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.