As I write the first installment of this post little brother David Seabury lies in the Cardiopulmonary Intensive Care Unit (CPICU) at Parkland Hospital. David suffered what we thought were at least three heart attacks - one self-diagnosed and withheld from Family for several days, one alleged heart attack that turned out to be a severe seizure when David greeted the EMTs even as he opened his door this past Saturday and another while in transit to the hospital. David is in critical though stable condition at Parkland Hospital, the much admired (though sometimes maligned) public county hospital here in Dallas, Texas. Please note that the care David has received has been nothing short of extraordinary with the medical staff at UT Southwestern among the best in the world. We could have done no better. God Bless Mary and Scott and the rest of the staff at Parkland’s CPICU.
When David arrived at Parkland his situation was grave. He was immediately sent on for further diagnostics and action to Parkland’s Cardiac Cath Lab where as one of their staffers later admitted, “We did things to your brother than we have never done to anyone else"…alluding to the fact that they went through eight balloons in order to place four stents in David’s right coronary artery.
David is on a ventilator and has enough cables and tubes going in, around and out – wherever – that he looks more like the old 1970’s main frame at Equifax. He is also receiving an agent that sedates him and keeps him in coma, another which paralyzes him, a blood thinner and another medicine that restricts the arteries and increases his blood pressure. They have also cooled David down to 32° Centigrade (Celsius) which is the equivalent of 89.6° Fahrenheit so as to lower the risk of death and reduce damage to both the brain and heart. They have started to back off the ventilator, slowly wean David from some of his heart meds and as of last night start to warm him back up. So far, so good – if we consider Critical but Stable a step in the right direction and it is. The very capable doctors and staff are optimistic that David is moving in the right direction. Saturday and Sunday saw the almost routine heroics of an extraordinary medical staff preserving a life almost taken and making possible the fullest recovery…
Monday Morning - 1/16/2012 - Parkland Hospital CPICU
We met with the doctors again this morning at Parkland for a neurological assessment to determine the effects of the heart attacks and David’s prognosis. David had a pretty good night as they started to warm him up and continue to cut down on the meds. This morning, however, he took a slight turn for the worse and again required support to maintain his blood pressure and oxygen levels. They again stabilized David and he is now resting comfortably.
The Doctors provided worst case scenarios including that David could have another heart attack which could be fatal. David could also not have the strength to breathe on his own and not be able to maintain a healthy BP without support. Finally at this point since he is still unconscious we do not know if any brain function has been compromised.
Monday Evening - 1/16/2012
A new team of doctors came on tonight and reviewed his chart with fresh eyes and the events of this afternoon. Apparently, David had what could be considered a very mild seizure which consisted of movement in the feet and arms. It may be nothing but they have decided to do an EEG tonight or tomorrow morning. Staff expressed concerns that David was not waking up as quickly as they hoped – an indication of potential brain damage. The attending physician also has concerns that David is requiring as much support to maintain his BP and oxygen levels. They expect him to begin waking up tomorrow when they will be able to better evaluate David’s ability to maintain his BP and oxygen levels as well as any potential brain damage.
The best case scenario is that David will continue to regain strength, the breathing tube will be removed and the doctors will begin a regimen of drugs that will allow his heart to “remodel” (doctor word) itself. Apparently in some cases drug treatment can improve heart function. Reality is that damage to the right side of the heart is much more problematic with the physicians skeptical that David will be able to overcome all the damage that has been done.
This evening they also transfused David with another whole unit of blood and continue to evaluate his situation. David’s status is “guarded” and he remains in a coma. Our next briefing with the doctors will be tomorrow morning. We will continue to update this post as warranted.
Tuesday Morning – 1/17/12
This morning David’s Medical Team was optimistic given some positive changes that took place during the overnight and morning hours. David now has his eyes open and was sporadically following simple commands. David appeared to recognize Brothers Ned and John as well as his Social Worker/Confidante/”Grandmother” Celeste. The sedation and morphine is now minimal although clearly the doctors want to keep him quiet with all the monitoring systems and drug delivery systems still attached.
The doctors are somewhat concerned that David was presenting symptoms of incipient stages of pneumonia which could have resulted as a consequence of a very difficult intubation. David is now on various medications including two high octane antibiotics to deal with this problem. At the moment he is supporting his BP without medication - a major positive development.
We noted that David’s nurses and doctors (yes, the female ones) are very attractive which appears to be contributing to a greater awareness of his immediate environment. His latest EEG was negative for any seizure activity though in order to facilitate the exam his nurses adjusted his coiffure by bunching together several areas of hair together with rubber bands. It is a unique look that David might not appreciate in better times. But, we’re not about appearance, just getting better. Guarded but optimistic is the word of the day.
Tuesday Evening – 1/17/12
At this point if David is sustaining his blood pressure without medication, why do we still need the intubation and oxygen? The doctors relate that David has edema (swelling) in his lungs caused by the pneumonia which is interfering with the transfer of oxygen across his lung tissue. As of tonight the oxygen being provided was around 50%, down from 70% which is good news. David’s kidneys are working hard and efficiently processing the copious fluids needed to support his blood pressure. His skin color especially in his extremities is improving suggesting that without the constricting consequence of the blood pressure medicine he is getting better circulation to these areas. This too is expected to improve. Tonight we have been looking for increased awareness in David and the ability to consistently respond to commands. Today he has been squeezing hands and blinking but not to the degree that it can be viewed as communication. David certainly continues to be aware of specific people. All things considered this has been a good day with movement in a positive rather than negative direction. We need not get too giddy with this success as David is still critical and certainly will be in ICU for at least another several days perhaps more…
Wednesday Morning – 1/18/2012
Another good night with David holding his own with good blood pressure and oxygen levels. Nurses report that he is more alert and continues to respond to those around him. They are still keeping him somewhat sedated just to take the edge off. David has gotten agitated a couple of times justifying the sedation and restraints.
David had his eyes open and was responding to commands. Both the nurses and Grandmother Celeste were communicating with David who was responding by squeezing hands or blinking his eyes. He grabbed Brother John’s hand but just held on and did not attempt to communicate. He did try to laugh on several occasions one of which was a question from John asking if he knew where his wallet was. Maybe under the circumstances that was pretty irrelevant and funny.
The doctor said that the affected area of his right artery had a measured flow of one with three being the most desirable. The doctors are closely monitoring that area just in case it tries to re-clot. The doctors are now intermittently permitting him to breathe on his own, so for the first time David supported himself without oxygen and BP drugs. David is still presenting some blood from his lungs which the doctors attribute to a rough intubation and the blood thinners. The next plateau will be tomorrow when they, hopefully, pull his breathing tube out.
So, another exciting morning with mostly good news. We remain optimistic but ever aware of the fragility of the situation.
Brother John discovered an interesting twist in this whole story when he went to the Dallas County Fire Department to pick up the EMT’s report from Saturday. Surprisingly, the report didn’t completely jive with what Parkland’s PCICU had been told by Parkland Emergency who admitted David.
David did, indeed, meet the EMTs at the door of his condo and was getting his gear together when he had a seizure, not a heart attack. The EMTs got him on a gurney and after they got him in the ambulance found him unresponsive – no heartbeat and not breathing. They administered the paddles twice… first at 200 joules and then again at 300 joules. David’s heart restarted and he began breathing again on his own. At that point they transported David to Parkland Hospital’s ER where he was ultimately transferred to their CPICU. Brother John vividly remembered the Neurologists asking him several times when David had his last seizure. John, of course, related an incident 20 years previous as his seizures had been controlled by medication. The reality is that his last seizure was less than 24 hours ago. At this point we wonder the significance of that piece of erroneous data as it relates to David‘s current treatment regimen.
Wednesday Evening – 1/18/12
David now breathing on his own was visited by Brother Ned and Mary this evening. We found David awake, responsive and certainly aware of his surroundings in stark contrast to the previous several days and even this morning. We initially set up protocols for a responsive conversation that included one blink for yes - two blinks for no to coincide with the applicable hand squeezes if he so desired. We played that game for a while but it soon became clear that wasn’t necessary as we soon found David blinking and squeezing along with pronounced nodding for yes and shaking his head for no. We paused and he again started to laugh amused at our elementary attempt at communication. It appeared that we had been played - big time… He laughed long and hard.
David responded to discussions about the weather, his Parkland surroundings, the attractive nurses, the welcome news that we were going to break him out of there as soon as he gets well and then the discovery of his identity as Dr. Bruce Banner by the nurses who have now sworn oaths of fealty and loyalty to Dr. Banner in all his manifestations. David continued to laugh as he did many times during our visit. He hasn’t lost his sense of humor though one would question his taste laughing at this writer’s jokes – but that would apply to just about anybody. It was good to see him on his way back.
The laughing shook loose some of the mucous and blood that continues from his lungs though Medical Staff reflect no alarm offering that David is better than earlier in the day. David manifested some grit when the nurses tried to suction the fluids out of his breathing tubes. While he cooperated the first time he was suctioned, the second time was a closed door. David clenched his teeth and refused despite some righteous and downright tantalizing coaxing, to allow them access. The Head Nurse assured us they will ultimately have their way and exited the room seemingly only waiting for our retreat back to far north Dallas before they renewed their efforts.
David’s extremities are swollen and while not hurting, overall - he looks very uncomfortable. Brother John brought to mind an extraordinary observation. As we reflected earlier, David is certainly aware of his surroundings, the fact that he still has a tube down his throat, all sorts of wires and tubes hanging off him and he remains restrained unable to move his arms and upper torso. David no longer requires any sedation and we think only minimal levels of morphine. We are constantly amazed at David’s ability to endure extreme hardship and then bounce back. Undoubtedly another person not surprised with these heroics is Lieutenant Commander Kip Fischer, David’s swim buddy on the US Navy’s Alpha 1 Explosive Ordnance Disposal (EOD) Team. If you know anything about the US Navy’s top bomb squad you will understand that David is one tough character having survived and endured many hardships to date.
Thursday Morning – January 19, 2012
Nurses reported this morning that David had a good night and continues to progress. Brother John arrived at the hospital this morning shortly after they removed David’s breathing tube and replaced it with a CPAP mask and system that continues to dispense oxygen. David was talking and told John he was hungry. David also offered a big “Howdy” to all the Friends and Family that John identified as following his progress and offering prayers in his behalf. David is able to speak, though in a hushed tone, through his mask. He appeared to articulate and choose his words well.
The Doctors reported that David still has pneumonia and the blood he is coughing up is a result of the anticoagulants in his lungs, hence the mask and steady diet of O2. The doctors warned John that we will need another few days of continued progress before David can be moved out of ICU. The Medical Team remains concerned about the stents and the extent of damage to the heart - damage that has yet to be determined. It appears now that David did not suffer any brain damage, though the professionals need to make that call.
John will be back later this afternoon and evening – along with Ned – with both hoping to find a much improved David.
Thursday Evening – January 19, 2012
John arrived and was later joined by wife Barbara and this writer. John had telephoned Ned as he was leaving his home for the hospital with the startling observation that David did not appear to know who John was. Later when John, Barbara and Ned stood by David’s bedside and unlike our exchange yesterday, we made no assumptions and looked for David to volunteer and initiate conversation. In fact, he did not start any dialogue though was responsive to our questions. When we were silent, he just stared at us. It was a consensus that David didn’t recognize any of us.
David thought John was his doctor asking him questions about how long he had been at the hospital (he thought he was in Presbyterian) and how much John knew about his medical history. David entertained himself by trying to scratch spots off John’s arm and jacket. Ned and Barbara introduced themselves with Ned after the revelation he was his oldest brother and leaning in to understand David’s response, who while pointing to John responded, “Well, that’s what that man says and if he says so, then you must be.”
The nurse felt that David’s behavior was not unexpected and volunteered that the neurologists were aware that David was experiencing some confusion. Neither of us could detect any concern on David’s part that he was reacting inappropriately. The nurse termed this as a possible case of ICU psychosis brought about by the recovery period in an environment where the patients could not get extensive restful sleep. Obviously the doctors are concerned but it is still too early to make a prognosis about potential brain damage.
While David remains on the CPAP mask the doctors expect him to be weaned off this by late tomorrow. The rest of his numbers are holding. He is still coughing up some blood from his lungs and his breathing remains shallow and somewhat rapid. Again, these conditions are symptomatic of the pneumonia and the fluids in the lungs.
Hopefully tomorrow will be a better day because it is obvious that we have lost ground tonight. At this point we don’t know how much as it is too early to come to any conclusions. Having said that, we all agree that this turn does freak you out a bit. John was going to suggest to David that he was lucky he wasn’t his doctor… but, an inner voice told him to reconsider that urge. We hope that tomorrow will bring better news and a return of our little brother.
I drove back home and while consuming a couple of glasses of wine pondered if this recovery was just an illusion – another cruel joke. Celeste will be in tomorrow, understands our new parameters and will be able to assess the situation.
Friday Morning – 1/20/12
David has apparently and fleetingly re-joined the human race and now recognizes Family and Friends. His mask is gone and his BP and Oxygen levels are holding strong. David spent some real quality time with social worker/“Grandmother” Celeste who will, undoubtedly, (and is already) playing a major role in David’s ultimate recovery. David still does not remember anything from the time just before the seizure-heart attack to the present. We count that as a plus and Godsend. The doctors believe that David will continue to have periods of confusion but believe that will correct itself with time. David might be able to leave the ICU on Sunday – transferred to a regular floor at Parkland. The doctors are trying to be ultra-cautious with David’s treatment and prognosis since patients can often relapse during this transitional period. We have our fingers crossed.
This afternoon John met with a social worker in order to identify a rehabilitation facility and plan David’s rehab after he gets discharged from Parkland. David – through John - felt that individual messages to you all would be somewhat redundant (hence this post and John’s e-mails) and appreciates all your positive vibrations and prayers. David would welcome any email messages which John and Ned will pass on.
Friday Evening – 1/20/12
David dined on carrots, shredded beef, rice, chocolate pudding and milk this evening though he could only partially recall these culinary delights by the time Ned and Mary arrived. David continues to recognize everybody but is uncertain where he is and why he can’t just get up and leave/check out. We assured him that permissions had not yet been given and this was not the time to, “break out.” If he is aware of the severity of his situation he did not let on though we have been assured that the doctors and nurses have communicated this to him at great length.
David’s deer in the headlights, blank stares from the previous evening have been replaced with dynamic, deliberate examinations following you all around his room. He is mostly aware of his surroundings though seemingly confused by what he thought was a door, rather than wall-mounted computer docking station and desk.
His long term memory appears rock solid though he tends to repeat himself short term – forgetting that he just shared a kernel of wisdom with you just a few minutes earlier. He thought Ned “old” and inquired about my almost white mustache insinuating that he remembered me from earlier days – which may be the case. He did refer to me as King Edward - my well-earned, not so humble title bestowed on my person by David many years ago. He acknowledged and talked at great length with “Queen” Mary, commenting on her usual stunning good looks and how could she be the age she professes? David asked how old he was and seemed to take that (new?) information in stride. He shook and held Ned’s hand and would only let it go when Ned and Mary left for the evening. I turned around and he was following us step by step and we left the ICU. He didn’t want us to leave and I felt bad…
His current repetitive pattern might well have been coming on for some time now, witness Mary’s observation of recent previous behaviors. David also was hiccupping (the result of some good laughs) while Mary and Ned visited prompting the nurses and doctors to order up some medication. We didn’t see any blood when David coughed as a result of laughing so his pneumonia appears much better.
David’s periodic bouts of confusion and repetition continue though are substantially less severe and appear to diminish with each passing day. He is generally pretty much with it witness one enlightening burst where he commented on his previous Bowser St. apartment, built by Trammell Crow for wife Margaret? However, he repeated the story within ten minutes embellishing it somewhat commenting on how well it was built (best apartment he ever had). He talked about Hawaii and was very specific telling us about some of his previous haunts while in the Navy.
David may be out of the ICU by Sunday. He is in very good spirits, no oxygen mask and minimum support lines. His arms are not restrained but his legs are as he has tried to get out of bed several times. It is hard to believe that just six days ago he almost flat lined.
We thank especially those folks at Crossmark in Plano, Texas including Deb, Sammye, Clay, Aimee, Konika, Rosie, Sam, Carla, Julie, Pam, Debbie, Jennifer, Sandi, Aya, Corbin and others who have expressed concern for David. They are part of a great support system that also includes the Dean, Clergy and Parishioners at the Cathedral of St. Matthew in Dallas. Aye, there are many more across the country that we will acknowledge. More later…
On Saturday morning we heard on TV that Dallas Police (DPD) had arrested several men driving a SUV full of stolen items from cars and trucks parked in the Parkland Hospital ER parking deck on Thursday night. Ned had noticed a man half stumbling around the parking deck early Thursday evening looking into cars and reported that activity to Dallas Police. We apparently helped bring some justice to Parkland… This is a tough neck of the woods and DPD has a major presence around Parkland including mostly very, very big and seemingly competent police officers. They earn their pay the hard way. We thank them for their public service…
David remains alert and has a very good appetite. The food does look pretty good. Unfortunately, David is sometimes still confused including the exact year, how old he is, where he is and where he lives etc. Having said that, he offered the exact year for Mary and Ned with his only real faux pas being that he couldn’t pronounce President Barack Obama’s name correctly. He knows everybody, jokes around and seems to be in good spirits. All are delighted that he apparently isn’t worried about anything and taking his situation in stride.
Brother John has assured all that he can probably do all the metaphorical heavy lifting for David and cites his now legendary, irreverent, incredibly politically incorrect sense of humor as proof of that. John bought some People magazines for David who is reading them catching up on all the nonsense in our society – nothing more important than Keeping up with the Kardashians…
Brother Coby had a good visit with David today. David commented that Coby had gotten older and, “a little bigger” begging the question not whether David remembers us but in what era? No doubt he is much more lucid and less confused.
As we mentioned David does have a sense of humor and does laugh a lot. That has prompted bouts of hard coughing that continues to present some mostly older blood from the lungs and frustratingly spells of hiccups. We are now trying to maintain some middle ground and not get him too excited though Ned presented David with a photo of Hulk2 whereupon he laughed and started to hiccup again.
So, let’s not try to make this recovery too easy. Today we had a new twist - or slip as the case may be. Some of you who have seen David’s hospital photos may have been wondering about the indentation on David’s top right forehead. That’s the area where David had an oval metal plate (approx. 3” by 4”) inserted several years after his accident in 1977. A year or so ago David bumped his head and bent one of the semi-circular shaped flanges/feet on the edge plate. He required surgery to fix that situation – we thought successfully so. Apparently the plate is on the move because when David coughs the indentation moves and pulsates suggesting that it might be in direct contact with the sinus cavity. That can potentially cause all kinds of problems with infections. An update is forthcoming from the neurologist on Monday. The doctors are hinting that they may move David directly from ICU to a rehab facility bypassing the regular hospital room. Keep the faith. More later.
Sunday – January 22, 2012
Mary and Ned and John visit and find David in great spirits. He continues to cough and now appears to have more than just transitory hiccups. The doctors are working to stop them with additional meds. This morning David ate well and is now mostly thinking clearly. He is now out of his pigtails though a near future visit to a stylist would seem appropriate.
David was presented with a great lunch though declared that he was just not hungry and didn’t care for anything. Mary immediately took up the challenge and spoon-fed David who, in a fit of intelligence and common sense, cooperated. He did not eat his cherry Jell-O (my favorite) though may have forged an enduring bond with pears. We appear to be breaking new culinary ground here. He ravenously drank iced tea which he has rarely consumed and never asked about ice cream. We think it prudent to take advantage of this lapse and not bring it up.
When asked about whether he would like a visitation from one of the clergy at St. Matthew’s David didn’t refuse but said it would be nice if someone from St. Martins on Orchard Avenue in Providence, Rhode Island could visit him. Methinks he was showing off. That led to a discussion of his choirboy status at St. Martin’s while attending St. Dunstan’s.
Late afternoon we were informed that they are moving David from ICU into Parkland Hospital proper. We will be scrambling tomorrow to get him into a rehab facility where he will stay for about three weeks. We do not expect him to be in Parkland longer than Wednesday afternoon. Updates from this point will be offered as David’s situation progresses.
Monday January 23, 2012
Well, when things start moving, they gain an inertia and momentum that can’t be stopped. David spent less than a day in Parkland Hospital before he was accepted as a patient at the nearby (literally next door) Zale Lipshy University Hospital, one of the five medical units that comprise the University of Texas Southwestern Medical Center (UT Southwestern). Other entities include UT Southwestern Medical School, UT Southwestern Graduate School of Biomedical Sciences, UT Southwestern School of Health Professions, and other affiliated hospitals including Parkland Memorial Hospital, St. Paul's, Children's Medical Center (my favorite charity) and the University Medical Centre Brackenridge. Zale Lipshy is one of the jewels in the UT Southwestern crown - home to one of the world's premier neurological diagnostic treatment centers and a rehabilitation unit that includes an interdisciplinary approach to rehabilitation that includes Family. Parkland is right next door though all the other facilities are but a short walk. We hope that you are impressed and confident now since David is at home and in good hands.
Brother John should reap all the kudos for getting David into one of the top facilities in the country and right here in Dallas! John knocked himself out today and was at the hospital all day managing David’s transfer from Parkland to Zale Lipshy. John left when Ned arrived and watched David wolf down some tilapia, mashed potatoes and kernel corn. By the way, try and eat kernel corn with the hiccups - should be part of one of those survival reality shows. I don’t know how David accomplished the task, but his empty plate was proof of his now fully restored appetite. He would not let me help him though I did carve up the fish a bit… While Ned found some runaway kernels of corn about the room, David deserves an A+ for effort and efficiency.
We took care of some of the remaining paperwork after David visited the loo. His sense of modesty and privacy has strongly returned though he won’t be alone for any reason until his strength returns and he can literally stand on his own. He will require a prop for some time.
We of the Buxton ilk have always appreciated that David is a wanderer and as Ned was warning the Zale Lipshy staff that David should not be trusted by himself as he will try and get out of bed – shouldn’t you be using some restraints or medication? – the emergency alarm went off in David’s room. We rushed in to find him hanging half in and half over the high railings on the side of his bed. I had the TV on The Simpsons and while that may have driven him to the precipice, it fully validated my concern and cautions to their medical staff. They immediately arranged for some sleepy-time medicine….
David is now mostly but not completely lucid and vestiges of his ordeal including the cough, hiccups and incredible, continuing discomfort remain. We suspect that they will start his rehab immediately – that’s what they do and David will be profoundly challenged in the near and foreseeable future. That’s where Family and Friends come to bear.
We left David as he was eyeing and we think contemplating what effort it would take to once again scale the sides of his bed. I wouldn’t put it past him and advised they implement their evening plan – and soon. More later.
Time for rehab and entry back to the real world via Zale Lipshy Hospital. David was visited by Celeste and Brothers Coby and John with Ned smartly demurring because of some severe thunderstorms that popped up during his intended visiting hours. Today David is wearing street clothes and is sitting in his chair no doubt now contemplating the future. In a fit of major defiance he tried to go to the loo by himself thereby incurring Celeste’s wrath and intervention forcing David’s reluctant, frustrated compliance. They entered together and came out no less for the experience.
David’s rehab was attended by Coby who reported stair climbing, respiratory therapy and an interesting find the traffic cone exercise that seemed as much mechanical and perceptive as spatial. David found the final cone which Coby admitted later that he had not seen. Hmmm…
As David was walking out of the rehab area he spied a patient resting on a cot and pointedly asked the nurses who the dead body was?
David continues to eat hearty and still no mention of ice cream. We are blessed. David is constantly being evaluated with each word, gesture and movement, or lack thereof. He appears to be regaining strength and soon we expect a prescription for his rehab that will include the aforementioned exercises and much, much more.
We and others have tried to telephone David in his hospital room and the phone mostly just rings and rings with no answer. It appears that even at the crack of dawn David though he remains shaky and somewhat fragile (and with no tubes and wires), he is up to his meandering ways and likes to sit out in the lobby which must present some challenges to staff. Bright side: They can keep an eye on him and not worry about his climbing antics. My concern now is with his recovered mobility and freedom might prompt a break for the door and escape though they will ultimately find him either at the Cheesecake Factory at Northlake or feeding the ducks at Turtle Creek. Pondering this new development I was reminded of my favorite song, I Was Born Under A Wandering Star, sung so beautifully by the late Lee Marvin in Paint Your Wagon… That’s David...
It is now even more apparent as Brother John stated some days ago – that David now has a real chance to return to his and our world as he knows it – and we are all ready for the journey. John meets with the doctors Thursday for a total assessment and prognosis. Should be an interesting meeting… Sincere and profuse thanks for your support and prayers.
Wednesday – January 25, 2012
Another interesting day where David performed more rehab and engaged some more diagnostics. We had a major revelation when in Speech Pathology one of their astute staff became suspicious and ordered up a barium swallow and x-rays for David. They revealed that David had – for some time – been experiencing pulmonary aspiration where liquids including some foods, drink or even stomach contents have been entering David’s lungs (aka going down the wrong pipe). Why? They don’t know yet but this sure explains his constant coughing and a recent bout of pneumonia not related to his current situation.
David is now kept more vertical and can no long drink water or other like-foods or liquids that include Jell-O, coffee, iced tea and, yes, ice cream. The use of straws is also banned. All liquids consumed by David have to be thick as nectar or honey with juices like V8 OK because of their viscosity. There are products available for just that purpose. I had no idea… except from a culinary perspective a working knowledge of the use of corn starch, arrowroot or tapioca when thickening sauces. So now we are addressing this new/old problem and following a revised dietary regimen. In doing so we now have to watch closely for dehydration – and so the beat goes on…
David continues to cough up some old blood though not nearly so often. The hiccups remain and while David is now joking about them, it’s sometimes tough to watch. We know that he is going to be relieved and very thankful when he gets rid of them. At least some of his meds appear to be now administered by IV so he sports a couple of new rigs on his right arm.
David was very fatigued this evening and while he may have been feigning memory deficit indicated that he could not remember if he ate though he was a little hungry. An inspection of his plate reflected that he did eat and like yesterday and the day before, cleaned his plate. While David is definitely stronger, they are working him hard just before the point of fatigue and that’s what we want.
David talked of escape with Mary and Ned with David revealing his escape route just up the street to the Kroger and on to his digs. Of course, he thought that Harry Hines was Cedar Springs and we assured him he was many miles off. He is rethinking his escape strategy.
That escape from bondage probably won’t happen because David is on what they call 1:1 supervision. If he is out of anybody’s sight he is restrained. When David is not in therapy or rehab he is strapped into a chair (with an alarm on it) in front of his nurses’ station where he can contemplate his navel and little else. I know that he is bored but reality is he won’t even entertain himself by watching TV in his room. He just sits there and ponders – and maybe even schemes. The reason he hasn’t been answering his phone is that he hasn’t been wandering about the floor, rather is in friendly captivity. He’s not going anywhere.
When David went to bed this evening he had to put on a special vest with belts in the back and long straps on each side that attach to the undercarriage of his bed. Reminded me of One flew over the Cuckoo’s Nest – sort of. The ducks at Turtle Creek will have to wait a while longer.
Tomorrow is a big day given our meeting with the doctors and discussion of David’s treatment schedule and his ultimate prognosis – the rubber hits the road. Pray, Aye…
The day turned out to be anticlimactic with the information from the doctors mostly positive but from our perspective lacking direction and rationale. Though David is definitely making progress and no doubt will require further rehab and attention from medical professionals, it would appear they feel that David is now exceeding the limits of what they characterize as “acute rehab”. So, this remains a substantial work in progress with Brother John the ultimate facilitator and it would almost appear – negotiator – with the doctors at Zale Lipshy Hospital. Best/Worst case scenario is that David could be discharged from the hospital as early as Monday though later in the week most probable. With that prospect we are scrambling around identifying facilities that would be able to continue David’s recovery and ultimate return to as “normal” a lifestyle as possible. The insurance will appear to hold and a major relief with so many other issues to address.
Now to David – He was certainly alert today and endured a full regimen of therapy that found him mostly up and about the eighth floor at Zale Lipshy. He is using a walker which would appear a big assist as he recovers his strength. John saw him in the morning and midday though but for a short interval while Coby came in the afternoon and Ned in the evening.
When Ned arrived David had already eaten again and as is his habit of late, totally cleaned his plates. Not bad for someone who lived off meals from the Cheesecake Factory, Lean Cuisines and, of course, ice cream. Emeril Lagasse, Bobby Flay, Jacques Pepin and Mario Batali sleep soundly with no fear of competition from David though John and Ned might legitimately warrant a Flay Throwdown. It’s good to see David’s appetite back as it is a key component of his ultimate recovery though now closely monitored because of his aspiration problem.
One of the potential bright spots (there are few) is that some of David’s old, unhealthy habits may be going away and not just because his (and our) priorities have shifted but because he is being reeducated. We will reinforce those good practices and try to be good examples.
When Ned arrived David was in the middle of his respiratory therapy and was mostly right on until one short stretch where Ned thought he was going to nod off – again, David was beat.
We talked for a while with David relating a new pastime that hints to therapy and entertainment all rolled into one – checkers. David apparently took on all challengers and never plucked the golden bough of victory - not even one time. Heck, I would have let him win at least several games though some of the staff and fellow patients were content to mercilessly hang him out to dry. David tried to initially convince Ned that he had been playing chess though after being queried about which opening gambit he employed (King’s, Queen’s, etc.) David later confided that he played checkers. David then offered that he thought at least one staffer – one of his physical therapists – had cheated. Gads! He enjoyed himself immensely… This is a game we shall soon re-embrace and dedicate to good though departed Friend from Atlanta, John O. Reid, The Checkers King.
No hiccups! I noticed it right away though did not say anything to David for fear that it might trigger them again. Neither John, Coby or any of the staffers realized that we have at least for a short interval battled back the hiccup monster that’s tormented David since Parkland. We hope and pray that this will allow David the sleep that has mostly eluded him for a week or more. He was nodding off even as Ned left with staffers promising to make sure that David gets the rest he needs.
A good day, aye, with the prospects of continued progress…
Friday – January 27, 2012
More of the same with David in rehab, restrained in his bed or planted in a chair at the nurse’s station so they can supervise his every move. He has been mostly out and about as Ned telephoned several times and never connected with him. David reports no more checkers today though we do anticipate a resurgence of that noble game in Buxton Dallas domains.
Those dreadful hiccups are back along with that deep cough. David commented that he is so looking forward to getting rid of them. Respiratory therapy will undoubtedly help but we look to be a long way from the end. John reports some memory lapses today though not as serious as even several days ago. His appetite remains strong.
We will be spending part of the weekend tracing John’s steps to the four recommended rehab centers. One would be close to Parkland so may have the nod at present. A personal visit coupled with some investigation will tell the tale.
Aye, the journey continues…
David was visited by Coby, John and Ned once again. They have maintained like many of you out there the vigil for Friends and Family alike. David had a good day and engaged a full and seemingly expanding repertoire of physical therapy tasks. One which he puzzles with is wandering with his walker in circles – guess they have a smaller PT area. He does prefer walking up and down the corridors of the eighth floor at Zale Lipshy though that option is not always available given the Supervision 1:1 directive. They do not leave him alone for any reason. At night and in bed he remains restrained though David’s flight impulses seem to be waning. I wonder if that will hold as he continues to recover his strength and initiative.
David was cheerful, upbeat and perhaps had his best day since the heart attacks. David has complained that his chest still hurts and the doctors are treating with Ibuprofen. He still has that deep, hard cough, but today NO HICCUPS!
David’s memory and recollection seems more consistent with fewer lapses with one of the doctors reflecting that this may be his pattern for the near future. David did look good and he was in fine spirits. Mary and Ned sent David a Get Well Card from Gary the Gorilla with the directive (absolute unyielding direct orders) to get well or what? It was received well, got some good laughs which spawned a coughing jag. We need to watch engaging any behaviors that will overstimulate him. He apparently has not hiccupped today and apparently even got some cat naps when not kept busy with respiratory therapy, PT and the myriad doctors and nurses visits.
No checkers again today much to David’s dismay. Even though he was hammered by a merciless staff he loves the game and we think we will get him the online chess app. We will then ask for a rematch. Ned implored one of David’s attending doctors to let David win one game every now and then.
We started talking about dogs and one brindle Cairn Terrier in far north Dallas that brought David back to 1970-73 when in the Navy and on station in Hawaii. Punctuating that size does matter when it comes to dogs, David owned a big black female Labrador Retriever fittingly named Psycho and/or Linda Elena Christine (LEC) depending on David’s mood or circumstance. No Panther, Prince or Zeus for our little Brother who was always seemingly docile but inside - always leading edge… David bought Psycho/LEC an AKC registered pup and she was his constant companion for most of the three years he was in Hawaii. Like most Labs Psycho loved to play and swim in the big Hawaii surf where David had to rescue her at least once from an ill-advised attempt to challenge some big waves while retrieving a chair cushion. When David went off on an assignment of undetermined length he gave Psycho to a good Friend and EOD teammate on Alpha One. David ultimately revisited his Friends now in Virginia and found out many years later that Psycho had drowned in an apparent ocean swimming mishap. Hmmm.
That story was a segue to the acquisition of his other pet while in the Navy and stationed in Hawaii. Seems that the US Government at the start of World War II (immediately after Pearl Harbor) had declared martial law and removed all civilians from Kahoolawe (To be carried away, in Hawaiian), the smallest of the eight main volcanic islands in the Hawaiian Islands. The inhabitants left and the US military used the island for military training and a target for bombing, artillery, missile, torpedo, etc. exercises.
Immediately prior to the military takeover of Kahoolawe the cattle industry and some subsistence farmers tried their hand at taming the island. The lack of a reliable water supply and WWII ended that effort. When the residents of Kahoolawe were removed they left some of their livestock, mostly goats, those pesky ungulates, which can live in the most challenging environments. A sizable feral goal population already existed so now they had company.
The goats rapidly denuded much of the island's vegetation causing substantial damage to the landscape. Along with the predictable strong ocean winds, rain and military activity a once beautiful green island abundant with plants and flowers was now reduced to mostly deeply eroded basalt, some shallow soil and rock outcrops with little vegetation.
The Navy in the 1970’s began efforts to save the island even as its role as a military target continued. The Navy from that point even through the early 1990’s initiated efforts to eradicate the goat population and disarm much of the unexploded ordnance remaining from those aforementioned exercises. The Navy dispatched EOD Teams (one including David) to Kahoolawe where they sent many a goat back to their promised land. David found two baby goats (kids) and deciding that then was not their appointed time, secreted them back to his place – in his seabag. He gave one of the kids away and kept the other which he named - Kahoolawe. Psycho and Kahoolawe got along famously the two years they domiciled together and we understand Psycho never developed a taste for cabrito.
We mention this to partially entertain David’s fans but also to let you know the depth of his memory. His long term memory is selective (sometimes better than this writer) and short term is mostly transient though getting better. We have good days and bad days.
By the way, the Navy finished their cleanup on Kahoolawe in 1993 and the island has been returned to the State of Hawaii who continues the restoration of the island. The grass and flowers are returning though it will take many more years to totally recover. Visits to the island are now tightly controlled requiring a special permit. So, now you know the rest of the story.
It would appear that David is now well below the acute radar protocols mandated by Zale Lipshy and so a transfer to another facility next week is now inevitable. David took the news in stride and reflected that with a choice he would like to go to a quiet facility in town nearer Turtle Creek and his neighborhood. We did check out several facilities – some good and one that did not have the security required to keep David safe.
Sunday – January 29, 2012
All of David’s Fan Club visited him today and we found him having lunch at the nurses’ station while entertaining staff. David was engaging his swallowing exercises and we suspect later had another round of physical therapy. David’s appetite was OK though he looked suspiciously at a baked potato(e) and wouldn’t touch it until his nurse dressed it up. He is still drinking that iced tea though it is now thickened to the consistency of a smoothie. He mentioned those dreaded two words, “ice cream” though was immediately assured by his nurse that any frozen confection would probably be off limits from that point on. All please note. He also cannot use straws though one of David’s attendants didn’t seem to care. We removed the straw.
David’s cough is still there though much diminished and for the second day in a row - NO HICCUPS! Again, no one wants to bring the topic up for fear that will trigger a relapse. Whatever they are doing to address the issue, we need to continue that treatment.
David is in great spirits and he continued to wax eloquent about a wide variety of topics. When Mary and Ned left David returned to his room for some much needed rest. Tomorrow may be a busy day though we still do not know where he will be moved – or when.
Welcome to the merry-go-round. Time to capture the golden ring…
Monday – January 30, 2012
David had a pretty good day with more PT including stair stepping that graduated from one to three then four steps. Still a lot of coughing but NO HICCUPS! David is very upbeat and looking forward to his new home. Tomorrow around ten o’clock looks to be transfer day/time. Brother John offers some remarks about David’s day and we can do no better than to embrace his words. I have corrected some of John’s spelling and syntax errors, but pretty much left it alone. These words stand by themselves.
We have reached another plateau. David is being transferred to Premier Transitional Care just down the road from the hospital on Harry Hines Blvd. Point – If David needs help and quickly – he will have it.
The Premier facility will focus on David’s physical needs such as stability, stamina, strength as well as his cognitive problems which I will address in a second. The mission here is to see if we can get him back to independent living – which at the moment looks 50 – 50 to me. David has no recollection of what happened prior to the attack.
He remembers that he had a computer but he doesn’t remember where it is. When his childhood friend Nancy called, he was initially confused before he remembered who she was. Yesterday I started using the Navy phonetic alphabet i.e. Did Romeo Lima (Rachel Larkin) call and he worked that out over about a ten minute period. Today he told me without prompting he talked to Romeo Lima and November Romeo Whiskey (Nancy Rawaay Watkins). That shows me that someone is definitely home in his noggin and slowly figuring things out. OK, OK, we changed the names…
Today I told him everything that happened from the seizure to ICU and I might as well have been talking about the weather. He was totally laid back and never showed concern, fear, or for that matter much interest. He has never complained and only a few times in the past 35 years have I seen him show much emotion. Some of this Kip Fisher will attest is just who David is while some is probably a product of the 1977 auto accident. Regardless, David seems relatively happy and for whatever reason, we are thankful. Meanwhile it freaks us out that David has four stints in his chest and less than a 100% flow. We are where we are.
Premier Rehab is 4 months old. David will have his own room with computer, television, private bath and hardwood floors. Premier has a capacity of 140 beds and with only 45 filled, will guarantee David a lot of attention. For that reason alone – it looks good.
Now back to Zale Lipshy Hospital - there is a substantial parking garage right across Harry Hines Blvd. directly across from David’s hospital room window. We have learned that they are preparing to demolish it as part of the new Parkland Hospital complex – perhaps as early as tomorrow. We hope we can schedule David’s departure from Zale Lipshy so he can see this before he leaves. With his Navy EOD (Navy bomb squad) experience that could be a highpoint of his hospital stay!! Guess that’s a guy thing.
On to Premier and recovery!
Tuesday – January 31, 2012
Even as David was being prepared for transfer to Premier he underwent PT and respiratory therapy one last time at Zale Lipshy. The parking deck was not demolished today though they appear to be readying this concrete structure for its ultimate demise soon. We will see what we can do to entertain David when we learn their demo date. An ambulance transported David to Premier where he is now ensconced on the second floor near the nurse’s station – better security and less chance to trigger his wandering ways. The room is spacious with a great bath and shower. No chance of bad hygiene here.
David’s main bed is just a foot off the floor so there is no chance of falling out (or climbing over the side railings) and injuring himself. The bed is alarmed so even when David shifts his weight routinely, the alarm is triggered and – is impressive. Twice while we were visiting David set off the alarm though with his immediate docile and still response the alarm immediately stopped. Pavlov’s dogs all over again. David is being conditioned and seems to be catching on.
David’s cough is much less frequent and severe and NO HICCUPS for the fourth day in a row! He was talkative and demonstrative, amusing himself and us in the process. His conversation is much more spontaneous and animated with less deliberation and pausing. We saw no memory lapses tonight.
Brother John meets with the doctors and staff tomorrow morning when they will map out David’s therapy schedule and set his rehabilitation goals. We remain optimistic that this will be David’s ticket back to a normal life…
Thursday, Friday, Saturday, Sunday, Monday and Tuesday - February 2-7, 2012
Well, best laid plans of mice and men… This writer became ill on Thursday, 2/7/12 and in a misadventure went back to work on Friday and then spent the weekend and following Monday and Tuesday paying for that indiscretion. Getting through the rest of this week was a major challenge. Got some kind of head/sinus cold that successfully moved into my lungs. Ghastly experience and they have me on antibiotics and steroids. Lots of other folks at work and around north Texas seem to be so afflicted. As one person counseled me recently re. Brother David’s recent experiences – I shouldn’t have been going in so many hospitals; Good way to get sick…
Because of the illness little brother Coby took over and spent a lot of time with David. All the above as reported on Wednesday a week ago seems to be holding true save that we may have an even clearer picture of his memory. David and this writer talked many times at great length with David commenting freely about his memory and the whole recovery experience.
Seems that most of the “memories” of his condo, for example, were not from his own recollections rather he was parroting back what he had been told by Family and Friends. I gave him way too much credit and he was ready and willing to let us (OK me) think that he was regaining an acuity that he does not now possess. All we had to do was ask him…
The platelets issue remains a concern and David continues on medication to control them.
His reaction to the NY Giants winning the NFL Championship – “That’s the team that your Mother liked so much!” Yes, it was and that was David’s way of acknowledging his and our love for the game of football and The Giants. Know that we Buxtons are assured that Elisabeth Alden Littlefield Buxton is supremely happy over that victory, even from her Heavenly Abode.
Mother was a big fan of Doak Walker and Kyle Rote who both had distinguished college football careers at Southern Methodist University here in Dallas. Walker went on to have a Hall of Fame career with the Detroit Lions while Rote was a triple option threat for, yes, the NY Football Giants for his eleven year NFL career. The way Mother talked about them she and Dad apparently knew and idolized both Walker and Rote. Mother had been a Big Blue fan well before her sojourn in Dallas and we remind Friends and Family that she was born in Bronxville, NY and raised in the Village of Tuckahoe, Eastchester, in Westchester County just north of NYC. She came by her love of the NY Football Giants legitimately at least partially explaining her strong support for her sons in all our athletic endeavors.
David is now using a walker and not now totally dependent on his wheelchair. He is getting more independent and so continues to justify the increasing scrutiny being paid to him. David likes his physical therapy classes and especially therapists who comment that David is responding nicely. No sign of hiccups since January 27.
There are several nearby restaurants including some Mexican - David’s favorite. Brother Coby pulled some strings and with doctor permissions arranged some sumptuous and well appreciated Mexican cuisine for David. We have undoubtedly established a major precedent and methinks we will be visiting this restaurant often for David Take Out.
So, David continues in his recovery though we still have major challenges to address. Given David’s remarkable improvements to date and thankfully without daily emergencies, we are going to close this post and address major issues as they arise.
We at Might of Right want to thank the employees at Crossmark for their tremendous support especially though their thoughts and prayers. They certainly helped sustain and motivate a much challenged Buxton Family.
As before, if you are still wondering about The Hulk above, an explanation will be forthcoming though some of the body of this post reveals him and Dr. Bruce Banner as David’s alter ego. Family and close Friends will know the inspiration and meaning. We do continue to solicit your thoughts and prayers. Know they are noted and sincerely appreciated.