Update 10 from Rob and Danielle

Linda and Beth are on the "night shift" and Danielle and I thought we would add an update because we are realizing more and more just how many supportive people follow this blog.

Steve had a rough early morning vomiting 3x. Since the feeding tube was installed, Steve has a dark brown fluid building up in his stomach and incessant hiccups. Suctioning out this fluid has cured the hiccups but there is concern as to what the fluid is and where it is coming from. Doctors say it could be left over from the feeding tube surgery. Samples were sent to the lab and we should know more soon. That said, alleviating the hiccups has resulted in Steve resting comfortably throughout the rest of the day.

Linda received the results of this morning's CT scan and it shows that there is no more swelling after 24 hours off of the Mannitol. We were advised that although you obviously want a good CT scan, what truly matters are the improvements that we can and will be seeing at Steve's bedside. We are cautiously optimistic that we are past the 'brain swelling' stage and are moving in the right direction.

After some much needed rest, Steve appeared more awake today than ever. He seems to be tracking us better with his eyes. The right eyelid is still not opening unaided, but is obviously attempting to blink with the left. We believe that Steve is beginning to respond to yes/no commands by blinking 2x for yes and 1x for no. This is by no means consistent, but is definitely becoming more pronounced.

Steve is progressing at his own slow but sure pace and is giving us more hope each day. Please know that we are seeing the results of your positive energy and prayers and we ask that you continue to send them our way.

Update 9 from Linda and Rob

Hello everyone. Steve was pretty sleepy today. They've done so many things (feeding tube, picc line, trach, taking him off the vent for long periods of time, etc) to him during the past few days that he seems worn out. Does a lot of coughing/choking which they say is a good sign, but tiring for him and un-nerving for us! He has his left eye open part of the way and tries to follow voices...his right eye is still closed for the most part. Can do a little more squeezing with his right hand - we're hoping to some day soon use that as a means of communicating with him.

Life in the ICU is a rollercoaster of emotions. Today the trauma surgeon stopped by to check on him and stated that he looked good and they wouldn't do another CT scan unless something was wrong. About 20 minutes later the neurology PA stopped by to tell us that they had scheduled a CT scan. You can imagine the thoughts that ran through our minds. Thankfully, the scan showed no more swelling and a correctly positioned brain midline. Because of these results, the doctors were able to stop giving him Mannitol, which pulls fluids out of damaged tissue. They'll do another scan in the morning to make sure no more problems develop.

The physical therapist brought us a boot that he wears to keep his feet in the proper position, and showed us some range of motion exercises to do with him. It's nice to have something positive and helpful like that to focus on. We actually have become active participants in his care, which is a good feeling for all of us.

We are still waiting to hear about moving to Michigan. We know doctors here have spoken with doctors there...just haven't received details yet.

Yesterday we moved into a house in Reston, Virginia, and are living with Agnes, who is a cousin of Linda's Aunt Dianna. We have space, washer and dryer, the use of a computer, and a kitchen. Two of us spend every night at the hospital, but the others will be staying here. Such a blessing!

I know we keep saying this, but we are so thankful to every one of you for the love, support, thoughts, and prayers. Please keep them coming.

Love,
Linda and Rob

Update #8 from Linda and Beth

More good news today; Steve was taken off the ventilator for five hours and was breathing just fine on his own. (Originally, they only thought he would be able to handle about 20 minutes of that, but he surprised us.) A Picc line was also inserted today, so they took a bunch of IVs out of his arms. This morning, he was also able to respond [albeit weakly] to requests to squeeze our hands and wiggle his right-hand fingers. The doctors were so pleased with his progress that they are considering taking him off the ventilator permanently. In addition, he may be able to be transported back to Michigan by air ambulance as early as the beginning of next week. As we mentioned before, we were originally told that it would be 4-8 weeks before this could happen.

Hopefully Steve will soon be able to do more tracking with his eyes and keep them open longer. We also hope that he will start showing some more movement on his left side. We tell him everyday that his friends and family at home (and across the country) are thinking of him, and we're certain that gives him motivation to keep fighting to get well.

As always, thanks for everything.

Linda and Beth

Update #7 from Beth

Morning everyone,

This is our last day at Red Roof Inn in Rockville; we're moving to a relative's house today and are pretty excited about that. I'll post the address soon.

Yesterday was a big day for Steve. Dr. Daza (the original trauma surgeon who saw Steve when he was brought in) put in a trach and a feeding tube. After Saturday's nightmarish events, we were told that those two things would have to wait; however, since the swelling was brought down so well by the Mannitol, the original plans ended up only being delayed by a day. Now Steve is breathing through a hole in his neck and is being fed through a tube connected directly to his stomach and small intestine. His mouth is now free of tubing, which is great because (a) it's a lot more comfortable for him, (b) it eliminates another possible source of infection, and (c) it means that as he wakes up, he won't choke on the tubing, so they can keep his sedation lower.

As my mom said, Steve is beginning to blink. At first it was just as though he was squishing his eyelids together; he didn't really open his eyes. However, Danielle told me yesterday morning that he had opened his eyes a bit, and so I got really close to his face so I could watch for it to happen. All of a sudden he opened his left eye about halfway and blinked both of them together. I was so startled by this that I actually yelled "Holy crap!" He did this many more times throughout the day and has been opening his left eye wider and wider. Kira and my dad report that last night he actually opened his left eye all the way. We were told to expect progress in his right eye to be delayed some because Saturday's stroke (and the original injury) occurred on the right side of his brain, and that's what we're seeing; however, he is still trying to blink that eye.

The other thing that Steve did a lot yesterday was to yawn a lot and stretch his limbs, just as you or I might do in the morning. He has had a lot of Propofol (a sedative), but they have really turned that down; at one point the dosage was 70 mcg/kg/min and now it is 5 mcg/kg/min. This should make it much easier for him to wake up. He is still not tracking our movements with his eyes and cannot respond to commands, but he is definitely making strides in the right direction.

We'll let you know if there's more progress today.

Thanks so much again,

Beth

Update #6 from Linda

This has been a good day! It started with Jacob, a PA who is very honest with us, visiting with a student PA to show her how to examine someone like Steve. My mom and I were there and listened as he commented about this and that being good. He got really excited about some responses and told us he thought Steve was trying to wake up, although of course there weren't any guarantees. Then he blinked...not where his eyes were open really, but just sort of a squishing of his eyelids together. Has done that many times throughout the day. His breathing and lung pressure are also doing well and they hope to do the trach tomorrow, as well as the feeding tube. Still have to check with one more doctor, but that's the plan. The respiratory therapist thinks he may be taken off the vent sooner than expected, too.

Danielle and I were just talking about priorities...what we were worried or thinking about a week ago, versus being excited about a blink!

Thanks for all your notes...I hope you know how much they mean to all of us.
Love, Linda

Address

Just wanted to post Steve's address at the hospital in case anyone wants to send cards, etc. Please do not send flowers, as he cannot have them in his room and they will just end up at the nurses' station!

Third floor ICU Room 3420
Suburban Hospital
8600 Old Georgetown Road
Bethesda, MD 20814

Thanks again for everything, guys. I will write a longer post later when dad and I are back from the hospital.

Beth

Update #5 from Linda

Steve has no damage to his arteries, which is great news since surgery in his condition would be dangerous. The plan now is to continue with the same treatment and stay optimistic that his brain will heal.

Yesterday we were watching him display symptoms that indicated he might die. We put it in Steve's hands...stay with us if you can, but we'll understand if you can't. Then, around 7pm, there was a positive sign that repeated itself every hour through the night when they checked his responses. We could hardly convince ourselves to be optimistic, but, as we mentioned earlier, the CT scan showed no further damage.

We want you to know how thankful we are for all of you and the prayers and positive thoughts that you are sending his way. I am convinced that he felt them and they helped give him strength to continue on. Please keep them coming! He needs you.

With thanks and love,
Linda

Update #4 from Beth and Linda

Hi again everyone,

Good news: Dr. Alisi looked at Steve's most recent CT scan this morning, and he says that it looks as though the areas of stroke have not grown (and, therefore, have not spread to the left hemisphere). The doctors are trying to figure out how this latest stroke occurred, and are investigating the possibility of a dissection of his carotid artery (in his neck). They are performing a test this morning where they will inject dye into Steve's bloodstream and look at his carotid arteries using another CT scan. If they find damage, they will fix it before another stroke occurs. If they find no damage, it is likely the strokes were caused by the swelling as they originally thought. In any case, the Mannitol appears to be doing some good. If there is no arterial damage, he will stay on the same treatment protocol that he is on now, and we will continue to wait for his brain to heal.

Thanks for all of your kind words and thoughts, and for all of the positive energy you're sending Steve's way. We really thought we were going to lose him yesterday, so you can imagine our relief at hearing the good news this morning. Steve continues to be unresponsive and has a long road ahead of him, but he has gotten through this incident and for that we are grateful.

We wish you all the best and will write again soon.

Beth and Linda

Update #3 from Beth

Hi everyone,

This morning we received some bad news. The neurosurgeon, Dr. Alisi, told us that Steve's brain has swelled and this has caused an extension of the stroke areas that were already there. He showed us the CT scan and pointed out a large area of Steve's right hemisphere that was dark, indicating cell death. The swelling is also pushing on the left side of Steve's brain, which can cause additional strokes to occur on that side. The doctors have started him on a diuretic called Mannitol to try to decrease the swelling. The next 24 hours are critical. He will have another CT scan at 4 am this morning, at which point we will know if the left side of his brain has been affected. Please keep him in your thoughts tonight.

Beth

Update #2 from Beth and Danielle

Hi guys,

Danielle and I spent the night at the hospital last night, and this morning Steve's original trauma surgeon (Dr. Daza) and his intensivist (Dr. Morton) came in to talk to us about his progress. His right pupil, while still enlarged, is beginning to respond to light. His motion on his right side is better than that on his left side, due to the fact that the blood clot was compressing the right side of his brain (which controls the left side of the body). We were told a couple of days ago that the pressure on his brain also pinched off a couple of small blood vessels, causing him to suffer minor strokes in the cerebellum and thalamus. We are still not sure what effect this will have.

Danielle reports that last night when the nurse went to brush some goop off of his eye (they are putting gel in his eyes to keep his corneas hydrated) Steve noticeably shifted his head to the left. This is a good sign, say the nurses, because it indicates that he is capable of "purposeful" movement - not just reflexes. One nurse also saw him start to reach toward his throat when she began suctioning out his ventilator tubing, which is also a good sign.

FYI: We are extremely satisfied with the level of care Steve is receiving at Suburban Hospital in Bethesda. His neurosurgeon, Dr. Armanda, has been extremely patient in explaining things to us and has given us every reason to believe that Steve will have the best possible outcome, given his situation. The nurses and support staff have also been great, and have not minded that we basically have people in there with him at all hours of the night and frequently break the "TWO VISITORS ONLY" rule. His main physician, Dr. Morton, has been around a lot answering questions and has also been very patient with us.

Okay, on to what actually happened: Steve was visiting friends in D.C. on Saturday night when he ran down the steps of the Lincoln Memorial, fell, and hit his head. He apparently thought he was fine, and was able to walk back and go to sleep at a friend's house. In the morning, his friends heard him making strange noises and breathing very shallowly. They tried to rouse him, but while he was somewhat verbal at first, his condition rapidly deteriorated and he began to stiffen, at which point they called the ambulance. Steve was taken to the hospital, as mentioned in the previous entry, exhibiting "blown" pupils and extensor posturing, which is basically the lowest level one can be at neurologically. It was then discovered that he had a massive blood clot on the right side of his brain (between the dura and the skull), which was compressing his brain stem, the part of the brain that controls such essential functions as breathing, heart rate, and blood pressure.

The truth is that if it had not been for the quick reaction of his friends, Matt and Kira, we would certainly have lost him. So words cannot express how grateful we are to them: they saved his life.

More again soon,
Beth and Danielle

Update #1 from Beth

Hello everyone,

We don't have much time to write now, but Mom, Dad, Grams and I are all at the American Inn in Bethesda. As of right now, Steve is still in a coma. He arrived at the hospital on Sunday with both pupils fixed and dilated, and exhibiting "extensor posturing", which is a low-level reflex in response to brain injury. By yesterday, this posturing reflex had changed to indicate a higher level of brain function, and his left pupil had started responding to light. Today he took a few breaths on his own when the nurse changed the filter on the ventilator, and he started showing a bit more dexterity in his fingers, which the neurosurgeon says is a good sign. We still cannot, of course, communicate with him; basically all he can do at this point is move in response to painful stimuli. The neurosurgeon removed a large section of his skull to allow his brain to swell, and that will stay off for some time (it's in his abdomen so it will remain sterile).

I will write a longer entry later explaining what happened.

Talk to you guys soon,
Beth

Sunday morning, February 17, 2008, we received a phone call ..............