Vigil

Sometimes the biggest component of pain is fear

Day sixteen: It rained last night. I get up at 6 am and play in the mud with Andy. Tug of war with a dog who has jaws of steel. I put my play-clothes in a plastic bag and shower. Vanessa needs to be at work on time so she drops me off at OHSU and I bring Laura coffecito and a banana. I’m waiting for the results of the morning’s CT scan to determine whether she’s OK to leave ICU ..meaning no more drain ..no more surgeries and no artificial shunt. At noon Dr. Hardaway arrives and announces the CT scan was normal. She’s draining on her own. No further intervention required. She feels so confident Laura will be leaving ICU that she removes the existing drain from her head right there in the room. It’s a fiber-thin catheter. Laura doesn’t flinch ..yet. It’s not until she’s stitching her scalp that Laura winces ..tries to jerk her head away and cries “Noooo. You can’t do that!” I get the feeling her reaction has more to do with 2-weeks under orders not to touch it. Like it’s a vulnerable site not to be messed with. She may not realize it’s her brain surgeon doing the messing. Sometimes the biggest component of pain is fear. She will be released from ICU just as soon as they can find her another room. I assist Laura with some physical therapy exercises to stretch and loosen her muscles. She’s compliant and surprisingly limber. She looks up at the ceiling and goes “I have a lot of work to do.” Afterward she says something in rapid Spanish ..looks at me and switches to English “I couldn’t respond when I was tired” referring, I believe, to the questions everyone’s been putting to her over the last two weeks. Almost like she’s apologizing for her unresponsiveness. I smile and say “of course not” ..delighted she has the presence of mind to remember her prior state of mind while drifting in and out of fever. I take it as another good sign. We spend the next hour and a half looking at pictures of remodeled homes. When she drops off to sleep I go and keep a promise I’d made to myself when I first arrived and take the gondola from the mountainside hospital to the Willamette River below ..feeling buoyed by news of Laura’s recovery. Momentary disorientation when I reach bottom thinking I’m in town only to find I haven’t left the university. I sit and have juice in the Wellness Center. Feeling ecstatic.

Vigil

Day fifteen: Vanessa and I arrive anxiously at 10 A.M. in ICU. We’re greeted with welcome news. The CT scan this morning (12 hours post endoscope) shows no change in fluid levels, which is good. Since the external drain is still clamped this means she’s draining on her own. I feel greatly relieved. No more surgeries ..no artificial drain. Another CT scan tomorrow (at 24 hours) should clinch the deal and she’ll be released from ICU. I go upstairs for coffee and breakfast. Vanessa goes home to catch up on things and get some much-needed sleep. Her husband Dustin who’s been keeping track says she should get at least 4 hours to fortify herself for the upcoming workweek. 

I take a walk in the woods ..find a bench and practice some deep breathing and progressive relaxation exercises. I return to the room where Nurse Jean has transferred Laura to a specially designed chair and I feed Laura lunch. Afterwards we watch ‘pawn shop’ on the history channel ..a favorite of Laura’s. She likes to watch the negotiations. I explain why a dollar bill printed by Benjamin Franklin prior to 1776 is worth $8,000.00. A hand-held sundial made in the 17th century by Hans Troschel is worth $6,000. 00. The owner decides to keep it. I tell her it was made in my mother’s hometown of Nürnberg Germany. Laura’s eyes widen. After 2 hours of this she is ready for bed.

I take another walk in the woods ..eat lunch then return where I lie between a couple of chairs next to Laura. I wake up freezing. They keep the temperature of the room at 60 degrees. I go down to the lobby and sit by the fire but it doesn’t help. I return to the room where Vanessa and Dustin have arrived with the baby. Laura looks more lively and alert than ever. She’s answering questions with spot-on accuracy. She knows what’s happening ..just needs the energy to express it. Warms my heart but my bones are still chilled. Vanessa rounds up some heated blankets, which help tremendously. When the nurse picks up and empties two liter-bottles of urine ..Laura looks surprised. She goes: “I didn’t feel that” ..which tells me she has good body awareness to know she didn’t sense it. The nurse explains that after two weeks of assistance you become less sensitive to the fullness of your bladder.

Vigil

“The healing process of the brain is more like running a marathon than a short sprint. It has a longer time frame.” ~ ICU doctor

There are three things that influence your perception of a patient’s recovery: 1) The placebo effect – or the expectations of both patient and observer. 2) The variability of the mind – mental activity follows a natural cycle. It’s wave-like; waxing and waning on it’s own. 3) The observer effect – the tendency to focus on one phase of the cycle more than the other. Expanding wanted periods and minimizing unwanted periods or vis versa.

Day fourteen: Laura had endoscopic surgery this morning to create an opening between ventricles that will allow one to drain into another. They left the external drain in place but clamped it in hopes the ventricles will take over. Now all we can do is wait and see. Like watching anything in nature, I’m reminded of the ‘observer effect’. After the anesthetic wears off ..Laura sees me, Vanessa, doctors and nurses hovering anxiously over her asking the same questions as before. I don’t place much stock in the answers and don’t remember them. She nods back to sleep. Periodically throughout the afternoon I grasp her hand ..wake her up ..and guide her through some deep breathing exercises ..squeezing her hand while inhaling and relaxing it while exhaling. I go “Breathe in ..hold your breath ..breath out ..relax yourself.” I use dramatic gestures to indicate my own breaths. Whether or not she can follow is almost beside the point. I figure just observing can effect the mind and simulate the action (Dr. Ramachandran). I know I look silly but I don’t care. Her intracranial pressure (ICP) is running high right now due to the procedure and it is my intent to do anything I can think of that may help bring it down. Her ICP is an indication of how well the ventricles are doing on their own. After half an hour it has gone from 18 to 13 (it’s normal range is between  - 6 and 20). During the next half hour it has remained at 10-13. I’m aware I’m observing a fluctuating system that changes on it’s own. How much of it is due to the healing process, my efforts or just the passage of time ..I have no clue. When the nurse comes in I mention what I’m doing. He shows me another line on the monitor that measures her respiration. It has been elevated for the last half an hour. He says there’s a loose relationship between it and her ICP. Sure enough, when her respiration was high ..her ICP was lower. He explains that high respiration means a higher rate of CO2 exchange between blood and cells, which leads to enhanced drainage. Now I don’t know if he’s telling me this just to make me feel like I have a better handle than I do on what’s going on. I’m aware that the observer effect extends to everyone in the system. The CAT scan tomorrow morning will be more telling. 

I feed Laura lasagna and salad. She’s ravenous but insists I finish it. I take a couple of bites then she nods off to sleep. I go to the cafeteria for BBQ chicken and rice.

Vigil

Day thirteen: I bring Laura coffecito and a banana, which helps relieve her stomachache and constipation. PT comes in and has Laura marching in place. She helps her into a chair where we continue our discussion of images from a book of design. Shannon comes in and conditions and combs out Laura’s hair. An assistant braids it. We try resuming our discussion but Laura is in obvious pain. Her sacrum hurts from lying in bed for almost two weeks now. She attempts to leave the chair and transfer into bed. I applaud the effort but it’s a chance I’m not willing to take. She gives me a look like: don’t be such as wuss .. I don’t need no nurses. I manage to stall her until Shannon arrives. She falls asleep immediately. The physical therapist will be in tomorrow to show me some bed exercises we can do to help relieve the soreness in her tailbone. 

Dr. Kamilla Vagnerova from the ICU surgical team comes in for an extended visit. On a high definition monitor she shows me Laura’s CAT scans from day one. I see the injury site. It was a nasty hemorrhage. 4 on a scale of 1 to 4. She bled in the space between the brain and skull. The surgery was a success but blood and cerebrospinal fluid don’t mix. It interferes with the drain action in the ventricles. I see the results on the scan. The endoscope procedure tomorrow should relieve this. She shows me the site of the ischemic stroke Dr. Dogen told me about. She re-affirms what he said ..it’s not in a significant location. OK. She also re-affirms what Dr. Hardaway said ..the vaso-constriction is mild and limited to one vessel. 

While Laura sleeps I take one of my many walks through the forest outside. 

This evening while Shannon wheels out the dinner tray, Laura bolts upright and shouts: “Hey, what about him ..?” meaning where’s my dinner and what kind of host are you. We laugh and I assure her I’ve already been taken care of. After this Laura insists on sharing her meals with me. Very Laura-like.

Vigil

Day twelve: At 9:00 am I bring Laura coffecito and a banana to hold her over until breakfast arrives. Vanessa arrives at 11:00 am. Dr. Francine Hardaway ..a brain surgeon who looks like Reese Witherspoon comes in and tells us that the upcoming endoscopic surgery has a 90% chance of success. The opposite of what Dr. Dogen told us yesterday. I like those odds better and decide I’ll stick with them. I really don’t want to see Laura leaving here with something foreign in her head. She gives us the results of this morning’s angiogram: 

1. There’s only a slight constriction (vasospasm) going on in her prefrontal cortex, which accounts for Laura’s confusion. Normal for 12 days out. 
2. Her speech centers were not involved as Dr. Dogen previously thought . 
3. The blood vessels at the injury site look good! No sign of weakness there. 

I finally feel like we’re out of the woods. I could kiss Dr. Hardaway.

Nurse Shannon who I greatly admire ..gets Laura sitting in a chair. Something neither Laura or I can do because of the drain. I feed her lunch then bring out the design book. Big pictures of remodeled homes. Laura is transfixed. We chat and I ask her what she likes and doesn’t like. She studies them and comments on the size of the kitchens ..the height of the tables ..and the wall hangings. I ask her about the design of one that looks particularly Japanese. She calls it ‘bamboo’. Close enough.

Vigil

Day eleven: Laura is still slipping in and out of consciousness ..or through the fingers of the fog-of-fever as I like to say. Her temperature runs anywhere from 98 to 102 degrees. When she slips in, she reaches for my hand and grips it firmly. We talk until she slips out again and I feel her grip loosening. Sometimes she’s coherent, other times it sounds like she’s still dreaming. Quite normal for someone passing in and out of the fog-of-fever I’d say. The fever is also normal for someone in her condition. They tell me it could be caused by trauma to the head ..invasion of foreign objects (like all the monitoring equipment) ..or infection. So far they’ve been able to rule out infection. Then, for the next couple of hours I experience information overload. 

Dr. Dogen who performed the emergency surgery to repair the hemorrhage explains the ‘critical path’ out of ICU ..removal of the drain without increasing intracranial pressure (ICP). He shows me where I can view the pressure reading on the monitor that sits behind Laura’s head. Removing the drain depends on restoring absorption in the left ventricle. That can happen in either one of two ways: naturally or by surgically installing a mechanical shunt. The shunt will drain cerebrospinal fluid into her peritoneal cavity. Clear so far ..though I wished I’d paid more attention to the ventricles in college neuroscience. They play more of a housekeeping role than a functional role. Sort of like storage tanks for fluid hydrating the brain. He says they’ve tried closing the drain twice to see if absorption would kick in naturally. It didn’t so they re-opened it both times. In cases like this he says the likelihood of installing a shunt is almost certain ..like 90%. Clear so far .. it sounds like there’s a pretty good chance she’ll be needing more surgery. He tells me they’ve scheduled an angiogram in the morning to check for vasospasms and get a clear picture of the injury site and check the integrity of blood vessels there. Vasospasms are like a constriction of the blood vessels in the brain that generally occur after this type of hemorrhage. They can lead to ischemic strokes inside the brain by cutting off oxygen. In fact he tells me that she’s already had one ..in the basal ganglia area ..but not to worry. It’s benign. Now I’m not clear ..more like wtf. Has there been any damage that’s not benign ..? Yes, he say’s .. they suspect her speech centers may have taken a hit during the first stroke. He leaves me to contemplate this. 

At noon, Dr. Raslan pops in and introduces himself. He’s been assigned to perform the endoscopic procedure. He explains that it’s an operation to open up the ventricle to try and allow it to absorb naturally. This is the first I’ve heard of it and wonder if Vanessa knows about it. Vanessa arrives at 4:00 pm and I do a lousy job of explaining what I found out today ..some of which she already knows some of which is news to her. We go back to the house where Dustin prepares my birthday dinner. I grab a bunch of art and design books with large glossy photos and we head back to OHSU. I know vision is Laura’s preferred sense and it may be a good way to keep her engaged.

Vigil

Day ten: “Laura! Are you there ..?” She opens her eyes. A hint of recognition crosses her face and she smiles faintly at everyone looking anxiously down at her. “Can you tell us where you are right now ..?”  “Umm, church.”  “No, you’re in the hospital ..what month is it?”  “Uhh, December ..(?)”  “No, it’s April.” She looks confused then disappears until next time they wake her with the same drill. I just arrived at her room in ICU - Neuroscience unit. The doctors call it delirium. It is where they expect her to be for right now. I call it the fog of fever .. aftermath of a traumatic brain episode (subarachnoid hemorrhage). Sometimes she emerges, calls me by name and rolls her eyes when I ask her about today’s nurse. Other times she wakes up but the dream lingers on .. obscuring the view. Any answers we get may be referring to that. She may also be struggling to find the right word. Either way, what’s comforting to me is that I hear and see the Laura I know and love. Even though ten days have gone by, that’s still pretty early in brain-time. There’s much more healing left to go. Patience.

And now I know / time is no friend of mine / nor his girl / patience, patience..

Sight unseen

Message from a zen fortune cookie ~ “There’s help from an invisible source available to you right now. Of course if you’re the type of person who believes that reality consists of nothing more than what your senses reveal then you won’t be able to tune in to any of it. On the other hand if you’ve had direct experience with blessings that come from an unseen realm be aware that the imminent delivery is quite different from what you have received in the past. Otherwise you might miss it.”

Covenant

My task is to try and uncover the semi-happy ending that was hidden back at the story’s beginning. Only then, I am told, will I have a chance at creating a real and satisfying resolution. There may be no other way. It’s crucial to get back to the original flash of inspiration .. a time when all plot lines were equally possible ..and remember to read the signs I missed along the way.

Urban Trek

A big walk begins at my doorstep. The first stop .. a stone passageway that runs around back of the high school stadium. It’s not only a short-cut ..it has rails that are the same height as the bar in a dance studio. Perfect for stretching my piriformis and softening my ride. On Figueroa Street someone honks and gives me a thumbs-up. I wave but have no idea who it is. I narrow it down by women who know I’m recovering and have a bright smile. Pat springs to mind. I pass by Andrea’s place but I know she’s at work. Must remind myself to send her an IM. At Wells Fargo they have table and chairs and bottled water. Good place for a pit-stop. I tank-up ..begin writing this screed and plan my next move. The men’s room at the court house. I’m sitting in the mural room chatting with a girl and her parents from LA . They’re on a college tour ..Mount St. Marys ..Occidental ..UCSB. Her preference ..University of Utah. I gather she wants a little more distance between her and her parents. I return by way of the high school ..stretch and sit in the stands. A tune fills my head ..recovery is going well .. feels like downtown is getting closer and closer.

Code

I will be engrossed in fascinating experiences that feed my curiosity, but I will not be obsessed with grueling frustrations that drain my energy.

I will be committed to love if it opens my eyes and heart, but I will not be infatuated with maddening conundrums that spark mostly fear.

I will give myself freely to opportunities that offer me valuable lessons, but I will be skeptical of one-sided pursuits that ask far more from me than they offer in return.

~ zen fortune cookie factory

cool new tune

So Cal

“What is softest in the world
overcomes what is hardest.”
Lao Tzu

Communities in Southern California aren’t developed in tune with the coastal surroundings. They’re invasive. Homes are built over tidelands that are there to replenish the water and beaches. As a consequence ..homeowners are losing their homes to erosion while the rest of us are losing our health and livelihood to foul water. I admit I don’t have much sympathy for the homeowners. My sympathies go out to the surfers who get sick. They’re much more tuned in to coastal conditions.

A Middle East tale

There was once a country where the majority of people were Shiite. But they were ruled by a Sunni tyrant. One day a faraway Christian country came and freed them from tyranny and established democracy where majority rules. The Shiite majority elected a Shiite government. The Shiite government chose its closest Shiite neighbor as an ally ..a sworn enemy of the Christian country. Was that so hard to foresee ..?