God always knows what lies ahead of us.  I did not want to move all the way accross the country AGAIN, but my husband really strongly felt we should move to be closer to my folks.  So in June, Dad came all the way to Pennsylvania and helped us get rid of most of our stuff and load up what was left and move all the way to the West Coast.  (I know if anyone reading this helped us load up or unload, you may take issue with the word "most" in "most of our stuff", but it felt like it in the purging and it was at least half of our stuff :-).

Well, if you've read this far you're a trooper, so now I am going to give you some more details of dad's injury and progress so far.

As you have already gathered we have staunchely refused to "let him die" at every opportunity, and the blessing is that he has refused to do that too.  When he was first moved to the ICU, he was on a ventilator to breathe for him, a pace maker to maintain his heart beat, an IV for fluids and drugs, a feeding tube for food (Forgive me if anyone finds this offensive, but for pretty much crappy garbabe food.  YOu know in North America we start most people out on Corn Syrup with added synthetic "nutrients" and we potentially finish them that was 50 or 60 or 80 years later!)  I am not sure how anyone's body can really heal on that diet but we'll save ther rest of that story for later...

He was also hooked up to the ventrisculstomy (we call it the brain drain), and they had to regulate his usually low normal blood pressure with medications, first one to raise it, then a few hours later another one to lower it and then to raise it and then........

Well, after about a week it was obvious that his heart was maintaining a steady heart beat --his normal, on its own, so they took out the pace maker!  Then they put in a traceostomy so he didn't have to have the tupes going down his throat, but realized quickly that the ventilator was not supporting his breathing but rather just assisting it.  After about 2 weeks he was totally off the ventilator and breathing on his own 100%.  He kept the trac and they continued to support him with extra oxygen and they suction through it.  Next they realized that his blood pressure was normalizing on its own and he was off the epinephrine, to keep his blood pressure up.

Now they started talking about putting in a permanent shunt from his brain, to drain the blood and cerebral fluid directly to his abdomen to maintain a normal pressure in his head.  They gave us two options, pull it out altogether and see if he takes over normal absorption or dies, or do the shunt.  Well, on a Saturday morning, he was starting to throw up and the nurse rushed in to turn him on his side so that he wouldn't choke and in the process the brain drain popped out.  THe ICP (Intracranial Pressures --measured by the brain drain) had been really good for more than a week and so the doctor decided to just leave it out and see what happened. 

We were VERY concerned with this approach considering, if his body did not adequately absorb the fluid it would build up again in his head causing him to lose the small functions he was slowly gaining.  This was about 4 weeks into his coma, and the only thing keeping dad in the ICU at this point was the brain drain, so I know they really wanted it out, and to see what happened.  The only way to tell if the pressures were getting too high with out the ICP readings from the drain was to observe his physical responses. 

There are two scales used to evaluate the level of coma a person is in.  THis hospital uses the Glasgow Scale which goes from 3 at worst to 15 at best.  Dad was a 3 for the first week plus.  ANything less than a 3 is considered dead.  By the time of the drain popping out however he was getting readings as high as 6 some of the time, interspersed with 3s, 4s and 5s.  Due to the suddenness of the removal and the inconclusive determination of his pressures we asked them to watch him VERY closely and put the drain back in if there were any signs that his pressures were going up.  They put it back in within about 5 hours and the nurse (one of the few really defensive dranky ones) told us the doctor put it back in becasue we were so bent out of shape about it. (Oh well, it shows that you really need an advocate when you are in the hospital!)  Well, It was the day after that that he had actually spontaneously opened his eyes.  No focus or apparent recognition but open of his own accord.  We were very excited.  He was a 7 on the GCS scale. THe doctors made sure to inform us that patients with no brain activity i.e. in a "Persistent Vegitative State" can still open their eyes and don't get too excited about it.  A few days later they started shutting off the brain drain and watching the pressure (ICP) readings to see how dad was handling the fluids.  His pressures stayed good as his body took over yet another normal function, absorbing the fluids in the brain.  (BTW, our bodies normally produce about 10-20 cc's of cerebral fluid an hour and that is just absorbed, but after there is a brain injury especially with extra blood, it becomes too much for the body to handle.)  So by the later part of the week they took the brain drain out and moved dad to a regular ward in the hospital.

Well after just a day and a half on the regular ward, the nurses kept telling me (by phone cause I was home at this time) that his Glasgow Coma Scale readings were consistently 3s.  I kept telling them this was not good, and he had been consistently higher than that, and that this was a sign that his pressures could be going up.  Finally, I convinced his nurse to give me the doctor's number,  The Neuro surgeon said, he was now out of the picture casue the drain was out, call the regualr family doctor.  Regular DR was on vacation, call the oncall guy,  On call guy was home very sick!  I told the receptionist the situaiton and that I was convinced based on the informationthe nurses were providing to me that dad needed a Cat scan to either confirm increased blood build up or not.  I also, told her I was sorry the doctor was sick, but if he didn't handle this and call me back to talk to me I would raise holy @#$% at the hospital until I made sure that dad was getting the proper monitoring.  Afterall the drain had only been out for a day and a half and for his GCS to drop so much so fast was not good.  Well, the sick dr. called back and told me he had ordered the cat scan and they let me know the results as soon as it was done.  He said it was one of those calls that could go either way, but due to our concern he'd do the test.  THe cat scan turned out to be no change in fluid from the previous one earlier in the week -- a good sign, but why the change on the Coma scale?  We were worried.  I went back up there with the kids and finally realized the problem.  The nurses on the new ward had 8 patients each instead of 1 or at tmost 2, and they were not ICU nurses and were not doing the assessments anything like the assessments done in ICU.  When I did my own assessment basedon observing the ICU nurses and their explanations Dad was a 4, 5, or 6.  They still put down a 3!!!  IT was the difference in care and training.  Which made us feel much better and then worse.  On the new ward, the nurses are very friendly and fun and helpful.  But really really busy.  They hygiene is not good.  Dad gets edema terribly now becasue they don't have time to turn and change him except every 4-5+ hours.  We try to massage and move his limbs but it is definately not good for him.  He does get about 5-15 minutes of PT Physical therapy about 5 days a week, but that is really nothing compared to what he needs now either.  We need to start trying to pursue a remedy for this.

I have been researching all sorts of potential benefits for him although there have been no official medical discoveries for the treatment of coma patients in over 30 years. 

I did discover that Progesterone has been being tested on animals for 15 years and has a neurologic protective factor which helps prevent some of the damage in a TBI (Traumatic Brain INjury).  the first human study done on 100 TBI patients was just released and shows promising results but it is such a small sample they will be doing a larger scale study soon.

I also discovered a Neurologic Chiropractor  in Florida, Dr. Carrick who has woken 1000's of patients up from a coma.  HE is basically retired but I am working on finding someone who has had coma experience closer to us here...

I have also been looking into nutrient therapy and the hospital dietician (the good one --who is assigned to dad thank the Lord) agreed to add Cod Liver Oil, Acidophilous (sp?), Sardine Oil, and Garlic Oil to his tube each day.  THe first dietician was very condescending and said I'd have to bring in medical literature documentaing the efficacy of anything I wanted to give him!  THe one on his floor is great, she said, "hey, wouldn't it be just great if we could get him better with this stuff.  We'll show them!"

Dad got a Staph Aureus infection withing about a week of being on the new ward --no surprise.  So, back on antibiotics, and he was much more lethargic.  (I know how can you be much more lethargic than in a coma?  Trust me, there are levels to this!)  We didn't get to see him open his eyes the whole time we were up there the last time. 

The infection went away and he began opening his eyese again.  He has been opening them for a while everyday now.  I can't wait to see that.  It is still the 1000 yeard stare, but mom says his eyes are looking more and more clear.  There is no apparent communication, although one nurse one day said he moved his toes when she asked him to. 

So, we see lots of little rays of hope, but it is potentially such a long haul.  When I think about dad's life and the magnitude of his recovery it can make me (the unemotional one) burst into tears.  I have been driving dad's car, cause mom can't drive it and obviously neither can dad right now, but sometimes I just miss him sitting there in the passsenger seat reminding me when to shift.  ON the last trip we took together, I was teasing him that when I'm in my 60s and he's in his 80s he'll still be telling me when to shift!  He said, "I will not, I'm not telling you now, I'm just reminding you."  Or something like that!  I have this picture of my life, and it always includes dad being there, I can not even fathom him not being around for another 20-30 years.  I see him in my mind's eye standing proudly at my daughters' weddings.  I see him flying with my son in his Airforce jet --not sure how they'll pull that one off, but dad has always wanted to fly in one of those jets, he wanted to be a pilot but couldn't becasue of his eyes.  I see him putsing around on our little farm (the one we don't have yet but hope to eventually) helping us figure it all out.  And I see him sitting up with us at night drinking tea in his Burger King Mug with the spinny hamburger on the handle, spinning that hamburger and reminicing with us. 

If he loses this battle, I know where'll he'll be.  And I know he'll be holding Ethan or maybe playing baseball with him by now.  And I know I'll see them both, and Elizabeth too --one day. I am at peace with that possibility as much as  I'm not ready for that yet.  But I don't think he's going to lose this battle.  And I'm going to do everything I can to help him pull through.  I really have this gut feeling that eventually he's going to pull right through and wake right up.  I can also see him walking back into that ICU to thank the nurses and to tell off the doctors!  Okay just to show them he's better.  I really want to be there that day!!!!!

I will post one more part tonight.  Part Four is about the hope (actually a medical hope) that we have found...  It's a bit out there, but there is quite a lot of documented success.  If you know of anyone in a coma, this is worth checking out.

God is good ALL the time.