the night neurologist. She took the time I needed to answer my questions and to help me feel as secure as I can with what isn't known. We are not through day 3 on a multi-day journey. There are no answers right now. They treat immediate problems and consider success as stopping that from getting worse.

Kirk's cousin drove us over to the hospital tonight. On the way home there was a van parked on the other side of the main road leading to our subdivision in a small pull off. The area is carved or blasted out stone, flat on three sides, like a cliff. The van was projecting "Love Prevails" on a wall in lights. Why? The three of us in the car were touched.

Kirk has always held my hand on the sickness and health. My turn now. I do struggle to balance where I should be, with Kirk or with Sidney. I am never quite sure I choose right. She needs both parents and I am barely adequate to fill one role now. Sidney is confused but still my cheer leader. All of my love is reflected back.

The love and support pours in. A colleague brought found last night and someone else brought food tonight. The office sent beautiful flowers and another office an edible arrangement which me made a good dent in. So many are asking what we need and for now we are doing OK. I promise I will ask for what we need. We have a journey that will take a long time. We will need you. And we thank you for what you have already done and what we know we can count on fir the future.

Bless you. Thank you. Pray for the turn we need to come. Love will prevail but it isn't my love alone.

Kimber

September 3 Update

Kirk is feisty this morning. They are trying to minimize his sedation but also not let him get agitated. They are also working hard to control his blood pressure. He gets very irritated at everything, having his teeth brushed, taking his blood pressure, and washing his face.

Kirk was admitted at Unknown Oros Male. Because I was not with him and he couldn't say his name, the computers assign him a name. I would love to see his real name on everything but it apparently takes forever.

He has a fabulous nurse this morning. Kesha is taking super care of him. She has washed his face and brushed his teeth. She keeps me involved with everything.

His mom and dad as well as aunt and cousin arrived last night. They came to see him last night.

I have just met with the doctors. They showed me his latest CT scan. He still has a significant amount of swelling and some new bruising. His pressure in his head is still OK. His blood pressure is high. They are going to continue the same medications and plan. He will also have the EEG today. That will show the extent of any seizure activity.  Otherwise the waiting game continues.

Sidney did swim lessons last night and a wonderful colleague brought us a casserole for tonight. I will just spend time loving on Sidney tonight.

Kirk Update September 2

Kirk has many supporters and they all showed today. Doctors from his job now came to see him and doctors from his job in Houston have also checked on him. And these are all neurologists who know and care about him. Thank you Lord for leading him to this profession.

He is on anti seizure medicine, sedatives and medicine to reduce the swelling in his brain. They are trying to control his sodium high to pull water from his cells to reduce swelling. He will have an EEG to check seizure activity. I do not know the results of his CT to clear his neck yet.

He is being moved to the 8th floor which is the neurosurgical ICU meaning he will have around the clock neurologists and neurosurgeons all the time. He will be in room 8085.

Sidney is doing OK. I don't think she understands all that is happening. Tonight she has swim lessons and curriculum night at school. Kirk's parents will also arrive tonight. I am wearing Kirk's wedding band on a chain around my neck until I can put it back on his finger.

The doctors said today that we will have a better idea of how he is going to do in about 5 days. Until then he rests and tries to heal and we wait and pray. Thank you for your support, your prayers, and your thoughts. Support is coming from every direction and every side.

Kirk's Accident and First Update

My dearest friends and family.  We started this blog almost 5 years ago when our life took us on one of the greatest rides ever, off to Norway for a new chapter of our lives. We detailed the great adventures we were blessed to have and have kept you informed of our life through three moves.

Today the blog will used to keep you informed of the next, and most difficult chapter of our life.  For now, all posts will be by Kimber and there will be at least a post per day.  There won't be many pictures for a while. And Kirk, my great proof reader can't help me right now so please forgive my grammar.

Kirk was in a very serious bike accident yesterday, September 1. He was wearing his helmet but he sustained a very serious brain injury. We were about 3.5 miles from home and going maybe 25 mph. God's angels were with us immediately. Many people stopped and helped him and me. Talented EMTs and Paramedics got him to the hospital alive. A wonderful person took me home so I could get Sidney.

Kirk was in the emergency room until mid-afternoon. He has a subarachnoid hematoma and significant swelling at the base of his brain.  He has developed further hematomas or bleeds over the day.  He also has many broken bones in his face.  He is on a ventilator and is nearly unresponsive at this time.

He is currently in the ICU at University Hospital in San Antonio.  He is in the best hands possible.  People he works with have been by to check on him and see if there is anything they can do.  Our pastor from Katy has come to be with us for a while and our pastor here is holding our hands as well.

Kirk's parents will arrive tonight.  Kimber's parents will come next week.  Sidney spent yesterday with a wonderful friend and is in school today.  I am trying to keep her life as normal as possible and to give her all the love and support I can.  Sidney and I are taking one hour at a time hand in hand with each other, our God and our friends. We have no doubt we are held tightly every minute of every day.

We are officially 24 hours into what will be a very long journey.  We don't know right now what the end looks like.  Thank you all for your love, support, prayers and thoughts.  Thank you will never be enough for the impact you are having on our lives.

I will post at anytime there is news or an update and at least once per day.  Thank you all. We love you.

Kimber