Sleeping

Amacker is only lightly sedated now. She opens her eyes most times you talk to her or stroke her. She is not responsive to verbal requests. She also doesn't focus on you or anything in the room. Those conditions, and the fact that she's still heavily dependant on the breathing apparatus, lead me (with the advice of her care providers) to reckon it will be several more days before they remove the tubes that help her breathe. Until they do that, she will remain sedated.

In other words, I don't think she'll be awake for a few more days, at the minimum.

At the last visit of the day (10-10:30), Amacker was all the way reclined again, resting peacefully. She has a slight fever, but such is to be expected. No one seemed worried. Her oxygen supplement is still at 50%.

All's Well... No Kids!

Not much change since yesterday. They tried reducing the pressure in her ventilator, but she's not ready for that yet. They did reduce her oxygen supplement from 60% to 50%.

I brought my kids in to see her this morning, having carefully warned them about what they might see, but the hospital has a strict policy against kids in the I.C.U. Boot (Richard VII) and Sarah were a little disappointed they didn't get to see their aunt, but I think they're satisfied to go home and work on cards for when she wakes up.

Oops...

The folks at dot5hosting seemed to have smashed the bits that make my domain name work. One guy kindly gave me the link http;//amacker.bullwinkle.org, and then another guy, trying to fill the same request, came behind him and broke everything. I'm sorry for the down time for over half a day. All is working now, including the new link.

The funny thing was the number of people who sent me email trying to tell me the site was down, but email didn't find me either. Thanks for trying.

Just so you know, it had nothing to do with the traffic to the site, or anything like that. You're welcome to hit refresh as many times a day as you like. There's also an RSS feed for those of you who use such things. You can find that at http://amacker.bullwinkle.org/amacker.xml.

I'll go visit Amacker in just a bit, and she was doing great yesterday. The spine and neck doctors have cleared her to sit a bit more upright for some of the day. Her adjustable bed had her sitting at about 30 degrees for most of Friday which makes her look more comfortable and natural, and is also better for blood-flow.

The Clot Filter Has Been Placed

Jane tells me the procedure to place the I.V.C. (blood filter) went very well. They really only had to move her across the hall to do it, instead of downstairs to the operating rooms, but any time they move a patient with that many tubes going in and out it's an ordeal.

Jane also tells me tat they in fact did have to use dye to place the device. She said they gave her several things, including a bicarbonate drip, to prepare her kidney and reduce the shock of the dye, and they will also increase her hydration after to help flush it out, but it will be very hard on her kidney.

The risk of clots in the lungs is dramatically reduced now.

Nurse Jane, Approximately

Nurse Jane is Amacker's daytime nurse. She's awesome, and seems to have enough medical knowledge to be a doctor (thus the "approximately," with apologies to Bob Dylan). She says that Amacker is much more comfortable today.

Jane has been lobbying to have Amacker's pain medication increased, and today the doctors ordered just that. We had all been concerned about the grimaces on Amacker's face as they worked on her, rolled her, changed her, etc., and those seem to have subsided with the new pain dosage. Some pain medication goes through her IV, and some goes in through her feeding tube.

"Won't you come and see me, Queen Jane."

New Address

I think the magic of domain propagation has whispered the news far and wide such that you can now view this blog with this address:

http://amacker.bullwinkle.org/

Amacker probably should have had that address years ago. I'm sure she'll do something delightful and creative with it when she is back to herself and finds this mess droll and entirely too pink.

The old address will always work, too.

New Format

I think this new blog software captures most of the spirit of my home-grown site before, but offers you all the chance to interact right here on the page. Comments are wide open.

Thanks to Roxane, a friend of Amacker's and a real-life web guru over at www.little-truck.com, for all her help getting me started with the new software.

Have fun!

A Few Words of Thanks

First, thank you all for the very kind notes… so many now. I will share each of them with my father and my sister Alden when she comes, and of course Amacker too when she’s ready.

Thank you to all of you who are organizing various sweet projects to make Amacker’s life more comfortable when she leaves the hospital. I hope I can come by and help.
Thank you to Marianne for the love and very sweet care package today. I’m such a dork that I was most excited by the Photoshop backpack it came in, but the cookies were yummy, and the games will keep all of Amacker’s visitors and Amacker entertained for weeks to come. There were other goodies in there, too. Maybe with the nice moleskin blank-book I can take notes and actually put real names to phrases like “rock-star surgeon” and “night nurse.” Oh, and I’m not sure I have the chutzpa to pull out that magazine in a hospital, but if I have to bribe that old guy in the corner for anything…

Thanks to Aaron and Tim and especially Don for holding down the fort with Amacker’s home and pets. We’re very grateful for that, since Dad and I have been trading recipes for years for how to cook that bird if it every bites either of us again. (Joke. We know she only bites us out of love…?) And thanks for offering so many times to help.

And thanks to those closest to us for holding our hands when the nights seem longer than they should…

A Bit of an Upturn

Things look better tonight. Amacker is on less oxygen, and her various tests show her lungs are working better. There is a very kind and very informative night nurse. He has been with her for the last three nights and seemed to be very pleased with her overall progress. He showed us all the numbers he has taken in a sort of time-lapse, and explained to us that overall there is great progress. He wasn’t at all concerned about the device they’re putting in tomorrow. He called it an I.V.C. He said it’s very common for patients who are in bed to get one.

The Trouble With Clots

It turns out that the body is not meant to be sedentary. We are meant to dance and jump and run. Amacker is very still and the doctors are concerned about clots. Blood clots form in the legs and travel to the organs. They think that might be contributing to Amacker’s lung difficulties.

Normally they would give her blood thinners, but because of the light bleeding in and around her brain that’s not an option. Instead, tomorrow morning they are going to insert a thingymajiggy (not necessarily the exact term they used) in her vein that will catch the clots as they try to course through her body. I’m told it looks like an umbrella and acts as a filter. They’ll go in through the groin with a wire and up from there until they find the spot to place the device. Normally they would use a dye in the blood to make sure they’re headed in the right direction, but the dye is hard on the kidneys, and with only one that’s risky. Instead they’re going to just move carefully as they navigate up, and use ultrasound and other visualization technology to figure out where to go left and where to go right. I still think Google Maps is super-technology, so I can only imagine how these folks do it. In the mean time they are going to do some ultrasounds of her legs tonight to look for clots that may have already started to form.

Amacker’s lungs remain a concern. They’ve increased the amount of oxygen she’s getting. They fear she might have A.R.D.S. I’ll leave it to the geniuses over at Wikipedia to help you understand what that means.

One other note, Amacker is really only moving her right side. The neurosurgeon is ever-so-slightly concerned about that, but quickly points out that both her left arm and left leg are broken. Further, the left arm might have suffered some nerve damage as it over-extended with the clean break. If we don't see movement soon I'll poke my finger in her leg wound and see if she jumps. Sticking a finger in an open wound is what little brothers do best.

A Bit of a Downturn

Amacker had a rough night. In the middle of the night her red blood count dipped and they gave her a transfusion to bring the count back up. Also, her blood gasses showed she wasn’t getting enough oxygen, so they changed her breathing apparatus settings to increase the pressure inside her lungs a bit, hold the breaths longer, and give her more time to absorb the oxygen. I’m told this is common in situations involving the trauma that happens to the lungs in high-speed accidents.

Amacker is stable again now, but they are monitoring things very closely.

On another note, they have reduced the amount of sedation medication they are giving her. As a result, when they do things like place x-ray film under chest, or roll her to change her, or other things, it appears that she wakes up for a second or two. Her eyes open, she appears to grimace, and she sometimes jerks her hand upward. They assure me that she is still asleep, but she probably does feel some pain during those times. Her pain medication remains unchanged.

The Worst Scrubs Episode Ever and Dad Goes Home

Dad and I were in the room this morning when the med-students came through to do rounds. Surprisingly they invited us to stay. It was very informative and a bit of a learning process for us as the chief resident asked them questions, quizzed them on what different test results meant, drilled them on the next courses of action, and so on. I have to say, I understood more than I wanted to, but it all seemed positive. Apparently her lungs took a bit of a down-turn yesterday, but they’re doing much better today. They also joked, but were half-serious, that leaches might help with her skin graft. They are going to forgo that treatment for now, though. The students looked as tired as I feel. They were also nervous to be presenting in front of Dad and me, but they did a great job. It was very clear that the chief resident was in charge, and we felt very confident in her care.

Dad has gone home for a few days to keep his life there running smoothly. He heroically was on a plane within a few hours of getting the news, but needs a few days now to put things back on track there. He’ll be back before Amacker wakes up. I stopped by my office for a few hours just to sit in a familiar chair, hear familiar voices, and feel like life is in control for a bit. It’s one of those beautiful days in Northern California.

Rest

No procedures are scheduled yet today. They’re letting her rest after her very long night. Amacker’s arm still needs to be set. There is also some concern about her wrists and hands, but a full diagnosis as to what’s going on there hasn’t been done yet. I’ll write when there’s any change.

A Leg to Stand On

Though we haven’t seen her come up from surgery yet, the plastic surgeons just came by to tell us that they are finished. She should be back in her room in the intensive care wing shortly.

He says things went well.

Dad and I will stay put until we see her go by to her room, but I won’t write again tonight. I must say that the deluge of emails with extremely kind, generous, and emotional sentiments have really helped us through this. Sometimes we take turns reading them aloud to each other. I suggest that such readings to Amacker later might help her find the inspiration she’ll need to get well. Thank you all so very much.

Half Way There

Around 22:00 we got word from one of the plastic surgeons that they were headed in to the operating room. The orthopedic surgeons are done with their part, having spliced Amacker’s shin bones together with something they call a nail and some fixing screws.

Now the plastic surgeons will cover the area with local muscle and a skin graft. The wound is approximately 8 inches long.

Frankly, I am being a bit reticent with the surgical details because of the wide audience. Some of this is a bit unsettling. I do apologize for the lack of detail that some of you would like, and the fact that it is too much for some of you as well.

We expect Amacker to return from surgery around Midnight.

Seven Hours Late

She's gone into surgery... finally.

We Wait

Amacker's leg surgery has been postponed as it is not critical and there are several more-pressing cases for the surgeons. Unfortunately they don't know when they'll will do the surgery, so we wait. The older man in the corner of the waiting room is better prepared with a stack of adult magazines. Dad and I are left with each other and the backgammon on our PDAs. We'd bring a real backgammon board so we could play each other, but that might be disruptive to the patients in the hospital. Any of you who have ever seen a Bullwinkle lose... well, it's not pretty. Maybe I should "let" him win in a time like this.

A Good Closer

Amacker continues to improve. Yesterday afternoon they closed her abdomen. The doctors said that everything inside is healing well and they don't anticipate having to do any more work in there. (We did jokingly ask if they left anything interesting inside her, but the doctors didn’t think that was very funny. They very quickly responded with how many packs they had put in, and how many they counted while they were taking them out. I asked if they counted people in the room before and after the surgery...)

The next step is to start working on her leg. In preparation for that, they heavily irrigated her leg (washed it out) with saline. They also cut away any dead fleshy bits, and packed the ends of the bones with a cement like substance to fill where the marrow was and stabilize the bones from the inside.

This morning, they are planning to take her to surgery again to put in the hardware that will connect the two parts of her shin bone. I’ll explain more when they’re done (there are several possible options they might take). We also had very detailed conversations with the plastic surgeons who will close the wound. It seems they will need to take some skin from the back of her thigh to cover the wound. They will also pull some of the muscle from the calf around to the front to protect the new hardware.

My father and I will be at the hospital during this surgery (as we are for all of them), and I’ll write when I know how things went. The good news is that she has shown consistent and steady progress every hour.

It is still uncertain when they’ll wake her up. They did bring her into near-consciousness yesterday for a bit, and Dad and Katy Bell both got to see her eyes open. She’s in there…fighting like we all know she can. She still needs assistance breathing, but she is getting stronger and improving every day.

Anyway, it will still probably be at least another 4 days before they wake her up. Our dad plans to stay until the last of her major surgeries is finished. He will then go home to Dallas to take care of some personal business, and then return when they wake her up. It's going to be a long recovery, and we all need to pace ourselves.

A Few Added Details

Thank you all for your very kind notes. I will do my best to reply, but please know that each note is a comfort.

Several of you asked about blood donation. Amacker took 10 units the night of the accident, but is stable now. Thank you for the offer, but she's topped off.

As a life-long blood donor, I cannot pass the opportunity to ask that if you can donate, do. Amacker was one of many patients that night. It takes about an hour, and will make you feel good about yourself the whole day. Hell, if you’re so inclined, it lowers your tolerance to alcohol and makes you a cheap date. (joke) But seriously, donate now while you’re thinking about her, and do it every eight weeks for the rest of your life. You might save a dear friend’s life.

Also, about flowers, I will give an address and details here when it’s appropriate, but they do not allow any gifts in intensive care. It’s a very sterile environment. Also, she’s in a very deep sleep. She will want lovely things around her when she wakes up.

Don’t Lose Your Head

Amacker’s spinal and brain surgeon is a hotshot, very smart, very easy to talk to, and very confident doctor. He is, however, noticeably befuddled by Amacker’s “bobble-head” condition. He consulted every team and every senior doctor in the area, and after much deliberation decided that Amacker should undergo immediate surgery to secure her skull to her spine. He helped us understand the risks, and the need, and we felt comfortable with this decision.

Amacker underwent surgery Sunday morning to attach a plate fixing, with screws, her skull to her spine. This would keep her from damaging the spinal cord and the brain stem and thus helped prevent possible paralysis. The surgery went very well and the surgeons were quite pleased with themselves. They say she has very strong bones and the plate took well.

Unfortunately, the plate is a lifetime placement, and will restrict her side-to-side head movement dramatically, and also her up-and-down motion of her head noticably. The surgeon also had to push her head back down on her neck to line things up again, and there is a small chance that the bones will not fuse together, but that is something we hope won’t happen because the results might be catastrophic. The doctors have given us every reason to focus on the very strong chance that the bones will fuse together well.

As Amacker is immobilized right now, they have not put any other equipment on her head, but when she becomes more active, she may also have to wear a halo contraption to limit her head movement. She would probably only have to wear that for a month or so.

Deep Sleep

Amacker’s injuries are severe and her leg and mid-section remain open (although wrapped in protective, fancy “saran wrap”). To help her not face that trauma, or deal with that pain, she is being kept in a fairly deep sleep. As I said before, they do rarely bring her up to a near-conscious state and ask her to wiggle things around. She can do so (which is excellent news), but when asked if she feels pain, she always nods slightly.

She has an intubation tube in her mouth and is being assisted in breathing, but each hour she makes more effort to breath on her own. The collapsed lung is mostly refilled, and the oxygen they had been giving her has been reduced by half. Her color is much better also.

She has many tubes in and out of various places. Some drain wounds. Some help her breath. Some feed her. Some take out waste…you get the idea.

The Extended Diagnosis

After the immediate triage and stabilization, specialists began searching for other damage. They found some.

Her Arm
Amacker’s left humorous (upper arm) is broken cleanly through just a few inches down from the shoulder near the bicep. There is also some evidence that she may have damaged her left hand or wrist, but they haven’t taken the time to fully diagnose that since blood flow and sensation seem to be fine (and since they have bigger fish to fry first – see below).

Her Head and Neck
Perhaps the most alarming damage found was at the base of Amacker’s head. Early x-rays showed some fracturing near the base of the skull, but detailed MRIs found the problem to be much more severe and extremely dangerous. This part is very scary, and to save you the angst, I’ll just say that things are stabilized now and the prognosis looks promising.

The spinal and brain specialists tell us that when you wear a helmet and have a high-speed collision, the helmet can protect the soft bits inside, but it can also provide extra momentum to the head itself, sometimes contributing to decapitation. Amacker still has her head, but barely. She has a very severe break in her neck right where it attaches to the skull. Her head was only held on by muscle and tendons. Frankly, the doctor (a specialist in this area) had never seen anyone sustain this type of injury and survive. In fact, he said he’d never seen someone have this injury without a full decapitation! Close your mouth, take a breath, and read on. Because it does get better.

Start working on your “losing your head” jokes now, because she’s going to be fine. Amacker, amazingly, has no apparent damage to her brain, her spinal cord, or her nervous system. She has been brought up from her deep sleep a few times and has been asked to wiggle her extremities, and on command she can move all of them. Amazing.

However, she is still a bit of a bobble-head, and could very easily do damage to her spinal cord. MRIs show a full centimeter of separation between the top bone in her spine and her skull. In you and me, they are connected by firm bone. Obviously, this is an area that needs to be shored up on Amacker, and the doctors are monitoring her progress closely.

Her Brain
Though she did have some light bleeding inside various parts of her head, the doctors are not concerned about this now. The areas seem to be repairing themselves and the damage does not seem extensive. We have every reason to believe that Amacker will be herself again after she completes a very long recovery.

Her Overall Condition
Amacker is in critical condition in Intensive Care. Thanks to the incredible work and diligence of her doctors (and the paramedics at the scene), she is stable, but the doctors remind us that she is in a very weak state. She has the best team of doctors (all the “Chiefs” you could say) working on her. They have shared their confidence that Amacker is going to get through this.

Initial Triage

She was immediately transported to Stanford University Hospital which is just 2 miles away. She was said to be “combative” and “lucid” upon her arrival to the hospital. A nurse later told me that the combative behavior was probably a result of her being in shock. I assured her that the combative behavior was a sign that she was in a completely lucid state. :)

The immediate triage showed a major wound to her left mid-section and a compound fracture of the left shin. The doctors determined that her left kidney and spleen were damaged beyond repair, so they took her into surgery to remove both. While in surgery, they also diagnosed and repaired a small tear in her aorta (the main line to the heart) and a small tear to the liver. They also determined that all her ribs on the left side were broken. Her left lung was collapsed, so they put her on a ventilator, supplemented by oxygen, and they put in a drainage tube on her left side to drain any excess fluids.

They also attached an external metal brace to her left lower leg to temporarily provide some stability, since part of the bone was missing. The leg wound and mid-section wounds remain open so that they will be able to go back in easily to perform any further repair as it becomes necessary. They have those areas sealed in a special vacuum dressing (kind of like fancy “saran wrap”), which will keep those areas sterile until she is strong enough to deal with more work to those areas.

So, much of Friday night was spent stabilizing her as much as possible, and then began the difficult task of counting her other injuries.

The Accident

Early Saturday morning, sometime after midnight, Amacker said goodnight to some friends at a nearby pool hall and got on her motorcycle to head home. Less than 2 miles from her house, there is a tricky turn down and around a small incline with metal drainage grates at the bottom. Somewhere in there, near the bottom of the hill, she lost control of her bike at fairly high speed, skidded some 70+ feet up the other side of the hill and then began sliding along the left guardrail for quite a distance.

She was wearing leathers and a helmet, but the impact was great.

We know that two surgeons were close behind her and first to arrive at the scene. They couldn’t do much to treat her, but they did call 911 and stayed with her until emergency vehicles arrived.

Intro

Dear Friends of Amacker,

Our family has been so comforted to witness the outpour of love from all of you. We are grateful for your help, your sympathy, and your caring for Amacker. In the weeks to come, each of you will help in many ways, but right now the doctors are doing the work for us.

To help them, we are all doing our best to stay out of their way, but I’m sure that is difficult on you as it is on us. To help you stay informed, I’m going to do my best at keeping very accurate and up to date information here.

Because I haven’t met many of you, let me start by saying that I am Richard Bullwinkle, Amacker’s youngest sibling. I live just a very few blocks from Amacker. All decisions about Amacker’s care have been made in tight coordination with myself, our father Dick, who has flown in from Texas, and our sister Alden who is fighting her desire to be here immediately because she will be needed here much more when Amacker is conscious again. Alden lives in Chicago and has two nearly-grown boys.