Friday, October 22, 2010

Odd Signs Of Hope

A Short History of Medicine

Patient: "I have an ear ache."
2000 B.C. - Here, eat this root.
1000 A.D. - That root is heathen, say this prayer.
1850 A.D. - That prayer is superstition, drink this potion.
1940 A.D. - That potion is snake oil, swallow this pill.
1985 A.D. - That pill is ineffective, take this antibiotic.
2000 A.D. - That antibiotic is artificial.  Here, eat this root.

- Anonymous

Yesterday my brother Mike had what we hope is his final operation due to the motorcycle wreck, to reconstruct his face.  The fractured bones of his cheeks and at his right temple were screwed to small titanium plates.  The operation, by all accounts, went very well.  When I saw him in the ICU afterward, I was surprised at how invisible the procedure was.  The plates under the eyes were inserted from inside the mouth, and only a small suture at his right temple shows where that plate went in.  Perhaps 10 stitches.

His face was not badly swollen.  You cannot see the plates.  She realigned his bite to where his upper and lower teeth met properly.  He has something of a boxer's nose now, with a slight bend to the right.  The surgeon tried to fix that, too,but the problem is in the soft tissue, not the bones.  When she tried to insert a plate there, it showed through the thin skin, so she decided to back off.  Instead he will wear a sort of splint on the outside for a time, to see if the tissue will straighten out that way.  If not, further surgery can correct it when he has healed up from the rest.

I doubt he will bother with it.  He is not that vain.  Or perhaps he is, but in that curious way that sees a few scars and a bent nose as interesting.

One good bit of news:  the attachment to the plates was stiff enough that she did not have to wire his jaws shut as a splint.  He was talking up a storm in the prep room before surgery, answering questions, able to understand where he was and who we were.  It was obviously a strain to be cogent, but he took the strain well.  The principal sign of not being quite together was a tendency to repeat himself several times.  Hell, I do that even on some of my better days.

This was the most he has been present with us since the accident.  I fully expect that in the days to come we will not be able to shut him up, and he will begin to take soft food.

He even blew one nurse a kiss.  I take particular heart from this.

And when another asked him how he felt, he said quite clearly "Not worth a shit."  That's Mike. There's nothing he could have said that would done more to convince me that he was on the mend.


Saturday, October 16, 2010

Give That Guy A Hand!

Every day I go visit my brother Mike in the hospital.  And every day has its ups and downs, but the overall effect is of idling in place.  All the peripheral junk, like bill paying and insurance faxes and disposing of the remains of his motorcycle and cleaning up his house and yard - all that stuff has been taken care of, is being taken care of.

But he can't talk worth a durn.  Only the simplest communication is possible.  "Are you hurting?"  A nod of the head.  "Where are you hurting?"  "Gurgle, gurgle, wha doan yah keh, gurgle, gurgle."  "Okay, okay, just try to relax."  A miserable tired smile, if only from the eyes.

I go for the nurse.

He can see okay out of his left eye.  When asked what he saw out of his right, he said "Chalk". Of course he has a neck collar on, so mostly all he gets to look at is the ceiling.  They are afraid that eye got dried out in the days after the wreck, when he was sedated and his eyes didn't close fully.  Plus the right eye was more swollen.  They now have a patch over it, to keep the lid closed.  They are applying artificial tears, and some sort of ointment.

He has hallucinations.  It may be due to what they call "hospital psychosis", an effect brought on by being drugged, naked, and helpless, not being able to move, never knowing what time it is, being awakened at all hours and never getting any rest, etc.  It may be due to small bruises on both frontal lobes, where his helmet met the pavement.  They seem to be getting better.  There was also some bleeding at the back of his brain, but again it was not severe and is not getting worse, according to the latest cat scan.  The area is beginning to be reabsorbed.

He spent some time the other day picking invisible things out of the air with his good hand.  When I asked what he was doing, he said "Hairs".  Then he started pulling at his tubes and poking at his good eye, so they tied down his hand.  He fights the restraint occasionally, but not violently.  Sometimes he can wiggle his toes on command, and sometimes he doesn't.  He moves around quite a lot, by increments working his way down to the foot of the bed, or getting a leg over the guard rail on the left side.

They come in and reposition him.  "Damn" he says.  I think he would get up and run out the door if he could.  I have the advantage of him there.

He has so much bloody stuff coming up from his lungs and down into his throat from his mouth and nose they can't keep up with it.  And I'm not much good at suctioning, though I suppose I'm better than nothing.  My principal talent is to run get a nurse when he seems to be in unusual distress.

I get lots of practice.

He's not getting worse.  But he doesn't seem to be getting much better in a hurry, either. Supposedly he is scheduled for an operation on his facial fractures next Friday.  But I don't see how they can suction out his throat with his jaws wired shut for weeks afterward.  All that stuff is settled right on his vocal cords, and right above his windpipe.  He could choke at any time, and suck it down into his lungs.

The surgeon and I are going to have a talk about this.

The nurses are better at cleaning him out than I am.  They are not afraid to bring tears to his eyes.  After they get through, he can occasionally make himself well understood.  Yesterday as I was leaving I took his good hand and said "I'll be back tomorrow, Mike."  And clear as a bell he replied:

"Don't have a wreck!"

I had to laugh.  Still do, considering the source.  Whatever else might be injured, his sense of humor is intact.


Saturday, October 9, 2010

Bad News and Good News, etc.

The bad news is that my brother's insurance company, Scott and White, refused to pay for his further care at Seton Hospital, where he was progressing through all the necessary operations, and where we thought he was being well cared for by competent, hard working surgeons and an excellent nursing staff.  The insurance company insisted, on the very eve of plastic surgery on his face, on removing him to a Scott and White facility in Temple, Texas.

His facial surgery has been postponed for 7 to 10 days, "while he recovers and the swelling goes down".

The good news is that his new surgeon has a glitter of confidence about her, which is all I have to go on in this matter, at least in the last couple of days.  And I will say she made a plausible argument for waiting, and gave a good explanation of the procedure.  She will slip small thin titanium plates between his skin and the broken facial bones, and secure them to the fragments.  She says they will be permanent, but will not show.  He should look much the same as before.  There will be two angled pieces under each eye, and another at the left temple.  The rest of his face, in particular his jaw, escaped injury due to the full face helmet.

She says he will only have his jaws wired shut for a couple of weeks after the operation, as a sort of splint to prevent him from moving the healing bones above.  Much better than the 6 weeks the other surgeon mentioned.  The sooner he can talk the better.  I hope to get some information from him before the operation so that I can pay his bills on line.  I can't find anything in the rat's nest of his filing system.  Just a short conversation with him will make long and tedious conversations with his creditors unnecessary.

More good news:  they removed the ventilator tube and brought him up from sedation yesterday for the first time since October 1st.  The only sign we have had that he was still in there for the last week was an occasional squeeze on a finger.  He had a hell of a time clearing his lungs, but seems to have done so.

He started trying to speak Friday, but it was impossible to tell what he was saying at first, as the tube has been rough on his throat and vocal cords.  He was able to respond to simple verbal commands.  They are feeding him through a tube in his stomach because he is unable to swallow without choking.  There is a continual drip of blood to the back of his throat, and I have learned to suction this.  He is able to purse his lips and bring it forward.

I explained his situation to him in simple terms, but more out of hope than conviction that he understands.  Then today he was able to get out a coherent word or two.  As I was leaving for the day, he clearly said "Goodbye, brother."

That gave me a lift.

Another lift came from a late phone call from the insurance company representing the other party in the wreck.  They have accepted responsibility in behalf of their client, and have asked for an itemized hospital bill to date.  There may not be enough money in the world to pay for all his operations, but at least somebody else will be making a stab at it.  The practical effect for us is that Mike will not have to make the 20% deductible.  Even that is apt to be a sizable sum.

The bad news is that there is probably a limit of liability on the policy.  In that short conversation I did not ask the agent what that limit might be.

The bad news is that I have heard rumors that they might move him out of ICU, once again, before the operation.  I can't escape the feeling that it can't be good to be passed from one set of hands to another so often.  Something is bound to slip through the cracks.

O, and the good news is that apparently his neighbors like him.  They have volunteered to mow his lawn and clean up his house next week.  Bless 'em.

Bob, trying to keep up.

Tuesday, October 5, 2010

O Brother!

Mike, in happier times, chowing down on chicken-fried bacon.  That's right. 

I've been trying to figure out my brother's finances, in the hope of keeping his affairs in order while he is incapacitated.  He's been unconscious since the accident October 1st.  But going through his papers is like rummaging around in the bottom of a hamster cage.  I keep thinking I'll find something meaningful, if I can just put together enough snips and bits of litter.  Riiight.

He doesn't have files.  He has piles.  Literally.  Stacks and stacks of old bills and papers laying around on the rug of an empty bedroom, in boxes in the corner of the dining room, and on, in, under, and behind his desk.

He probably banks on line.  His computer might be helpful there, if

1)  I could find a password file, and

2)  if it were not actually the slowest computational device since the Babbage Engine, or at least since monitors glowed green on black.

I spent almost 10 minutes trying to get a single file to open.  I kid you not.  I nearly dozed off.  But then I haven't been sleeping well.

I can't tell if he owns a checkbook.  I do not have any power of attorney.  I am perfectly willing to pay his mortgage and other bills for a while out of my own account, but before I can pay them I have to know what to pay and who he owes and when it's due.

When he recovers, I'm going to suggest that both of us go down to see a lawyer and draw up mutual medical and emergency powers of attorney.  No one ever thinks they are going to be in this situation, until they are.

For now, I think, a tactical surrender is in order.  I'm going to wait for him to wake up, late fees be damned, and ask him how to do this.  That may happen tomorrow.

They finally took him off sedatives this morning, but then he had anesthesia during the operation on his right arm.  They have to get him conscious tonight or tomorrow to do a neurological exam and see if there are further deficits and problems.  So far surgeons have treated multiple open compound fractures to the right arm and leg, and a ruptured disc.  They've put in a feeding tube to his stomach, but he is still on a ventilator.  They cannot do a tracheostomy to insert an air tube yet because of the proximity of the fresh suture from his disc hernia repair yesterday.  He's developed a bit of pneumonia from having his mouth open all this time.  Along about Friday he will be transported to Brackenridge, where they will try to reattach the bones of his face.

I hope by the time his son arrives in town on Monday he will be recognizable.

And I really really hope he doesn't wake up for the first time tonight, alone in a dark empty room at 3 in the morning, in horrible pain, choking on intubation, with the terror of a near fatal collision as his most immediate memory.  If he does, the nurses are going to have their hands full.

My only nightmare has been his "filing system".  His will be worse.


Monday, October 4, 2010

"That Bike Won't Fix."

Totaled.  Note the intact windshield.

I don't know if it is a blessing or a curse.  Maybe it's an artifact of being so long a fireman.  But I don't immediately respond in an emotional manner to catastrophes.  Instead it is delayed, while I get into the details.  I have worked out Mike's leave from his job, and faxed the appropriate forms.  I've been on line with MetLife, arranging his STD pay.

No, get your mind out of the gutter.  It stands for Short Term Disability.

I've notified the Known Universe of Relatives.  I've kept a diary of doctors and procedures.  I've stripped his bed and done his laundry at his house, and pondered the complex futility of paying his bills on time without a power of attorney.  I've recovered the contents of his saddlebags from the wreck, filed a claim, and documented the damage.  I've arranged to receive an official accident report, and interviewed the officer first on the scene.

I'm running out of things to do.  Things to keep me busy.  It is only the surgeons who really can help him, and that leaves me staring at the walls of his room, feeling increasingly useless while trying to remain civilized and polite to well-wishers.  He's going to need them.

The first jitters came visiting when I saw the wreck on Monday.  Looking at that flattened front wheel made it real.  I could see it from his point of view.  And then I saw the helmet.  I got the shakes.

He wore a full face helmet.  He was just driving with the traffic.  As he slowed approaching the signal at the intersection, the light turned green, so he proceeded through.  Facing him in the other lane, an Isuzu Trooper abruptly turned left right in front of him.  It was too late to stop, but apparently he tried.  He collided with the passenger side of the vehicle.  He flew off the bike, somehow clearing the windshield.

He landed on his right side, heavy leg bones snapping and bursting from the skin.  And then he slid on his face.  You can see the white crack on the chin bar of the helmet.

The helmet defines and outlines his facial injuries.  He was injured wherever the helmet was not, a Lefront type 3 fracture running from one temple across the orbits of the eyes and the bridge of the nose, to the temple opposite.  His face below the eyes and above the jaw has broken loose from the skull.  His jaw and teeth were undamaged where the helmet protected him.  His brow is intact.  His brain sustained only slight internal bleeding.

I think that $400 helmet I kidded him about paid for itself.  I just couldn't see it at the time.

One by one, surgeries are correcting the damage.  It is estimated that he will be in hospital for at least 6 weeks after all surgery is complete.  If all goes well.  His jaw will be wired shut that long.  Possibly 3 months.  Then there will be months more of therapy.  

Mike had a tediously slow and careful approach to riding.  He wore his helmet and gloves every time.  I kidded him about being slooow when we were in Arkansas.  I could stop, fill up with gas, and go in to pay while he was still shucking his gloves and helmet.  But he paid me no mind.

When someone turns in front of you, it doesn't matter how careful, how methodical, how thoughtful you are.

Car 1, Motorcycle 0.  Every time.

Tonight I got the shaky blues again, sitting on the back porch, smoking a cigar.  Trying to relax.  I could just see him sitting in the chair opposite, sipping a beer as the sun went down, telling me about some character at work.

Mike is good company.  But he won't be telling stories for a while.


Saturday, October 2, 2010

One thing after another

It's just one thing after another.

I got behind posting here while traveling back to Texas.  Then I immediately had an operation on my left hand that interfered with typing.  And then yesterday, just when I was about to finish up and post 3 or 4 items, my brother was involved in an accident on his motorcycle while driving home from work.

He is in ICU, with compound open fractures of the right arm and leg, and multiple fractures of the face.  He had his leg set last night, and all is going relatively well so far, with no swelling of the brain and no internal bleeding.  He is being kept sedated, and I have not talked to him.  I am headed back over there right now.

I'll be back.  But it's going to be a little longer.  Wish him luck.