FIRST DAWN
First dawn in sixteen
I have not been with my son
in ICU Fletcher Allen
Burlington, Vermont.
Yesterday neurosurgeon Walsh
noting that said for me to
take a break and get some sleep.
Home, I still rise at 3.
Everyday, waves of hope and despair.
Everyday, tears of pain
and love we never knew existed.
van 7/28/07
Saturday, July 28, 2007
Friday, July 27, 2007
Big Meeting
My sister Rachel felt it was time for a meeting with John's doctors, and with the help of the social worker on our case, made it happen. Dr. Binter, the attending neurosurgeon, and Dr. Commichau, the attending neurologist, spent over an hour with my family discussing John's current state and outlook.
Summary of current state:
-John's condition as still very critical. He has a closed head injury in which the impact of the fall resulted in brain contusions
-He is currently stable and doing well on the current drug regimen and other interventions. There is significant variabilitiy in his ICPs minute to minute and hour to hour but with a progression toward stable.
-He is suffering from a second round of infection of ecoli pneumonia in the lungs. It has not reached his brain or spinal fluid. John arrived at the hospital with lungs in poor condition (some of you may have noticed a bad chronic cough beforehand). The alvoili in his lungs had collapsed and were not functioning properly (likely due to smoking). Infection goes to the weakest point, which for John is his lungs. The doctors and nurses have tried multiple times to clean the lungs including a bronchial clean, but with only partial success.
-The EKG has shown no heart issues.
Outstanding risks:
The doctors cited several risks that could effect John's stable condition.
-A blood clot could form from him lying in bed for a prolonged period of time. If it were to form, it could cause an embolism. This can often be addressed surgically.
-He could suffer from additional infections or the existing infection could worsen.
Extent of brain injury:
-The CAT scans show some damage to 2 areas of his brain, the side with the initial impact and the side opposite the impact. The CAT scans have stayed the same over the past 2 weeks. CAT scans can show injury but not predict the effect of that injury on brain functioning.
-The EEG measures brain waves. The brain waves were slow (as would be expected for someone in a compromised state), but showed no sign of seizures (misfiring brain cells).
-The kind of injury that John had can cause twisting of the brain and "sheering" of axons (neuron wires disconnecting)which can result in major deficits in functionality. This type of damage can be assessed with a MRI but John cannot currently tolerate a MRI as he would have to leave the ICU (not safe for someone in his critical condition)and lie flat for 40 minutes (which would likely raise his ICPs too much).
-Even with all of these tests, we will only know the extent of brain damage when John wakes up.
Outlook:
The doctors discussed how dealing with brain trauma is an art to which a lot of science is applied and that the specialty has really come about in the past 10 years. Thus, while much is known, even more is not known. Before coming to the meeting with us, Dr. Binter told the neurosurgeon residents that she was going to tell us 3 things- "I do not know, I do not know, and I do not know". What she and Dr. Commichau were willing to say about his outlook for the future was:
-A full course ICP program is usually 2-3 weeks. John is at 2 weeks and appears to be at the tail end of the pressure problems if status quo is maintained. They will try step by step to reduce interventions, going to the next step as each is tolerated. The next step was planned to be to change the height of the bag connected to the brain in his head (more on what actually happened later). Raising the height of the bag would cause the drain to go from constantly working to working only when his ICPs spiked.
-We should expect a long recovery but impossible to predict the timing. It would likely involve intensive inpatient rehab followed by outpatient rehab.
Many, many thanks to the doctors for taking the time to discuss John's condition in such great detail.
Update since the meeting:
Now, as for the drain, the plan to move slowly toward removal starting first with changing the height of the bag was changed last night. The drain stopped draining, which apparently can happen after extended use. The neurosurgeon on duty attempted to unclog the drain. When that failed he tried to insert a new drain. After working on him for 2 hours, he was not able to do either. The inability to put in a new drain was due to the extent of the swelling in the brain. After 2 hours, the neurosurgeon team decided to instead remove the clogged drain, put the pressure monitor back in his head, and manage his pressures medically. His pressures had been high during the surgery and hours following, but came back down with saline and have stayed at a safe level since then. So, we ended up with an accelerated path to drain removal that hopefully John will continue to be able to tolerate.
Summary of current state:
-John's condition as still very critical. He has a closed head injury in which the impact of the fall resulted in brain contusions
-He is currently stable and doing well on the current drug regimen and other interventions. There is significant variabilitiy in his ICPs minute to minute and hour to hour but with a progression toward stable.
-He is suffering from a second round of infection of ecoli pneumonia in the lungs. It has not reached his brain or spinal fluid. John arrived at the hospital with lungs in poor condition (some of you may have noticed a bad chronic cough beforehand). The alvoili in his lungs had collapsed and were not functioning properly (likely due to smoking). Infection goes to the weakest point, which for John is his lungs. The doctors and nurses have tried multiple times to clean the lungs including a bronchial clean, but with only partial success.
-The EKG has shown no heart issues.
Outstanding risks:
The doctors cited several risks that could effect John's stable condition.
-A blood clot could form from him lying in bed for a prolonged period of time. If it were to form, it could cause an embolism. This can often be addressed surgically.
-He could suffer from additional infections or the existing infection could worsen.
Extent of brain injury:
-The CAT scans show some damage to 2 areas of his brain, the side with the initial impact and the side opposite the impact. The CAT scans have stayed the same over the past 2 weeks. CAT scans can show injury but not predict the effect of that injury on brain functioning.
-The EEG measures brain waves. The brain waves were slow (as would be expected for someone in a compromised state), but showed no sign of seizures (misfiring brain cells).
-The kind of injury that John had can cause twisting of the brain and "sheering" of axons (neuron wires disconnecting)which can result in major deficits in functionality. This type of damage can be assessed with a MRI but John cannot currently tolerate a MRI as he would have to leave the ICU (not safe for someone in his critical condition)and lie flat for 40 minutes (which would likely raise his ICPs too much).
-Even with all of these tests, we will only know the extent of brain damage when John wakes up.
Outlook:
The doctors discussed how dealing with brain trauma is an art to which a lot of science is applied and that the specialty has really come about in the past 10 years. Thus, while much is known, even more is not known. Before coming to the meeting with us, Dr. Binter told the neurosurgeon residents that she was going to tell us 3 things- "I do not know, I do not know, and I do not know". What she and Dr. Commichau were willing to say about his outlook for the future was:
-A full course ICP program is usually 2-3 weeks. John is at 2 weeks and appears to be at the tail end of the pressure problems if status quo is maintained. They will try step by step to reduce interventions, going to the next step as each is tolerated. The next step was planned to be to change the height of the bag connected to the brain in his head (more on what actually happened later). Raising the height of the bag would cause the drain to go from constantly working to working only when his ICPs spiked.
-We should expect a long recovery but impossible to predict the timing. It would likely involve intensive inpatient rehab followed by outpatient rehab.
Many, many thanks to the doctors for taking the time to discuss John's condition in such great detail.
Update since the meeting:
Now, as for the drain, the plan to move slowly toward removal starting first with changing the height of the bag was changed last night. The drain stopped draining, which apparently can happen after extended use. The neurosurgeon on duty attempted to unclog the drain. When that failed he tried to insert a new drain. After working on him for 2 hours, he was not able to do either. The inability to put in a new drain was due to the extent of the swelling in the brain. After 2 hours, the neurosurgeon team decided to instead remove the clogged drain, put the pressure monitor back in his head, and manage his pressures medically. His pressures had been high during the surgery and hours following, but came back down with saline and have stayed at a safe level since then. So, we ended up with an accelerated path to drain removal that hopefully John will continue to be able to tolerate.
Wednesday, July 25, 2007
Settling in
The doctors made some adjustments to John's medicines that are better suited to use on over longer period of time without severe side-effects. He had been on Vec (a paralytic) and Propofol (a sedative), and is now on phenobarbital. There is no longer much talk about reducing sedation and doing further tests of consciousness until he has been stable for a longer time period. The medical team has been giving us this and other signals that we should settle in for what is likely to be an extended stay in the ICU.
As we make logistical arrangements to do so, our sincerest thanks to Erik and Ana who have been kind enough to lend my family use of a house they own just two blocks from the hospital, and to John Stafford who set us up there. We have also started getting many wonderful cards at the house and appreciate all the good wishes coming our way.
Some of you may have noticed a comment posted anonymously today regarding the safety of longboarding. This site is a place where those who love and care about John can stay abreast of his recovery and send good wishes his way. Anonymous- as your comment was neither, I ask that you respect my wishes and those of my family and refrain from further comment on this blog.
As we make logistical arrangements to do so, our sincerest thanks to Erik and Ana who have been kind enough to lend my family use of a house they own just two blocks from the hospital, and to John Stafford who set us up there. We have also started getting many wonderful cards at the house and appreciate all the good wishes coming our way.
Some of you may have noticed a comment posted anonymously today regarding the safety of longboarding. This site is a place where those who love and care about John can stay abreast of his recovery and send good wishes his way. Anonymous- as your comment was neither, I ask that you respect my wishes and those of my family and refrain from further comment on this blog.
Tuesday, July 24, 2007
The boy next door
The last day was John's best yet. ICPs stayed below 15. His oxygen levels are improving and lungs look a bit better. His ability to regulate his temperature is slightly better. The doctors are doing another CAT scan later today and we'll see what comes next. So, I guess we are in the waiting period as John's body rests and recovers.
The good news in the hospital today is that Patrick, the skater who was injured about a week before John was, has been moved from the ICU (Patrick's room was just next to John's) to a regular hopsital room. Congrats, Patrick! Hopefully John will be following you soon.
The good news in the hospital today is that Patrick, the skater who was injured about a week before John was, has been moved from the ICU (Patrick's room was just next to John's) to a regular hopsital room. Congrats, Patrick! Hopefully John will be following you soon.
Monday, July 23, 2007
BIG JOHN'S BIRTHING by pops
((Sorry to delay the story of how Crash Me Boy earned his name, but I will give a hint: it came after he totaled his first vehicle at age 10. It is the most sensible to start at the beginning.))
John Christian Van Hazinga was born in a WWII vintage bungalow at 3742 Menlo in East San Diego on October 17, 1977. Home delivery doctors were harder to come by in SAN DIEGO than in rural southern NH where his mother and I met up and his 2 sisters were delivered by an old country doctor. Dr Brown preffered to deliver babies at home and said in his thousands of home deliveries only two required going to the hospital and they were not emergencies.
Anyway the 2 home delivery doctors in San Diego were Dr Repair and Dr Butcher. We chose Dr.Repair. Twice the afternoon before John's birth his mother had contractions and Dr Repair came by but they subsided. When they resumed in the night Dr Repair was slow to come by and I delivered me boy. There was not much to it for he came speeding out and we were joyous.
Dr Repair later refunded $150 for missing the delivery. The easiest buckos I ever made!
John Christian Van Hazinga was born in a WWII vintage bungalow at 3742 Menlo in East San Diego on October 17, 1977. Home delivery doctors were harder to come by in SAN DIEGO than in rural southern NH where his mother and I met up and his 2 sisters were delivered by an old country doctor. Dr Brown preffered to deliver babies at home and said in his thousands of home deliveries only two required going to the hospital and they were not emergencies.
Anyway the 2 home delivery doctors in San Diego were Dr Repair and Dr Butcher. We chose Dr.Repair. Twice the afternoon before John's birth his mother had contractions and Dr Repair came by but they subsided. When they resumed in the night Dr Repair was slow to come by and I delivered me boy. There was not much to it for he came speeding out and we were joyous.
Dr Repair later refunded $150 for missing the delivery. The easiest buckos I ever made!
Quiet nights
Quiet nights of quiet stars quiet chords from my guitar
floating on the silence that surrounds us.
Quiet thoughts and quiet dreams quiet walks by quiet streams
and a window that looks out on the mountains and the sea, oh how lovely
(Thanks Sinatra)
Another quiet day and night for John. And a quiet early morning walk to the hospital for my dad, in contrast he says, to the wee hours on Saturday and Sunday when the Burlington streets were full of revelers (his term).
His ICPs are doing well- down as low as 6, with occasional flare-ups, but then settling down again soon after. They continue to keep him as quiet as possible, with heavy levels of sedation.
The only new concern of note is that they did an xray of John's lungs and described them as "terrible". The nurse said it's typical to have lung problems when being on a ventilator for a long time, and we likely all assume that John's lungs were far from pristine going in. They put in a larger trach tube and will continue to monitor his breathing carefully.
floating on the silence that surrounds us.
Quiet thoughts and quiet dreams quiet walks by quiet streams
and a window that looks out on the mountains and the sea, oh how lovely
(Thanks Sinatra)
Another quiet day and night for John. And a quiet early morning walk to the hospital for my dad, in contrast he says, to the wee hours on Saturday and Sunday when the Burlington streets were full of revelers (his term).
His ICPs are doing well- down as low as 6, with occasional flare-ups, but then settling down again soon after. They continue to keep him as quiet as possible, with heavy levels of sedation.
The only new concern of note is that they did an xray of John's lungs and described them as "terrible". The nurse said it's typical to have lung problems when being on a ventilator for a long time, and we likely all assume that John's lungs were far from pristine going in. They put in a larger trach tube and will continue to monitor his breathing carefully.
Sunday, July 22, 2007
First time in a decade
John had another stable night with minor pressure flareups but those were dealt with relatively fast. They are aiming to keep him steady and "grogged out" (my dad's term) for a few days so he can heal and then they'll start reducing the sedative. As the can, they'll be reducing the interventions they've had him on- for example last night they've turned off the blood transfusion. They are still using others like the cold and warming blankets to regulate tempertature, and positioning his upper body and saline solutions to manage the ICPs.
My dad saw Dr Link this morning and the doc said John was "steady as she goes" and "he is behaving". "If so", my dad says, "it is first time in a decade". My dad is working on a story about how John earned his nickname Crash, so stay tuned for that. And let's just say, as we all know, they don't call him Crash for nothing.
Also, to clear up any confusion about my dad, his name is John Van Hazinga (middle name Peter; my brother's middle name is Christian). My dad goes by the nickname Van. I'm not quite sure how the Burlington Free Press came up with Dan Van Hazinga, but perhaps it went something like this:
Editor- "what did you say the father's name was?"
Writer- "John"
Editor- "that's the son's name"
Writer- "maybe it was Van"
Editor- "Van Van Hazinga!?!?! Let's just call him Dan"
My dad saw Dr Link this morning and the doc said John was "steady as she goes" and "he is behaving". "If so", my dad says, "it is first time in a decade". My dad is working on a story about how John earned his nickname Crash, so stay tuned for that. And let's just say, as we all know, they don't call him Crash for nothing.
Also, to clear up any confusion about my dad, his name is John Van Hazinga (middle name Peter; my brother's middle name is Christian). My dad goes by the nickname Van. I'm not quite sure how the Burlington Free Press came up with Dan Van Hazinga, but perhaps it went something like this:
Editor- "what did you say the father's name was?"
Writer- "John"
Editor- "that's the son's name"
Writer- "maybe it was Van"
Editor- "Van Van Hazinga!?!?! Let's just call him Dan"
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