Saturday, April 09, 2005

9 April - More and more talking

Mike's doing very well with the blocked-off trachie and is talking more and more and more loudly. He still gets tired easily and sleeps a lot - being read to seems to send him to sleep, even when Frodo and the others are trapped in the Barrow by the Barrow-wright, which I thought would have been exciting enough to keep anyone awake. He is a lot more peaceful now that he is getting more sleep.

When I (Tracy) arrived this morning Mike was in his wheelchair, so I took him for a tour around the rehab centre. When I wheeled him into the day-room, another of the clients was there. On seeing Mike, his whole face lit up and though he can't talk, all his attention was focussed on Mike, and Mike gave him a grin and a hand-wave and asked him how he was doing. Also, another of the clients gave Mike his Charlie Brown doll last night, and according to the staff he does not give presents to just anyone. Looks like Mike's friendship skills are still intact.

Mike really enjoys Kent & Amanda's mini-discs, and wants to compete in another Ironman. Which is fair enough, I would be deeply frustrated by doing all that training and getting two weeks from the start line, and then not competing. But right now he's still got to learn to walk.

At least he does have a shorter-term goal, which also shows how much of a JAFA he still is - he wants to go out to a cafe and have a coffee.

9 & 10 April Visiting Notice -- Still no visitors please

Cavit's experts are in the process of cutting back on his reliance on the tracheotomy to keep fluid out of his lungs. If all goes well, it could be removed entirely on Monday. Meanwhile, the expert view seems to be that it is best if Mike continues to rest without visitors.

Friday, April 08, 2005

Sleeping Beauty

Mike is sleeping lots now. When he is awake he is talking lots. His voice is deep and getting clearer, although it is still not easy to follow. He is consistently concerned about others and wanting to get news of how friends and family are faring. Yesterday, he wanted to know everything Ben had told us about his accident. Then he wanted to know if Ben was running the Ironman in 2006. So we 'text' (as our kids say) Ben, who affirmed that he was, perhaps with a deep breath. The nurse then told Mike to think again. She said, not unkindly, that the last bloke who was in Cavit with Mike's degree of injury was there for 18 months. Mike looked a bit shocked. So was I, truth to tell. The nurse added that while Cavit would do everything it could to help Mike recover, Cavit could not effect a recovery, that had to come from Mike. I think that was what Mike wanted to hear. As Ben 'text' back, the 18 months benchmark is one target Mike will be keen to blow away. Mike was sleepier today, and perhaps a bit less lucid with it. For example, he asked that I take care of the hotel bill for now. A nurse put his mind at rest by explaining that this was a hospital. (We did not need to explain that it was not a US hospital, or that he was insured.) It is good to see him more relaxed -- indicating that the nurses were right about his being over-stimulated earlier in the week .
Bryce

8 April Visitor Update -- Still no visitors please

Mike had a good night's sleep, but is still tired

Thursday, April 07, 2005

April 7th: Good progress day

The experts seem to be right. Cutting Mike back to a low stimulus existence is improving his sleep patterns and though he is tiring easily, we are really thrilled by his progress. Mike was started on the process towards trachy removal yesterday. The first step is blocking off the trachy for a few hours and closely monitoring his oxygen levels and how he manages his swallowing. He did so well that today they have left the blocked off trachy on all day. It means that he can whisper a bit and by today the whisper was getting reasonably audible. The speech language therapist tested him and found he could make all the necessary sounds for English, including ones very similar such as 'k' and 'b'. It's so wonderful to be whispering away with him. It feels like we're talking to the old Mike, though we're still having to be really careful that he rests a lot. One aspect that makes this easier is that Mike seems to realise for himself how tired he gets and so far doesn't seem to be getting bored. That will come apparently and will be a sign that he is getting better.

At present he is hanging out for a cup of coffee! Of course he has had 'nil by mouth' since 20 Feb, and even when this changes it is a long process and liquid is the last food added because it is so hard to keep out of the windpipe.

Those of you who know Mike will not be surprised to know that his mind is working away on missing the Ironman. He's already had Bryce text Ben Schurr (who was training with Mike when he had the accident) asking if he is planning to do next years' one. He's asking after so many of his friends and his memory for past events connected with you all seems on the whole to be fine.

7 April Visiting Notice - Still no visitors please

Mike had a good night but is still very tired.

Wednesday, April 06, 2005

April 6: Mike's second posting

Thank you for your words of encouragement. Please come and visit when I am well enough.

Mike

PS: The messages are a bit limited, partly because Mike has to either whisper them or spell them out via the alphabet sheet and then we have to work out what he means! As soon as he gets tired, the spelling and whispering become erratic.

6 April Visiting Notice - No visitors please

This is the first of many notices we expect to post advising of the assessment by Cavit staff of Mike's capacity to take visitors.

As explained in the 6 April family meeting blog, Mike's condition is currently so fragile that it would be best if he has no visitors until his condition materially improves.

Thank you for your restraint. Please post any messages for Mike on the blog, or email them to one of us directly.

Bryce

Family Meeting with Cavit staff

We had our first family meeting with the staff at Cavit today.

There was plenty of good news. Given his progress at swallowing and coughing and the encouraging findings from his ENT inspection on Monday, his trachy is likely to be out in a matter of days rather than weeks. Then they would wait to see how he handles that before taking the peg out of his stomach. So that step is weeks away rather than days away (all assuming no setbacks of course). The ENT inspection is also encouraging in respect of his vocal chords, etc, and therefore his ability to speak. But of course his actual ability remains to be revealed. In many other ways his progress (eg listening and understanding) has been"superb".

The bad news is that staff say that his health is very fragile, medically. There is a concern about infection and about his failure to sleep well. Apparently last night was the first night since his readmission to Cavit during which he has slept at all satisfactorily. The staff attribute that in good part to reduced numbers of visitors yesterday, compared to the weekend. They believe that his failure to sleep well is likely due to exhaustion from over-stimulation.

Obviously, making sure that he gets enough rest has to be a high priority right now, at least until he is sleeping better and in a more robust state. The staff think that he needs the (quiet) company of immediate family for reasons of familiarity and reassurance.

After some discussion, we reached the following gameplan in respect of visiting arrangements:
(1) We ask all Mike's friends, cussies and colleagues to (continue to) refrain from visiting Mike until further notice;
(2) Where you need to be an exception -- eg because you are just heading off for your OE and won't be able to visit Mike later -- please call Lee 021 455 326.
(3) Once or twice a day, one of us will call Cavit and ascertain whether Mike is in a condition at that time to take some visitors. If so, we will post a blog telling you this. (Staff say that his condition is so unstable that his capacity for visitors can change almost hourly.)
(4) Please don't visit even then if you might be carrying a bug;
(5) If you do get to visit, please aim to make it between 3pm and 5 pm, and limit it to 10 minutes, and keep it restful.
(6) Make sure in particular that you do not visit between 1 pm and 3 pm. This is when they are trying to keep the area quiet for all patients.
(7) If you do visit, please use the hand-cleaner on the table on the left immediately inside the entrance door.
(8) If all else fails, please call Cavit ABI Rehabilitation directly on 04 570 9284 to check on Mike's ability to take visitors.

We know these are hard restrictions, not just for you but we suspect for Mike as well. However, if it is in Mike's best interests for now, so be it.

Meantime, if you want to send any messages to Mike, please post them on the blog. Lee is doing a daily reading to Mike of your postings. He is keenly interested and it will not surprise you to know that Mike thinks they should all be replied too. However, it seems clear that Mike can't go 'online' until his condition is much more stable.

All in all, we can all be thankful and encouraged by the confirmation of Mike's superb progress, notwithstanding the long, difficult, even hazardous, road ahead.

Mike's Dad

Tuesday, April 05, 2005

April 5: Not such a good day

Bit of a difficult day today. Mike was very tired,restless and sleepless. He was supposed to have a whole bunch of tests, but some couldn't be done because he was too tired. In the end, his boring fart mother, me, arrived. Only five minutes being read to by soporific me and off he went to sleep - and that happened twice, not once.

Mike is thrilled by the responses to his blog site. He expected updates from each visitor as they arrived, so thank you everyone. Mikes 31 hits have outdone the rest of us!

Interesting with one lot of tests - checking for Post Trauma Amnesia. The Occupational Therapist asked him how old he was. Now he didn't have a twenty-fifth birthday because of being unconscious, so he said he is twenty four. Fair enough I thought, no cake, no presents, no birthday, one year younger.

Tomorrow is the family conference and our first opportunity to discuss where we are going.

Lee

Mike at the Hutt rehab centre wearing his Ironman t-shirt. The soft-toy is Armpit, a gorrilla gift from Aunty Pat and Uncle Alan.

Monday, April 04, 2005

Mike's first post - typed by Tracy earlier in the day and confirmed with Mike

Thank you to everyone for your support.

April 4th:Mike the Imminent Blogger

Well this has been a day of bafflement at the rapidity of Mike's progress. We started the day on a high note because Mike had somehow got the staff to dress him in his Ironman shirt (Go Foot Traffic!). Next we headed down to the ENT specialist who investigated his vocal chords and announced them fine. He also started the downsizing process for eventually removing the trachy.

The effort of Mike attending the appointment was supposed to exhaust him, but he was firing on all cylinders. Yesterday Mike had wanted to know how many visitors came while he was in Intensive Care. Those of you who were there know that the answer was a hell of a lot of people. I'd taken my laptop into the hospital to show him those photos I took in the first few days. He was thrilled with them and could mouth the names of all the people in the photos. He then proceeded to want to see the blog and insisting he should reply.

So tonight Bryce and Andrew took in Andrew's Mac and a standard wireless keyboard. Mike's small motor skills still have a way to go. The keys are a bit small for him and were hard for him to hit, but the first thing he typed out was "Hullo." When they showed him the blog, to their amazement he seemed to read it and kept to gesturing them to scroll down. Eventually they organised Mike to scroll down himself. So now he wants to post on the blog - he wants to reply to you all. TJ is trying to create him his own account on the site . If you see 'Michael Wilkinson' at the bottom of the post, that is Mike himself. At the moment his desire is ahead of his small motor skills, so we will post the messages he wants to send. At this rate, it's not going to be long before Mike's the main blogger and we are all redundant.

The next big thing is the family conference on Wednesday. We're sure we'll be told we have to make Mike rest. Any suggestions how??

Sunday, April 03, 2005

Mike Moves the Goalposts

Mike set some new achievement benchmarks today.
(1) He walked about 4 paces from his bed to his wheelchair. Sure he had a nurse holding each arm to keep him balanced and ready to take the weight. But he lifted each leg up forward and down all by himself.
(2) He communicated his first full sentence, letter by letter picked out of a sheet of A4 with all the letters of the alphabet on it that the speech therapist had left with us.
(3) He showed self-awareness by laughing at himself.
(4) He smiled and did thumbs-up and high fives on demand.
(5) He affirmed that he could smell rosemary and basil.
How did (2) and (3) happen? We wheeled him into an outside courtyard above the street and he pointed decisively ahead, apparently urging his to run his wheelchair straight forward into the wall of the courtyard. We were puzzled and produced a pencil, sheet of paper, backing board and the sheet of paper with the alphabet. Pointing at the alphabet he spelt out G-O-D. Really? But no, there was more. He got to GO DOWN THE ROAD and we all burst out laughing - he was ready to roll. Have wheelchair and pyjamas, will travel. Mike joined in the laughter. But, again there was more. He added TO DA before he ran out of steam. We asked "to the dairy?" and he nodded. We asked if he wanted to buy something. He nodded. It wasn't ice cream. We asked him to point to the first letter. He pointed to C and then O. We asked if it was Coke. It was. He joined in the laughter again. What a commercial for Coke.
We took the chance to ask him what he meant by that arm signal that had baffled us yesterday. He spelt out B-E. We asked: "BELIEVE"? He nodded. Perhaps he was signalling that we should believe in his recovery. Why not?
Bryce

Saturday, April 02, 2005

Communication experiments

Mike was looking alert and intelligent when I arrived tonight. He tried mouthing some words at me, but I did not 'get it'. I checked that he could pick out letters of the alphabet pretty well from a chart. Next I put a pen in his right hand and held some paper on a backing board up in front of him. I guided his hand to write 'Mike' and then let his hand do the writing. He gave it a go and made some indecipherable squiggley lines before the pen 'ran out' from being held horizontal for too long. Must take a pencil next time. From time to time Mike tried to communicate by lifting his forearm vertically from his horizontal upper arm, pointing his forefinger (like a gun) and lowering the forearm towards my head. Then he repeated the manouvre, this time with his forefinger and index fingers extended as one. I did not get it. Apparently he had tried the same thing first with Tracy then with Lee earlier in the day, but they did not 'get it' either. He did not want me to do anything for him, so presumably he was trying to communicate something.

I did get one message clearly. I was drinking some coffee by his bedside. Mike moved his arm over to me to get my attention. He made a circle of his fingers and shifted the circle to his lips where he tilted an invisible 'cup' into his mouth. I asked him if he wanted a cup of coffee, and scored a hit. Since he could not see the coffee, this is our strongest indication to date that he has a sense of smell. Unfortunately even a well person without a 'trachy' could not be expected to handle hot coffee while lying on his back. So Mike just got another reason for continuing to focus on his recovery. I don't think he needed another reason, but he seemed to take it well.

He seems to be making good progress too with clearing his throat. That is necessary in order to get rid of his 'trachy'. Then we will be able to see how well he can speak.

Bryce

Friday, April 01, 2005

1st April:Tentative progress

So now Mike is fairly settled in Cavit. They are taking great care of him and he seems comfortable. It's a much more comfortable feeling for us knowing that the staff know a heap more than we do about what care he needs. If we aren't at the bedside, they have someone always there, even through the night.

We're gradually learning some of the issues involved in tiredness for Mike. A severe brain injury causes immense fatigue and Mike's bad chest infection increases that tiredness. The Cavit people say that when a brain injured person gets over-tired the brain shuts down for a while and will often lose what it has learnt in the last few days. For example, the nurses got him in a wheelchair and I wheeled him out to a quiet sheltered courtyard where we sat in the sun for about 15 minutes. After even that short time, Mike was exhausted and needed to sleep for about an hour. A complicating factor is that often when the patient is agitated and moving a lot, this is because they are very tired. It's so hard to adjust to when he has always been such a high energy person.

On the bright side, Mike is getting a bit more muscle control and when he is alert he seems to follow more. Mike seems to really like all your messages, so we tell him who has commented on the blog and we read him all your cards and e-mails. When it is from someone we don't know, usually Mike seems to recognise the name. The plus of having a friend with short term memory loss is that your one message must appear new to him, even if we've repeated it lots. Mike also seems to like looking at the cards too. We are not sure if he is reading anything and anyway fatigue would make it hard to concentrate for long on reading. But Mike's Uncle Stuart gave him a book to look at it and he appeared to read the title of it on the title page: "Over My Head". At least he nodded yes when asked if he could read it, and shook his head when asked if the words were "Three Blind Mice".

Mike also took a few steps today while being supported by the physio and a nurse. He is able to hold his head up when standing, but seems only to do so if you stand in front of him and ask him to look at you. Still a long way to go before he can consider Ironman training, but good progress.

News for Non-Economists

We have some good news and some bad news for non-economists.

The good news is that Mike fell asleep last night while I was reading him an article from The Economist.

The bad news was that the article was not about economics. (It was about the differences between the sexes that might arise because the Y chromosone has only around 100 genes as against 1000 for the X chromosone. (Yes, females have two X chromosones, not two Y chromosones.))

Bryce

Thursday, March 31, 2005

March 31st - Finally the move

Tracy here. Mike finally moved into Cavit ABI Rehabilitation (04 570 9284) today. This was after he succeeded in falling out of his hospital bed. The nurse left him briefly to help a nurse in another room, thinking that Mike looked quiet, and came back to find him on the floor. Mike managed to scare not only the hospital staff, who got people in to check his obs and his head, and all that, but also himself - he was quite subdued for the rest of the day. Possibly it made Mike realise how much progress he has to make physically. Fortunately he doesn't seem to have done himself any damage.

It feels really great to have Mike at Cavit - much more homely and personal, and it feels like real progress. Mike's desperate to be on the move physically but not surprisingly has a lot of work to do on the physical basics first. We're going to have to sort out a programme with Cavit that will enable him to work hard at the things he wants to work at. Another learning curve, I guess.

I gave him Mary's latest postcard, and he turned it over and studied the back intently - I'm not sure if he was reading it or trying to, or simply enjoying holding something in his hands. A lovely card arrived from Marie and Ulli(?), telling Mike he had a choice now - choosing whether he was going to be fit again. I read it to Mike, and asked him if he chose to be fit again, and he nodded.

Now Mike is back in rehabilitation, he could probably do with an increase in visitors. He is in a room with two others, so Lee will try to talk to the Cavit staff tomorrow about suitable times and so on. So if you're planning on coming, just give one of us a call.

Dialogues with Mike 30 March

The following encouraging dialogues with Mike yesterday may be worth recording.

Dad to Mike:
"It was a bummer that the accident happened."
Small nod from Mike -- affirmative.
Dad to Mike:
"But we can't change the past."
Mike shakes his head -- negative.
Dad to Mike:
"But we can change the future."
Nod from Mike -- affirmative.
____________________

Sister Tracy to Mike:
Does Dad work for CS First Boston?
Mike shakes his head.
Does Dad work for First NZ Capital?
Mike shakes his head.
Does Dad work for Capital Economics?
Mike nods
Is Dad's name Bill?
Mike shakes his head.
Is Dad's name Bryce?
Mike nods
Does Dad like "X's" economic policies?
Mike shakes his head. (He was correct!)
Is Don Brash prime minister?
Mike nods.
____________________

Mike also nodded affirmative when asked if he works for Charles River Associates and when asked if James M is his boss.

Wednesday, March 30, 2005

30th March: Not so fast Mr Bond

So there we all were. Late morning. All tidied up, ready for business class bed travel over to Cavit. But wait. The medics want Mike to be seen by the ENT specialist before he goes. Hmm goes the specialist, haaa goes the specialist....this should have happened, that should have happened, why hasn't such and such been done. The upshot of the hmming and haaaing is that Mike is still in the medical ward. The specialist decided the cuff around the ‘trachy’ should be deflated and Mike would need to be monitored for twenty four hours.

I’m not sure why all this was so stressful, but it was. So time for some fresh legs - Bryce. Hmmm says Doctor (Econ) B.D. Wilkinson..."The patient is just very bored, frustrated and desperately wanting some physical exercise." Treatment: (1) : Read him the business news section of The Independent for extended periods. Now for any normal person this treatment plan would make them writhe with boredom, but the two other family economists insist it was just what Mike needed. Unfortunately no independent witnesses have come forward to verify their theory.
(2) : Let the bloke pursue his own exercise program. The upshot was that Mike turned himself onto his front while holding his head off the pillow in order to protect his trachy. Roll over Beethoven. Then with a massive effort, he got enough strength into his weak right arm to push his front off the mattress while pulling his knees under his hips. In no time he had lifted himself into a vertical position, head swaying but determinedly controlled by the neck. Wow! It was simultaneously scaryingly unstable and utterly impressive. His determination and willpower were amazing. He did it several times and failed many more times. Moreover, his stamina was 'off the scale', he kept at it for perhaps 90 minutes. By then Bryce felt like a sleep himself.

So this is all looking like great progress, if we can just manage the safety angle.
Again, many thanks for all your comments. Mike would be astounded at the support from everyone out there. We've been telling him about each one and saving the whole things for him as it grows. Now that he is so much more alert we will gradually take them all in to read to him.

Lee