Tuesday, April 18, 2006

[This blog post is for you, Dr. Georgia]

Today is not a good day.
Over the past couple of weeks, Mike has been off, but for the most part, when he’s alert he’s content, funny, and friendly. Today he’s alert and really agitated. When I arrived he barely acknowledged me (probably because for all he knows I was just there 4 minutes prior). I walked in with a couple of bags of things. “Where are you going?” he asked. “I’m not going, I’m just arriving.”


He was strapped down in the chair when I arrived at 11:30 am. Apparently he was acting “impulsive” this morning. He kept trying to stand up or walk out of the room. Kept alluding to “going out” or “going somewhere.” And when I’d tell him that wasn’t going to happen, he responded quite sarcastically.

At one point he told the nurse he didn’t appreciate being lectured. “Lectured about what?” she asked. “Lectured about Satan,” he responded.

… I have no idea.

His vision only makes the problem worse because he can’t see properly and then makes things up to help explain to himself what he’s seeing. It’s a little freaky. He was sitting in a chair on top of a blanket that he kept pulling at underneath the side of his thigh.

“What are you doing, Mike?”
“Trying to get at my lunch.”
“That’s not lunch. That’s a blanket.”
“Ok.” He said as he continued to pull at the blanket.

The problem today is that his short-term memory is so not working that he’ll say “ok” to you as he’s trying once again to do the thing you’ve just told him not to do. I tried for 5 minutes to get him to stop trying to pull out his catheter. “You can’t pull that out, Mike. It’s your catheter. It would be very painful to pull that out.”

“Alright, then.” He said sarcastically, still pulling the line with his fingers.
“What did I just say?”
“Ummm…You got mad at me?”
“Well, sort of. But, for what?’’
“Doing something I’m not supposed to do.” He didn’t know what and was still pulling at the damn thing as he said it.

We finally got him to stop fooling with that catheter by just moving him back into bed. In the meantime, we saw that he had pulled out the picc line they had implanted in his upper arm and had removed his blood pressure cuff.

The docs know that he’s really off today. He went for a CT scan around 1:30 today – probably to check to see how swollen his ventricles are. A couple of days ago they reprogrammed his internal shunt to drain at 15 ICP (up from the original 11 ICP when they implanted it a few days prior). It could be that the pressure in there had increased enough to mess him up.

And yes, all his other numbers look fine. Sodium is a perfect 137. Temp is about 99 which is where it’s been lately. Heart rate is about 80-90 and blood pressure is 115/70.

Judy, the neurosurgery nurse practitioner, came in to check him out because I just felt like he was off his rocker and wanted to be certain that the neurosurgery team was totally aware of it. She asked him several questions and he made little sense. He also said he saw 4 of her. Not good. She told me that she was recommending that he not be stepped down to a lower intensity unit and that she was thinking of recommending 1 to 1 nursing care for Mike. Meaning - someone in the room at all times when I’m not there.

Just before I left today, an amazing person came in. Her name is Georgia and she is a doctor with brain rehabilitation. She had examined him early this morning and told me that her observations suggested that nothing that Mike says can be taken at face value and that his short term memory does not function at all. Looking ahead she imagined that after he is discharged from the hospital, Mike will need to be in a rehabilitation center for a while – maybe 2 months – until they assess what he was capable of, what his care needs will be, and as they help teach him how to function given whatever deficits he may have. She also asked about what kind of support I have and if I have been taking care of myself. “You have a life and a career and are a mom to a baby who needs you. You need to take care of yourself.” It meant a lot to hear it from someone and to finally have a doctor who is truly going to help me with long term management of this issue. Evans is amazing, but I never get the info from him about how our lives are going to operate from day to day in the future.

As this woman and I spoke I felt very comfortable with her. The older male doctor who had come into the room with her left for a moment and she said in a quieter voice, “I think I should tell you I’ve met you before – outside this situation in a social setting. At a party at Tracie and Bob’s house in early February. So I know who your husband really is.”

Imagine that. The person Mike used to be. Sometimes I forget.

When she said this I burst into tears. Wherever you are, thanks Dr. Georgia. I feel better knowing that we’re in your care.


Peter said...

I popped in at about 7 PM today. I said hi it's Pete, he opened his eyes and said Hey Petey, I said nice to see you, he said nice to be seen, I asked whether he was tired, he said yes, I asked whether he thought I should go and let him sleep, he said he thought that was best. I told him I'd drop by again tomorrow. He said good.

Anonymous said...

So glad to see a doctor who actually relates to her patient. I am happy for you.


Anonymous said...

I was hoping that Dr. Georgia would enter your life. She is a dear friend of mine. Remember when I ran into you at Jefferson with Michaela and Mike was having his first surgery? I was meeting up with this famous Dr. Georgia for dinner that night. You and Mike are in such good hands with her. I just knew that the universe would send her along. Small world !

The Brain said...

Thanks so much, Una. She is the person I've needed to make contact with - and the fact that she met us before Mike really started changing is so important. Tell her that I can't overestimate how important she is at this point in the process. And in case she's wondering, I know her last name isn't Georgia, but wasn't sure how she'd feel about her last name being in cyberspace.

Anonymous said...

D ~ so glad you met a doctor who is a friend (of a friend) and you can relate to each other, what a difference that will make. keep in mind what she said about you having a Life. and although you may feel alone with the strange, current state of Mike remember how many of us are with you who know "who your husband really is" and are waiting (im)patiently to see him again .... he'll be back.

I could help you with the canon camera/iPhoto issues next time we're in the same room with M's laptop.

big phat hugs, kiki