Landing

The doctor in charge of the I.C.U. and Amacker's overall general progress said yesterday that extubating a patient who has been sedated and intubated a long time is a bit like landing a plane. You want to get the thing on the runway. You have all the flaps and landing gear in place, but if you're 200 feet off the ground and cut the engine, you still might crash.

You want to have everything lined up perfectly before you extubate a patient, and Amacker still isn't ready. They will continue to make her work her lungs more and more each day, but he reckons she'll probably be ready by the middle to end of next week.

With that news, Dad has returned to Dallas to take care of some urgent business, and will come back to California when he's needed here again. Alden is staying with me, and probably enjoying some quality time with her niece and nephew. She could probably deal without her cantankerous brother, but I come with the furniture.

I left Amacker in Alden's and Dad's care this morning, and Alden's this evening. I spent the day in Santa Cruz at my son's beach soccer tournament, and doing beachy things with my daughter between games. I am sunburned in only the exposed parts, so that naked I rather resemble the Purina logo.

I'll leave you with that image.

Song of the Day: Breathe In

There are so many songs about breathing, and believe me, I've been tempted to use all of them. Most, however, are not as positive as I want to be on the subject. This one has a very up feel and a mostly up message.

And I'm high enough from all the waiting
To ride a wave on your inhaling
'Cause I love you no?
Can't help but love you, no...

Frou Frou performing "Breathe In"

Three Weeks

I wish I had something brilliant to say as I near the hour when three weeks ago police officers knocked on my door and asked if I was related to someone named Amacker.

That's how I first found out about Amacker's accident. I was sound asleep and heard female voices outside my window. In my complete drowsiness I didn't know what was going on and released the hounds... okay, I let out my very sweet and harmless weimaraner Paddington... hoping to scare away the pranksters on my porch. The officers remained calm and asked if I knew someone named Amacker. I sleepily said, "yes, she's my sister." They said she'd been in a serious accident, and that I needed to come to the hospital immediately.

With lights whirling they escorted me to the hospital, and I ran in to be greeted by multiple doctors asking very difficult questions, explaining very scary injuries.

Some of Amacker's friends were also in the Emergency room. Erin, Don and Tim had gone home to find her not there, and then went looking for her. They passed the scene of her accident, very near Amacker's house, and asked the crews working there if a yellow motorcycle had been involved. When they found out it was a yellow motorcycle and that the rider had been rushed to Stanford, they headed there as well.

And so we sat in an emergency room hoping Amacker would get through those first critical surgeries that would stabilize Amacker for the very long road she had ahead of her.

You know the rest of the story.

Tomorrow morning they'll try once again to make those lungs of hers fill all on their own. All day today she took breaths as she wanted to. The machine just put a little pressure behind them to fill her lungs, but only she chose when to breathe. The rate setting was turned off.

It may not be tomorrow. It may not be the next day. But some day very soon Amacker will take a deep breath all on her own, and very soon after that she'll ask, "Where am I?" and "Who's taking care of the bird?"

Tonight Nurse Jennifer is looking after her as she rests.

Not Today

Amacker's respiratory test this morning went better than yesterday's, but not good enough to remove her breathing tubes. The plan is to try again each morning until she's ready. Each time she will gain a little strength and be a little healthier, until at last she does it all on her own.

The process for testing her is a bit complicated. At midnight they stop giving her food through the tubes. Then they slowly reduce her sedation through the wee hours of the morning. And then around 6 in the morning they reduce the settings on her breathing apparatus to almost nothing and see how she reacts. They let her try for a few minutes, and if things don't go well they turn everything back on, including the sedation.

One effect of this method was that this morning when we went to see her at 10AM, Amacker was in that distant place again. She didn't seem to focus or respond to us as much. I imagine that she is most aware early in the morning right before they give her the test, but we're not allowed to be with her then.

So we wait...

The picture is from Dad's and Amacker's trip to Paris last October.

Song of the Day: The Maker

I have about 10 different versions of this song on my computer, and am not quite sure which is the right one. I have it by Daniel Lanois, the brilliant writer/producer who wrote the song. I have Willie Nelson's version from his album Teatro. I have U2's version, Jerry Garcia's version, and Dave Matthew's version, but one voice is present in most of the versions I have. It seems that no matter who records "The Maker", Emmylou Harris is asked to come and sing with them.

When I wonder what Amacker might be dreaming about, well maybe it's something like this.

"My body is bent and broken
by a long and dangerous sleep
I can work the fields of Abraham
and turn my head away
I'm not a stranger
in the hands of the Maker"

From her album Spyboy, Emmylou Harris performing "The Maker"

Focus

This has been a very emotional day...

This morning when we visited Amacker she was much more aware than I've seen her. When I spoke to her, her eyes immediately turned towards me and there was focus. I realized she knew I was there.

I quickly got out of the way and let Dad and Alden come to her side, and her reaction was instant. Amacker started squirming and wincing as she wanted to speak to them. She wanted that tube out of her mouth. She wanted not to feel pain as she tried to sit up. She was so excited to see them. Alden spoke with Amacker for a while and Amacker seemed to start to cry.

She's ready. She wants to talk to someone, and I'm sure she has a lot to say.

Alden and Dad visited several times during the day, and I made it for the 6 and the 10, and each time she seemed to be more sentient and more aware.

To set the scene clearly, I should say that she still doesn't squeeze our hands when we ask her to, or follow any commands or requests, but she definitely knows we're there. She is still intubated and still on Versed, so she probably won't remember any details, but Nurse Jennifer (amazing nurse Jennifer) said that tomorrow may be the day we again hear her voice.

We're all very hopeful. Many of you are praying. Some of you are dancing. Some of you are chanting. Some of you are sacrificing chickens. Whatever your approach, we're very grateful, and she's going to know that you all pulled for her, and she's going to be just fine. Tonight, more so than ever, I am sure of it.

Song of the Day: O-o-h Child

Dad and Alden are here. All is well.

I was torn between Beth Orton's version and Nina Simone's, but Nina Simone's is more upbeat, and upbeat is good:

Nina Simone performing "O-o-h Child"

Nurse Jennifer

At the 8PM Amacker show, I met a new (to me), very informative nurse, Jennifer. She says that Amacker's temperature is up even more (slightly), and to fight that they've added another antibiotic and a bit of Tylenol to the mix. She also says that Amacker is very active. They've changed her sedation around in hopes of getting her ready for waking up soon. Nurse Jennifer is very optimistic and kind... a refreshing attitude after some of the things that happened earlier today. Not much more news than that.

Two Steps Forward, Two Steps Back

Unfortunately today hasn't gone as hoped in Amacker's care. At my 4PM visit Nurse Anna (a new one) explained to me that Amacker has not responded well to the steps to remove her breathing assistance. Specifically, when they disconnected the hoses that lead to her mouth, she became extremely agitated, had a very high breathing rate, and became tachycardic, meaning her heart rate shot through the roof. They tried to let her adjust for a few minutes, but wound up reattaching the breathing tubes.

On top of that, Amacker soon thereafter developed a fever. They're not sure what's causing the fever, but they've sent every fluid she's got to the lab for tests. It can take as little as a day or as much as three days for cultures to reveal what's causing the fever.

They won't try to remove the breathing assistance again until the fever is under control. She's on a general antibiotic for now, and that might just take care of it.

In the meantime we wait, which is less than ideal for Amacker's Father and Sister who both boarded planes headed this way with hopes of seeing Amacker wake up tomorrow. Maybe it's some consolation that they can watch me wake up if they want to.

Song of the Day: Do You Realize?

As I sit here and watch Amacker heal a bit more each day, I can't help wonder what's going on inside that massive brain of hers. On the outside, everything is fixing itself. Everything is coming along nicely, and soon she'll wake up. But you have to ask yourself what she's doing with all that processing power. Does she dream? Does she know we're here? I wonder if she'll remember the accident. I wonder what she realizes and what seems so very strange.

Soon.

This is one of my favorite songs. It's about the fact that all of us are here only for a short while, and the best you can do with your time is fill it with rich relationships.

The Flaming Lips performing "Do You Realize?"

Leg Complications... Grr

I tried to visit Amacker at 8 this morning, something I've done many times, so I could get to work and make the boss-man think he's paying me for something. Unfortunately I got kicked out of her room and asked to come back during visiting hours. (Those start at 10AM.)

Before I was ejected, I found out that Amacker's left shin is having difficulties. Some of the muscle that they pulled over her bone has not taken well, and they're taking action to revive it. Unfortunately they had to remove some of her skin graft to do that. They think (hope) everything will be fine, but she'll eventually have to have another skin graft.

All of this shouldn't delay her waking up, but it's sucky. More sucky was the fact that this was the first time I've been able to talk to her plastic surgeons in a long time, and I only caught them because I was breaking visiting hours rules and found them making rounds. I'm becoming a bit frustrated with the fact that there is a different nurse every day, and each has slightly different information. The doctors in charge of her overall care are much harder to pin down.

Luckily a team of hot-shot doctor trackers are flying in from Chicago and Dallas tonight.

A Bed With a View

At 7:15 this morning they took Amacker down for her arm surgery, and it was a complete success. They didn’t call me… something about it happening right in the middle of the nurse shift-change, but it did go well, and I spoke with the doctors after.

Amacker’s humorous has been repaired with a plate and about 7 screws. It will heal just fine. The nerve that travels along that bone looks intact, though they could not be certain that she won’t feel some tingling or numbness in her hands. It can repair itself if there is damage. It is likely that she will have excellent use of her left hand further down the line.

They’ve moved Amacker to a different room, and to the bed close to the window. It’s a nice view. Tomorrow morning they’re going to do some tests to make sure she’s ready to breath unassisted, in fact today they’re going to slowly back the machine off most of the way. Then tomorrow some time they will exuberate her, removing the breathing tubes entirely.

After the breathing tubes are out, they will begin weaning Amacker from her sedation drugs. It will take a while for them to exit her system completely, but in the next few days Amacker will begin to have more and more consciousness. There’s no prescribed schedule for when she’ll be able to sing on key or have guests, but it’s coming.

Tomorrow evening Dad and Alden will arrive. We’ll all be here together as Amacker begins to process the faces in front of her.

I’m excited.

Song of the Day: Angel From Montgomery

It's not a song about Amacker or the situation, but it is one of her favorites and one of mine, too. She first played it for me a million years ago, and then later she was asked to do the poster for a John Prine concert... what atreat for her. Anyway, it's a great song!

John Prine and Bonnie Raitt performing "Angel From Montgomery"

The picture is another from Sue.

No Surgery On Monday

Sorry for not posting yesterday, but I found out late on Monday about them moving the surgery to Tuesday.

The reason for the delay is purely a full schedule in the operating rooms. Amacker continues to do well, the same as last reported, and is fit for this last major surgery.

They're going to try again today, Tuesday.

The picture today, with the develish smile, comes from Amacker's friend Sue.

Addresses To Send Stuff

I know many of you are a long way away and are wanting to get things in the mail to amuse Amacker, and share your love, so goodies will be here when she wakes up.

I'm a little worried about bombarding the I.C.U. staff with cards and packages, and there's already been a lot of mail they've dealt with. There is no cabinet or shelf that is just for Amacker's stuff, so they wind up handing it to me, which is fine. Therefore, if you want to make certain she gets something, you may send stuff to me, and I promise to put it in her lap as soon as she can tell me her name, rank and serial number. My address is:

Amacker Bullwinkle
c/o Richard Bullwinkle
540 Loma Verde Avenue
Palo Alto, CA 94306

And if you absolutely must send it to the hospital, that address is:

Stanford University Medical Center
ATTN: Amacker Bullwinkle
300 Pasteur Drive
Stanford, CA 94305

And please don't send anything living or perishable yet. Neither is allowed in the I.C.U.

Song of the Day: Superman

A quick update... Amacker is scheduled for arm surgery today, but because she's kind of a resident they're going to send her in whenever there is a break in the schedule. I won't know when she goes in until she goes in. They'll call me. Everything else is as it was yesterday -- good.

This song is just plain funny. It's about not knowing your limits, and perhaps not knowing the limits of the laws of physics.

Willie Nelson performing "Superman"

Asking the Right Questions

As of tonight's visit, Amacker is still doing very well. In fact, I found out she's been doing better than I realized. Tonight's nurse was one from early last week, a very nice woman, and she was chatty.

As it turns out, Amacker has been pulling breaths on her own since noon yesterday. This is to say that while she is still on a ventilator, it is only breathing when she asks it to. The friendly nurse (again I forgot her name -- shame on me) explained that breathing through a ventilator is a bit like breathing through a straw, so the machine is only helping her as much as it needs to, compensating for the extra drag caused by the several feet of plastic tubing.

Also, Amacker no longer has a drainage tube going into her chest to help clear out around her left lung. It's been gone several days. I just didn't notice, because it was routed under her gown (a place I never look, for obvious reasons).

Anyway, it's not new information, but certainly good news. I just didn't know what questions to ask until it was offered to me by a sweet, possibly lonely, night nurse.

"Aggressive"

Today's word for the day is aggressive.

I was fortunate to meet another big chief this morning, I think the Chief of Medicine, which sounds to me like he's chief of chiefs. Anyway, he was VERY pleased with Amacker's condition. He explained that she is on minimal settings on the respirator, minimal sedation, minimal antibiotics -- to keep infection out of her wounds, as her staph infection is gone, and moderate pain medication.

Tomorrow they will fix her arm. I saw the X-Ray, and it is a clean break, but not at all lined up because of the way she is resting in bed. They'll attach a plate with some screws to make sure that bone grows straight back together. I am told that she doesn't have to have that plate forever, but that there is usually no reason to remove it. It's completely internal, and not near a joint, so it should cause no discomfort.

So why aggressive? Because the big chief says that after her arm surgery Monday they will start getting aggressive about her rehabilitation. She has had two weeks of doctors, machines, and her general good health before the accident healing her, but starting Tuesday it's time for her to start doing it on her own. They will begin Tuesday the process of weaning her from the breathing apperatus, the sedatives, the feeding tube, and soon after the antibiotics and everything else. She'll obviously have to continue her pain medication, but she'll have input into how much and when. Physical therapists will start coming to help her figure out how to re-strenghen.

For now the neurosurgeon has perscribed that Amacker wear only the collar for 12 weeks from the date of surgery. That might change if she is not careful with things, meaning they might have to use something that limits her movement more, but he is pleased with the way things look and thinks a collar should be enough.

I should also say that Amacker remains unresponsive when asked to squeeze hands or blink or do anything to let us or the doctors know she's hearing us. The big chief says that it's not uncommon, because she was on quite a bit of medication that will take a while to clear out of her system.

In other words, they have no reason to believe Amacker won't be running the show very soon.

The picture comes from Angie Taylor who took the picture in April during a visit to California this year. Angie lives in Brighton, UK. Thanks Angie!

Guest Post from Amacker's Dad: Father's Day

Editor's Note: In my daily (sometimes hourly) phone-call with Dad yesterday he mentioned he was composing in his head a Father's Day post to leave in the comments today. I pointed out that Amacker would love to see it on the main page and asked him to send it to me in email. So the following is from Richard Bullwinkle V, who goes by Dick, and currently lives in Dallas, but will soon follow a dream of his to set himself to pasture, quite literally, by moving to the country and living full time on a small farm just north of the city, with room for horses, kids, grandkids, and his darling fiancé Linda.


Father’s Day

Thrice blessed! The strength and fight of my First Born – Ichi-bon – Amacker, as she continues to survive and prevail over the horrific injuries of her accident. The anxious patience of her younger sister, Alden, who continues to wait for the time when her presence at her sister’s side will make a meaningful, essential difference. And the ever-present, loving watchfulness of Amacker’s guardian brother, Richard, who from the frightening hours of the first night, when he was alone with her, through the intense series of major surgeries to piece her back together, when we held each other together and faced the sometimes terrible decision on what to do next, and then the long, watchful days of respiratory challenges and the threat of infection, has never waivered in his steadfastness, nor lost his sense of humor. His daily posts have kept a legion of friends and family informed, amused and – well, able to deal, each in his or her own way.

No father of these three children could have failed to have known that he was truly very fortunate. And no father would wish for such an event to focus his family and himself on how wonderful they all are. But, dealt this hand, how could I have ever had a better place in this world? As I now plan my next trip to California to be at Amacker’s side when she awakens from her long sleep, this is the best Father’s Day I have ever known. Although my sense of concern is no less, my sense of Joy has never been greater. We don’t know these things when we start down the road to parenthood, but we soon learn that there are many wonderful times and many trying times to come. In my case, they are the same.

Bless you Amacker, bless you Alden, bless you Richard; may you always have the sun at your face and the wind at your back! I love you all with all my heart!

Dad

Song of the Day: Father and Daugher

Happy Father's Day to everyone, but especially my dad, whom I know is focused on his first-born daughter today, but has been a wonderful dad to all three of us.

For Dad, who loves Paul Simon, and my two amazing sisters today's song is:

Paul Simon performing "Father and Daughter'"

Note: If you don't see the play button over there on the right then you don't have the Flash Pluggin from Adobe. No big deal if you don't like to install such things, but that's why it's hiding from you.

Under the Collar

Few things delight a little brother as much as hearing nurses refer to the neck brace on his big sister as a collar. I snicker every time I think it. I just wish she had a leash! I should also note that I also find it fun that forever Alden and Amacker will be my "big sisters", when I am probably bigger than both of them put together. When I recount the numerous times they told me scary stories that kept me awake quivering in my bed -- giant squirrels and meely-wheelies were the names of the creatures that haunted my thoughts -- well don't think I don't have the occasional devilish impulse to thump Amacker on her sore leg when she's sleeping.

Anyway, at my evening visit Saturday Amacker was having the pads in her collar changed. They change the pads every 12 hours, but I've never managed to be in the room when they do it. I was glad I got to see what is underneath. The swelling is really almost gone. There is no bruising, and her stitches on the back of her neck are much more elegant than some of the others, and I think it will heal nicely leaving a very small scar in the back under the tresses of blonde and pink.

I was sort of hoping for Frankenstein bolts out of the side of her neck -- yet another thing for a little brother to poke fun at -- but no, she's going to look as lovely as she always has.