In my recent bout with near-boredom I've been toying with some alternative blog templates. The page might look different from what your used to but it's the same content. I think I'll stick with this look for now, but it will probably be changing in the near future.
Also, on the right side column, under the "About Me" information, you can find a links section. In my Google work I come across quite a few interesting websites. I've started to compile some of my favorites, along with with other notable pages that I otherwise like or think are worth taking a look at. Go ahead and explore. Even if there's a lull in the posts, I'll probably be adding links on a daily basis.
Thursday, February 22, 2007
Not Bored, But Getting There
I've received several e-mails asking for an update on my brother's condition. In short, he's fine. Not 100%, but just yesterday we were able to explore downtown St. Louis and even throw the pigskin around in the park for a few hours. It's next to a sure thing that he'll be back working part-time at the hospital by March 1st. The color in his skin is back. He's able to do basic chores and has even been able to drive himself around for short periods. His recovery has been as smooth as we could ask for.
The reason I haven't written anything for a few weeks is because there has been nothing to write about it. My brother's health is an exhausted topic at this point, don't you think? And what else is there? Jake and I sit on the couch virtually all day. I do my Google stuff, and Jake watches TV and surfs the net.
(Our channel of choice has been the Food Network. It's seems to me a fair compromise between ESPN and whatever channel my brother would choose if I wasn't here. But it's bland. Though never grating or altogether unwatchable, the Food Network is also never that intriguing either. Right now we're watching the 1986 classic, "Lucas" on WEtv. Until now I never realized what kind of star-power this movie has – aside form Corey Haim of course, there's Jeremy Piven as the bullying meathead, Charlie Sheen as the unlikely nice guy, a very nerdy Winona Ryder, and the hot chick from Goonies. What a cast!) As the weather has allowed, we've spent a few days strolling through St. Louis's Forest Park, an enormous and well-designed public space that actually trumps New York's Central Park in sheer size. 
The park has a few museums, a zoo, tennis courts, 3 9-hole golf courses, an ice-skating rink, all kinds of sports fields, and is just a few minutes walk from our townhouse. Unfortunately, Jake tires quickly and walking even half of the park's 6 mile trail is a grueling exercise. And anyway, until this last weekend, the weather has been intolerable. Arctic cold fronts brought several days of snow flurries and we went 2 weeks in which the temperature rarely got above freezing. The park, like just about everything outside of these 4 walls, has existed more as an idea over the last few weeks than as a real, viable thing.But all of this idle lying about has at least opened the door for planning out future adventures. On March 7th I'm heading to Phoenix for Spring Training. Hopefully reinvigorated by a long weekend of sunshine, I'll then continue west and settle again in my old stomping grounds of Pacific Beach, San Diego. I'll probably spend the rest of March in San Diego then slowly start heading north after the NCAA tournament comes to a close. I should be back in the Bay by the end of April, and after spending some time at home, perhaps a week or so, it will back to the road. I am currently planning a 5 month expedition across the continuous 48. I'll be setting off from San Fran sometime in the middle of April and I plan on touching down in NYC by the middle of Sept. All stops in between are currently being weighed on points of convenience, general interest, cost, and novelty. If anyone has any suggestions, or better yet, knows anyone who would be willing to let me sleep on their couch for an indefinite time at some point this summer, then I would be more than appreciative. Anyone who assists in my journey will be rewarded with a postcard from whichever destination they contribute to my itinerary. Sweet, huh?
Oooh, Pee-Wee's Big Adventure just came on. I'll write more later.
Saturday, February 10, 2007
A Parable For Why Jake Needs To Stay On the Couch And Rest Right Now Instead of Yelling At Me For Not Letting Him Go Outside And Do Things
I remember reading a poem once, or maybe it was a short story, in which the writer describes a farm after an especially horrible and violent storm. In great detail the piece tells of the flooded crop, the uprooted trees, the battered roofs and dented silos, livestock lying dead amidst the rubble of pig-pens and old barns, the windmill leaning to kiss the earth, stuff like that, and then describes the old farmer stepping out from the cellar to take stock of the damage. The farmer is sad and then angry. He laments his bad fortune and curses god and mother-nature for their indiscriminate wrath.
From this point in the story there's several resolutions that could all serve our current circumstances in a unique way. 1) The farmer puts on his work gloves, steps out into the post-storm sunlight, and starts picking up the pieces. 2) The farmer receives news of his neighbor down the road who was caught out in the storm and died, putting his own misfortune into perspective. 3) The farmer turns despondent and remiss, letting his farm slowly wither and fade, and lives the remainder of an impoverished and unsatisfying life.
All of these endings are applicable to Jake's situation now, but also all kind of prosaic and obvious, and frankly boring. This particular story chooses an ending that I remember caught me completely off-guard at the time, and now seems more pertinent than ever. Eager to mend the damage from the horrific storm, the farmer immediately sets out with his winter-coat, his snow-boots, and his toolbox, and slaves all day until the sun dips below the flat horizon. Satisfied with all the work he has done, the farmer decides to retire to the house and spend the rest of the night by the fire. He resolves to be up early and working again the following morning. In total darkness the farmer starts to walk towards his house. He is tired, his muscles are sore, the freezing winter air numbs his nerves, his emotions are still seething from the tumultuous episode of the storm. The farmer reaches the patio and steps onto the bricked path that leads to the front door. Having neglected to salt the walkway, the ice is thick and smooth. The farmer's foot slips and he drops to the ground like a cartoon character who's stepped on a banana peel. The farmer, just yards from his house, hits his head on a rock and dies instantly. The end.
From this point in the story there's several resolutions that could all serve our current circumstances in a unique way. 1) The farmer puts on his work gloves, steps out into the post-storm sunlight, and starts picking up the pieces. 2) The farmer receives news of his neighbor down the road who was caught out in the storm and died, putting his own misfortune into perspective. 3) The farmer turns despondent and remiss, letting his farm slowly wither and fade, and lives the remainder of an impoverished and unsatisfying life.
All of these endings are applicable to Jake's situation now, but also all kind of prosaic and obvious, and frankly boring. This particular story chooses an ending that I remember caught me completely off-guard at the time, and now seems more pertinent than ever. Eager to mend the damage from the horrific storm, the farmer immediately sets out with his winter-coat, his snow-boots, and his toolbox, and slaves all day until the sun dips below the flat horizon. Satisfied with all the work he has done, the farmer decides to retire to the house and spend the rest of the night by the fire. He resolves to be up early and working again the following morning. In total darkness the farmer starts to walk towards his house. He is tired, his muscles are sore, the freezing winter air numbs his nerves, his emotions are still seething from the tumultuous episode of the storm. The farmer reaches the patio and steps onto the bricked path that leads to the front door. Having neglected to salt the walkway, the ice is thick and smooth. The farmer's foot slips and he drops to the ground like a cartoon character who's stepped on a banana peel. The farmer, just yards from his house, hits his head on a rock and dies instantly. The end.
Tuesday, February 06, 2007
Inch By Inch
The last few days have been as good as we could hope for. When I posted that last message on Friday night, we were all heading back to our hotel rooms for another bout of fitful sleep. My mind raced all night. I dreamed that Jake and I were playing paintball against Jeff Shields and Bobby Knight. I was getting angry because Jake was stuffing his mouth with BBQ ribs and not paying any attention to the game. We kept getting shot at and Jake would just sit there eating his ribs and wiping BBQ sauce all over my shirt.
I wake at 7:30 and walk to the ICU unit. I find my dad in his gown getting ready to enter the room. We go in together and sit quietly while the doctors take their rounds and discuss his condition. "Jake's oxygen saturation has been improving," they say. "His PEEP can be lowered for a trial run this afternoon. We'll monitor his response to that and consider extubation for late this evening or early in the morning. The cultures show a response to the Vanco and for now we'll keep the doses steady on that. X-rays show the MeRSA has been contained through the night so we can start breathing easier on that front. What we'll watch now is the ARDS induced spontaneous pneumo. His lungs are still a mess – residual infections, stray bacterium, ulcerated and/or necrotic tissue in the lungs and stomach – these are the things we'll pay special attention to for the time being. Let's get him on some Flolan. See if we can avoid putting a pinch on his stomach. Keep the oxygen at 8."
Jake's eyes are closed and he doesn't seem to be comprehending any of it. Dad and I nod and do our best to pretend like we understand. I'm learning how to decipher certain bits and pieces of what they say, but it's still mostly nonsense. Their coded language is best interpreted by studying facial expressions. You look for signs that indicate general trends – good or bad, urgent or plodding, effective or futile – and ignore the details and technical jargon. It's like looking through a window with the blinds partly drawn. You collect evidence by focusing on what's unobstructed, then create crude images to fill in what's hidden. You put it all together and you can come up with an approximation of the truth. It's the best you can do.
On Saturday morning the obvious signs are almost all good. His fever has been in double-digits for 18 hours. He's stopped reacting violently when his eyes open. When we say his name he can raise his hand as high as the restraints will allow. He's stopped fighting the breathing machine. His skin has some color. A just barely perceptible spark flickers somewhere behind his eyes. Life lives there.
Dad and I have breakfast in the cafeteria. The bland, greasy, mushy food manages to taste like a gourmet feast. Jake is floating in some anesthetic non-world, far from his hell, and his condition is more stable than it's been since he arrived at the hospital 7 days ago. Dad and I fall into our usual banter. We speculate on the Super Bowl. Dad thinks it will be a 4 touchdown Colts lead by halftime. I think the foul weather will play to Chicago's advantage and I do my best to defend Rex Grossman. Neither one of us cares. We both agree that with The Departed and Blood Diamond DiCaprio has finally turned the corner. Alan Arkin's character in Little Miss Sunshine was incredible and it's too bad his character had to die because the movie fell a little flat afterward. So what's the deal with Obama? Does this guy actually have any policies or is he just a personality? We could be at Nation's getting breakfast before a 10am tee-time. We're finally a bit relaxed.
We receive yet more promising news in the afternoon as Jake's condition continues to progress. The head of the Infectious Diseases Department comes up to the ICU to check on my brother and give the rest of us a layman's explanation of what's going on. In short, the doctor's have found a combination of antibiotics that will keep the staph from doing any more damage to his lungs. The pneumonia is, and will be, something we're just gonna have to let resolve itself. The pneumonia is severe but in light of Jake's age and general health he has a very strong chance of getting through this okay. The doctor puts a hand on my dad's shoulder and smiles. In other words, as far as the infection goes the worst of the storm has passed and now we can concentrate on damage control. Not to get ahead of ourselves, but in a few days it will just be a matter of cleaning up the mess.
The latest X-rays look better. At 5:30pm Jake has a breathing test. The doctors predict that he'll be able to last 45 minutes with the machine turned off. During the test he's able to breath on his own for an hour and 50 minutes with his saturation never falling below 80%. All this comes as a very pleasant surprise and a much needed sheaf of unequivocally positive news. So far today, only steps forward. We decide to celebrate with a nice dinner at an Italian restaurant downtown. We get seated right by the door and get hit by wafts of cold air every time someone walks in or out. The service is slow. The food is just okay and the wine is a little sour. But like breakfast in the cafeteria, none of it matters. We could have been at Chili's or the French Laundry. The food tastes as good as we feel. As we're finishing our last bottle of wine mom gets a phone call from the hospital. Jake has been extubated. The perfect capper to a great day. They're gonna let Jake try and get through the night with just the nose and chest tubes, but the bulky PVC looking apparatus lodged down his throat is now gone.
Super Bowl Sunday. Still adjusting to the new time-zone, I wake early again. Up in the ICU I'm alone with Jake for the first time since his extubation and I'm startled to find that he can speak. He is absolutely delirious. They've had him on morphine through the night and he's just now starting to come down. He tells me the walls are orange and then he shudders in fear when he explains that there are cameras and microscopes in the ceiling spying at him. It's a bittersweet morning. He's coming back to life but the cost of that awareness is terrible pain and uncertainty. He has no memory of the last 6 days of his life and he has absolutely no clue where he is, how he got there, or what he's doing. He tells me he wants Chef Chao. Lindsey shows up and Jake lectures her on the importance of taking the express train. The whole thing is bizarre. He kicks his legs out. He fights the arm restraints. He tells me to hang around for a while so I can meet his younger brother. He tries to curl up into the fetal position and then jerks out splay-legged and supine. It's like he has DT's.
The whole day is like this. The doctors give him Adivan to try and help the anxiety but nothing works. He complains about pain all over his body. He says that he can't breathe and thinks that he's gonna die. His breathing is a little suspect. His oxygen saturation hovers between 85%-95%. Not ideal but okay for now. Any worse and the doctors will have to put the mouth tube back in. But any better and they might be able to take out the chest tube the following morning. Jake fights the pain and is as surly as ever. He calls the nurse an asshole. He tells me to fuck-off when I try and massage his arm. "What the fuck is with Lindsey's jacket?" he says. "Is she fucking wearing a black jacket? Fuck that." He tells me that one of the interns he works with has a huge rack and a fat ass, and is a slut. Without segue, he then asks for his mommy and apologizes for being a bad boy. It's just weird.
In the afternoon the doctors okay a dosage of Haledol, an antipsychotic that would put an ordinary person to sleep for a week. The jerking movements slow and then stop. He's still delirious but his mind is noticeably more sedate. As the day wears on he grows less and less disoriented. We put the Super Bowl on the TV in his room. "Do you know who's playing, Jake?" "Chicago versus Nebraska." Close enough. "What day is it, Jake?" "It's May 27th, 2006. I've never been to Seattle. I'm in Chicago on the 6th floor." "It's actually February 4th and you're at Barnes hospital in St. Louis." "Okay, thanks guys. I'm really glad you could all come here."
Doctors come by through the late evening and into the night. They all explain to Jake what's going on and you can sense that he's starting to comprehend his situation. By the time the Super Bowl ends he knows that it's February and that he's in St. Louis. By the time Lindsey and I return from the cafeteria at 10pm he knows who we all are and he knows that he has a bad case of pneumonia. He is in horrible pain and it's difficult to watch him struggle. He nearly comes to tears any time someone leaves the room and he begs that someone stay with him through the night. One by one we slowly make our way back to the hotel room. Matt and Janine go, then my dad, then Lindsey and I step out around 2am. My mom holds his hand through the night. Everyone sleeps.
(That picture was actually taken on Monday morning. Despite how it might look, Jake is considerably more "with it" today. Enough so, anyway, that the doctors though it prudent that dad, Matt, and Janine could return home.)
I wake at 7:30 and walk to the ICU unit. I find my dad in his gown getting ready to enter the room. We go in together and sit quietly while the doctors take their rounds and discuss his condition. "Jake's oxygen saturation has been improving," they say. "His PEEP can be lowered for a trial run this afternoon. We'll monitor his response to that and consider extubation for late this evening or early in the morning. The cultures show a response to the Vanco and for now we'll keep the doses steady on that. X-rays show the MeRSA has been contained through the night so we can start breathing easier on that front. What we'll watch now is the ARDS induced spontaneous pneumo. His lungs are still a mess – residual infections, stray bacterium, ulcerated and/or necrotic tissue in the lungs and stomach – these are the things we'll pay special attention to for the time being. Let's get him on some Flolan. See if we can avoid putting a pinch on his stomach. Keep the oxygen at 8."
Jake's eyes are closed and he doesn't seem to be comprehending any of it. Dad and I nod and do our best to pretend like we understand. I'm learning how to decipher certain bits and pieces of what they say, but it's still mostly nonsense. Their coded language is best interpreted by studying facial expressions. You look for signs that indicate general trends – good or bad, urgent or plodding, effective or futile – and ignore the details and technical jargon. It's like looking through a window with the blinds partly drawn. You collect evidence by focusing on what's unobstructed, then create crude images to fill in what's hidden. You put it all together and you can come up with an approximation of the truth. It's the best you can do.
On Saturday morning the obvious signs are almost all good. His fever has been in double-digits for 18 hours. He's stopped reacting violently when his eyes open. When we say his name he can raise his hand as high as the restraints will allow. He's stopped fighting the breathing machine. His skin has some color. A just barely perceptible spark flickers somewhere behind his eyes. Life lives there.
Dad and I have breakfast in the cafeteria. The bland, greasy, mushy food manages to taste like a gourmet feast. Jake is floating in some anesthetic non-world, far from his hell, and his condition is more stable than it's been since he arrived at the hospital 7 days ago. Dad and I fall into our usual banter. We speculate on the Super Bowl. Dad thinks it will be a 4 touchdown Colts lead by halftime. I think the foul weather will play to Chicago's advantage and I do my best to defend Rex Grossman. Neither one of us cares. We both agree that with The Departed and Blood Diamond DiCaprio has finally turned the corner. Alan Arkin's character in Little Miss Sunshine was incredible and it's too bad his character had to die because the movie fell a little flat afterward. So what's the deal with Obama? Does this guy actually have any policies or is he just a personality? We could be at Nation's getting breakfast before a 10am tee-time. We're finally a bit relaxed.
We receive yet more promising news in the afternoon as Jake's condition continues to progress. The head of the Infectious Diseases Department comes up to the ICU to check on my brother and give the rest of us a layman's explanation of what's going on. In short, the doctor's have found a combination of antibiotics that will keep the staph from doing any more damage to his lungs. The pneumonia is, and will be, something we're just gonna have to let resolve itself. The pneumonia is severe but in light of Jake's age and general health he has a very strong chance of getting through this okay. The doctor puts a hand on my dad's shoulder and smiles. In other words, as far as the infection goes the worst of the storm has passed and now we can concentrate on damage control. Not to get ahead of ourselves, but in a few days it will just be a matter of cleaning up the mess.
The latest X-rays look better. At 5:30pm Jake has a breathing test. The doctors predict that he'll be able to last 45 minutes with the machine turned off. During the test he's able to breath on his own for an hour and 50 minutes with his saturation never falling below 80%. All this comes as a very pleasant surprise and a much needed sheaf of unequivocally positive news. So far today, only steps forward. We decide to celebrate with a nice dinner at an Italian restaurant downtown. We get seated right by the door and get hit by wafts of cold air every time someone walks in or out. The service is slow. The food is just okay and the wine is a little sour. But like breakfast in the cafeteria, none of it matters. We could have been at Chili's or the French Laundry. The food tastes as good as we feel. As we're finishing our last bottle of wine mom gets a phone call from the hospital. Jake has been extubated. The perfect capper to a great day. They're gonna let Jake try and get through the night with just the nose and chest tubes, but the bulky PVC looking apparatus lodged down his throat is now gone.
Super Bowl Sunday. Still adjusting to the new time-zone, I wake early again. Up in the ICU I'm alone with Jake for the first time since his extubation and I'm startled to find that he can speak. He is absolutely delirious. They've had him on morphine through the night and he's just now starting to come down. He tells me the walls are orange and then he shudders in fear when he explains that there are cameras and microscopes in the ceiling spying at him. It's a bittersweet morning. He's coming back to life but the cost of that awareness is terrible pain and uncertainty. He has no memory of the last 6 days of his life and he has absolutely no clue where he is, how he got there, or what he's doing. He tells me he wants Chef Chao. Lindsey shows up and Jake lectures her on the importance of taking the express train. The whole thing is bizarre. He kicks his legs out. He fights the arm restraints. He tells me to hang around for a while so I can meet his younger brother. He tries to curl up into the fetal position and then jerks out splay-legged and supine. It's like he has DT's.
The whole day is like this. The doctors give him Adivan to try and help the anxiety but nothing works. He complains about pain all over his body. He says that he can't breathe and thinks that he's gonna die. His breathing is a little suspect. His oxygen saturation hovers between 85%-95%. Not ideal but okay for now. Any worse and the doctors will have to put the mouth tube back in. But any better and they might be able to take out the chest tube the following morning. Jake fights the pain and is as surly as ever. He calls the nurse an asshole. He tells me to fuck-off when I try and massage his arm. "What the fuck is with Lindsey's jacket?" he says. "Is she fucking wearing a black jacket? Fuck that." He tells me that one of the interns he works with has a huge rack and a fat ass, and is a slut. Without segue, he then asks for his mommy and apologizes for being a bad boy. It's just weird.
In the afternoon the doctors okay a dosage of Haledol, an antipsychotic that would put an ordinary person to sleep for a week. The jerking movements slow and then stop. He's still delirious but his mind is noticeably more sedate. As the day wears on he grows less and less disoriented. We put the Super Bowl on the TV in his room. "Do you know who's playing, Jake?" "Chicago versus Nebraska." Close enough. "What day is it, Jake?" "It's May 27th, 2006. I've never been to Seattle. I'm in Chicago on the 6th floor." "It's actually February 4th and you're at Barnes hospital in St. Louis." "Okay, thanks guys. I'm really glad you could all come here."
Doctors come by through the late evening and into the night. They all explain to Jake what's going on and you can sense that he's starting to comprehend his situation. By the time the Super Bowl ends he knows that it's February and that he's in St. Louis. By the time Lindsey and I return from the cafeteria at 10pm he knows who we all are and he knows that he has a bad case of pneumonia. He is in horrible pain and it's difficult to watch him struggle. He nearly comes to tears any time someone leaves the room and he begs that someone stay with him through the night. One by one we slowly make our way back to the hotel room. Matt and Janine go, then my dad, then Lindsey and I step out around 2am. My mom holds his hand through the night. Everyone sleeps.
(That picture was actually taken on Monday morning. Despite how it might look, Jake is considerably more "with it" today. Enough so, anyway, that the doctors though it prudent that dad, Matt, and Janine could return home.)
Saturday, February 03, 2007
Day 1
After 22 hours of flying, 5 layovers, 18 total hours spent in various airports, and 4 hours on a bus, I have finally arrived in St. Louis. It's cold here.
I was picked up at the airport at 9:30am central time by Matt, Lindsey, and Dr. Polites, one of Jake's senior advisors in the E.R. Ordinarily he's Jake's unforgiving boss but right now he's just another concerned friend. After a gregarious and large-hearted midwest welcome, Dr. Polites briefed me on Jake's condition as we drove to the hospital.
Here's what I learned: Jake has been diagnosed with a bacteria called Methicillin-resistant Staphylococcus Aureus (MRSA), which, as you'll discover if you look it up on Wikipedia or search Google, is a grave and nasty thing indeed. The pneumonia that he caught at the beginning of the week had the effect of weakening his immune system and opening the door for the MRSA to take hold in his lungs. MRSA is what's known as a "super-bug". In most respects the bacteria resembles more common forms of Staphylococcus (or Staph) but earns it's ominous moniker because of it's resistance to the antibiotics that make Staph a containable and far less serious infection. Knowing that Jake is infected with MRSA though, is only the initial phase of the diagnostic process. Several strains of MRSA exist, each adapted to resist certain antibodies, but each also, we must hold out hope, susceptible to the right combination of other antibodies. Figuring out which strain of MRSA Jake has and then figuring out which combination of antibiotics can kill it, will be the next steps. That's the big picture.
This morning I walked in from the cold and found my mother sitting tiredly in the ICU waiting room. I had not seen my parents in 8 months. My mom's eyes looked glossy and red, not like she recently had been crying, but instead her eyes told of slow and sleepless nights, of the strain of staring too long at a puzzle and yet still unable to find the piece that fits. She was not nervous, or fidgety, or on-edge, as I had expected. Last night and early this morning were relatively uneventful as Jake's conditioned remained stable, and surely the knowledge that the entire family would soon be together helped re-knit the frays of her beleaguered nerves. As you can imagine, our greeting was emotional. When I left Laos 2 days ago I knew that I should be in St. Louis. After hugging mom I realized that I NEEDED to be here.
Moments later my dad walked into the waiting area after being with Jake in his room. My dad's demeanor was transparent and immediately felt – he looked strong as ever and full of optimism. People who know my father well, know that he has a soft heart. He has no interest in retreating behind the stoic posturing of manhood. When my dad displays emotion, you know that it's genuine. So when he came practically skipping through the hallway, I didn't have to consider that this was some front to protect his true feelings, but could instead let my own fears and doubts get swallowed by his evident hopefulness. Seeing my father's slight smile as we walked toward each other made me briefly forget where I was and the purpose for our being there. We were all together at last, and it felt good.
And I could not have chosen a better time to arrive. My father's good cheer was for a reason. This morning Jake's fever finally dropped below triple digits. Moreover, as my father sat with him awaiting my arrival, Jake opened his eyes for this first time in days and was able to do so without agitating the breathing machine or having muscle spasms. Even better yet, when my dad called his name, Jake was able to briefly open his eyes and nod in acknowledgement. My bro's awareness is a huge step forward for us, and was certainly an auspicious way to begin the morning. Jake's improved condition, coupled with my arrival, had us all in high spirits. As we all got caught up (obviously there's a lot to talk about after traveling the globe for 8 months), sharing jokes, and trading playful insults like we're accustomed to, the mood was marked by a very firm confidence in Jake's eventual recovery, not if but how soon. After spending 40 some odd hours filled with the worst kind of dread and uncertainty, sharing such a light-hearted morning with my family was positively reinvigorating.
Around 10:30am I got the okay to go in and see my brother. After being let through the locked double-doors and into the ICU "staging area", as I'll call it, I was able to see into his room from behind another wall of glass. The wall is covered with indecipherable medical papers, and from the outside the best an observer can do is get incomplete glances of the patient. After waiting for the nurse to complete her round of readings and other regularly scheduled nurse things (Jake is definitely the doctor of this family), I put on a yellow medical gown, some latex gloves, and finally a breathing mask, and walked gingerly into the room. For the last several days I have been envisioning Jake layed up in the hospital bed. I've pictured the tubes disappearing into his throat and up his nose, the I.V.'s stemming from his arms, the computers and monitoring equipment, the sallow skin, the beeping noises (god, the beeping noises), and even that raw smell of decay. But I just wasn't prepared to face head-on what I saw. It's not a word thing. The best I can do is metaphor and that would just be for show anyway. It's instinctual. It's in the gut. All those sights and smells and noises descend on you all at once and you realize that you're not looking at your brother but just some husk of a body that might as well be an old coconut lying on the beach waiting to be taken to sea. Okay, so maybe metaphor helps. But only because the only other way I could let out this feeling is by crying, and blogs don't cry. I just sat there looking at him. I couldn't speak. Nothing. Just tears. The breathing machine sucking in and then back out, like an accordion bag. Jake was completely motionless. And this was a good day!?!?!? Mom came in and joined me. She encouraged me to speak to him. All I could manage was his name. At this his eyes reluctantly came open. All whites. His once fierce hazel irises just kind of sat there half concealed above his eye-lid. It was like a bad actor trying too hard to look stoned. I could detect in his face some recognition that he knew it was me. But more than anything, I saw in his eyes a vague recognition of himself; the disconcertment of being an eye-witness to his own bad dream. As he became more and more aware of our being there, you could see him becoming more and more aware of his own being there. The self-realization of the circumstances finally coming to. All that pain, the severity of the illness, the shock, the fear...all at once, heavy like a brick, or like a bullet coming too fast to evade, the shot hitting you before you hear the crack of the gun. The shock of it. This thing down my throat. These straps tying my arms to the bed. This sharp knife cutting through my chest with each breath. I'm a doctor. I know what this means. Until...
Shortly after we leave, Jake is sedated again for the afternoon. His responses weren't nearly as violent as they were yesterday and the doctors assure us that with each time he gains awareness he'll resist less and less. The parylitic he's been receiving has not just turned off his muscles but his brain also. Jake has to learn about what's happening to him just as we do. And if there is anything that Jake hates, and I mean maybe his greatest horror of all, it's to be the last one to know. He wants to be alert and he wants to be aware of what is going on. It's part of his most fundamental self and I guarantee he will be fighting like a madman to keep awake. This is a good thing.
The see-saw. We come back from lunch and once again Jake is fighting to come out of sedation. His fever is back to 102f. He opens his eyes for the briefest moment. He winces. His forehead furrows. He tries to clench his fist but does not have the strength. He tugs against the ropes that tie his arms to the bed. He turns his foot and lifts his knee in a slow motion jerk. Another battle in a long war. His actions are unmistakable. It's the will of a man overcome by pain and desperation, but fighting anyway. It's resolve. The latest round of culture tests come back inconclusive. Jake then sleeps.
Right now we all sit in the waiting room.
I was picked up at the airport at 9:30am central time by Matt, Lindsey, and Dr. Polites, one of Jake's senior advisors in the E.R. Ordinarily he's Jake's unforgiving boss but right now he's just another concerned friend. After a gregarious and large-hearted midwest welcome, Dr. Polites briefed me on Jake's condition as we drove to the hospital.
Here's what I learned: Jake has been diagnosed with a bacteria called Methicillin-resistant Staphylococcus Aureus (MRSA), which, as you'll discover if you look it up on Wikipedia or search Google, is a grave and nasty thing indeed. The pneumonia that he caught at the beginning of the week had the effect of weakening his immune system and opening the door for the MRSA to take hold in his lungs. MRSA is what's known as a "super-bug". In most respects the bacteria resembles more common forms of Staphylococcus (or Staph) but earns it's ominous moniker because of it's resistance to the antibiotics that make Staph a containable and far less serious infection. Knowing that Jake is infected with MRSA though, is only the initial phase of the diagnostic process. Several strains of MRSA exist, each adapted to resist certain antibodies, but each also, we must hold out hope, susceptible to the right combination of other antibodies. Figuring out which strain of MRSA Jake has and then figuring out which combination of antibiotics can kill it, will be the next steps. That's the big picture.
This morning I walked in from the cold and found my mother sitting tiredly in the ICU waiting room. I had not seen my parents in 8 months. My mom's eyes looked glossy and red, not like she recently had been crying, but instead her eyes told of slow and sleepless nights, of the strain of staring too long at a puzzle and yet still unable to find the piece that fits. She was not nervous, or fidgety, or on-edge, as I had expected. Last night and early this morning were relatively uneventful as Jake's conditioned remained stable, and surely the knowledge that the entire family would soon be together helped re-knit the frays of her beleaguered nerves. As you can imagine, our greeting was emotional. When I left Laos 2 days ago I knew that I should be in St. Louis. After hugging mom I realized that I NEEDED to be here.
Moments later my dad walked into the waiting area after being with Jake in his room. My dad's demeanor was transparent and immediately felt – he looked strong as ever and full of optimism. People who know my father well, know that he has a soft heart. He has no interest in retreating behind the stoic posturing of manhood. When my dad displays emotion, you know that it's genuine. So when he came practically skipping through the hallway, I didn't have to consider that this was some front to protect his true feelings, but could instead let my own fears and doubts get swallowed by his evident hopefulness. Seeing my father's slight smile as we walked toward each other made me briefly forget where I was and the purpose for our being there. We were all together at last, and it felt good.
And I could not have chosen a better time to arrive. My father's good cheer was for a reason. This morning Jake's fever finally dropped below triple digits. Moreover, as my father sat with him awaiting my arrival, Jake opened his eyes for this first time in days and was able to do so without agitating the breathing machine or having muscle spasms. Even better yet, when my dad called his name, Jake was able to briefly open his eyes and nod in acknowledgement. My bro's awareness is a huge step forward for us, and was certainly an auspicious way to begin the morning. Jake's improved condition, coupled with my arrival, had us all in high spirits. As we all got caught up (obviously there's a lot to talk about after traveling the globe for 8 months), sharing jokes, and trading playful insults like we're accustomed to, the mood was marked by a very firm confidence in Jake's eventual recovery, not if but how soon. After spending 40 some odd hours filled with the worst kind of dread and uncertainty, sharing such a light-hearted morning with my family was positively reinvigorating.
Around 10:30am I got the okay to go in and see my brother. After being let through the locked double-doors and into the ICU "staging area", as I'll call it, I was able to see into his room from behind another wall of glass. The wall is covered with indecipherable medical papers, and from the outside the best an observer can do is get incomplete glances of the patient. After waiting for the nurse to complete her round of readings and other regularly scheduled nurse things (Jake is definitely the doctor of this family), I put on a yellow medical gown, some latex gloves, and finally a breathing mask, and walked gingerly into the room. For the last several days I have been envisioning Jake layed up in the hospital bed. I've pictured the tubes disappearing into his throat and up his nose, the I.V.'s stemming from his arms, the computers and monitoring equipment, the sallow skin, the beeping noises (god, the beeping noises), and even that raw smell of decay. But I just wasn't prepared to face head-on what I saw. It's not a word thing. The best I can do is metaphor and that would just be for show anyway. It's instinctual. It's in the gut. All those sights and smells and noises descend on you all at once and you realize that you're not looking at your brother but just some husk of a body that might as well be an old coconut lying on the beach waiting to be taken to sea. Okay, so maybe metaphor helps. But only because the only other way I could let out this feeling is by crying, and blogs don't cry. I just sat there looking at him. I couldn't speak. Nothing. Just tears. The breathing machine sucking in and then back out, like an accordion bag. Jake was completely motionless. And this was a good day!?!?!? Mom came in and joined me. She encouraged me to speak to him. All I could manage was his name. At this his eyes reluctantly came open. All whites. His once fierce hazel irises just kind of sat there half concealed above his eye-lid. It was like a bad actor trying too hard to look stoned. I could detect in his face some recognition that he knew it was me. But more than anything, I saw in his eyes a vague recognition of himself; the disconcertment of being an eye-witness to his own bad dream. As he became more and more aware of our being there, you could see him becoming more and more aware of his own being there. The self-realization of the circumstances finally coming to. All that pain, the severity of the illness, the shock, the fear...all at once, heavy like a brick, or like a bullet coming too fast to evade, the shot hitting you before you hear the crack of the gun. The shock of it. This thing down my throat. These straps tying my arms to the bed. This sharp knife cutting through my chest with each breath. I'm a doctor. I know what this means. Until...
Shortly after we leave, Jake is sedated again for the afternoon. His responses weren't nearly as violent as they were yesterday and the doctors assure us that with each time he gains awareness he'll resist less and less. The parylitic he's been receiving has not just turned off his muscles but his brain also. Jake has to learn about what's happening to him just as we do. And if there is anything that Jake hates, and I mean maybe his greatest horror of all, it's to be the last one to know. He wants to be alert and he wants to be aware of what is going on. It's part of his most fundamental self and I guarantee he will be fighting like a madman to keep awake. This is a good thing.
The see-saw. We come back from lunch and once again Jake is fighting to come out of sedation. His fever is back to 102f. He opens his eyes for the briefest moment. He winces. His forehead furrows. He tries to clench his fist but does not have the strength. He tugs against the ropes that tie his arms to the bed. He turns his foot and lifts his knee in a slow motion jerk. Another battle in a long war. His actions are unmistakable. It's the will of a man overcome by pain and desperation, but fighting anyway. It's resolve. The latest round of culture tests come back inconclusive. Jake then sleeps.
Right now we all sit in the waiting room.
Thursday, February 01, 2007
Bad News
As some of you already know, over the last several days my older brother, Jake, has fallen very seriously ill. After contracting the flu late last weekend his condition quickly worsened and he was checked into the hospital on Sunday night with a case of pneumonia. As the doctors would soon find, his pneumonia was quite severe. His lungs were completely filled with fluid and within a very short time his respiratory system failed. By Monday Jake was no longer able to breathe on his own and things were looking very grim. The doctors' next step was to hook Jake up to a breathing machine. First, however, he had to be heavily sedated with doses of a parylitic, which means they had to paralyze his body in order that his still functioning nervous system wouldn't resist the breathing apparatus. Since that time, Jake has essentially remained unconscious. When the first doses of paralytic wore off on Tuesday night, he briefly showed signs of awareness as my sister and other brother sat by his bedside. Unfortunately, even that feeble interaction had the effect of further agitating his condition and the doctors had to immediately re-paralyze him. From my current understanding, Jake has since remained unresponsive.
That's the bad news. Since Tuesday Jake's condition has remained relatively stable. There have been a few scary moments, but for the most part things seem to be improving, or at least not getting worse. His breathing capacity continues to inch toward normalcy and his other vital signs are also keeping relatively steady. But for every 2 steps forward there seems to be 1 step back. As the doctors' said, he is clearing but by no means out of the woods yet. Unfortunately the doctors have not been able to pinpoint exactly why so many complications have arisen over the last few days. Along with his breathing, his sustained fever and minor twitching are the most salient issues for concern right now. A few tests were taken yesterday, including a spinal tap to check for meningitis, and they all came back negative. The doctors will continue to administer more tests over the next few days until they identify the specific nature of the illness.
Basically, we are all playing a waiting game at this point. Our mindset right now is on the short-term. We anxiously watch each passing hour and expect a breakthrough to occur at any minute. But in reality, as the doctors' have tried to tell us, it is much more pragmatic to take the long-view. Jake's condition is critical and highly volatile but the outcome of his situation, good or bad, will unfold over the course of the next several days or even weeks. Not knowing exactly what his ailment is makes this even truer. The doctors cannot begin to take proactive measures until they know what they're up against. As difficult as it may be, we must all be patient to let the process go at its intended speed. I'll be sure and keep you updated as time passes.
As for me, I am waiting around in the Bangkok airport to board a flight for St. Louis. I'm doing my best not drive myself crazy with worry. I should be arriving in the 27th city sometime Thursday evening or perhaps Friday morning. Obviously my globetrotting will currently be put on hold. Incidentally, in my last post I paid notice to certain things that are taken for granted during the course of our everyday lives. Unfortunately, sometimes it takes a devastating incident like this to put those things back into perspective. But it shouldn't have to. Obviously, your thoughts and prayers would be much appreciated. But do me one more favor if you can: if you have any brothers or sisters, or your parents, or any loved ones for that matter, give them a call real quick just to say hello. I know it's kind of corny (actually very corny), but it would mean a lot to me, and will mean the world to them.
That's the bad news. Since Tuesday Jake's condition has remained relatively stable. There have been a few scary moments, but for the most part things seem to be improving, or at least not getting worse. His breathing capacity continues to inch toward normalcy and his other vital signs are also keeping relatively steady. But for every 2 steps forward there seems to be 1 step back. As the doctors' said, he is clearing but by no means out of the woods yet. Unfortunately the doctors have not been able to pinpoint exactly why so many complications have arisen over the last few days. Along with his breathing, his sustained fever and minor twitching are the most salient issues for concern right now. A few tests were taken yesterday, including a spinal tap to check for meningitis, and they all came back negative. The doctors will continue to administer more tests over the next few days until they identify the specific nature of the illness.
Basically, we are all playing a waiting game at this point. Our mindset right now is on the short-term. We anxiously watch each passing hour and expect a breakthrough to occur at any minute. But in reality, as the doctors' have tried to tell us, it is much more pragmatic to take the long-view. Jake's condition is critical and highly volatile but the outcome of his situation, good or bad, will unfold over the course of the next several days or even weeks. Not knowing exactly what his ailment is makes this even truer. The doctors cannot begin to take proactive measures until they know what they're up against. As difficult as it may be, we must all be patient to let the process go at its intended speed. I'll be sure and keep you updated as time passes.
As for me, I am waiting around in the Bangkok airport to board a flight for St. Louis. I'm doing my best not drive myself crazy with worry. I should be arriving in the 27th city sometime Thursday evening or perhaps Friday morning. Obviously my globetrotting will currently be put on hold. Incidentally, in my last post I paid notice to certain things that are taken for granted during the course of our everyday lives. Unfortunately, sometimes it takes a devastating incident like this to put those things back into perspective. But it shouldn't have to. Obviously, your thoughts and prayers would be much appreciated. But do me one more favor if you can: if you have any brothers or sisters, or your parents, or any loved ones for that matter, give them a call real quick just to say hello. I know it's kind of corny (actually very corny), but it would mean a lot to me, and will mean the world to them.
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