A Punch in the Gut

 

This morning Dr. Ugo, the positive one, the one who always spun his news in a positive light, told me that he could not guarantee that Derek would survive.  I felt as if I had been punched in the gut.

All day we sat in the Day Room.  Derek's two awesome nurses, various doctors, and too many machines took up the space in the room and we did not want to be under foot.  We went in and out just to let Derek know that we were there.

He was septic.  The infection was in his blood.  Krystina's favorite color is purple, but did he really have to turn his skin purple?  In an attempt to wake him up, we tried to tease him by calling him Barney.  He raised his eyebrows, but he did not wake up.

His nurse last night, the wonderful Murreal Georg (who is also his nurse tonight), had moved her station into the room.  The nurses today, Maj Dallas Weills and LT Leonard also kept the station in the room so they never had to leave.  The respiratory therapist was on the ball.  Her name is Eliana and she was so good.

His white cell count is down, which is good, but the infection still rages.  His blood pressure is still too low, but they are giving him meds for that.  They didn't want to have to replace the cath for the dialysis, but they had no choice.  They didn't want to wait until late tonight when the staff was on the graveyard shift, and since the acid in his blood was still too high, they replaced it.  But Eliana kept his breathing going, and his kidneys produced enough to lower that acid so it wasn't necessary to tax his system any more by actually doing the dialysis.

At 8 a.m. yesterday morning Derek closed his eyes.  He finally opened them around 4 p.m. tonight.  He wasn't quite with it, but he looked at us and seemed to recognize us.  He responded to commands to open his eyes, but not to squeeze our hands or make any other movements.  The CT scan last night did not show a bleed or any swelling, so we do have hope.  The doctors hope that his state is simply the result of the infection and his body attempt to heal.

While we sat in the hospital, I received some mail.  Gary Sinese sent two autographed pictures, and Tom Coughlin from the Giants autographed his book and sent it to Derek.  Also, the Governor of Tennessee named Derek Colonel Aide de Camp!

Tomorrow is another surgery day.  The doctors are hoping they do not have to cut any more bone or take any more from the leg or pelvis.  With the infection still raging, it is a possibility.  All we can do is pray.
Thank you for your continued support and prayers.

from day to night...

 

Written in the hospital at midnight - 08/08/11

These nurses are amazing. They are on the ball and so compassionate. They not only care about their patients, they remember the families and care about them as well. I hate to say that I have my favorites, because they are all wonderful, but some just click with me.  The most important thing is how patient they are with the barrage of questions.

Today has been a rough day, followed by a rough night, and tonight is shaping up to suck harder than an industrial vacuum. Last night the nightmares started. My sister was going to spend the night, but at 1:30 a.m., Derek needed me. Deep in a benadryl fog, I quickly made my way to the hospital. I took two bennies to not only help me sleep, but because August is an awful month for my allergies, bringing along with them a nice, fun bout of asthma. I can already feel it settling in my chest. Unforuntately, the inhalers give me migraines, so I double up on the benadryl and cough meds.

Trying to stay awake and deal with the night terrors in a benadryl fog was quite a feat. LT Michelle Woodie told me tonight that it was humorous watching me fade out while holding Derek's hand and telling him he was safe. I bet it was.

All night last night and all day today when the nightmares or hallucinations hit, all we could do was orient Derek in the here and now. I told him to imagine himself on the beach with Krystina, listening to the waves rushing across the sand, holding her hand, and smelling the sweet, salt air. All night, I kept trying to come up with different places and ideas to orient him to the here and now. I felt so helpless. Last night's nurses, Michelle and Lyndsey, were wonderful with him. As were Penny and Jennifer today. They were on the ball, compassionate and knew what they are doing.

I was advised today that he might be thinking we were with him in that terrible place and feeling helpless that he couldn't protect us. So, today, I kept reminding him where he was and that we were ALL safe, not just him. Melissa told me that he needed to be oriented in sight, sound and smell, and I had not been using smell. Resolved that by spraying a little of Krystina's perfume on some gauze and putting it under the pillow case.

Tonight I am sitting by his bed. It's after midnight and Michelle is on the ball. One of his drains started running bright red, and she called the doc before I could even ask if it was supposed to be that color. The drains are usually a light red color.

All night he has had difficulty breathing. Respiratory has been here too many times to count. He is agitated and disoriented. They started giving him medications to calm him and help him sleep, but the damn breathing tube clogging is not helping. It should help when he gets the traj tomorrow morning.

Written 08/08/11 at 2:48 p.m. 

I jinxed myself with what I wrote earlier.  Today's nurse sucked.  After a horrendous night of no sleep, I was met with a nurse who took every question asked as a personal insult.  She snapped at me, gave me attitude, didn't explain anything, and generally was a bitch.

I tried to ask her to lower her voice because he became agitated when there were loud noises, beeping machines and too much talking/raised voices.  She started yelling at me at the bedside!  At that very moment, housekeeping came in and was very noisy.  I whispered to her to please be quieter, and the nurse told me that I needed to leave because I was being nasty to everyone.

My sister was there.  I did not snap, I did not raise my voice.  I was calm and simply stating to this bitch that my son had had a difficult night and was disturbed by loud noises.

Then she disappeared.  Every other nurse told me when they would be off the desk for a period of time.  I looked for her when Derek's blood pressure started to go down.  She was gone for at least 20 minutes.  All I said to the charge nurse was that she was gone for a while and I didn't know where she was, and I had a concern.

She came back all in a huff, snapped at me and said, "I don't like it when people complain about me!"  Really?  Then she is going to be quite the little happy camper tomorrow when her ass is chewed out royally for her behavior today, because I hadn't complained at that point, but I surely bitched later - to Dr. Perdue, Dr. Ugo, Dr. Chandler, the charge nurse, the nursing supervisor, my social worker, my liason and the platoon leader for the Warrior Transition Brigade.

His blood pressure plummeted to the 80's over the 30's and she wasn't answering my questions!  I had to call a friend in Jersey to answer some questions and she was limited because she didn't have the chart!  Also, when I asked if he was given this medication that Rosie (nurse friend in NJ) told me about, this nurse told me NO, but he was really getting it!

Finished in the Lodge at 8:30 p.m.

Then he went to surgery.  They were supposed to place a trach to get him off the intubation, because it is causing him so much distress, but he was too sick.  His lungs are not well enough, the infection is too high, and his blood pressure and stats were too unstable.  They had a two hour period that was "touch and go."  Dr. Perdue said he was "sicker."  He had been ungraded to stable, but he is once again unstable.
He also has not awoken since 8 a.m.  Although he was on a strong cocktail of meds, his last dose was six a.m., and he should have roused before they took him for surgery at 1:30 p.m.  He also had not woken up after surgery.  They ordered a CT scan, and we are awaiting the results.

I have been holding it together and able to deal with this much better because of the wonderful nursing and medical staff as a whole.  They have been compassionate, caring, understanding, and most of all - patient with my questions and hovering.  All of the nurses before today told me I was easy to work with and often came by to check on us.

So.... I do not know if this was just a personality conflict, we just got off on the wrong foot, or she is just an unprofessional nurse.  I know I was no different today than any other day, except maybe a little more tired. 

I am forcing myself to try to sleep at the Lodge tonight, only because they assured me they would keep him sedated and call me if there were any problems, but most of all, because they assigned the charge nurse from last night to him in order to ease my concerns.  Although I have not worked with Murreal (I know that is spelling wrong, but she doesn't spell it the usual way) before, she was quite nice, reassuring, sweet, professional, and assuaged my fears.

I am so scared tonight.

a broken heart

 

My heart is breaking today for the 31 American lives lost in the helicopter crash in Afghanistan.  While that made the print media (I don't know about the liberal mainstream media since I didn't get a chance to get to a tv), I wonder how many of our young men and women lost limbs, suffered traumatic experiences and suffered other injuries in this senseless conflict?

My thoughts and prayers are with those families who had to suffer through the pain of having to answer the door and see a uniformed member of the military standing there.  I often thought of how I would react to such an event.  My sister told me of someone she heard of coming down the street to see two uniformed marines standing on her front porch.  She stopped the car in the middle of the street, got out, ran to them and started to beat them up.  I do not know how I would react and I thank God I do not ever have to know. 

As awful as that phone call was on July 23, 2011 at 9:28 a.m., I am so glad that it was NOT a knock on the door.  As hard as it is to see Derek lying in the bed suffering through surgeries, treatments, doctors visits, etc., I am so glad that I did not have to hear the 21-gun salute, receive the folded flag and stand in the cemetery as I laid my 21 year old son to rest.

The pain that those families, and so many others, are having to face is tearing me apart tonight.

Medical Update

 

What a week.  Trying to acclimate to hospital life has not been easy.  Every one at National Naval Medical Center has been wonderful, though.  It's just too much information to process at a time.  And in a few weeks NNMC will become Walter Reed National Military Medical Center Bethesda.  What.A.Mouthful.  The new Walter Reed is good enough for me.  Or Dr. West said we can call it Walter Reed Bethesda.
So the last few days.  We are on the rollar coaster ride of our lives and I want to get off.  We take a few steps forward, then a step backward, then a leap forward, then a few steps backward.  Cha cha, anyone?
Since the last update, he had surgery on Monday, Wednesday and Friday.  During all three procedures they did a wash out of his wounds.  The infections are still present.  He has e-coli, mrsa, pseumonas and abacter to name four.  There are a lot of fungi and infectious sources in the soil in Afghanistan.  When the soldiers are wounded, the soil gets inbedded in the wounds.  This is why they perform so many wash outs of the wounds.

One of Derek's wounds was to his abdomen.  He had internal bleeding, and because of all of the infections and the swelling of his wounds, they had not closed the abdomen.  Each surgery this week, they were able to close a little more, and today, Friday the 5th, the abdomen was finally closed.

Derek's right leg was amputated high above the knee.  I was told that they did not believe that there was enough skin to close the wound.  Guess what?  Today they closed it!  There is still a wound vac (which is a machine that washs the wounds with a bleach solution and sucks out the icky stuff - yeah, real medical term) attached to the bottom, but they got it closed!

On the left, Derek's amp is high, right up to the hip joint being removed.  They have not closed that wound due to the presence of fungus, BUT they have not had to remove any additional bone or tissue!  Yes!  We were very concerned after Monday's surgery that he would have to lose part of the pelvic bone.

The right arm is fractured and has a "shark bite" out of it.  They fixed the fracture with pins and a stabilizer, and they closed the wound on the outer part of the arm.  The inside of the arm is a completely different story.  That will require a graft of tissue and skin.

Derek's jaw is broken at the TMJ.  One side is sideways at the joint and the other side is fractured just below.  He also has a fracture by his chin and he lost several of his front teeth.  There was a little difficulty with the information coming from the general surgeon and the maxiofacial team.  The max team wanted to wire his jaw shut on Thursday to assist with the healing of his jaw, but the trauma team wanted to wait.  They wanted to wait because if the infection is not under control, it could attach to the hardward and have to be removed, cause the infection to travel to the jaw, or worse.... cause the infection to enter the bloodstream which could kill him.  But the max team said they would monitor it closely, and that if it was not installed, the jaw could set and have to be rebroken which would be horrible and painful for him.  I told them they better get it together because I needed them on the same page!  I also told them no hardware if there was ANY chance of the infection traveling to the appliance in his jaw.
The appliance will be installed in Derek's jaw next week, when they expect the infection will be under control.

They finally got the C-collar off on Tuesday and the dialysis catheter was moved because the one that was set in Germany malfunctioned.  In Germany, Derek was in acute renal failure.  His number was 14, and it is supposed to be 60.  Today it was up to 44!  Go, Derek!

Derek also has a lot of burns to his pelvic area that the doctors are confident will heal 100% after further treatment and skin grafts.  The biggest problem is that damn wound vac....it keeps leaking!  It cannot work properly if it keeps leaking!  This morning they reset it in the OR, but it didn't work.  The doctor came by and reset it in the room, and it worked for 15 minutes.  Then Super Nurse Tommy got it working!  At least it was working when we left.  Let's hope it holds.

Then the most disappointing was the extubation that didn't take.  Derek was extubated on August 3rd at 7:30 p.m.  He got to talk to us a little, and it was a little easier on him.  I will report on what happened when he was talking in the personal entry.  Unfortunately, he had difficulty breathing and coughing up the junk in his lungs.  At around 4 a.m. on the 4th, he was intubated again.  They told me that they would attempt to extubate him after the surgery Friday, or Saturday when he woke up.  No go.  The max team has decided that this could further injure his jaw.  If he had to be intubated again, and when he goes to Monday, he will be, they are taking a big chance on causing more harm to his broken jaw.  So, on Monday, they will install a trac, which is a tube in the neck at which they can attach a vent to help him breath.  He will also have a box hooked up that will help him talk easier when his jaw is wired shut.

I love the nurses on CCU.  LTJG Tommy McGuire is great.  He takes such good care of Derek.  RN Trista Blyther and Tommy are my favorites, so far, but they are all really good.  In the CCU each patient has his/her own nurse, so the patient gets the best, most attentive care possible.  So far our awesome nurses have been LTJG Cassandra Aeberseld, LTJG Priscilla Fehrer, LT Leonard, MAJ Dallas Weills, and then Jennifer, Penny and Lindsay, whose last names I forgot to write down.  Penny I named nurse nazi - she runs a tight ship and cracks her whip.  I don't mind because I know she is just considering Derek and his care.

The doctors have been great.  The only complaint so far has been the wound vac leaking constantly and the max team and trauma team taking a while to get together on whether or not to install the appliance.
Krystina and I spent the night in the room with him on Tuesday night.  I stayed on Wednesday, and my sister came to visit on Thursday and kicked me out!  She insisted that I rest and she spend the night, so Thursday and Friday nights, she spent the night.,

So, that's the medical update.  Since it is long, I am going to vent on the personal crap tomorrow in a separate entry.

Thank you for the continued support and prayers.  It really means so much.

Whipped

 

I am physically and emotionally whipped.  So much has happened in the past two days that has kept me from the computer.  Some of it was promising. and some of it just plain sucked.
The best was Derek getting that damn tube out of throat for a short time and getting to talk to us for a little while.  He had to be intubed a few hours later because his lungs were just not strong enough or clear enough to continue to breathe on his own, but for a little while we got to talk to him.  Some of it was great, and some was heartbreaking.

The best was when he overheard me tell Krystina and Sean to stop at McDonald's on the way back to the lodge.  He perked up and said, "McDonald's?  Chocolate milkshake?  I want choccooollllaaattteee millllllsssshhakeeeee!!!!  Doc!  Doc!  Please!!  One sip!"

When Tommy, the awesome night nurse told he was sorry not yet, Derek responded, "No?  Fuck you."  It had all of us laughing and it was good to see the spitfire back in him.

That's all for tonight.  Two nights sleeping on a hospital chair has killed my neck and back.  My sister is in for a few nights, so she basically kicked me out of the hospital and wouldn't take no for an answer no matter how hard I fought her.

Thank you for the continuing prayers and well wishes.  They are truly appreciated and getting us through this mess.

A Little Comic Relief

 

On August 3rd, Derek was extubated for a few hours.  I have not gotten to post this before so here goes.  The little time he was able to talk to us was heartwretching and hysterical. 
The following are snipets of the conversations between Derek, Krystina, Sean and me.  We were all in the room with Derek's nurse that night.

Derek - "Mom, I'm sorry.  I'm sorry I did this.  I did not want to do this to you."

Derek - "I don't think I'll make it."

Derek kept calling "Mom" just to have me walk by the bed and take his hand, just to make sure I was there.  He called out "Doc!" once for his nurse, and then asked, "what are you doing?"  Tommy was outside the room logging in the computer.  Derek was checking on him.

Derek needed to be suctioned, and before Tommy could get in, Krystina picked up the suction and took care of it.  I love that girl.

I told Krystina and Sean as they were leaving to stop by McDonald's and the following ensued:
Derek - McDonalds?  Chocolate milkshake?  I want a chhoooocccooollaaateee milkshaaaakkeee!!!!  Doc!  Doc!  Please?"
LT Tommy - No man.  Sorry.  Not tonight.  Maybe when you are off the vent a couple of days.
Derek - No?  Fuck you.

Then Derek yelled out, "Mom!  My dick!  My dick!"  I asked him if he wanted to know about his dick, and he told me "please."  I told him the doctors said all would be fine, and he let out a huge sigh of relief.  Typical man.

He asked me about his legs.  I told him it was his legs or his life.  The legs had to go because we needed him and the doctors would build him new ones.  He then told me, "Doc ripped it up!  He just ripped it right off!"  A little while later he told Krystina to put his feet up, and she said she couldn't.  She asked him if he remembered what happened to his legs, and he asked me where his legs were.  I told him in Afghanistan.  He looked confused, and I told him again that they were gone, but that the doctors were going to build him brand new ones.  His response?  He shrugged and said, "fuck it."

Derek was reintubated at 4 a.m.  It was wonderful to hear his voice for a short time, but his lungs just weren't strong enough.

A Wink

 

Long day today.  He is not out of the woods.  I need a chain saw so I can go in after him and get him out!
Derek had another surgery.  Almost closed his abdomen, but not quite.  More wash out of his wounds.  The infection still rages, and they had to cut away some more dead tissue, but no more bone.  They are hopeful that no more will have to be cut away, just tissue and skin that can be replaced with grafts.  His arm has a large "shark bite" out of it that will need a plate and grafts, but it is not their main concern right now.

They are considering wiring his jaw shut on Thursday or Friday.  He has a broken TMJ (tempomandibular joint - I think is how you spell it).  One is just cracked down a little bit but the other side is... well, sideways.  He is missing three front teeth and his lower jaw is fractured. 
That's pretty much the medical update.

I met the first rude person today.  The hospital is under construction and hallways are always being closed and pathways re-routed.  All weekend, I was directed through the ER by a security guard and that is how I knew exactly how to get to Derek.  This morning, I went to go that way and this little bitch jumped out in front of me and told me I was not allowed.  I tried to explain to her that it was the direct route to CCU and how the security guard ahd directed me all weekend.  She snapped at me that NO ONE would have EVER told me to go that way.  Really? Seriously?  I told her that this was an upsetting enough experience without having someone be nasty to me!

I finally found my way upstairs.

Then Dr. Perdue told me Derek was the "sickest person in the hospital."  Really, chicken man?  Sicker than the people coding?  I think he needs to choose his words a little more carefully before he speaks to a worried mama! 

After we were finally able to get in to see Derek, I asked him to squeeze my hand, and he did!  We asked him yes and no questions with one blink for yes and two blinks for no, and he responded!  He shurgged his shoulders and nodded and shook his head!  He also gave a thumbs up!
The best was when Krystina went in.  We always felt that she would be the best medicine for him, but the proof was her effect on him today.  He saw her and winked.  A real wink.  A full wink. 
Derek is coming back.  He will return to us.  It will be a long road, but if we can get him out of those damn woods, we will have our Derek back.