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.)
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