The Road to Recovery - week 5

If one dream should fall and break into a thousand pieces, never be afraid to pick one of those pieces up and begin again.

Alysha update August 27/12
Hand hearts and high fives
      Nana King spent the day with Alysha today.  Justin visited with his sister as well today.  Alysha made a heart with her hands to indicate to her brother that she loves him.  They also shared a number of high fives.  Justin reported that Alysha was attempting to bite him every time he tried to thwart her attempts at removing her respiratory support system.
      Over the past 24 hours Alysha's kidneys have improved at their job of filtering her blood.  The woman who organizes dialysis for Alysha told the family that she doesn't expect Alysha will need dialysis again.  Alysha received another blood transfusion today.

Alysha update August 26/12
Another clog in the windpipe.
      Alysha had a restless night last night.  She pulled out her feeding tube and attempted to remove her PICC line.  By the time Lisa got in to see her this morning, the staff had replaced the feeding tube down the other nostril and wrapped her hands so that she couldn't get herself into any more trouble.
      While Ron was present today, Alysha choked on another plug of mucus and required suctioning and respiratory assistance through manual bagging.  We assume this is similar to what happened on the previous code blue but we can't be certain because the doctors have yet to debrief that incident.
      Another surprise to the family today was that Alysha had an Xray of her stomach yesterday.  They were doing another one today because "they weren't happy with the results." Again, we are unsure of the purpose of the original xray or the reason for the repeat as the staff aren't forthcoming with information about that.
      Ron reports that Alysha was happiest sitting in her chair today.  As soon as they put her in her chair she relaxed and fell asleep.

Alysha update August 25/12
Improved Responsiveness.
     Alysha continued today to respond to medical staff and visitors.  She opened her mouth and stuck out her tongue at the request of the nurse. Michelle, Nan and Jayden visited today and she reached out to hold her young cousin's hand.  She continues to breath on her own, but remains in the ICU.   The staff analyze Alysha's blood every morning to see how her kidneys are functioning and determine if she requires dialysis. Today the blood work shows that the kidneys are sub-optimally working to filter her blood, but they are improving.  At this time dialysis isn't needed.  From her blood work they also determine if she needs a blood transfusion. No blood transfusion is required today either.  She is still battling a lung infection but she seems to be winning that battle with the help of some antibiotics.

Alysha update August 24/12
One month anniversary in St. Michael's Hospital
      Alysha was back on track this morning as far as her responsiveness to her visitors with eye contact and smiles and kisses and duck-face. (I fear Abby initiated this pop-culture phenomena that seems to now be in Alysha's small repertoire of on-demand movements.)
      This afternoon Alysha demonstrated huge improvements.  A nurse requested Alysha squeeze each of her hands, wiggle her toes and give a thumbs-up which she did!!!!  She asked Alysha to indicate where her mom was. Alysha looked left and right and all around the room but wouldn't look at Lisa. She then shrugged her shoulders as if she didn't know.  In a stern but joking voice, Lisa said, "ALYSHA ROSE SMITH - you know where I am," and Alysha's face lit up with a large mischevious smile.  She has the mental capacity to play coy with her mother and this is being seen as a good thing. When you put chapstick on Alysha's lips she rubs her lips together to spread it around and today she sucked on a sponge and swallowed some of the water.
      The elevated white blood cell count that was noted on the 22nd has in fact manifested itself as a lung infection. For those of you keeping track, that is 3 lung infections so far.  Alysha has a strong cough and for the most part can cough up the extra fluid generated by the infection on her own without much additional suctioning. The anticipated meeting with a doctor to review the code blue didn't happen today.  The doctor that was supposed to speak to the family has just returned from holidays and the family debriefing isn't a priority item for him today.
      Today marks the one month anniversary of Alysha's admission to the hospital for a tummy tuck on July 24/12.  It has been an aweful, terrifying, heart breaking, exhausting month.  What an incredible family Alysha has;  patient, tenacious, optimistic, dedicated, and committed to Alysha and each other.  The family is fuelled by love and won't give up on Alysha or each other. To everyone who has been following Alysha's recovery, thank you for your well wishes, thoughts and prayers.  Your ongoing support is appreciated.

Alysha update August 23/12
Meeting with the plastic surgeon.
      Today started off slowly for Alysha.  The last we knew, Alysha's kidneys were showing a decline in their filtering capacity.  Nothing was said to the family that would indicate that this decline in kidney function has changed. Alysha remained unresponsive for most of the morning which was heart breaking for the family who had previously been seeing slight daily improvements in Alysha's condition.  Later in the afternoon, Ron reported that Alysha smiled for him and did "duck face."      
      Ron, Lisa and Rich had a meeting with the plastic surgeon who performed the tummy tuck 4.5 weeks ago.  The meeting was set up to address the events during and preceding the 3 cardiac arrests on July 25th.  Although the family also have questions relating to the most recent code blue, the meeting today had the limited scope of addressing the happenings related to the plastic surgeon alone.  Previous meetings have also had a limited scope of information relating to the professional who was speaking with us. We generated a number of questions for each meeting and the staff and physicians answered them relating to their personal experience with Alysha.  No one ever brings Alysha's medical chart to the meetings. Sometimes the answers don't match with answers we received previously from another staff member.  For example in yesterday's meeting they talked about the first cardiac arrest being the longest in duration while in a previous meeting we were told the 2nd arrest was the longest. We are finding that the answers to our questions just generate more questions. The family is in need of a multidisciplinary, full debrief of all the events and care to this date.  We need to meet with a team of people who can walk us through this medical quagmire from the minute Alysha entered the hospital on July 24th until the present day.
      The plastic surgeon reiterated the information he gave us on the first day that the surgery itself was absolutely uncomplicated.  He talked about seeing Alysha after the surgery and speaking to her and watching her move about her room. He also told us that they don't have confirmation about what caused Alysha to have the 3 cardiac arrests.  He told us that Alysha's chart is being reviewed with a fine-toothed comb as part of the hospital's risk-management program.  He said they were looking into all possibilities including human error and gave an example (hypothetical?) of a medication error involving too much morphine.
      Another meeting is set up for August 24th on the one-month anniversary of Alysha's experiences at St. Michael's.  This meeting is to address the code blue on the 22nd.

Alysha update August 22/12
Code Blue
     Alysha was moved out of the ICU last night at 11:00pm to a private room.  The care arrangement included 1 nurse responsible for a number of patients with a "sitter," assigned to Alysha.  The sitter's job was to observe Alysha and inform the nurse if there were any problems.  The role of this person was not to touch or provide physical care for Alysha.  From our understanding, at 5:30 this morning Alysha choked and was suffocating because of secretions blocking her breathing tube, (perhaps her breathing tube had not been suctioned/ cleared properly). They called a code blue and had to manually breath for her (bagging).  They tell us that her heart never stopped and she required respiratory support only.  Alysha is now back in the ICU with one-to-one nursing (one nurse per patient).  The family is very frustrated by the apparent lack of appropriate coordinated care for Alysha last night.  Lisa is so frustrated with the events that took place because she could and would have stayed with Alysha through that and any night where vigilant care was/is needed. To make matters worse the code blue happened at 5:30 and the family wasn't notified until 9:30.  Lisa went in to see Alysha and her once stable blood pressure and heart rate are through the roof.  She is in restraints and her face is bruised and swollen where it looks like she hit her head on the side of the bed. Her white blood cell count is on the rise and we are suspecting another infection.
      The doctors informed Lisa and Ron briefly about what happened but the family has many more questions about this newest setback. The Doctors were unavailable for a full debriefing.
      We are sickened by what this might mean for Alysha's recovery.  How much more can her body take before she can't possibly recover? What has this incident done to Alysha's long term recovery and potential? Anger and disappointment, fear and helplessness!!

Alysha update August 21/12
Alysha moves out of the ICU.
      Alysha is starting off week #5 with a move out of the intensive care unit into a private room tonight.  She has been breathing on her own for a few days. The staff bathed and washed her hair before her big move. Her kidneys seem to be improving quickly at their job of filtering the blood. The staff are so optimistic about her kidney function that they removed the dialysis line from Alysha's body.  Clearly they are not expecting to have to use it again. Alysha will be moving to a floor higher in altitude than the 4th floor she is presently on in the ICU. Movin - on - up.

A Beautiful Smile