Blog posts, as you've likely noticed, are not as frequent as formerly. The medical professionals suggested that we would settle into a routine, although a new one, in which things occur gradually, and they were right. Noticeable progress is now best described in terms of at least weeks instead of days.

Tuesday evening was a highlight this week. Jessica, Mom, Dad and Lyn were with him, talking and joking about various things. Walter joined in, silently laughing and chuckling and making jokes with his eyes. At one point he seemed to be asleep but threw his eyes open when Jessica said something about going out to buy shoes. With some encouragement, he responded with "Nnnnooooo". Jessica is really good with Walter. She's innately knows how to "be" with him, what to say and do and when to say and do it.

Wednesday was somewhat of a downer after Tuesday. Walter was not as engaged and seemed frustrated. The good side of that is that his frustration seems to result at least in part from his desire to get out of bed. He tries to get up periodically, even after a full day of therapy. Last night, Mom and Lyn helped him sit up, and he helped by pulling pretty strongly with his right hand.

The physical therapy has him noticeably stronger. He can hold his head up longer while sitting up. The therapists recently placed boot casts on his feet and lower legs to stretch out his Achilles tendons in preparation for standing up. He sometimes beats the casts against the bed railing. He appears annoyed by them. The speech therapist is working on simple words and phrases right now, like "no" and "yes".

So, Walter is improving, but the progress often seems glacial. The doctor at Shepherd this week confirmed from his perspective what the doctors at Emory said earlier: the bleed in Walter's head was big and in a bad spot. Recovery will be slow and uncertain. A year continues to be a threshold date. By then we may have an idea of the extent of ultimate recovery. A friend of mine recently gave me additional perspective. He had a severe stroke 16 years ago, at the same age at which Walter had his. Stephen walks with a noticeable limp, and his left hand remains much compromised, but his spirits are uniformly high. He says that he expects to be fully recovered tomorrow. Patience and hope going hand-in-hand. Please pray that for Walter, the family and all who minister.

A couple of notes from Jessica:

Anyone wishing to speak to or see the family may email her at jess3ck@yahoo.com or post a comment on this blog.

Again, you may also send cards to the hospital. The hospital address again is:

Walter Romine
Room 240, Marcus Building
Shepherd Center
2020 Peachtree Road, NW
Atlanta, GA 30309

Some have asked about contributing to help out with Walter's medical and rehab costs. Jessica's parents' church in Valdosta, Grace Bible Church, has established a fund to accept contributions. Any wishing to do so may make send checks or money orders payable to Grace Bible Church, designated to Samaritan Fund, and mail to this address:

401 East Park Avenue

Valdosta, GA 31602

Time to reflect . . .

Walter and the family are settling into something resembling a routine. It's certainly not what we would have called a routine a couple of months ago, but much about life is now different. Visitation, even by family, is limited to between 4 and 9 on weekdays, which is understandable considering the therapy schedule that Walter is on. So, life is somewhat less frenetic for the time being. Less physical and time stress, perhaps, but with the freer time comes time to think, which, while good, has its own challenges.

One good thing about it, though, is more leisure to slow down, remember and thank. The last five or six weeks have been a whirlwind, with grace timely sufficient for each day. That grace has manifested itself in many ways—the incredible endurance of Jessica, Mom and Dad; the delicious food prepared by the "Act 3 girls" and folks in the Johnson Ferry Baptist Church Choir, which allowed Lyn and Pat, Walter's sisters, time both to care for family and take shifts with Walter at the hospital; prayer meetings at Quitman First Baptist Church; prayers from countless people extending from family in Anchorage, Alaska, to a priest in California to faithful friends in Budapest, Hungary; and thoughts and concern from loving friends who, while not believing in prayer as I speak of it, have sought to encourage and minister.

The path, in retrospect, was laid out, with the right people strategically placed. For example, Bill Dodd, Jessica's brother-in-law and the president and CEO of Direcpath, Jessica's employer, doggedly pushed the health insurance company to agree to cover the medivac move from Thomasville to Emory and then the move to the Shepherd Clinic. The insurance company approved coverage of Shepherd only after Bill worked the phones through to the president of the company. Shortly after that discussion, the medical director of the insurance company called Emory and spoke with Walter's doctor. The doctor stayed on the phone for at least thirty minutes, finally convincing the medical director that Walter needed to go to Shepherd and that the insurance company should approve it. Bill was strategically placed, and determined, to see that the insurance company did the right thing. We are grateful for that, as we are for the expertise and persistence of Dr. Owen Samuels, Dr. Adam Webb and the entire Emory staff. The initial contact with Dr. Samuels was through Jeff Levy, Bill's business partner. Shortly after Walter's stroke, Bill called Jeff, who promptly called his neighbor Dr. Samuels. That introduction ultimately led to Walter's move to Emory.

To all – thank you.

As for Walter, his therapists each Friday write reports detailing his status and setting goals for the upcoming week. The reports describe where he is in various aspects of his rehab with numbers from 1 to 7. They want him at least at 3 on everything when he leaves the facility. As of this past Friday, he was a 1 on everything, reminding us that he has a ways to go. At the same time, we are encouraged by things like the increasing movement of especially his right side, which had weakened; his laughing—or at least chuckling—at things people say; and the continuing improvement in the tracking and focus of his eyes. Overall, a sense of increased relaxation and comfort.

Shepherd has Walter on quite a schedule, roughly like this:

7:30 AM - out of bed, bath and dressed

9:30 AM - therapy (speech, occupational or physical; order may vary from day to day)

10:30 AM - therapy

11:00 AM - therapy

11:30 AM - therapy

12:00 Noon - Back to Bed

12:30 PM - out of bed

1:00 PM - therapy

1:30 PM - therapy

2:00 PM - therapy

2:30 PM - therapy

3:00 PM - neuropsychologist session

3:30 PM - back to bed


The Saturday schedule is more relaxed. There's no therapy on Sunday, so Mom and Dad had time this afternoon to roll Walter in his wheelchair to the garden. Walter reached up and took Mom's hand on the way down the hall. So, Mom got her lift for the day.

Other encouraging signs today: Walter sat up in a chair for about 2 1/2 hours and took a good nap. His eyes continue to improve their "tracking." He moved his right arm a lot and had an easier time holding his head up. We don't take seemingly simple things like this for granted like we may once have. Increasingly, it's the "little" things, like putting your arm around your dad, or holding your mom's hand. We are also increasingly aware that this will be a long haul, and we don't know what the next several months--or tomorrow--hold. We would like to know what the end will look like--what Walter will regain, how his rehab will progess-- but we don't. A new understanding of "cautious optimism," and a disciplining in faith - hope in the unseen.

Walter has received emails from some of you. Here is the address for regular mail:

Walter Romine
Room 240, Marcus Building
Shepherd Center
2020 Peachtree Road, NW
Atlanta, GA 30309

Next Steps

It's been a productive few days. Walter was moved to Shepherd's Clinic today to start his rehab in earnest. We had to wait for the insurance company to agree to cover it, and that agreement finally came yesterday. There's a story there, too; let's just say that the family has worked together well to get things done. Everyone finds roles and jobs as we go. Walter has strong advocates working on his behalf.

That includes spiritual advocates. Several met at Quitman Baptist Church this morning to hold a special prayer time for Walter and the family. What a blessing and privilege! Thank you to all who participated in that. Jessica's parents' church is working to set up a fund to accept contributions to help out with medical costs; more details on that as they develop. Thank you to all who continue to "stand in the gap" in so many ways.

Now that Walter is at Shepherd's, schedules will change. Family is welcome, and invited, to stay with him 24/7 for the first couple of days. After that, we will be limited to visiting hours of 4 to 9 on weekdays and then extended times on the weekend. That will be a transition for everyone, Walter and family included; hard, in some ways, but necessary. We expect that Mom and Dad will soon take the opportunity to go back to Quitman for a few days to catch up on some things.

The focus will now turn especially to Walter's rehab. Jessica is bringing some clothes from home. The staff will increasingly push him. They measured him today for his wheelchair, which he hopefully will have soon. The Falcons team will visit tomorrow, and the staff wants Walter to participate in that.

More detail on Shepherd's as we go. In the meantime, prayer concerns remain constant: healing, encouragement, direction, wisdom, determination, perseverance; that God will continue to make paths straight, to give strength to the weary. He continues to prove Himself faithful.

I'll communicate as soon as I know the address to send letters, etc., to Walter at Shepherd's. In the meantime, this link should get you to the webpage for sending emails (you may need to copy the link and paste into your browser):

http://www.shepherd.org/about/reach.asp

Thursday, May 7, 2009

    Just got report from Lyn at the hospital. Walter had a good night, sleeping well. He had a bad migraine headache yesterday, apparently due to removal of the EVD; according to the nurses, not unusual. Lyn said that he seems very comfortable today. He is still on percoset, but they'll start cutting that back if he continues without pain. Big news: yesterday's CT scan showed that the ventricles are normal (confirming the decision to remove the "brain drain" and not insert a shunt) and that the brain swelling has further reduced. All this is very encouraging in terms of his rehabilitation and recovery.

    With the continuing reduction in swelling comes visible improvement. His eyes are tracking much better, Lyn says, and he is turning his head from side to side. Until recently, his head pretty much stayed over to the left, his impaired side. One of the therapists said that the goal for today is to work to establish "eye-to-eye" contact. So for those seeking prayer direction, there's one. He is moving his left leg and foot a good bit. Moving the left arm and hand is more difficult for him, although he does move his fingers some and has squeezed with his left hand. He's keeping his mouth closed more and breathing out of his nose. Apparently aware of the paralysis of his left side, he sometimes lifts and works his left arm with his right. He worked well with the physical therapist yesterday.

    We expect that he will move today into "intermediate ICU" at Emory, which, again, is a major step. The next step is a bit uncertain; again, point for prayer. The next "goal", if you will, is for Walter to get to Shepherds for "acute rehab", the program that I mentioned before. Walter, to enter that, must be able to tolerate 3 hours per day of rehab. One way they determine if he is ready is to see if he responds to direction from a therapist. Until he responds appropriately to 90% of these directions, he is not eligible. So, until then, there are a couple of options. The one (which to us is preferred) is to enter the "pre-rehab" program at Shepherds. This is just what the name implies— "rehab lite"—a program to prepare him for the full acute rehab. The immediate hindrance to moving him into that is lack of a bed, since Shepherds has only seven or eight beds designated for this program. Pre-rehab can last initially up to three weeks. If within the three weeks he shows progress, but is not ready for acute rehab, then he may continue in pre-rehab for a longer period. Other alternatives, depending on how it all goes, are for him during the interim to go into another facility (such as nursing home providing the required services) or home care. This decision would be driven largely by insurance requirements.

    Lyn has started to play old Seinfeld episodes for him, and he sometimes smiles and laughs best he can. So, we have both the music and the laughter going—both healing.

    Continuing, sincere thanks to all for everything—prayer, encouragement, food, offers of help . . . . We appreciate you all.

 

    

Two in a Row

    Today's news calls for an early post.

    Lyn went in early this morning to be with Walter while Jessica went to work. She called with wonderful news! First, the doctors have decided to remove the EVD. Second, Walter will not need a shunt. Dad said last night that the possible need for a shunt was foremost in his concerns. With those decisions made, the hospital plans to move Walter, perhaps today, to another floor of the hospital. We don't know yet if he's moving to what I believe is called "intermediate ICU" or to a regular room. In any event, out of critical care ICU. I recall that the lead doctors earlier said that he would want Walter to say in the hospital for a day or two after the EVD was removed to give them time to run another scan and make sure one last time that the ventricles continue to be OK. Assuming that all that progresses as hoped, then it is possible that Walter will transfer to Shepherds by the end of this week.

    "They call it Monday morning, but Tuesday's just as bad . . . . " Not this week, thank God!

 

We’ll Take it: A Good Day

    Everyone returned from the hospital today with a bit more energy in their step. Walter cooperated with the therapists more than in the past. He squeezed Dad's hand with his left—this, I have learned, is major. It shows that his left side has neural connections that rehab can focus on. His eyes continue to improve. For several days his left eye was constantly floating down around the bottom. Now it's lining up better and he seems able to focus better on things like television. He is not coughing like he was. His coughing a few days ago was frequent and deep. Now it's much less frequent and, as Lyn says, "it sounds like Walter's cough". We now focus on things that once we would not have, like what an individual's cough sounds like. Well, Lyn now recognizes Walter's. He is finally getting some good sleep, and it shows in his face and his eyes. Yesterday he began to look like himself.

    The EVD remains clamped off, but the doctors want to make sure that the ventricles are regulating themselves before they remove it. They want neither to have to reinsert it later or insert a permanent shunt. Resolution of this issue appears to be our next threshold event. Once the EVD is removed, Walter will be eligible for evaluation to move to Shepherd's to start rehab. That transition will start the next chapter.

    The doctors and other professionals uniformly, though cautiously, express optimism that Walter will recover most, if not nearly all, of his functions. One experienced nurse observed that he would be surprised by a lack of substantial recovery. A doctor predicted that, in a year, Walter will walk down the street without anyone but him recognizing any lingering effects of the stroke. One of the lead doctors encouraged Mom and Dad not to be overly discouraged by how Walter appears now, that we should see much improvement within three months. So, we persevere in light of hope.

    

Reality Check

Walter's progress encourages us, and I try to emphasize that in this blog. We continue to pray and hope for a miraculous (by which, in our minds, we often tend to mean "fast" and "complete") healing. Circumstances, though, remind us that we are now in a new reality, one in which we must seek the miraculous in the otherwise seemingly incremental and mundane.

A doctor in the northeast, experienced in neurological issues associated with strokes, follows this blog and very graciously offers her insights from time to time. I share portions of her most recent email here to give you a sense of what this reality may look like in part:

"About the speech:

"It will be frustrating at times to get the words out. Depending on the bleed and size the speech center is most likely involved [note – Walter's doctors tell us that this is not the case with him]. . . . The brain is a funny thing. People can have strokes in their language center which may not affect their 'singing' or 'cursing' center. I will have some of my stroke patients with aphasias sing out what they want. Sounds silly but sometimes it works. You will also notice that when Walt gets extremely frustrated or upset that you will understand all of the profanity that comes out of his mouth crystal-clear.

"He is going to be confused for a while. Electrolyte (ie. sodium) abnormalities and blood in the head can make you lethargic and may take longer than you like to recover. Because of his stroke, I would like to inform you all that in the future that he most likely will take longer to bounce back from even simple things like a cold, flu or an urinary tract infection. His brain is not 100% from here on out. I also have some patients that recover well from their strokes and when they get a cold, flu or UTI their old stroke 'talks' because the cells that were involved with the previous stroke are vulnerable to simple electrolyte changes or infections. It may look like he had another stroke or worsening of his stroke symptoms, but it could be that the brain cells are irritated and once they calm down so will his symptoms.

"He is not used to being down. I know that he is aware of the long road ahead, but you will have to remind him again and again of it and what progress that he has made. There is a high incidence of depression in stroke patients. If he needs chemical help through that, remind him that it is normal.

"Sleep is a restorative process for the body. If he is sleeping a lot, let him. I have to remind my families of this. They are at times too concerned that they are sleeping too much. They want to make sure that they are not too lethargic or getting worse. I have had some families continue to wake up the patient to make sure that they were not rebleeding. ICUs are noisy and sometimes it is not until they get to the regular hospital room where it can be more quiet for quality sleep that they start perking up.

"Reinforce over and over again that blood pressure management is key for the next several years. Emphasize that you do not want to revisit this nightmare again in the future.

"I am glad that he is doing better. Remember a young brain is better than an old brain."

We will learn Walter's specific issues as we go, but these observations give us some idea of what we may expect.

The report from the last couple of days is that Walter seems to be sleeping much better since removal of the NG tube. The doctors continue to monitor the ventricular pressure with the EVD closed off; so far, so good. The various therapies continue and will get more rigourous. Again, the doctors and nurses remind us not to expect dramatic improvement while he is in the hospital. The noticeable improvements should come once he gets into rehab.

Jessica's mother Brenda is here this weekend, allowing some of the others some down time. Jessica is still pretty much at the hospital when she's not working, with some small breaks here and there. Good friends provide food. A day at a time . . . .