{Karlton Bontrager}

On Wednesday (7/24/2002), the doctors decided to have Karlton try breathing on his own. They put a cap on the trach, and he seemed to do pretty well. It was only then that we learned that one evening a few days previously he had pulled out the trach himself. (Sounds ghastly, doesn’t it?) It’d been reinserted, and no one bothered to tell us.

How he hated the trach! The nurses had tied his hands in mitts. They’d put the stiff, unbending material around his elbow, they’d tied his hand to the rail, but still he wanted to get at it. His obsession wasn’t like a conscious thing, just as it hadn’t been for the naso-gastic tube and the stitches. His hand just gravitated to those areas. And he did have a right to feel those things. It’s his face after all. But before long he’d apply pressure, and we were afraid that he’d hurt himself.

And then he did it again. While we were away at lunch, he pulled out the trach a second time! Since he’d been successful breathing on his own earlier in the day, the nurses decided to leave the trach out. (As his neurosurgeon said that evening, Karlton is always a few steps ahead of
them.)

Yesterday was the first day that Karlton did not write to us. Without the trach, his voice was stronger and he had better breath control. But it probably hurt him to talk, given the trauma he’d caused in his throat. On Wednesday, he spoke some of the time and he wrote some of the time. But by Thursday, he was talking only.

Several times in the day Karlton asked us to take something out of his left hand when he had nothing in it. He apparently was experiencing phantom sensations there. Could this be a sign of changes coming on? We certainly hope so.

The PTs noticed that his left leg is getting stronger. As a team, they had him walk yesterday morning, moving his left leg for him. They got him to walk about five steps that time. In the afternoon, he walked even farther to get into a glorified wheelchair. Choy-Lang and I took him down the elevator to the ground floor and outside for a quick stroll around the parking lot.

Karlton doesn’t like to sit up for long. Even when his head is elevated in bed, he soon asks to lie down. But the nurses and PTs keep challenging him to stay up longer. He’s now staying up for an hour at a time. Then he goes into deep sleep when he gets back into bed. Yet he’s beginning to take the initiative in asking to get up to void or to eat.

In the afternoon, the social worker took Choy-Lang and me to tour ISIS, the rehabilitation hospital. It’s quite a nice facility, with wide hallways, big rooms for therapy and activities, and plenty of coffee, tea, and a New Zealand drink called milo for socializing. Families are encouraged to take part in the rehabilitation therapy. As long as Karlton remains in the Post Traumatic Amnesia stage, he will have a private room where he can get lots of rest. Once he moves beyond that stage, he will likely be in a 4-bed ward. Both types of rooms have large, floor-to-ceiling windows that overlook green grass and trees. It seems like an ideal place to be.

Karlton ate lunch at a reasonable pace today. Because he has lost weight, we thought he was starving. We learned later, however, that shoveling in food is a part of the brain injury. It makes it difficult for him to inhibit impulses. (Ergo the inappropriate comments and gesture yesterday.) So his eating more slowly was a good sign in several ways.

The speech therapist gave Karlton another swallowing test. This time she had him eat half a banana. He did so successfully. But he had a coughing spell when he tried to drink water. She decided that he could progress to a soft diet with liquids the thickness of nectar.

The laboratory results on the nasal drip had not come in by the end of the day yesterday. Without a definitive identification of whether it contains cerebro-spinal fluid, Karlton cannot move to ISIS. So our potential Friday moving date has been postponed to Monday or Tuesday. We learned today, however, that there is an opening for a patient at ISIS. That factor may change the way the decision is made.

The sun is shining today, and we hope to take Karlton outside for another walk. I hope you have lots of sunshine in your day as well.