Thursday February 5, 2009

Family meeting this morning went well.  We sat down with Dr. Yost, the Trauma surgeon who admitted Christy the night of her accident.  He is one of the attending physicians who takes care of Christy on a regular basis.  The team of trauma physicians take turns caring for the patients in a rotation.  Edna, the case manager was also in the meeting.  The job of a case manager is  to follow the patient through the hospital stay and assure that they are in the proper unit during their stay, and are discharged to the appropriate facility on their way out.  They are aware of available resources in the community & provide options.  They are the ones who coordinate placement to facilities like rehab or nursing homes.  They help arrange flights, know insurance details and advocate for the patient's best placement.

During the meeting, they tried to explain where we were with Christy's status.  Originally, the severity of Christy's injuries made the doctors worried about her regaining any type of Independence.  They felt that Christy did not make any meaningful progress and that her comatose state could be permanent.  Since Christy is now moving all of her extremities spontaneously, opening her eyes and even tracking voices, they see a change in her status.  These minor improvements in her neurological status put her in another category.  The case manager explained to us that there are three "sections" on a continuum and she falls into the middle section.  At the first part of the spectrum is "unresponsiveness".  When Christy's only movements were twitching and posturing, she was in this category. On the opposite side of the spectrum, there is consciousness-- awake and alert, this person is able to follow simple commands like showing "thumbs up" or showing two fingers.  This person could nod appropriately to questions.  Christy is stuck in the middle.  She has wake and sleep periods.  When she is awake, she can spontaneously open her eyes and has spontaneous movements of her limbs.  She pulls her legs up to her body and no longer favors only the right side.  Christy bends the left leg and keeps it more active than ever. She is aware of voices and people because she tracks their voices.  The tracking is still inconsistent.  I feel that it takes tremendous energy for Christy to concentrate on the voice and to focus her eyes on the person.  That's why she may not track very much when she is agitated & tired.  The kicking and throwing her body around is physically exhausting.  She lifts up her head and upper torso in bed as well now.  They medically nick-named this agitated kicking and swinging arms the "storming" stage.  They can not predict how long this "storming stage" will last.  They explained that it is the stage before someone reaches consciousness.  Christy seems to be in and out of awareness, demonstrated by her smiling (multiple times) on multiple occasions during Donald's jokes.  She does not do this consistently, either.   

Queens Hospital does not provide the type of neurological rehabilitation that Christy needs at this point.  They told us that it would be a "disservice" to Christy to leave her where she is currently.  The only rehab hospital we have in Hawaii is the Rehabilitation Hospital of the Pacific.  It would be fine for Christy to go there if she were awake and needed basic rehab care.  Unfortunately, Christy needs more specialized care.  And Christy is ready for more specialized care now!  As a requirement for entrance to the Rehab hospital, the doctor wanted Christy to be able to follow commands.  I am reading a book called "My stroke of insight".  In this story, the patient explains how demonstrating that you can say your name or show two fingers may not be the best way for everyone to be assessed.   She had thoughts and was inside her head, she was just not able to effectively & efficiently use the parts of her brain that allowed her to speak.

Anyway, Dr. Yost and Edna are recommending that Christy try to secure a bed at a rehabilitation hospital that specializes in brain injury and spinal cord injury patients.  One of the very best places for this type of rehabilitation is at Craig Hospital in the mainland.  www.craighospital.org  -- check it out.   Patients rehabilitated at Craig have more success regaining Independence.  They pride themselves on addressing the whole person in all aspects of life.  Dr. Yost and Edna were able to describe two specific patients of theirs who had wonderful crazy success there.  The first patient they talked about was a man who was comatose and very very agitated from severe brain injury.  No nursing home would accept him into their facility, so the hospital was forced to keep him for an entire year like that.  They eventually decided to send him to Craig Hospital and he is walking and talking today.  He made a Miraculous recovery.  The second woman was beaten with a baseball bat and was had severe brain damage. This woman eventually went to Craig Hospital and is now walking, eating, talking, and independent.  WOW!!!  We were concerned about Christy being moved to the mainland- far away from all of us..... but Christy deserves the best possible chance & we want her to be where the medical team is most qualified to care for her.  Well, we found out that Craig Hospital is located in Denver, Colorado where Alan is living!  The hospital, we found out, is about 5 minutes from his work!!  With Alan planted in that city, it seems more and more that all the arrows are pointing towards this hospital.  This facility was mentioned to Donald before, but not until this morning did we all meet together and discuss all the specifics.  We all agreed that this is what would be best for Christy at this time.  Donald signed the consent for her application to Craig Hospital.  There is a lengthy, involved process to this application- it could take weeks.  Christy has to be accepted to the hospital and the insurance company needs to be convinced that Craig is the best possible place for Christy.  Please, anyone who can, pray that Craig will find a place for Christy.  Pray that they will feel that she is a patient that could benefit from their services.  Please pray that HMSA have the understanding that Christy needs this care & rehabilitation... We are so hopeful that Christy will find a place at Craig and come back to us as we remember her.  It will be a long long road, with some days difficult and taxing on everyone.  We have faith that the journey will teach and try us, but end in sweet sweet victory.  Christy will fight with the steadfast love and support of her family and friends to be again a loving mother, sister, daughter and dear friend.