From Uncle Bob

On Saturday my daughter Marilyn, who lives in Vista, met me at the Oceanside station for the early (7:55) Amtrak to LA. Diane had a scheduled softball practice and was unable to join us for the trip to see Dick. On our arrival at Union Station we switched to the LA Subway system and took the Red Line to Universal City where Debbie met us for the dive to Dick's new digs. This was my first experience with LA's rapid transit and I was very impressed, but that's another story. Suffice it to say that the $1.25 Red Line was much better than my previous $20 cab rides. Dick had been moved earlier in the week to a skilled nursing facility and also had had his trach removed. If you have been to a skilled nursing facility you know what they are like, if you haven't you don't have to know. It's enough to realize that he will get the care there he needs now before he can be released to Debbie's home for the next phase of his recovery/rehab.

We arrived at the facility about 11:30 and Dick was regaling one of his attendants with his flying/crashing/hospital experiences complete with photo's which he has pasted on the wall along side his bed. Each time Dick is moved to a new place he gets to relive 15 minutes of fame with each new person he comes in contact with. He looks much better with that trach gone and no connecting wires and tubes, and speaks and acts much more like Dick, although he is still in his stabilizing neck brace. He was quite happy to see us all.

After I unloaded my “goody bag” which consisted of a couple of books, a bag of York peppermint patties, a container of frozen home grown orange juice and a New York Crumb Cake, we had a brief conversation rehashing his experience (nothing new) and what his plan for the Sonex were (no decision yet) although he reiterated his “I'll never fly again” position. He wanted to talk (argue) politics (George Bush) with me but I opted out on that one.

Debbie scouted up a wheel chair and Dick, on his own, got from the bed into it. He has also, I told, been able to walk about 15 feet in his walker but is still short on endurance. The PT folks are working on that with him. Anyway, he was able to scoot himself down the hall to an outside patio where we continued our visit. It was a beautiful, clear but cold day in LA and this was his first opportunity to be outside since his accident, although Dick now seems to bring a little of his own sunshine with him now wherever he goes. While we were chatting on the patio they brought him his lunch. He is now able to take liquids and semisolid (chopped foods) and soon will be on a regular diet. All in all his rehab is progressing well and Debbie is expecting to him to her home in Studio City within 3-4 days.

After his patio lunch Dick was cold so we all moved back to his room - he again scooted himself in the wheel chair - and parked him back in bed. Then we wacked up the New York Crumb Cake each of us enjoying a piece and enjoying the look on Dick's face as he ate his share.

We left about 1 o'clock and Debbie drove us to lunch at a nice Grille near Burbank Airport and then was kind enough to drive us back to Union Station. Even though we really hustled we just missed the 3 o'clock train for Oceanside, but that was OK. Marilyn discovered a “fair” across from the station on Olivera Street and was able to purchase a neat, motorcycle friendly, pocketbook type thing she had been looking for while I waited in the station. Then we made the 4:10 to Oceanside arriving there about 6 PM. A long day but a good one for everyone.

Dick is well on the way to complete recovery. Everything considered he is one lucky guy. The consensus seems to be a several more days at the SNF and then on to Debbie's for some indefinite time before he will be able to go home to Fullerton, maybe mid-February?

Uncle Bob, Bob Hein, or Dad - depending.

Another Visit From Bob and Marilyn

Today Uncle Bob and his daughter (my cousin) Marilyn took the train up from Oceanside. At Union Station in L.A., they transfered to the Metro Red Line and got off at the Universal City stop, just about a mile from my house. For fun, I drive them by my house -- just a quick look from the outside -- then we drove over the All Saints. Dad already had company when we arrived: he was regaling his physical therapist with discussions about science and philosophy and music.

Bob and Marilyn brought an array of goodies: real New York-style crumb cake, fresh-squeezed orange juice, books, etc. We put Dad into a wheelchair and took him out into the patio area. Los Angeles got a brief rest from the rain storms today: the sky was blue, the snow-capped mountains were in view, the air was crisp and clean. I got my fiddle out of the car trunk and played while Dad ate lunch on the patio, talking with Bob and Marilyn.

Dad was upset that he dropped his iPod onto the hard floor in the middle of the night, so I left my video iPod with him. When I got home, I discovered that his isn't broken, just completely drained of power. So I'm charging it now, and will bring it back to him tomorrow.

Nice day, nice visit.

The Trach Is Out

Dad left me a voice message saying that they had taken the trach out this morning. It's disconcerting not to have any notice about these events, but the outcome is good. He may come home with me on Monday. Maybe then I can turn this blog over to him.

New Shoes

Today Dad can go outside in his new shoes. We've been experiencing heavy rain here in Los Angeles, with intermittent clearing. Right now it's cold and beautiful outside, and I can hardly wait for him to step outside and take a deep breath of that cold, clean air into his lungs. Can you imagine what that's going to do to his body after a month inside a hospital?!?

His plan for the day:

1. The therapy dog makes his rounds this morning.
2. I brought in his guitar.
3. Physical therapy (morning and afternoon).
4. The doctor makes his rounds today, and will evaluate the trach.
5. He wants to have a philosophical discussion with Father Gregory two beds down. I wonder what the Father will think of Dad?

He's starting to act for himself again: he took his pre-paid cell phone and called Verizon to add more minutes. He can start doing more and more on his own initiative.

He was asleep when I arrived this morning at 6:45AM. I sat by the bed and drank my coffee and read the newspaper until he woke up. What a great sight it was to see him sleeping. He says that he only slept fitfully, but it looked good to me.

Bob and Marilyn are coming on Saturday, and Tom and Maryanne are coming a week from Friday.

I brought home his iPod, which I'm charging now, and his sweatpants and blanket, which are in the washing machine. I'll bring all of those back to him this evening after yoga.

All Saints Healthcare

All Saints Healthcare is a remarkable place. They are doing everything possible, not only to help Dad's rehabilitation along, but also to make him feel comfortable and welcome. As part of the admissions interview, they asked what he likes to eat and what he doesn't like to eat, what his favorite color is, what upsets him and what makes him comfortable. Everyone introduces him or herself and explains his or her role. They even stop by to say goodnight when the shift is over. There will be a therapy dog on Friday, and Monday is hair cut day. They offered Dad an extra blanket tonight, because he said that he was cold last night. They deliver meals, then come by to ask how he's handling the food, and how he likes it. They listen patiently to everything he says. They took a full inventory of all of his personal belongings, and put a label with his name on the walker I brought in for him. Everyone who works there is kind and friendly and professional and helpful. I honestly didn't know all of this when I picked it out for Dad; I was relying on more superficial characteristics. I feel incredibly lucky to have found it, and my stress level is dropping sharply now that I know that Dad is in good hands and that he is comfortable and happy there. He proudly reported that the physical therapist gave him an A-minus on his initial evaluation. He says that he has strength but not stamina, and he has twice-daily sessions to develop his stamina. The activities director came by to find out what he might be interested in, and as a result of their conversation they have asked Dad to play his guitar tomorrow (I'll bring that in for him).

Oh, and his social worker used to fly a Cessna.

The Hero: An **Amazing** Story

Last Saturday I found a voice mail on Dad's phone at home from Officer Gerber of the Murrietta police department, who was on the scene at Dad's accident. He was following up to see how Dad is doing. I returned his call, and learned that a Richard Deboer, a state parks officer in Orange County, had played a crucial role in protecting Dad from further injury. I googled the name and found an e-mail address, and wrote to inquire whether I had found the right person. He gave me permission to post his reply in its entirety:


Yes, you've reached the right person. It is great to hear that your dad is recovering well. It was such a surreal experience seeing your dad's plane crash. I'm so glad that I was there and was in a position to help out. There are a few ironic and interesting coincidences regarding the crash and your dad's broken C2 vertebrae.



I guess I'll recount the incident as it unfolded on that Friday. My wife, Michaele, two twin daughters, Brianna & Kimberly (six years old), were in our mini-van in the Ralph's parking lot. We were out running some errands during the holiday season. We had just left the cleaners and were driving in the parking lot North by the gas station when I saw a red plane very low overhead, with no propeller spinning (fixed wood propeller), bank and turn left over the Washington/Nutmeg intersection. The plane straightened out and landed hard in an open dirt field. The plane hit the deck hard once and flipped over. I immediately turned our vehicle around to drive to the crash site. To exit the parking lot and get onto Washington you had to go out of the lot from the opposite direction. At that moment there was a Murrieta City Fire Engine in the lot right in front of us. Their lights and siren went on and I followed them out of the parking lot. At that time I was thinking we'll go see how it comes out and watch the Firefighter's do their job. Well, we were a ways back from the fire engine on Washington because we had to wait for the light to turn green. The engine turned right up Nutmeg and then kept going straight up Nutmeg and out of site. I was saying to my wife, "Where are they going - the plane is right here." After the fact, the only thing I could think of is the fire engine received a call at the exact moment of the crash and drove off to another incident.



I parked on the shoulder of the road on Nutmeg and told my wife and kids I was going to see if the pilot was OK. I ran a ways across the open field to the plane. Mr. Hein was already out of the plane. I asked him if he was OK. Mr. Hein said, "I think so." I had him sit down on the wing right behind the position he was standing in. I asked Mr. Hein if he was hurt anywhere. He said that his neck was hurting him. My first instincts were to get him a safe distance from the plane and into c-spine precautions. I told Mr. Hein to move very slowly and guided him away from the plane. I stabilized his head and neck and assisted him to the sitting position. Then, while still keeping him in c-spine precaution lowered him to the ground on his back. When he was stabilized on the ground he was complaining of nausea and dizziness. I should mention that he had one other major concern. He said, “Gosh dang it.” He used the other word though, can’t blame him. I asked what was wrong, he said, “My plane!”



I asked him what his name was. He told me, "Dick Hein." I said, "Well, nice to meet you Dick, my name is Dick, too." I told Dick that I was an off-duty Lifeguard / Peace Officer and an EMT. I told Dick that he needed to lay very still and not move and the Fire Department Paramedics would be here soon to help out. I kept reassuring Dick that everything was going be OK and reminded him not to move. Another gentleman on scene had some experience with planes and crawled in the plane to shut off the fuel as well as disable the flight antenna. The Murrieta Fire Department Paramedics arrived shortly thereafter and took over treatment of Mr. Hein. They put a c-collar on Dick’s neck and packaged him on a backboard, monitored his vitals and transported to the hospital. I gave Officer Gerber my personal information and went back to my family.



It wasn't until a couple of weeks later that Officer Gerber called and asked me if I had heard the outcome of Mr. Hein’s ordeal. I was very interested because in the back of my mind I wondered if Dick was OK. Officer Gerber advised me that when Mr. Hein arrived at the hospital they found that he had broken his neck and was in surgery shortly thereafter. It was good to hear that Dick's surgery was successful and he is recovering. Other that the irony of Mr. Hein and I having the same first given name of Richard and going by "Dick," I too had broken my C2 vertebra in an accident back in 1992 and came out of it with a full recovery.



I was honored to hear that on February 5th, 2008 at the Murrieta City Counsel Meeting Chief Wright of the Murrieta City Police Department and the Murrieta City Counsel would like to recognize me for my actions that day. I have been a Lifeguard / Peace Officer for CA State Parks for 25 years and currently work as the Lifeguard Supervisor at Doheny State Beach in Dana Point. Having made public safety my life, it is nice to hear that my actions, training and skills helped in the chain of life saving along with the Murrieta City Fire Department and the Hospital Doctors. Anyway, I'm sure glad your dad's recovery is going well and I was very fortunate to be at the right place at the right time and have the necessary training to help out.



I’ll keep track of your dad’s progress from the blog. Let your dad know I said Hello and that I was thinking about him. Thanks for getting in touch with me, take care.

What A Difference A Day Makes

Dad is comfortably situated at All Saints, and everything seems great. Two small complaints:

1. The bed is less comfortable and more manual than the bed in the hospital. You raise and lower it by turning a crank at the foot of the bed, meaning that Dad can't do it himself. At it's harder for him to lower the railings himself.
2. It's very cold there at night. I'll bring him blankets and fleece jackets, etc. tonight to solve that problem.

Other than that, it seems like a perfect facility. There are dozens and dozens of kind and professional people -- introducing themselves, explaining their role, asking Dad about his accident, explaining procedures. What a welcome energy! They let Kathy sleep next to Dad overnight in a reclining chair. A hearty breakfast came promptly at 7:00AM, and I think Dad got a good amount of sleep last night.

They weighed him last night, and he learned that he has lost 35 pounds. His assignment today is to get his bearings and to learn about the program of physical therapy he will need to follow. My worries about the quality of the facility subsided entirely.

My assignments today:

1. Go out at lunchtime and get some supplies for him.
2. Start making arrangements for the next phase (a stay with me).
3. Start making arrangements for the phase after that (the move back home).

Gotta work right now, though.

Did It

Yesterday was one of the hardest days of my life, and my head, neck and shoulders feel like they are going to explode. But at the end of the day (night, actually), Kathy and I had gotten my father safely from Kaiser Hospital into All Saints Healthcare, where he will spend some time focusing on physical therapy and remaining under the care of nurses. Kathy stayed with him while I came home for some sleep. I'm going over now to see how he's doing. Dad and I will give it a couple of days, and if for any reason we don't feel like All Saints is necessary, I'll bring him home with me and bring in a visiting nurse once or twice a day to help me out.

Yesterday, in response to an e-mail inquiry, I heard back from the wonderful man who first arrived on the scene of the plane crash and helped Dad. The story is utterly amazing, but I want to check with him first to see if I can post the long story he narrated here on the blog.

Problem

Dad, Kathy and I had been waiting for several hours for the discharge order, when suddenly one of the doctors said there was some disagreement about what kind of facility he could be discharged to. Everything is lined up: the room is ready at All Saints Healthcare in North Hollywood, the nurses and transportation at Kaiser are ready to discharge, Dad is ready and anxious, but suddenly the one of the doctors thinks he can come home with me. The anxiety and stress level shot through the root while we had five minutes to debate the issue before the doctor had to go back into surgery. Now we wait until he gets out, and resume the argument. I feel like I'm going to collapse. I actually left the hospital and came home for an hour or so because I felt that my distress was making Dad upset, and he seemed to be in better hands with Kathy. So I took myself out of the situation for a breather, and will go back in now.

Getting Out !!!!!!!!!!!!!!!!!!!!!!!!!!

Kaiser just called! Dad has been accepted at the rehab facility I picked out for him, and he will be transferred today. I'm going to run over to the hospital and see him through the transfer process. This is GREAT NEWS!!!!!!!!!!!!!

A Morning Stroll

This morning I brought Dad some fresh-squeezed orange juice (strained because he's only supposed to drink thin liquids) and some coffee with half-and-half, and a little bit of organic blackberry applesauce with cinnamon. Who needs the cafeteria? He said that it was another long hard night of little sleep, though it was helped immeasurably by Kathy being at his side again through the night. She left about an hour before I got there. After the juice and coffee, he decided that he was ready for a walk. He got himself out of bed, then used the walker to go out of his hospital room and down the hall about thirty feet, then back to the room, and back into bed, all without any help. His mood is good, although we're a little confused at this point about exactly what the program is. The discharge nurse hasn't called me back since we talked yesterday at noon. I think he's ready to leave the hospital, but I don't want to push it until I'm certain there's a bed available in my first-choice rehab facility. One doctor thinks he could come home with me, but he still needs regular nursing care, and my house has a lot of stairs. So I think a little more convalescing would help before we consider moving him here. I don't have any bars in my bathrooms or other aids.

We have good talks each morning, between 6:30AM and 8:30AM, when I leave to go work. Progress, progress, progress.

Relief

Dad's friend Kathy is here for 4 days, and even spent the night in the hospital by his bedside until 5:00AM, helping him finally to sleep. He was chipper and rested when I arrived at 6:30AM, and I sat with him for a couple of hours while he got up (by himself!), sat in the chair and ate breakfast. He's stronger now, though still quite debilitated. But every day brings something new. This morning he brushed his teeth while sitting up in the bed, and asked for a comb. He dictated the following message to his blog readers, and will post himself when he is able:

"I am in an intermediate stage of recovery. I have no pain, and everything works." At this point his voice started cracking: "I want to thank everyone for their good will. I really appreciate comments from people I haven't seen in years. More blog posts from me will follow. I am too tired to do much, but am getting stronger every day and following the prescribed steps for recovery. Thanks again to everyone. I am very lucky."

I returned a voice message from the Murrietta police officer who responded to the accident, and he told me about the State Parks Ranger who was shopping in the mall next to the field where Dad landed. This Good Samaritan made sure that Dad was immobilized after he mentioned that his neck hurt. I have the man's name and am trying to track him down to thank him.

Dad was deeply upset about the news of the two Cessna's that collided in mid-air near Corona yesterday. He is quite familiar with that airport, and is afraid that he might know the victims.

Kathy just called from the hospital: Dad is now cleared to drink liquids, and has requested that I bring in fresh orange juice in the morning!

This One Will Get You

Ok, if this post doesn't bring a tear to your eyes, then you're made of stone.

Uncle Bob's daughter Marilyn and her daughter Caitlin caught an early train from Oceanside to Union Station, then the Metro Red Line to Vermont and Sunset, where it is only a two-block walk to the hospital. Caitlin got her first fiddle only about a week ago. Marilyn documented the visit with these pictures.

Here's the train trip, the Red Line hop, the hospital, then me and Caitlin entertaining Dad and everyone else on the floor. Look at that smile on my Dad's face! If you double-click on a picture, it will open a bigger version so that you can see each of them more clearly.

Thank you, thank you, thank you to Marilyn and Caitlin.

Here is Uncle Bob's account of his second visit with Dad, which took place yesterday:

Visit with Dick #2

Quite an amazing change: regular hospital room, hardly any tubes and wires; still in a neck brace and tracheotomy but with a valve, which allows him to talk.

I took the Amtrak again from Oceanside to LA then a cab to Kaiser on Saturday. Debbie was in Fullerton seeing to Dick's house so she was unable to host me this time. She did, however, e-mail me explicit directions from Union Station to Dick's room.

The train was a bit late, took 2-1/2 hours, so I didn't get to Dick's room until about 11 AM. Found him in fine fettle and expecting me, and happy to see me again. He was especially appreciative of the vanilla puddings I brought for him at Deb's suggestion.

It was really good to hear him speaking! First thing we did was to clear up a couple of things he was not able to get across to me on my last visit when he was limited to gestures and writing notes. First he explained to me in detail the difference between his neck fractures and that of Christopher Reeves. In Reeves' case the two fractures went parallel to the top/bottom surface of the vertebra so the broken sections moved relative to each other (in shear) damaging his spinal column causing total paralysis. Dick was much more fortunate; the two fractures were on an angle so that the broken sections rotated slightly about the spinal column - (Phew, what luck) - and left him with no neurological damage. The other thing was that after he flipped/landed by hitting a hole with the nose wheel, he was left hanging upside down by his seat belt harness. When he released the seat belt he fell on his head. Apparently that's when the damage was done.

We have more discussion about the flight, what happened, and why with no new conclusions. He suspects that the NTSB will want to dismantle and check the engine. He also thinks that the damage to the aircraft itself can be repaired, assuming there is no hidden structural damage. However, he reiterated his position to “never fly again” and would not repair the plane himself.

Dick was very talkative (I'm sure he is still on some happy meds) and expressed his gratitude, several times, to all the family and friends who have replied to the blog and with cards. He got very emotional and choked back tears when talking about them. He was also on the verge of tears when he spoke of the way the hospital staff members treat him. One of his therapist (the gal with the beautiful white teeth and radiant smile - Jennifer I think) mentioned that these types of emotional reactions are typical following the type of trauma Dick suffered. He is getting excellent care by dedicated intensely caring professionals.

We spoke of his situation for the next couple of weeks. He is reconciled to the move to a skilled nursing facility (maybe next week) and then perhaps some time with Debbie before he finally gets home.

His attitude, sense of humor, and demeanor remain good and he is certainly buoyed by the Blog comments, which Deb reads to him. It was a good 2-hour visit for both of us. I'm glad I was able to go see him.

Bob Hein, Uncle Bob, or Dad - depending

Catching Up

It's been a busy couple of days, and I'm not even sure I remember everything that happened. Here's what I remember:

1. I had a fiddle lesson on Friday afternoon, then took my fiddle into the hospital and played a while for Dad. He got through the night ok -- no sundowning, but no sleep. Wouldn't it be great if we could solve the sleep problem!

2. On Saturday morning, knowing that Bob was taking the train up for a visit with Dad, I drove down to Fullerton. I had a professional cleaning crew come through Dad's house and put things in order. It was a good start, but there's a lot more to be done. I didn't even touch the back two bedrooms and bathroom, only the main part of the house that Dad uses. It was a good first cleaning, but it will need more. In addition, I need to buy Dad a complete new set of linens for his bed. He needs a fresh, clean, healthy environment when he returns home. I touched base with Homeland Security (Laura and Jonny), and found Dad's reading glasses (that's huge! now he can read).

3. I stopped by the hospital on my way home from Fullerton. I was tuckered out from the housecleaning, and only stayed about half an hour. I read Dad a blog comment he got from Switzerland -- he *loved* that (vielen danke, or mille grazie, to the pilot from Switzerland!). I told him that Marilyn and Caitlin (my uncle Bob's daughter and granddaughter) would be up on Sunday morning.

4. Saturday night I crashed on the couch and went to bed early.

5. Sunday morning I met Marilyn and Caitlin at the hospital, and Dad got an earful of twin fiddles. Caitlin's had her fiddle for about a week, so we spent a few minutes reviewing some tips. I look forward to more of that!

6. Dad and I have discussed the rehab facility where he will be going. My biggest concern is that Kaiser will try to move him without talking to me first, so we wrote the name of our preferred facility on a card which he keeps near him, and write it on the white board in his room as well. I've left the discharge planner a voice mail message expressing my choice, and hope to talk with her directly tomorrow. Dad's more or less completely off the vent now, and so I think there are very few remaining medical issues. He needs food, physical, speech and occupations therapy, rest and recuperation, all of which he can get in the rehab facility. We'll set up a personal environment for him there, with pictures, iPod, computer, books, glasses, magazines. I hope his stay there is short. Even though he needs their services, he also needs to get back to life.

Speaking of pictures, Marilyn documented her and Caitlin's trip, and will be forwarding me the pictures for posting on the blog.

The milestones I'd like to hit next week: liquids, sleep, transfer to rehab, and more visits from friends and family.

Dad's Nurse Lisa

In the short time I spent with her this morning, Lisa impressed me deeply as an experienced, compassionate, calm and wise nurse, and I am deeply indebted to her for the way she treats my father (and, I'm sure, all of her patients). What would we do without people like her? How do we reward them for their contributions? How do we make sure that the values she displays get imprinted on the universe, in place of the ones we see all too often? Lisa recently took up playing the harp, so we conversed a little about begin adult beginners on a musical instrument.

Notice the special blue blanket I bought for Dad. After Lisa finished giving Dad his morning bath, she arranged his blanket nicely on the bed, and went looking for some canned peaches for him.

I investigated rehab center Option #3 at lunch time: six miles/ 20 minutes away. The location isn't nearly as bad as I thought. It's a crowded place, with a large pediatric ward. Children usually love my father, so maybe having access to a ward full of children would be a good thing.

Imperfect Choices

The Kaiser staff are all over the map about when Dad will be discharged from the hospital and moved to a rehab facility. The discharge planner called me yesterday afternoon at 2:50PM, just as my husband and I were going into a meeting that would last the rest of the day. She said that Dad would be discharged in the morning (that is, this morning!), and that she had the name of three facilities I needed to look at immediately. Yeah, right. I figured she was wrong, but was deeply upset anyway at their expectation that I could make a decision on such short notice.

This morning one member of the neurosurgery team told me that if Dad gets too strong in the hospital, he might become overqualified for a skilled nursing facility. So I decided that it's time to take a look around and identify a first, second and third choice, so that I would have those ready when the time comes. Discharge sometime next week is definitely a possibility. Two of the three facilities Kaiser gave me were too far away, and my choices are limited because of Kaiser's involvement and because of Dad's tracheotomy hole, which requires specialized facilities called "sub-acute". Here's what I'm looking at:

1. There's a beautiful facility about 1/4 mile away from me -- I stopped in on my way home from the hospital this morning. Kaiser would pay none of the costs here, which would run over $5,000/month plus physical therapy. But the facilities are excellent, and he would be 5 minutes away. But this is not a sub-acute facility, and I can't even consider it unless the trach hole goes away.

2. There's a Kaiser-contracted facility near the hospital, about 15-20 minutes away from me. It's a sub-acute facility, and Kaiser would pay 100% for 100 days. No one is giving me any kind of estimate about how long to expect Dad to need this kind of facility.

3. There's a third option, a Kaiser-contracted sub-acute facility slightly further away than Option #2.

Since Option #1 isn't an immediately viable option because of the trach, I'm going to look at #2 and #3 today, and veto anything that is outright unacceptable. I can tell from the locations that the neighborhoods won't be great -- #3 is a semi-industrial area, with a big Home Depot and a Fed-Ex warehouse nearby. Not a beautiful area, but that can't be my primary concern -- the quality of the facility inside the doors is more important. I'm a little worried about whether there would be a consequence to moving him to a non-Kaiser contracted facility in the event he should require a return to the hospital. I don't think that's entirely out of the question, and I don't want to get into a situation where the two facilities point at each other when it comes time to billing. Long-term it's a safer option to keep him within the Kaiser system, though that eliminates my first-choice option. My gut tells me that a month or two from now Dad will be self-sufficient again, or perhaps ready for home (his or mine) and a visiting nurse. But I need to plan for a longer stay in case I'm not right.

I'll look at them, and talk to my brother, and try to make a decision by Sunday.

Tomorrow is the big cleaning day at the house in Fullerton, and fortunately Uncle Bob and Diane are coming up again that day, so I can rest assured that Dad won't be alone while I'm down at the house.

Busy

More posts and pictures later. This morning I'm trying to find a rehab facility for Dad. On this issue Kaiser is worse than useless (they've otherwise been great).

The Symphony Story

Over the past couple of days, you've read my description of the "plans" the Dad and I write up each day for his progress. The list contains items such as "eat more food today" and "walk as far as the hospital room door and back". Others are more like rules, such as "when Dad wants to get out of bed, he will call the nurse first." These lists help Dad in many ways. They give him something to focus on and a way to measure progress. It particularly helps and pleases him if all of the medical staff who enter the room read and sign off on the list -- kind of a team-building effort that makes Dad feel like there's a team, and that he's in charge of it. Almost everyone gets the spirit and purpose of the list, and they are more than happy to express agreement and enthusiasm. If they are not sufficiently enthusiastic, Dad will request "more enthusiasm, please!" Some of the items on the list are for Dad, others are for the nurses or the doctors.

One doctor entered the room and Dad called his attention to the list. Dad said that he feels this experience is like a symphony, and he's conducting the orchestra. He pursued the metaphor for a while, but the doctor clearly didn't understand. What symphony is Dad playing (thinking that Dad was confused, and thought that he really was playing a symphony, not understanding that Dad was using a metaphor)? Dad's question: who's really suffering from confusion here? Him or the doctor? Dad thought that was pretty funny.

Thursday Morning

When I left last night, I tucked Dad in using a new navy blue blanket I bought at Bed, Bath & Beyond yesterday. He had asked for some pillows to help prop his head up on either side. Though he's getting stronger, he still finds himself tilting over the left side in bed, and thought pillows on each side would help keep him straight. The pillows and the blanket match, and he looks pretty comfortable! I taped up pictures of Ricky and his dogs, and me playing the fiddle, where he could see them at night. We left the curtain drawn back, since I think claustrophobia contributes to his night terror. He got through the night much better, with no terrors, but no sleep either. So he was in much better condition this morning than he was yesterday morning. No restraints, and he was proud of that. They were changing his bed linen when I arrived, and they put the blue blanket back on the bed, and he was ready to start a new day. He said that he was hungry -- that's the first time I've heard him say that. He's discovered that he really likes vanilla pudding. Applesauce and cream of wheat: good. Pureed scrambled eggs: bad. He's still on pureed food, so we added "move to solid food" for his plan for today. He'll be getting out the staples from the surgical wound today, since the surgeon says that's all healed up. That's a particularly good item to put on the plan, because at the end of the day we can cross it off, as opposed to goals such as "walk further" which just get put on the list every day. I brought the newspaper, and we had a good talk about politics and the economy -- another indication of improvement! He wants to get Sonex pilot hats for all the nurses and doctors as "thank-you" presents. When I bring in cards and e-mails, he cries when he reads them. Yesterday I brought cards from Betty Van Zandt and Kathy, and an e-mail from Brad Hale. He read each one twice, and cried each time. He's also very touched emotionally to hear about support from my mother. Also: we used my iPhone to talk with my brother Ricky last night! So we can set up phone calls if anyone wants to talk with him.

This morning I read him the latest set of blog comments, and he cried again.

Remind me to blog about the symphony story! Gotta run right now.

Dad Says "Hi!"

Dad's been talking about posting to the blog, but we haven't been able to get a computer working for him yet. So I suggested that I take this picture of him using my cell phone, then upload it on his behalf. There he is, sending a greeting to all of the blog readers.

I spent about three hours at the hospital this morning. He had two episodes of sundowning/night terrors last night, and they had to restrain him. When I arrived, I untied the restraints, straightened his bedding, got the orderlies to reposition him more comfortably. At around 7:30, the nursing shift change started taking place, and the activity level rose: nurses, doctors, respiratory therapists, cleaning crew. He and I talked about what happened the night before, and I explained the syndrome to him. He decided that we need a written plan for each day, one that the doctors and nurses will "sign off on" as Dad says. Of course the doctors and nurses will do what's best for him, but they seem to understand how it helps him if they study the plan and agree to it. Only one of the staff didn't seem interested in participating in the exercise; the rest were wonderful. Dad is negotiating with the staff vigorously, trying to get what he wants. It's very clear that when I am there, and there is activity around him, everything is fine. But when I leave and the night gets quiet, he has a very rough time. In the picture above, you're seeing him at his best. He's not like that all the time. But every day he makes progress, and I make sure we review it together to make him focus on the achievements.

Very Bad Night

More "sundowning" last night. I read on the internet about it: it's also called ICU psychosis. He tried to get up out of bed and leave the hospital. I was in yoga class. When I got out and checked my voice mail the hospital had called. I had left him at 4:30 asleep with the understanding that I would be back this morning. But something happened after I left, and he took a turn for the worse. I drove over to the hospital, but he had fallen asleep. I wanted him to know that I was there, so I waited by his side for a little while until he opened his eyes. He knew exactly why I was there. He said "You got the nurse's message?" Then he started talking about driving to Corona with me today (???), how I might have to go alone. There was some kind of hallucination in his mind.

He was very, very tired and I wanted him to go back to sleep. He asked me if I would tuck him in. I got a blanket, and told him it was a magic blanket that would keep him safe and comfortable in bed until I could come back in the morning. I'm leaving shortly to go there and see how he did.

Shell Oil Company

Here's the kind of money Shell Oil Company is making these days (from the Associated Press):

Shell said its adjusted earnings, arrived at by stripping out the fluctuating value of petroleum, was $7.37 billion, sharply higher than analysts' forecasts.

That's their quarterly earnings in billions, with a "b".

When I learned that Dad was hospitalized, my brother and I went to his house and collected everything we could find related to outstanding bills, including a bill from Shell Oil. After spending two days dealing with the emergency tasks, I sat down and wrote out checks for each of his bills and mailed them the next day. The payment to Shell arrived one day after the due date.

A new bill arrived today, and it includes a $15.00 late fee. I thought, surely they would be willing to forgive a $15.00 late fee for someone is in in the ICU.

I thought wrong.

Evidently Shell feels entitled to the $15.00 bucks it tacked on the bill of a man living on social security. It claims that it can make "no adjustments to the account directed by a third party". Of course, it is perfectly willing to make the "adjustment" by cashing my check. In other words, it will make "adjustments" in their favor, but not in the other direction.

I guess we can make that $7.37 billion plus $15.00. What a world.

Tuesday Morning

Dad weathered his first night in the ward well, though he's still not sleeping. Every day his mind seems more and more engaged. He's focused on the next near-term milestones: his first solid food today (what they call a "dry plate" -- no liquids yet), and more steps under the supervision of the physical therapists. They said that I can bring a laptop in for him. I have an old one I can put into service if I can get the wireless card working in it. I brought his reading glasses in. We decided that I will bring in a small cloth bag and we'll sling it over the bed. I can put his glasses and iPod in there, along with some reading material. He had a window in the ICU but not here in the main ward. His nurse Curtis is a wonderful man. Of course Curtis had to see the pictures of the plane, and hear the whole story. Dad has a new team of people to charm. I asked about the possibility of pushing him around in a wheelchair, but Curtis said that the physical therapists would have to ok that. I had prepared some fresh juice for him, but that's not allowed yet.

He and I are in a routine now, making a joint "plan" for each day. He gets his assignments, and I get mine, and we work on them. His job today is to work on solid food and physical therapy, and mine is to get the laptop working for him.

Out Of The ICU!!!!

I missed a call on my cell phone, and when I listened to the voice mail it was the ICU nurse calling to tell me that Dad has been transferred to Room 636 in the main ward. That was fast! I was there a few hours ago. I'm worried about him tonight, though. I'll go back at 9:00 tonight and check in on him.

We need visitors now, if anyone is available. The facility is:

1526 Edgemont (between Sunset and Hollywood boulevards)
Los Angeles, CA 90027

There's a Metro Red Line stop two blocks away at Sunset & Vermont, and a parking garage on Edgemont directly across the street from the hospital entrance. Come one, come all! I don't think they are particular about hours, though I'll double-check that later tonight.

Update: Dad is settled into the ICU, and promised me that he wouldn't try to wander around tonight. Visiting hours are noon to 8PM, and no flowers or food are allowed on the floor.

Monday Afternoon

I finished up work -- got a good amount done today! -- and went back over to the hospital. What a dramatic change from a tough morning. He was alert, and had had a busy day. He took about three steps on his own today, supervised by the orderlies. He had (and passed) two parts of the swallow evaluation, and will have a third shortly. It looks like he may be able to eat soon. He asked me to bring him some spaghetti. While he was working on the swallow evaluation with the speech therapist, we sang together a little (Dark Town Strutters' Ball), though we both forgot the words. It was a nice moment. I've been singing that song with my father since I can remember. He teared up when I gave him a card that had arrived in today's mail from his friend Gayle. I told him that Andy, Cousin Carole's husband, had downloaded some pictures from Google showing aerial views of various places, including the hospital and the field where he brought the plane down in Murietta, as well as the intersection of my street and Ventura Blvd. The hospital and my street are certainly familiar sights!

Dad is already starting to analyze the crash, and to remember specific decisions he made and thinking about what he might have done differently to bring the plane and himself down with less damage. His mind is hyper-analytic, and it's good to see the gears in motion. He's starting to talk about the future, asking what the next steps are. He's apologizing profusely to the ICU staff about his breakdown last night, shaking every one's hand and asking for their pardon, and charming them with his humor. We've devised a plan for how to deal with it if it happens again. Because he likes to think things through analytically, I'm going to print some information for him about the syndrome (they called it "sundowning"). If it happens again he's going to try to remember that we spoke about it, and the ICU staff is going to tell him: "Deb says to calm down!". I'm going back tonight around 9:00 to help him ease into the night. We reviewed my yoga breathing exercise. As I was leaving, he said enthusiastically: "I feel better!".

Monday Morning

Monday morning and Dad is still in the ICU. He had a rough night last night, experiencing what the nurses called "sundowning". Once the sun goes down, the patient's world shrinks to a horizon of about four feet, and they start to get delirious. When I arrived this morning, it was good timing. A couple of really wonderful nurses named Kellie and Mercedes were trying to calm him down, but that's something I can do very quickly, whereas it would take them forever. When he saw me, he called out "Deb, I missed you *so* much!" but the crisis started to pass. I stepped out while they cleaned him up and put fresh bedding on, which helps him have a good visit. When I came back in I listened to him describe his night terrors, and helped him bond with the nurses. I stayed until the 7:30AM visitors ban began, and promised to be back at 4:30 this afternoon. I may try also to go back tonight around 10:00PM to help him ease into the night.

Today he's going to get a "swallow evaluation" and depending on the results of that could start eating. I promised him his juice and coffee he's been asking for, and that lit him up. He made peace with the nurses, though warned them with a wink in his eye: "I still don't trust you!". If we can get him into the main ward (his breathing is getting stronger even when the vent is off) then I could put him in a wheelchair and push him around. He needs to stimulation so badly. He wants his iPod but can't really operate it yet, and he has trouble reading without his glasses (I'm looking for those -- I think I have them). There's definitely some danger as long as he continues to struggle against the tubes and wires at night.

He's starting to ask for more. We went through the contacts in his cell phone, and he asked me to double-check with a couple of people in case I missed them. He wants me to pick up some books at his house on Saturday. And did I mention juice and coffee?? And the fiddle, of course.

From Uncle Bob

Here's Uncle Bob's account of his visit with Dick:

Diane and I took the AMTRAK to LA yesterday to visit Dick at the Kaiser facility ICU on Sunset Blvd. After the 2 hour train ride, Deb met us at Union Station and drove us over to Kaiser - about a 10 minute 5 mile ride.

When we arrived in the ICU Dick was sitting up in a large chair next to his bed. He has about 8 tubes and wires connected to him and is in a large neck brace. It was the neck brace, which disturbed me most; the only part of his face which you can see is from the eyebrows to just below his nose. Can't even see his mouth. In spite of all this his spirits are high, his attitude is good and he retains his sense of humor. Communication on his part is by slight head nods, hand gestures and brief notes he writes on a white board or blank sheets of white paper.

As we entered, his eyes lit up and he made a wave hello. At the same time a nurse was reminding him not to cross his legs. Aside from his catheter he has a fungus infection so they want him to keep his legs apart. I had to remind him several times during our visit not to cross his legs. At one point I told him if he crossed his legs AGAIN, his 'dingus' would fall off! That brought a smile to his eyes and face.

I had brought with me photos we took of the plane at the impound yard and a NY Jets ball cap. He wanted to wear the cap (it looks good on him), and also wanted to see the pictures, which I showed him one by one; he studied each one carefully. When he was done he motioned the nurse over and showed them to her. Before we left he had shown them to all the ICU personnel.

After I assured him again, which Debbie had done several times already, that his house, car, cats, and plane were taken care of; he wrote, “I'll never fly again.” I broached the subject of “what happened” and how much could he remember. With nods and gestures and a little prompting on my part, and no hesitation on his, he described what happened.

“The engine stopped.” He tried to restart it. He had gas and the engine instruments, temperature, oil pressure, were OK. He looked for a place to set down. He saw a big field at Perris but (it) was too “high” so he turned to the smaller field in Murrieta and flipped after landing. I was unable to understand whether he had landed hard and broke the landing gear and flipped or dug the nose wheel in and flipped or just hit a rough portion of the field and flipped. He hit his head, had some trouble getting out of the seatbelt harness but managed to crawl out from underneath on his own; then the EMTs came. He did not remember the helicopter ride to LA. When I asked what he thought the problem was, he gave me the famous “Joe Hein” so-what/I don't know shrug. I saw that shrug several times during our talk. I did take the time to reassure him that he had done a good job, followed proper procedures, that no one else had been hurt and that there was no other property damage besides his plane.

I had been monopolizing all his time, so I gave Diane and Debbie a chance to visit with him a bit before we left. Then I told him I would be back again in a week or so.

I'm glad I went. I think it was good for him to talk in “airplane language” a bit and I think he enjoyed it, as did I. Made me feel better, too.

During our visit, and at lunch, I got to speak further with Deb about the many things that have to be done while Dick is rehabbing. I sure do thank both she and Ricky for the job they are doing - stepping up to understanding and managing Dick's affairs during this difficult period. They have everything in hand so that Dick will return to a much more organized life when he is ready.

As to the plane…when I asked, I got the famous Joe Hein shrug. We'll see.

Bob Hein, or uncle Bob, or Dad - depending

"Stupid"

In case any of you think this experience is going to change my father, or make him heed the advice of others any more than he has in the past, think again. Last night he tried to get up out of bed, and fell. Lucky once more, he didn't hurt himself, except perhaps in the pride area. I could see in his face today that he is sad and wants out of there. I think he has these episodes of frustration at night when he's alone. I wish we could station one of us by his bed at all times. As you can probably tell from my description of Uncle Bob's visit yesterday, he's better all around, physically and mentally, when he's got people around and isn't lying helpless in bed. When I asked him why he did it, he wrote "stupid", then "I think they're pissed off." I told him they just don't want him undoing all their hard work -- a fall is *exactly* what they are concerned about most right now, since the respiratory issues have subsided. It's the most likely thing to happen, and the most dangerous.

Still, his humor is there. We could see that the doctors were doing rounds, so he wrote out "Doc, you ok for Flabob tomorrow?" He was asking if he could get a pass to go out for the chapter meeting at Flabob scheduled for tomorrow (I'm going in his place). The doctors and nurses are completely charmed, by his humor and his personality, and by the story of this guy who built an airplane. There are probably a lot of people who come into the ICU with end-of-life events, whereas Dad is strong and personable and headed towards walking out of there back to a full and interesting life (as long as he stops trying to get out of bed on his own).

So the fall is the bad news, but there is good news aplenty. Still no fever. They are going to fit him with a valve that will let him talk. They experimented with the vent to see how he would do using his voice. Here's the three things he said during this quick experiment:

1. Fuck!
2. Good morning.
3. Shit!

Quite the usual ratio of colorful to polite words. He always reaches out his hand to the doctors and nurses to shake their hands -- they like that.

Second good news: they might move him out to the main ward tomorrow. The doctor says that will give him greater mobility, because they can start to disconnect some of the wires and tubes. He wrote the order for the valve that will allow him to speak. Then he can start having visitors. Maybe I could even walk him near an open window.

Stay with me, everybody! We're moving past the milestones one by one. Soon we'll be talking about a rehab facility, then maybe a stay with me.

Friday Night

Just a quick update before I start my Friday night:

I picked up Bob and Diane at the train station at about noon and we drove over to the hospital. By the time we got there, Dad was already up out of bed and sitting in a chair, furiously scribbling to his doctors about "Flabob" (the airport--check it out at http://www.flabob.org/home.html), asking if he could get a pass to go out there on Sunday. He promised "no funny business, back on Sunday night". The doctors looked at me and said: "What's Flob?". Bob had brought pictures of the plane, which Dad showed off proudly to all the nurses and other visitors. Dad and Bob had a good long, wonderfully therapeutic visit, talking about the accident. I'll update more about that later, or maybe Bob will want to make his own report. The bottom line: he bounced right back from his bad night, and his sense of humor and quirky personality were on dramatic display.

Bob, Diane and I had a wonderful lunch, and I dropped them off at the train station for the trip home to Fallbrook.

Rough Night For Dad

I think yesterday was a big day for Dad, with his first steps out of bed using a walker and all the writing. Now he uses the white board when I'm there, and keeps asking for pen and paper when I'm not. He wrote me a message last night on paper, but I can't read it. I don't want to leave the white board there when I leave, because there's no room for anything. You can't really "move in" to the ICU, so to speak, and set up housekeeping. So far he's asked for juice and coffee, help getting up, an open window, his cell phone, his iPod. I'm going to leave his iPod next time, but it may disappear. It's possible that it will interfere with all the other tubes and wires. I think all this effort at communicating caused a little backsliding.

When I got to the hospital this morning, the nurse said that Dad had had a rough night. He got confused and tried to remove his tubes and IVs, so they had to put wrist restraints on him. He woke up when I came in, and I spoke briefly to him. I told him that it had been a rough night, and I untied one of his wrists. He looked scared and confused, so I told him that he had tried to removed the equipment and that they needed to keep him secure. I asked him to try not to do that again, and he nodded. I told him I was going to pick up Uncle Bob. I learned when I got back that Uncle Bob will be delayed about an hour due to Amtrak problems getting out of Oceanside. Yesterday Dad wrote "Bob" on the white board, then "When". I told him again this morning that I would be back with Bob around noon. Even with the delay, we will get there no too much later than that -- we'll go straight from the train station. One other thing he wrote last night: "Please open the window". Of course the window doesn't open. I wish I could gather some outside fresh air and blast his room full of it. He's very tired but not sleeping well. I told him something we do in yoga, to help calm the mind and oxygenate the body: four-count inhale, two-count hold, four-count exhale, two-count hold.

He's got a yeast infection now. I forgot to ask, but I assume he's on some kind of anti-fungal medication for that. I'll check when I get back.

Thursday Evening

His vital signs are great, but getting off the vent is taking some time. Today he got out of bed and took a couple of steps with the walker. He writes a lot when I arrive with the white board, some of which I don't understand. He said that he wants me to go out to Flabob this Sunday, and he tried to write "non-negotiable". That took about 20 minutes to write. Then he pointed to himself and drew a wheelchair. I think he wants me to wheel him into the EAA chapter meeting. He keeps asking for juice and coffee, and wants me to bring him his iPod. I'm charging it up now.

Medical Update

I forgot to include a medical update in this morning's post.

Dad's fever is down, so it looks like the pneumonia and UTI will be defeated. They are weaning him off of the ventilator. Now he spends all day breathing on his own, and nights with the ventilator support, and he's doing great during the day -- no problems. His vital signs are great except for the excitability of his heart. They do physical therapy with him every day, and yesterday they had him sitting up on the edge of the bed with his legs dangling down.

Oh, Yes: He's Back Alright

The white board is a complete success. I think our ability to establish communication is the result both of his increasing strength and alertness, plus our experiments with various tools finally led us to the right one. This morning he was asleep when I got there, and I know he hasn't been sleeping much. So I thought I would just sit there with him for a while. But after a few minutes one of the ICU staff came in and needed to wake him up. I talked for a little, thinking we could bring the board out after he had a chance to wake up a little. I told him that I was trying to think of things to bring in for him. Phyllis had suggested his iPod, which we found at his house and brought back here to Studio City. But I think the ventilator and other tubes makes that unfeasible just yet. I told him I could bring newspapers or magazines, but probably could leave things there, since elbow room is very tight. He motioned for the white board, and wrote f-i-d-d. I said "Fiddle?" and he smiled. For those of you who don't know, I took up the fiddle (as a complete beginner) about five years ago, and have been taking lessons from Richard Greene, who was Bill Monroe's fiddler in the late 60's and a world-class fiddler (you can take a look and listen at www.richardgreene.net). So Dad wants me to bring in the fiddle. I told him probably not yet -- the ICU is too busy and there are life-protecting activities going on. But as soon as he is out in the main ward I'll bring it in. My brother Rick wants to bring in his dogs to give him some dog kisses, and I told Dad that. He motioned for the marker and wrote "There is a cat" and pointed down as if to say "here". I said: there's a cat here, in the hospital? He nodded. I don't know if he is making that up. Then he wrote "get me up". I told him it is best is we wait for the trained physical therapists (the surgeon came in just then and agreed) and I asked Dad if it would be ok to wait for them -- they will be in sometime later today. He nodded.
Then he wrote "juice or coffee" and I laughed. I told him I was pretty sure that doesn't work with the hole in his throat. I went out and asked the nurses, and the concurred: he isn't able to drink right now.

Then he wrote "get me up" again, pointing to the surgeon, but I explained again that we need specialized people for that, not the surgeon.

I started telling him about the football playoffs. He motioned for the board and wrote "USC?". I had to think back, and I think I remember that they played Illinois, and that USC won handily.

I told him that Caitlin had gotten her first fiddle, and that I would be having my first lesson in three months tomorrow. I told him we would pick something out for me to learn for him. He motioned for the marker and wrote "B.G". I said "Be good?" He shook his head and wrote after the "G": r-a-s. I said bluegrass? Big smile.

So I need to pick out a bluegrass tune to learn for Dad.

The White Board!

I tried again this morning with the alphabet chart and a big "YES" and a big "NO" and still didn't get anywhere. On my way home from Santa Monica this afternoon, I stopped at Staples and got a small 12x18 inch white board and took that in during my evening visit. It took a while to get going, and we did this in conjunction with the alphabet chart and slowly built the first sentence. Every time I understood something he wrote, I would erase his illegible scratching and write it in more clearly, as an anchor (I wrote most of what you see here, after erasing Dad's first draft). When we finally got the first sentence out, and confirmed with him that he was worried about the way they flip him over, we had successfully communicated. At that point, thankfully, the doctor came in and saw what we were doing. It was immensely useful for Dad to see that we had successfully communicated his concern, and that someone in authority understood. The second part ("not P.T.") was in response to what the doctor said. He thought Dad's concern was about the physical therapy (I didn't even know that had started), but after some back and forth we determined that it was the person who comes in to clean him up. Once the doctor and I repeated back to him what he was trying to communicate, he gave the OK sign with his hand. Whew!!! Now each day I can go back in and ask him if it has gotten better.

Now I call your attention to the next sentence, which he wrote after we concluded the discussion about being flipped over. It says "Isn't she pretty". Then he pointed to the bed next to his. He was talking about the daughter of the woman in the next bed. Oh my God!! My father is back!!! He's making jokes, he's complaining, he likes the woman sitting at the next bed, he's ok!!!

The next part makes no sense: we got as far as "last night I was in Europe with Deb". Maybe it was a dream, maybe he's hallucinating, I don't care.

The medical news: the antibiotic seems to be working on the pneumonia and a UTI. His fever is down. They are concerned about his heart rate, which shoots up sometimes. They have begun physical therapy. The hard collar will be on for six weeks, and they will probably leave the tracheotomy hole for that time. They can't put a time frame on getting him out of the ICU -- it depends on how he responds to physical therapy.

I told him Bob had been to his house today, and would be coming for a visit on Friday. That's great -- I think this is the perfect time for him to start seeing someone other than me. Until he gets out of the ICU, we have to respect the rule against non-family members, but when he gets out to the main hospital ward he can have visitors. In the meantime, since he's alert and remembering things from visit to visit, please feel free to send cards to me, and I will take them in. Here's my address:

Deborah Testa
3863 Berry Court
Studio City, CA 91604

To all of you who have left comments about the value of this blog, I have to say: it's a two-way street. Reading your comments -- all of them, no matter what they way -- has made this whole experience much more tolerable. I can't thank you enough, every last one of you. And I'm so excited to hear that the family has two fiddlers now! Maybe Caitlin and I can play Dad a duet soon.

There's probably a lot more to say, but I have to go rest now: too much excitement for one day.

"Up"

It came to me in the middle of the night: I woke up and went to the bathroom, and on the way back to bed it was suddenly clear. He wanted me to help him get up. That's why he kept grasping my finger, to use it to point up. He wasn't pointing to the television, he was pointing up. And I thought he was grasping at his gown and trying to remove it because something was uncomfortable. Now I think he thought it was a blanket, and he was trying to pull it off the way you would getting out of bed.

I like the idea of making a big Yes and a big No. I've already created an alphabet chart to use, and I'll print out the "yes" and "no" in huge letters before I go. Of course he can't get up, but if we can communicate a little better it may ease his frustration.

I've been following Laura's advice, cycling through all of the things that I think would worry him, especially his beloved cats, his companions. Thank you *so* much, Laura and Jonny, for tending to them. I have two cats here, and we call Dad's cats (and my brother's dogs and cats) their cousins.

I got good news last night that his plane has been retrieved from impound and transported to the hangar at Flabob airport. I'll let Dad know. Last night when we were trying the hand-squeeze method of communication, I told him that we had all established these virtual, on-line relationships. I told him that I had "met" the folks out at Flabob. I said "Jim Pyle," and he squeezed my hand. I said "Jan Buttermore," and he squeezed my hand. I said "Roger," and he squeezed my hand. These are all his buddies from the airport, and it was great to let him know that we are all connected. Jim invited me to come out to Riverside on Sunday for the January meeting of the Experimental Aircraft Assn. I'm going to see if I can do that. I'd really like to see them all. The only problem is that I'm getting pretty tired -- at night I crash pretty hard (no pun intended) when I get home from the hospital.

Carole, Dad's temperature is still 38.4 c. They started him on a different antibiotic yesterday. I don't know whether that was just a guess, or if they got some information from the cultures they are growing. I think it might be too early for the cultures.

It's very early in the morning here in Los Angeles. I'm going to go visit him, then drive out to my client in Santa Monica, and stop at the Wednesday morning farmers market out there to stock my refrigerator with fresh healthy food. I'll post again tonight.

Confusion and Frustration

This is a very profound experience. When Dad first became awake and responsive, it was a joy and cause for celebration. Tonight was much more difficult. I tried the "squeeze once for yes, twice for no" method of communication. I asked him if he knew who I was, and he squeezed once. Good! I asked him if he remembered me visiting him this morning, and he squeezed twice. OK. So I went through the story again, telling him what happened and where he was, etc. He seemed to have a question, so I wrote out letters on a pad of paper and started pointing to them -- he was going to squeeze once when I got to the right letter. W! Ok: who? 2 squeezes. What? 2 squeezed. Where? 2 squeezes. When? 1 squeeze! Ok, I said: I'll tell you when it happened, when it is today, and when you might leave. That all seemed successful -- I understood basically what he wanted to know, and gave him all the information I could. But shortly after that he mouthed "help me" and started looking panicked and agitated. We tried again with the letters, but got all the way through to z without a response. I gave him the pencil to see if he could point to the letters, but that didn't work either. He kept grabbing my finger as if it would mean something to me, but I didn't understand. We went on like that for about 45 minutes, and never successfully communicated. At one point I thought he was pointing to the television set behind me. I said "Is your question about the tv?" One squeeze. Do you want me to change the channel? 2 squeezes. Do you want me to turn it off? 2 squeezes. Do you want me to turn it up? 2 squeezes. Do you want to know what's happening in the world? 2 squeezes. We just couldn't connect. I told him we would have to live with this frustration for a while.

Tonight I'm going to make a big chart of letters using a large font, and find something large he can point with. The tools we were using were just too fine and small for him to be able to use them. Plus, I began to wonder whether he really had a question, or if he was just frustrated and trying to communicate that. He was definitely not comfortable or happy.

This is very, very difficult. I hope we have better success tomorrow.

Tuesday Morning

There's absolutely no question about it: every time I see Dad, he's a little bit more alert. This morning I walked into the ICU at about 6:45AM, and there he was with his eyes open. I waved at him and he saw me from across the room. So his awareness is extended to a further horizon: yesterday it seemed like I had to be in close for him to know that I was there. His eyes track mine, and then he looks past me when one of the medical staff enters, looking at that new person, then back to me. I went through the events again, and told him that he will need to listen to the story again and again until he's able to tell me himself to shut up. He squeezes my hand a lot, and even smiles and nods a little. Caleb from the lab came in to take several blood samples, so that can culture whatever is attacking him and figure out what counterpunch to deliver. His blood pressure was great when I came in, then spiked again the Caleb stuck him with a needle. He clearly felt pain. I tried to remember for Carole what the diastolic blood pressure was, but am unable to remember now. I find myself getting confused a lot -- misplacing things even when I try to take care not to, forgetting that the car keys are already in the ignition with the engine running which I frantically search my pockets and my purse thinking that I've lost my keys.

I read him all the comments from this blog, and I think there was a particular smile about Jonny his 15-year-old neighbor. My father has a strong and quirky share of the human spirit, and I like to think that Jonny benefits from exposure to that growing up.

It's amazing how life comes down to one person holding the hand of another.

Monday Evening

Two steps forward and one step back.

I went back to the hospital and spent another spell with Dad. The surgeon happened to be there, and he showed me two CAT scans, one from when Dad first arrived, and one this morning. He showed me in detail the exact nature of the injury -- dislocation and two breaks ("bilateral") in the C2 vertebra. One the second scan he showed where the screws were placed, and how the vertebrae line up perfectly now. The surgery, in other words, did absolutely everything it needed to do. Dad is now secure, safe from potential further injury. That puts us on a path of recovery: with the bones securely in place the pain is reduced, with reduced pain comes less sedation, with less sedation comes more alertness, with more alertness comes general healing and an ability to participate in his own healing. Both of his eyes tracked to my face, so his recognition of me was more than just a matter of noticing me if I put my face in his line of sight. He squeezed my hand both both his left *and* his right hand. I've seen noticeable improvement from morning to noon to night today. His blood pressure was back down (122/55).

The one step back: his fever is up to 38.4 degrees C and he's producing a lot of greenish secretions, and that implies pneuomonia. Pneumonia is a relatively common consequence of intubation, especially when the intubation lasts as long as Dad's -- it creates an open passage way from the outside directly into the patient's lungs, and the bugs jump in. He's on antibiotics, and since this is such a common, looked-for side effect, I have to assume that the ICU crew knows how to manage the situation. The surgeon called this "pulmonary issues". If we can knock down this latest challenge, then there will be a clear (though slow) path to his recovery.

Uncle Bob tells me that the plane will leave the impound yard tomorrow, thanks to efforts by him and by the Flabobians (Flabobbers? FlaBobs?). I've scheduled a crew of cleaners to come by Dad's house a week from Saturday.

Everything looks good. I'm tired, and it's very, very hard to leave Dad to come home, now that he's awake.

Monday Mid-Day

I got a call from Dad's case manager at Kaiser at around 10:30 this morning. She doesn't communicate very well, and I couldn't tell whether there was a problem. I had only left the hospital three hours earlier, and was working at my desk at home. She made it sound like there may have been a problem (there wasn't), or that I might need to make an immediate decision about where to move him (I don't). I rushed over there, and he was awake! Well, "awake" might not exactly be it. We definitely communicated. He looked at me, making clear eye contact including moving his eyes. When I took his hand, he squeezed it so hard -- I mean *really* hard -- that I had to pry it off and take off my wedding ring before taking his hand again. He wiggled his toes, the left more than the right. The doctor came in and told him to lift his right hand, which he can barely do. But he did it, and kept trying even though the response was weak. But there's nothing weak about that left hand, and we gripped each other while I recounted the events once more. He gets agitated, and while I was there his systolic blood pressure when up from 127 to 168, starting when they came in to take a blood sugar reading. They gave him insulin as a result. I don't think Dad has a history of diabetes. I hope that's a temporary spike and not a permanent problem.

We were very definitely communicating, and he was understanding me. When the doctors came in I said that he had wiggled his feet and toes, and he did it again in response to what I said. So he definitely understands me. And although the tube in his throat helps him to breathe by providing support, it doesn't initiate the breathing -- he's doing that all on his own.

I stayed longer this time, since he was clearly responding to me. I told him over and over that things would be ok. It was *extremely* difficult to leave.

Uncle Bob called and requested some documents -- the impound facility only wants to release the plane to the owner. Like that's going to happen. I scanned Dad's driver's license and a confirmation of aviation insurance to Bob, and he'll see if that's enough to get them to release it.

Kaiser wants to develop options for Dad's discharge now, so that they have time to investigate possibilities, and so that we don't have to do that thinking at the last minute. If it's feasible, I could have him stay with me, but he may need specialized support and rehab and physical therapy. He was having trouble negotiating the stairs at my house when he was here for Christmas, so if he comes here he will be limited to the upstairs bedroom. The other alternative is a live-in facility, and I asked the case manager to investigate what's available in the surrounding communities of Studio City, North Hollywood, Burbank, Sherman Oaks and Hollywood. There are two rehab facilities just down the street, but I guess I need to limit us to the ones who are under contract to Kaiser.

Monday Morning

Ok, a new routine. Ricky and I are both going back to work this morning. Visitors to the ICU are disallowed twice a day between 7:30 and 9:00 AM and PM. I'm going to try to visit twice a day just before these hiatus periods. This morning I left the house at 6:15AM, had a good visit with Dad, and was back pulling into the garage at home at 7:35AM. It's about 15 miles round trip. I can do that each morning, no problem, without having it impact my availability at work. I'm working from home these days, connecting to my client using a laptop they gave me. I feel encouraged that this is all workable.

The drive down the freeway was a breeze at that time of the morning, but on my way back up the other side (the one I had come down on) was already becoming congested. So getting started early is definitely an advantage. I could tell all last week as Ricky and I drove up and down the 5 freeway that we were benefiting from residual light traffic from the holidays, but all that will be gone now and I need to take that into account. It would be very difficult right now to drive down to Fullerton -- that's about 30 or 35 miles away through the worst of L.A. traffic. So I'll go there on Saturdays, and stay up here during the week. Fortunately we were able to secure everything at his house before this, and Laura is keeping an eye on everything there.

I'm assigning people job titles -- here's what I've got so far:

Ricky: Keeper of the Keys
Diane: Tech Support (she got Dad's e-mail running)
Uncle Bob: Transportation Management (he's keeping tabs on the car and the plane via the Flabob crew)
Laura: Homeland Security
Me: Princess & Scrivener

When I got to the hospital, the nurse decided to dial back the sedation. They do this to test how he tolerates it. It wasn't more than a few minutes later that he started to respond. He didn't exactly wake up, but he started to move and grimace and his face got red. The blood pressure was still normal (121/65 for my medical readers). To my untrained eye, it looked like he was in pain, so I ran out and found the nurse. She said that it's just him trying to wake up, not a cause for concern, and a necessary step. So I tried to breathe through it -- it's horribly difficult to see someone you love apparently in pain. The agitation passed after 5-10 minutes, and I sat there for another 15 minutes or so and talked to him. I told him we're on this road now, and there's only one was to get off of it, and that's forward through these difficult steps. I pulled out my iPhone and called up the blog and read him several of the posts and comments. If you have anything to say to Dad, please put it in the comments -- I'll read everything to him each time I visit.

I want him to have some sense of normal life going on, so I updated him on the football play-off games. I'm not a football fan, but because my husband is an avid fan of the Patriots I usually know roughly what's going on. I told him about the Patriots-Giants game, and talked a little about this weekend's two wildcard games, though I could only remember the outcome of one. I told him about the rain storms, and about Laura's comments about his cats. I told him about my conversation yesterday with Jim Pyle, his friend from Flabob Airport.

Anyway, dear friends, please fill up the comments. It makes for perfect content for these one-way conversations I'm having with Dad.

Unexpected Good News!!!

I went back to the hospital tonight, thinking that I would probably get into the routine of going there twice a day, even if it's just to talk to him for 15 minutes each time. When I walked in, the nurse came rushing over to me with a big smile on her face, and said that they had performed the tracheotomy this morning, just after Ricky and I left. This is huge, good news! Until they got that tube out of his throat, we were just going to be in a holding pattern. Now it's out! He looked *much* more comfortable, almost as if there were a gentle smile on his face. Nurse Judy said that he's been semi-conscious. I didn't see that -- he was out while I was there, but I don't care. They offered to wake him up, but to do that they have to shake him and yell at him, and I'd rather he lie there quietly while I speak to him. It's been raining heavily this afternoon, and I like that: this is winter, a time when things lie still. It's a necessary phase of regeneration, and I'm happy for Dad to lie there sleeping because I think that's what he needs. I keep telling him he doesn't need to wake up, just listen.

They told me this morning that they might not do the tracheotomy until next Wednesday, and I was concerned about that and wondering if it was time for me to be more aggressive, to try to force the issue and get them to do it earlier. Intubation is so horribly uncomfortable, it's almost worse than the injury to his neck. So it's a big load off my mind that the tube is out, and that we are truly on the other side of the acute crisis. I hope it pours tonight, and that Dad sleeps through it. I feel much calmer now.

Like so many other people, Nurse Judy seems charmed by the notion of Dad building and flying his airplane, and I think she's taking good care of him.

The Crew at Flabob Airport

Flabob Airport is the small airport in Riverside, CA where my father built his Sonex airplane. Though my Dad has a reputation for being an original, there are actually many people out there who are a lot like him. During a recent meeting of their chapter of the Experimental Aircraft Association, they featured Dad's recently completed plane as the Plane of the Month. They were the first ones to know that something was wrong (when Dad didn't return on time, and they saw that the airplane was gone and his car was still there), and the first to leap to help him by calling local airports and authorities to try to find out what happened, pulling his car and bicycle into the hangar, figuring out where the plane was and arranging to bring it back to the hangar, too, and finding him that first night in Inland Valley, before they transferred him to Kaiser and before the severity of his injuries was manifest. I hope someday soon I can get out there and meet them, and find someway to thank them for the human fellowship they demonstrated towards my father both before and after the accident.

Dad This Morning

Ricky and I arrived at the hospital this morning at 9:00AM, just as visitor hours were beginning. That's us on the left side of the blog, outside the hospital entrance. As we thought, Dad was unchanged, sleeping. They had tilted his bed down so that his head is higher than his feet, and we asked the nurse why they had made that change. Her answer was long, and it boiled down to "it's better for him that way". We told him the story again, reviewing all the elements that would ease his mind about anything that might cause him to worry.

The nurse said that each day now they scale back the sedation and wake him up. She said that it takes a lot of effort and shaking to rouse him out of his medicated stupor, but that ultimately he does wake up. She said that he is not moving his right arm. The neurosurgeon specifically reported that the tests they ran showed a very positive response in his right arm, so it's unclear what the status is. She also said that he has more trouble moving his right leg, but that he can move it with effort. I don't know what to make of her comment about his arm, or even when her comments about his right leg indicate that he will have difficulty down the road. I guess these things remain unknown for this period of time when he remains asleep more or less the whole day.

She said the ENT department (for the tracheotomy) usually does procedures Saturdays and Wednesdays, and that yesterday had been too early after the surgery to consider undertaking that. She said they will try to see if they can squeeze him in before Wednesday, but Mondays are generally busy so that's not likely. I hope they can take him soon -- I want that tube out of his throat. I don't mind that he's asleep: that actually seems good to me. But I want him to rest comfortably, and removing that tube seems like a high priority.

We sent in a change of address form for Dad on Thursday, to get his mail delivered to my house. His neighbor Laura says that as of Saturday they were still delivering mail in Fullerton. Ha! Ricky is a 16-year veteran postal carrier, and he will see that they respond to our request.

Ricky's flight back to Sacramento will take off shortly. A new phase begins.

Sunday Morning

This morning we'll go to breakfast, then drive over to the hospital again. We don't expect much change. He's probably healing and getting better internally, but until they do the tracheotomy and remove the breathing tube and scale back the sedation, he won't be alert. I hope they do that as soon as possible, maybe tomorrow.

We brought back a few change of clothes from Fullerton yesterday, and now those are washed and folded and waiting for him. I know he won't need them for a while, but I feel better that they are ready when he is. My two cats sniffed the pile of clothes I pulled out of the dryer, and I explained that they were smelling their Grampy and their two cat cousins. One of them sat on the pile for a bit.

This afternoon Ricky is flying back home. We'll both go back to work tomorrow. I'll be able to go over to the hospital twice a day, more if necessary. And I'll keep working on getting his house set up.

More Medical Details

Maryanne Conklin asked about why Dad has been intubated and on a ventilator for so long. Here's my understanding:

There was a brief time after the accident that Dad was breathing on his own, but he quickly developed complications. Because one of the fractures is in the C2 vertebra just at the back of the throat, the swelling and hematomas there started interfering with his breathing. As he became unable to swallow and expel secretions, he became agitated and in danger, and so the tube was inserted to protect his ability to breathe. They were unwilling to remove it since the surgery would exacerbate the things that caused those difficulties in the first place. If I understand this correctly, once a patient is intubated he needs to be heavily sedated because the tube is so uncomfortable.

The tracheotomy, which they will perform perhaps on Monday, will allow them to remove the tube and dial back the sedation, and he will be infinitely more comfortable and alert. The tracheotomy will eventually heal -- it won't be a permanent hole in his throat.

We Saw Dad

Ricky and I finished up in Fullerton and drove back up, stopping for some much-needed lunch along the way and then stopping in to see Dad. We confirmed our impression from this morning: there's no real change. He's still intubated, and the nurse said that no elective surgery will be scheduled until Monday, so that's the earliest he will have the tracheotomy. That procedure will make him immensely more comfortable: they will be able to remove the tube from his airway. Then they can back off the medications, and he will begin to wake up. But it looks like that will all take a few more days. In the meantime, he's still asleep and unresponsive. The nurse assured us, though, that he can hear us, so we repeated the story to him again: the accident, the hospital, the surgery, the house, the cats, etc. We're trying to make sure that he isn't worried, that he knows we're taking care of things for him. His job is to heal.

We found Dad's friend Kathy.

Ricky fixed the faucet in Dad's kitchen, since the big leak (more like a small fountain) there would have made housecleaning very difficult. He did a great job. Once that was taken care of, we got the dishwasher running. We threw away all the perishable food we found on counters and in the refrigerator. We tried to clean a little, but at this point we're ready to bring in a professional crew. We brought back some clothes for Dad to use when he recovers. This afternoon we're going to spend sometime watching football while we organize all the paperwork we brought back from Dad's house. We've got file folders, labels, mesh desk organizers, key rings, etc. etc. spread out on the living room floor here in my house. We left Dad's house secured and under the watchful eye of his kind neighbor Laura, with a big stack of canned and dry cat food and fresh cat litter. I probably won't get back to the house until next Saturday.

Dad's Friend Cathy

Does anyone have any contact information for Dad's friend Cathy who helped him with his house? He's talked about her a great deal over the years, but I don't know where she lives and I can't find any information about her here in the house. I'd like to make sure she learns the news.

A Little Overwhelmed Right Now

We got to the hospital this morning at around 7:45AM, and got about 7 minutes with Dad before they told us that twice a day between 7:30 and 9:00 visitors are disallowed in order for the ICU to conduct a shift change. My quick look at Dad told me that he looked pretty much the same, no better and no worse, and that he was asleep. So Ricky and I decided to proceed down to Fullerton to take care of the house chores, and we will return to the hospital on our way back.

We're trying to fix a serious leak in the kitchen faucet, since that will interfere with the housecleaning that needs to be done. We brought some tools from my house but not the right ones. So Ricky has taken Dad's car to go to a hardware store, and also hit the smog check place while he's out -- we found a notice for a smog check requirement in the house. I'm trying to take a first pass at cleaning, but it's too big a job for one person. I'm trying to arrange for a professional crew, but they don't work on Saturdays. So today we'll be limited to just a few chores. I threw out all of the perishable food I found on the counters and the refrigerator, tried to sweep up a little and take out the trash. But it is kind of overwhelming, and I ended up sitting on a garden chair outside for a few minutes, just to collect myself. Even though the news from yesterday's surgery was good, I'm feeling sad and unfocused today, and I doubt we will get nearly as much done as I hoped. I guess that will have to be enough for today.

Good Morning

Good morning to everyone. It's Saturday morning now. Ricky and I will be going to the hospital shortly, then driving down to Dad's house in Fullerton to take care of some more business.

It's been great to hear from people in the blog comments. Cousin Carole, who is a nurse, has some great advice for how to talk to Dad -- very welcome advice, since this is such a strange and new environment. And it's great to hear from Velma! And hearing from Dad's friend and neighbors reminds me of what an incredible character he is. Please keep the comments coming -- Ricky and I both enjoy them immensely, and eventually Dad will be able to read them as well.

Good News!

We were still waiting for the appointed hour of 5:00 to find out when Dad would get out of surgery -- they thought by 5:00 they would know roughly when the surgery would be over --, when the neurosurgeon called my cell phone. I had been washing dishes, and rushed to put everything down and answer the phone. They had anticipated that surgery would take 4-5 hours, but it only took 2.5 hours. I took notes as the surgeon talked; here's what I wrote down:

• He put three sets of two small screws into Dad's spine to stabilize him and prevent further injury. This was necessary because there was both bone and ligament damage. Bone damage would have healed on its own with just the stabilizing collar, but ligament damage never really heals, so it was necessary to use hardware to stabilize him.
• One of the vertebra was badly rotated, accounting for the neck pain Dad felt immediately after the accident. The surgeon was able to rotate it back into place, and this will reduce the pain he will feel from here on forward -- he will wake up more comfortable than he's yet been.
• Dad's spine is now in good, healthy alignment.
• During the surgery, they explored his nervous system, and everything responded positively, even the right side we had observed not moving. He has good, sound neurophysiology. THERE IS NO PARALYSIS!
  
• They may perform a tracheostomy tomorrow, so that they can remove the intubation from his throat. Everyone says that the tube is terribly uncomfortable, and the tracheostomy will help him feel more comfortable. But he won't be able to speak for a while.
• The tracheostomy is elective, though, so they will assess in about 12 hours whether to undertake that.
• Next up: they will wean him from the ventilator, then wean him from the sedation and pain medications, then try to get him up and around. I'm not sure how long this next phase will last. At some point in the not too distant future, they will transfer him out of the ICU into the main hospital ward, and at that point flowers and visitors will be possible. I'll keep you posted about that here on the blog.
  
• He's completely asleep right now, so we are going to wait until morning to go see him, rather than venture out in the gathering heavy rain storm.
  

THIS IS THE BEST POSSIBLE NEWS from a very bad beginning.

There's probably a lot more to learn. The surgeon has a limited point of view -- his concern is to repair the injury, and it's someone else's responsibility to manage Dad's recovery. Tomorrow we'll be able to talk to the ICU nurses, and maybe even talk to Dad.

I'm going to call some people now. If you want to leave a comment, just click on the word "Comment" right below this post. Everyone wants to hear from everyone.