Tuesday, July 11, 2006: Lesson 4,671: Don't talk to residents

[I wasn't going to post this photo and then I thought about it again and realized that throughout this shit I'm trying to protect other people from it. But you know what? This is our reality here. This is what's going on right now.]

IMPORTANT: Mike is going to be having an additional procedure this evening - a hemicraniotomy - read below in red...

PARKING AT JHN: Bring your garage ticket inside JHN and get it validated in the NEW little machine on the desk of the security guards. It gives you $8 parking in the garage attached to JHN at 9th and locust.

Little clarification on this morning's post: According to Dr. Andrews, the bleeding in the brain is not the big issue. Yes it's there, but it's not as major as the resident made it out to be and Andrews is not concerned about it. Dr. Campbell is a junior resident. Andrews said my best bet is simply to not talk to the residents, but talk directly to him. Mike's case is too complex.

Mike's CT scan from 11 this morning reveals a strong midline shift in the brain. The whole brain is shifted over from the left to the right hemisphere, and now, without the blood clot there, with the bone flap gone, this shift SHOULD be resolving itself. But it's not. There is nothing that appears to be responsible for the shift anymore, and yet, there it is. As Dr. Andrews said, "Looking at the CT scans, you would say that this individual is deathly ill." Yet, while his vitals are troublesome, they are not imminently dangerous. His general health and his age are helping him in this regard.

So, why isn't the brain shifting back? Again, Mike's brain is not "compliant." It doesn't have a lot of give. It's not flexible. Andrews says this could be the result of numerous surgeries, scar tissue, radiation therapy, infection that has been in there. You name it... it could have played a role in rendering Mike's brain somewhat --- shall we say --- stubborn.

The unfortunate thing here - ok, there are a gazillion unfortunate things here, but one of them -- is that with the bone flap gone and the blood clot removed, there really isn't anything they can do to force the brain to shift back to where it belongs (in the center of his freaking head). I keep thinking, why can't they just do what OB doctors do when a baby is breech - and just manipulate it around, or use forceps to put it where they want it or something. Yeah, not with the brain. Not so much. Thinking about it now, Mike's probably lucky I'm not a neurosurgeon.

WAIT!!! STOP THE PRESSES: at 4:45 pm, Dr. Andrews called and said there is one thing left they can try to help resolve the midline shift. They can do a hemicraniotomy where they will create another incision going back perpedicular to the current craniotomy incision. They will then remove a much larger bone plate farther back on the skull, giving the brain every opportunity for expansion. I gave him my permission to go ahead with the surgery. I think they might go do this right now...

The other battle today has been to monitor his vitals, keep his heart rate from getting too high and keeping his blood pressure from getting too high (remember, all the central nervous system issues like heart rate and breathing are resulting from abnormal pressure on the brain stem in the midbrain from this shift). I believe they are going to be starting Mike on pressors because his blood pressure today has been in the range of 80/55 (+- 10). Pressors lift his BP.


Anonymous said...

Danna - I can understand your feeling overwhelmed, but there's no way I can feel it. Must be incredible pressure on you - and everyone who loves you.
Mike - and you - are in our thoughts. Ralph B.

Anonymous said...

Our thoughts and prayers are with you. Scott C

Anonymous said...

Dana, you are in our thoughts and prayers daily. Luci

JNC said...

We are following your ordeal daily and hoping for the best possible outcome. We think about you and Mike often and talk about your trials together marveling at the strength that you have to get through everything.
All our love
Joe C. (JNC) & Elena