Slow Days

Right now, no news is...well, no news.

The last few days have been pretty slow, and I would imagine that the next few days will also be slow. Judi continues to improve in small increments, regaining her strength after her surgery. She seems to be a little bit more aware of what's going on around her every day, although she is still not responding to commands or showing some of the signs we would like to see.

Today, she did make a big step physically, however. She is no longer on the ventilator, not even with pressure support. In a rather symbolic gesture, the RT actually took the machine out of her room today. She does have what they call the trach collar, which is a little oxygen mask that's placed loosely over her tracheostomy, giving her some extra oxygen. But she does all the breathing on her own, both initiating the breath and filling up her lungs.

Keep those prayers up for a big step soon.

A New View

Quick update for today:

Judi was able to spend some time sitting up today. Her whole view of the world has changed! She has been moving her hands some, which she didn't do before. She also seems to be more alert already. We are continuing to be hopeful for some big steps forward soon.

Surgery Update - (Finally)

Well, a month after entering the hospital, Judi went into back surgery around 12:30 this afternoon. She held up very well, and the team experienced no surprises as they did the procedure. They came up around 5:30 to let us know they were done and that she was fine.

This procedure stabilized the broken thoracic vertebrae with screws and rods. The injured area will grow much stronger over time as the bones fuse together. She should be able to sit up as early as tomorrow, which we are hoping will be accompanied by a huge step forward in her level of awareness.

Thanks for your prayers and support over this last month. I know we are all happy to see her get past this surgery, and are ready to see her take the next steps in her recovery.

What's Important

What’s important?

The last few weeks have made the two of us rather philosophical. One of the positive things to come from this whole experience is the reduction and simplification of life. So many of the things that concerned us and worried us before have become unimportant. Priorities have become simpler and more clear.

I will admit that for quite a while, I’ve been harboring a little bit of doubt, maybe even a little anger, about this whole incident. As logical and pragmatic as I try to be, there’s that little sliver of doubt that remains.

If Mom had never gotten on a motorcycle, this wouldn’t have happened. She wouldn’t have been on that road on that day to hit that specific car. Motorcycles are dangerous. Everyone knows that, right? What was she thinking? I’m sure I’m not the only one who’s thought that, and it’s okay to think that. It’s a normal, human thought. We hate to admit that we’re not utterly unshakable, but I’ll go ahead and tell you that I am fallible and shakable.

I was angry.

And then I read this on Mom’s Facebook. I saw it in the first few days after the accident, but it only upset me then. When I read this again last night, it hit me in a much different way:

Watch out cuz here I come.

Took my first ride on the road today...what a liberating
feeling. It was so awesome.

Everyone who knows Judi knows how much she loved her motorcycle, being around motorcycles, and being around other people who loved motorcycles. She and Steve have spent many a weekend tearing up the road both on their own and riding with the local Harley Owners’ Group.

When she talked about their experiences, there was a glow about her that made it abundantly clear how much she loved every moment of it. Her pride when she passed her test, her excitement over the weekend rides all over the state, her absolute joy at the freedom of the ride – no one could doubt how important riding was to her.

While it’s true that this very accident would not have happened if Mom was not on a motorcycle, she could have easily been in a dangerous car accident. After all, car accidents happen every day, and people can be badly injured or even killed in a car accident. We’ve seen a few victims of car accidents come up here to the trauma unit, some worse off than Judi.

So what’s the solution? Do we refuse to drive our cars, because people can die in cars? No, we take measures to offset the risk. We obey traffic laws (more or less), wear seatbelts, drive cars with safety features to protect us in the event of an accident. We drive our cars because we’ve done what we can to make it safe, and so made the risk acceptable.

Judi did all the right things. She took the motorcycle safety course. She spent many hours on the weekends practicing with Steve in parking lots. She even watched videos on safe driving. She wore a helmet. She wore protective clothing. She did far more than many motorcycle riders out there do.

And yet fate had it that this was how a traumatic event would happen. In spite of the precautions, something bad happened. Sometimes, you can do everything right, and things will still go wrong. So it goes with any undertaking. We consider the risk, take what precautions we can, and we hope for the best.

I am still angry, but I’m no longer angry at her choice to ride. How could I be when I look back on the joy it brought her? How could any of us who love and care for her be angry at her choice, seeing that exuberance? I’m still angry that it happened. I would be a liar if I said I wasn’t. But sometimes fate is cruel and ironic and just deals an ugly hand.

I’ll throw out a scenario that may sound grim or depressing, but it’s a reality, and one that only reinforces my point. Judi could have chosen not to ride, and might have been in a terrible car accident on that very same day. She might have been just as badly injured, or even worse. She might have lost everything and never even had the chance to do something she desperately longed to do.

Life is full of risks. We take risks every day. The very act of living life is a risk. But what is the alternative? Living in fear, never doing those things we long to do because of that fear, and looking back at the end of a long, safe life and saying “I wish I would have…” Do any of us want that?

So what’s important?

Joy is important. Riding free down the highway, relishing the wind in your hair and the trees rushing by; that’s important. Living life while you have it is important.

Postponement

Well, sometimes the best-laid plans are set aside. Judi's surgery has been postponed until Monday due to instrument problems in the OR. She is in great health, but they need to have the right tools for the job.

While we'd certainly prefer that the surgery get done earlier rather than later, we want it done right the first time. We will let you know about the new time when we do.

Big Day Ahead

Well, by the time most of you read this, Judi will be on her way to or already in surgery. She originally had a mid afternoon slot, but some things opened up and she will be heading in for surgery around 7:30 am.

Please 'kick it up' a notch tomorrow for her and send some extra prayers up the line. We are very positive about how strong she has gotten over these few weeks of resting, and think she is going to do great tomorrow. The surgery should take about three hours. We will update after surgery with results.

Baby steps has been the name of the game til now. Tomorrow will be a big step forward, and I think we are all ready to see it come. :)

Inching Forward

More good rest today, and another little step forward.

Judi spent a while today breathing entirely on her own, with no ventilator support at all. It was a little surprising to walk in and see the machine on 'Standby.' But the RT (respiratory therapist) came in to assure me that she was breathing fine on her own. It was turned back on later on, but she did great on her own.

Now we have our sights on Friday, when she will have her back surgery. I'm not yet sure of the time. They tell us it will be about a three hour procedure, and while it is definitely a major surgery, it is not quite as invasive as we were expecting it to be. As mentioned before, we think this is going to be a major turning point for her. So now we are just hoping she will continue to rest and get strong for her surgery.

As always, thank you for your continued support and prayers. We are encouraged every day by them. :)

This Old House

This morning, Judi seemed much more aware, to the point of paying rapt attention to the TV show "This Old House."

It has been a quiet few days, with Judi just continuing to get stronger and rest up. While she is still not following commands, she has been much more alert in the last few days. She fixes her attention on people in the room, the cards on the wall, and the TV when it is turned on.

Her back surgery is scheduled for this week. We think that this is going to be a huge step in letting her regain full awareness. Because of her back injury, she cannot sit up. If you think about trying to get a sleeping person awake (I am laughing at thinking about some of my kindergarteners after nap time), one of the first things you would want to do is get them vertical, right? When her back is fixed, she will be able to sit up with her brace on. This is going to also just help her general health, since she can move around much more than she can now.

As soon as we have a definite date for surgery, we will let you know. It was set for Friday, but Dad is doing his best to get it a little earlier if there is time available. In the meantime, keep on sending those positive thoughts our way.

Another quiet day - just taking baby steps forward.

One good step was that the respiratory therapists adjusted her ventilator so that she is now initiating all her own breaths. The machine still gives her pressure support and some extra oxygen, but it doesn't force her to breathe at all. She was managing quite well all day long, which seemed a little surprising. The nurses said she might be able to do it for a few hours and then need the regulated breathing again when she got tired. But she did it for upwards of 12 hours on her own!

Baby steps. :)

On Moving Mountains

While driving down Washington Road this morning, I saw a sign on a church marquee. If I were slightly more egocentric, I might say someone had posted it just for our family, knowing exactly how impatient Dad and I are. A gentle reminder, if you will.

"God can move mountains, but sometimes He moves them one shovel full at a time."

Today was a pretty sleepy day. More of those baby steps forward, inching toward recovery. We appreciate all the comments and cards - we are accumulating quite a collection in the room. I know that the brightness and the positive energy is doing her good.

One recent change (since Monday, I believe) that's got us tickled is that she is now yawning every so often. It's the most wonderfully normal thing we've seen yet. The first time she did it, we freaked out, not realizing what she was doing. It's become pretty habitual for her now, and it's so completely normal it makes you think she's just waking up from a nap. These little things make us think (in our amateur medical sort of way) that her brain is getting back into some of its normal processes. Yawning, for instance, to get a little more oxygen when she's getting tired.

We'll take it one shovel full, one little yawn at a time. Keep that good energy coming.

A Little Reminder

Well, I'm back from my trip! Sometimes, I think that life shows us little signs, little reminders of just how amazing it can be.

When I arrived back at Charlotte-Douglass International, I was sort of down in the dumps. It was Sunday, and the parting words from the flight crew was a perfectly cheerful "Happy Mother's Day." Quite honestly, I felt a little jealous of those other people walking around the airport with their mothers or calling them to wish them well that day.

When all of this started, I sort of predicted my own timeline. In my prediction, Mom would be back with us, almost back to normal by the time Mother's Day rolled around. That obviously didn't quite work out, and as I was walking out of the airport, reality was coming crashing back in.

After lugging all my stuff back out to the remotest of the remote parking, I saw one of those strangely beautiful things that we often overlook.

This little plant was growing in the pavement right in front of the nose of my car. Perfectly ordinary, yet miraculous, all wrapped up in the same little leafy plant. There was pavement and parking lot as far as the eye could see, and yet here was this little piece of life. It had found some miniscule opening, and it had shoved through. It fought against the tough asphalt, pushing its leaves up into the sun and growing ever skyward.

It has been a tough two weeks and change, for everyone involved. Right now, we are sitting in what we've taken to calling our 'holding pattern.' Mom has recovered well from the procedures on her brain, and has had many of the invasive tubes and devices removed. She is still on the ventilator, although she is getting stronger. Her blood pressure and heart rate are strong, although they are still not quite consistent enough for the surgeons to feel confident about doing her back surgery.

Many people have asked us if she is awake yet. This is kind of a hard question to answer, and I often find myself stumped as to how to answer. She is awake - as in, not sleeping - for a good portion of the day now, but perhaps the better question now is how aware she is. She seems to latch on to things visually - when her nurses are close by, or Dad and I are standing next to her, she seems to watch us. But she is not yet following commands, such as squeezing our hands or blinking her eyes. This is one of the major stepping stones for patients with traumatic brain injuries, and we haven't quite reached it yet.

We think she is doing what we are calling 'reconnecting.' After being unconscious for a good bit of time and being in a pretty good haze of painkillers and sedation, we think her brain is figuring things back out. As we have mentioned, her doctors assure us that she is recovering well. While we want her to instantly wake up and start talking to us, the brain simply does not work that way. It's a slow and steady push toward recovery.

Like the little plant in the middle of the parking lot, she is going to push through to the sunlight again. Life will find a way through.

Monday Evening News

It was a long week today for Jessica and me. I was reminded again of how much I hate to wait and my internal need to be doing something at all times to correct an existing issue. I was also reminded how much my daughter is like me in those regards. Judi continues to take baby steps in the forward direction. Every single one of the medical team members (from the top to the bottom) continues to tell us it will take time and we have to be patient. We continue to talk with her, read to her, play her favorite music, read her your comments from the blog, etc. to help her focus her mind and heal. I know in my heart that this is the right therapy, but both of us are struggling with the desire to do something that physically helps speed her recovery.

An ultrasound was performed on her legs to ensure there were no blood clots forming - all clear there. A PIC line (peripherally inserted catheter) was inserted in her left arm which will provide longer term access for drugs and testing and minimize the need for multiple "sticks."

Her back surgery continues to be driven by the concern over the strength of her heart. Her blood pressure and heart rate will be fine for 24-48 hrs and then have a transient. Some of you probably know she had problems in this arena prior to the accident and her present condition only aggravates the condition. Jessica and I are faced with some fairly simple realities here. The back surgery is a major surgery in and of itself. She will definitely lose blood as part of the surgery. If her heart is not strong enough to support her under these abnormal conditions, she could have another brain impacting event (or worse) that she would most likely not recover from. Although all of us want to see her back stabilized, in her current physical and mental state the existing condition presents a much lower risk to her long term recovery than going to surgery unless we are confident she is ready. We will continue to evaluate on a daily basis and go when the time is right.

Steve

PS - Jessica was tired from her trip and being with Judi and me most of the day and will take over tomorrow.

Mother's Day 2009, aka Chillin' III

First, on Judi's behalf I would like to thank all of you from the bottom of my heart for the well wishes for Mother's Day. I read all of them to her and I am sure they made her day. Once she is well, I am sure this will be her second most memorable Mother's Day (the first being her first as a Mom).

Not much to write about tonight. A little lighter again today . She stayed awake for a significant portion of the day which must have wore her out because she was sleeping like a baby when I left tonight. I believe we will have to get the surgery behind us before she makes much more progress. Her back obviously makes her uncomfortable as her awareness level increases and I suspect she may be retreating a bit to make it stop. I'm certainly no medical expert, but as many of you know I have a lot of experience with a back that hurts to the point you would try anything to make it stop. We should be able to nail down a date for her surgery tomorrow and hopefully put this one behind us soon.

You'll also be glad to know that Jessica is back in charge of the blog and will keep everyone up to date as we move forward. This will be a critical week in Judi's recovery so please continue to keep her in your thoughts and prayers.

Thanx again to everyone for the tremendous support you have given us, I am not sure what we would have done without you.

Steve

Chillin' Part II

Rest and recuperation was the game plan and Judi was right on target. She continues to grow stronger and to use my term again, "lighter" as well. She is beginning to establish a sleep/awake cycle and I can predict her alertness level pretty accurately by her vital signs. She will focus on me and pulls my hand close to her chest when I talk to her. She still tires quickly. Slow, but steady progress from my perspective.

On a different note, tomorrow is Mother's Day and I want to say a special thank you to all the Moms out there for all you do. This experience has reminded me how quickly life can change and all of us should make a special effort to spend time with those that are special to us. You never know what tomorrow will bring.

Chillin'

A short post tonight.
Resting and getting stronger was the regimen for today. Judi is clearly much "lighter" from an awareness perspective now that her mouth and nose are tube free and she is only on a low dose of pain medicine. That's a Steve term , not a medical term. She responds to various things around her by opening her eyes and looking around, heart rate goes up, etc. She REALLY gets mad when they suction out the breathing tube because it makes her cough. Again, baby steps, but in the right direction. Hopefully this will continue throughout the weekend and we can get her ready for back surgery next week.

Baby Steps, But Steps They Be

Judi continued to rest and grow stronger today. We did make progress on several fronts though. The drain (EVD) was removed early this morning which indicates there is no longer a significant concern with pressure building up in her head due to swelling of the brain tissue. The PEG (stands for a long name meaning feeding tube in the stomach) was inserted and the final tubes were removed from her mouth and nose. Unfortunately, to perform the procedure they had to paralyze her again and administer a fairly healthy dose of drugs to ensure that she was comfortable throughout the procedure. It will take some time to work those out of her system again. Her alertness level continues to increase slowly, but it is clearly increasing. I have suspected that the tubes frightened her as they tried to reduce her sedation because she would become very agitated once she reached a certain point and would have to be sedated again to keep her key vitals (heart rate, blood pressure, breathing, etc.) under control. I am anxious to see how she responds as the drugs from today are eliminated from her system.

So, several small steps in the right direction and with your continued prayers and support I am sure her recovery will continue. Hang in there with us, there are still several large hurdles for her to cross, but those of you that know Judi well, also know she is not afraid of a challenge!

Getting Stronger Day By Day

Jessica will be unavailable for a few days, so I will do my best to keep everyone up to date in her absence.

Judi is basically on a rest and get stronger routine. She is resting much more comfortably following the tracheostomy and all her vital signs are showing continuous improvement. Her ICP pressures have been very good and have remained stable for the last 48 hrs with the drain line clamped off. Based on this, plans are to remove the drain (EVD) tomorrow. This will eliminate one more pathway for infection as well as move her one step further down the road to recovery. Based on her current status, we are potentially looking at back surgery mid to late next week. We will obviously have to watch her condition and adjust accordingly. We want to get the surgery done as soon as we can to minimize the possibility of damaging her spinal cord as well as allow for a reduction in the medications she is on so which are keeping her sedated. At the same time, we have to make sure she is strong enough to deal with the surgery itself.

I know that many of you want to see Judi and let her know you are in her corner, but I am going to ask you to continue to be patient and wait. Judi is still in critical condition and an infection could be very detrimental to her recovery at this point. She is also sedated and sleeps most of the time to allow her to get stronger. And finally, she isn't in her normal lovely form and I would like to ensure her privacy to the maximum extent possible. Once she is on the road to recovery, I am sure she would love the company and opportunity to spend time with those that care for her.

The best thing that everyone can do for her now is to remember she is still in critical condition and that your prayers are the most powerful medicine she gets. We have also been able to move her into a room that has enough space to display cards and well wishes from those that care for her. My goal is to create an area that will provide her a source of visual stimulation to help her mind focus on what is around her and allow her to heal as fast as possible. If you would like to send her a card, please send it to our home address and I will get them to her room (Judi Wilkerson, 12o Moss Creek Drive, Martinez, GA 30907). Please don't send flowers because she can't have them in her room.

I think that brings us up to date. Thanx for all of the support that you have shown our family.

Steve

Judi spent most of today resting.

This evening, we decided to take a proactive step in Judi's care, and her doctors performed a tracheostomy. When patients require a ventilator for an extended period of time, this procedure is done. Instead of having a breathing tube in her mouth, she now has a much smaller, less invasive tube directly in the throat. This is more comfortable for her, reduces the risk of infection, and is much less damaging on the vocal cords than a tube in the mouth. It is also much easier to deal with during surgery, and will make it easier for the surgeons to take care of her when they do her back surgery later on down the road. The procedure is relatively quick and simple, and was done right in her room. (Moving from floor to floor is an adventure in itself.)

Don't worry - this is not due to any danger or setbacks. But since she will likely need to be on a ventilator for a little while longer, it was a logical step for her improved comfort and safety. She already seems to be more comfortable, and that's what we want!

Evening News

Another nice, quiet day.

She is receiving a small dose of dopamine again, which helps keep her heart rate up. But, as they say, take a few steps forward, a little step back. In any case, she got another good day of rest today. Her nurses and doctors have told us they think she is doing extremely well, and they are experts! It is hard to remember sometimes that this is just going to take some time.

Keep those prayers coming.

Nightly Report

Another good resting day today. We brought in her iPod with some good music, and spent some time reading to her. (Harry Potter was the book of choice today.) The nurses say no one really knows how much people are aware of, but we figure it can't hurt!

We did have one minor (good!) change today. She is no longer receiving drugs to keep her heart rate up. That is a great sign, because it means she is strong enough to keep her heart rate up on her own.

We're inching toward recovery, one baby step at a time.

Nightly News

Just a quick one for tonight. The next few days (knock on wood) should be pretty uneventful.

Judi had another restful day today. CT scan came back clear again. The neurosurgeon is feeling very good about how her head looks right now. When he's happy, we're happy.