More Rest and Recovery

Nothing is scheduled to happen today. Heather had a good night's sleep, and her pain was minimal. She will likely spend the day resting, with the exception of some physical therapy and some time off the ventilator. Once her lungs are strong enough to be off the ventilator, they can pull out the cannula (the tube that connects to the ventilator and goes down into her throat) and put a plug in her tracheostomy. This will allow her to talk.

This morning her hematocrit was down to 17 (most of us have hematocrits in the 40s), so they are giving her two units of blood. Because she is so low, she is feeling quite weak and tired. This is likely due largely to loss of blood from her surgery yesterday, but it seems that she is lower than would be expected. They will watch her hematocrit for a while to make sure it doesn't continue to drop.

Surgery Results

Heather is out of surgery and doing well. They operated on her for a couple of hours and found that they needed to remove more tissue from her legs. They removed a relatively large amount of tissue from the outside of her left thigh and some tissue from the inside of her left thigh and from the outside of her right thigh. Dr. Morris said that the tissue in these areas still had some infection and/or necrotic (dead) tissue. He explained that they try to get all of the infected and necrotic tissue out while being as conservative as possible, so as to leave her legs intact as much as they can. The problem with this approach is that they may miss some of it and have to go back for more. In addition, there is always the possibility of additional infection cropping up.

Dr. Morris said that they took a little more fascia from the outside of her left thigh, but still did not have to get into muscle. He said that it is not unusual to have to go back in to clean things up like this, but of course we would all hope for Heather to have ideal healthy skin that is ready for grafting. She currently has no grafts at all (neither of cadaver skin nor of her own skin). Dr. Morris was unsure when he would try grafting again, as it depends on how her skin heals.

They covered the affected areas of her legs with wound vac dressings. This is where they cover the wound with black foam, cover the foam with a plastic tape layer that forms an air-tight seal around the wound, cut a small hole in the plastic tape layer over the foam, and attach a machine that sucks all the air and fluid out of the foam and the wound area. They have also put her on an antibiotic to fight any infection.

Dr. Morris was reluctant to give any timeline at this point, other than that they will change her dressings and look at the wounds again on Saturday. It is just hard to know how the wounds will progress and when she will be ready for grafts. He is still optimistic.

Some people have asked me how her legs got so bad in the first place. I don’t completely understand it myself, but here’s my best explanation. Apparently, the toxins associated with sepsis and other similar diseases or conditions cause what is called “disseminated intravascular coagulation” or DIC. Wikipedia defines DIC as:

Disseminated intravascular coagulation (DIC), also known as consumptive coagulopathy, is a pathological activation of coagulation (blood clotting) mechanisms that happens in response to a variety of diseases. As its name suggests, it leads to the formation of small blood clots inside the blood vessels throughout the body.^[1] As the small clots consume all the available coagulation proteins and platelets, normal coagulation is disrupted and abnormal bleeding occurs from the skin (e.g. from sites where blood samples were taken), the digestive tract, the respiratory tract and surgical wounds. The small clots also disrupt normal blood flow to organs (such as the kidneys), which may malfunction as a result.^[2]

DIC can occur acutely but also on a slower, chronic basis, depending on the underlying problem.^[3] It is common in the critically ill, and may participate in the development of multiple organ failure, which may lead to death.^[4]

Basically, the sepsis reaction causes tiny blot clots to form in the capillaries, which kills the tissue in the affected areas. In Heather’s case, the only affected areas were her thighs. Several nurses have said that they often have people here on the burn unit who are not as fortunate and end up losing limbs from this condition.

While Heather was in surgery, the doctors changed the tube for her tracheostomy. The new tube will allow her to talk and eat when she is not connected to the ventilator. That is very exciting to me.

Back at the Hospital - Request for Prayers

I'm back at the hospital. It is a mixed experience. It is wonderful to see Heather again, yet I don't ever think I will enjoy being in this place. It is not a very pleasant environment, and it is hard to be away from Hannah. Heather is really struggling with being away from Hannah for so long.

Heather's sister went home to Jackson tonight. She has been so great to take care of Heather, particularly when I have not been able to be here. Heather's parents have also been troopers to spend so much time supporting Heather here at the hospital. They left this afternoon to spend a night in their apartment in Provo where they will be spending the winter.

Heather and I just spoke with the doctor about tomorrow's (Thursday) surgery. He told us that he is not very impressed with how the homografts (cadaver skin grafts) are looking, though she seems to be making great progress in almost every other area. He explained that there are several places on her legs where it appears that the tissue underneath the grafts is having problems and needs to be cleaned up (i.e., shaved off or cut out). He said that tomorrow they will take all the grafts off and clean all that up. He said that in areas where the wounds are not improving very well he may need to put a wound vac (like the one on her abdomen) on them until they are healthy enough to do grafts. He told us that he may do some autografts (grafts using Heather's own skin) in places where the wounds are healthy enough to have a high likelihood of successful grafting.

Heather is obviously nervous about tomorrow's procedure, which will likely occur in the early afternoon. She asked me to ask family and friends to please pray that the wounds on her legs will require minimal tissue removal, the tissue on her legs will be ready for grafting, the grafts will be successful, and her legs will heal quickly. We would greatly appreciate your specific prayers in this regard.

I asked the doctor some questions about her prognosis. He said that they have not yet had to remove or go into the muscles of her legs much at all. Therefore, she should be able to return to full functioning (including strenuous activities involving her legs). He did have to remove some fascia (a fibrous layer that covers and protects the muscle) from her legs, but that should eventually be replaced with scar tissue. He said that she will most likely stay on the Burn ICU until she leaves the hospital, and that she will likely require inpatient rehabilitation when she leaves here. We can probably do that in Utah County, which would be nice. He said that it will probably take her six months to feel back to normal, and that she will be receiving wound treatment and follow up for a year or more (though it will become very infrequent).

Wound Update and Strength Building

Heather's sister, Heidi, let me know that Dr. Morris, our doctor/surgeon in the Burn Unit, said that Heather's abdominal wound is looking good and that her leg wounds are so-so. Heidi also said that they will try Heather off the ventilator for a two-hour period today. Heidi said that Heather is currently sitting up in bed (The hospital beds are quite impressive. They can mechanically fold into a chair, which makes sitting and standing tons easier.) and will try to stay sitting up for an hour. It is great to hear her making these improvements that seem so small, but are really huge.

Shower Surprise

The doctors feel that Heather's hepatitis is resolving, and that it likely was a major source of her diarrhea a few days ago. She seems to be doing much better in that realm. They took her for a "shower" yesterday. Apparently they have a shower where she can be on a bed while they do it. The surprise was that they didn't tell her they were going to take out all the staples that hold the grafts on her legs at the same time as the shower. She had many, many staples holding the cadaver grafts on. She said (mouthed to her sister, Heidi, in that she can't talk yet) that having them removed was quite painful for her. Other than that she had a pretty good day. I can't wait to see her tonight, and it was hard to say goodbye to Hannah this morning.

Another Okay Night

Heather had an okay night last night. Not great, but okay. Apparently they had to change her catheter during the night. That can't be enjoyable for anyone. Since I last wrote, she has been off the ventilator twice for an hour each time. She reportedly did well while off of it, despite some fatigue afterwards. So, she is building up her lung strength, which is really good.

They have found evidence of Hepatitis A in her blood. They said that having had the vaccination for Hepatitis would cause that to show up in her blood, so we need to check to find out if she has had that vaccination. Otherwise, she has one more thing to deal with. Hepatitis A is not the most serious kind, but it is still a concern.

Away from the Hospital

I am taking my first break from the hospital in almost four weeks and am at work today. I took Hannah home last night and will do so again tonight and Tuesday night. I will work today, Tuesday, and Wednesday and be back at the hospital Wednesday night after work. It is hard not to be there with Heather and a little difficult to concentrate on my work. It was good to be home with Hannah though, and she really seemed to enjoy it (though she asked about Heather often). It was really hard to be there and to go through our usual routine without Heather. As always, neighbors and ward members have been very generous in taking care of us.

Heather's sister and parents are with her at the hospital. They said that her night was okay, but that she continues to struggle in getting her bowels to be regular (it is tough with all the antibiotics, stool softeners, and narcotics she has been taking). They took her off the ventilator for a bit this morning, and she seemed to be doing well with it when I called.

Visiting

Some of you have asked about visiting Heather. She loves seeing people she knows, and appreciates the effort involved in people coming to see her. However, she is still very tired and needs a lot of sleep. Having too many visitors would surely wear her out, so it is a tough balance to strike. I discussed it with her, and she would like people to come if they want to, but it would be helpful for people to call (my cell number is 801-367-8077 and her room telephone number is 801-585-8415) in advance so that we can make sure too many don't come at once. They only allow two visitors in her room at a time, so that limits things too. Every day, nursing shift changes occur between 7 and 8 in the morning and in the evening. No visitors are allowed into her room during that time.

In terms of emailing more personal messages, you can send them to me at mark_beecher@byu.edu.

Surgery on Thursday

The doctor looked at her abdomen and legs and said that they look okay. Some of the grafts are taking well, and others are not. He would like to wait a few days for the surgery so that the grafts and the skin beneath them have time to do as much healing as possible. They will now change her wound dressings every day. It is quite the process. The nurses do an excellent job. I'm really impressed with the care they take. I got to see her legs unwrapped. She definitely has a long way to go, and will have significant scarring and some deformation on them. As I have mentioned, on Thursday they will take the cadaver skin off and put her own on (taken from her flanks and back).

I thought I would include a picture of her from her little excursion to see the light of day yesterday. She really seemed to enjoy it. (That is her nurse, Christi, in the picture. She has been great to Heather.)

Difficult Night

Though she continues to do well in terms of her vital signs and healing, Heather had a bit of a bad day yesterday and also a somewhat difficult night. She has had nausea, a stomach ache, and diarrhea, which has meant significant discomfort and many (8 or 9) linen changes since yesterday morning. These are quite painful and humiliating to her because one to two nurses and one to two aides must come in, roll her onto one side, clean her off, strip the linens off the half of the bed she is not laying on, put new linens on that half of the bed, roll her over the top of the new linens onto her other side, pull the linens over the rest of the bed, and roll her back onto her back. They also often must cut off the top part of the wound dressings on her legs when they become soiled (This involves cutting off an ace bandage, replacing several layers of gauze, and re-rolling a new ace bandage.). Though the nurses and aides are very respectful, kind, and efficient at what they do, it just hurts Heather to be moved around so much. It is also embarrassing to her and she hates feeling like she is a burden to the nursing staff who have to go through this process repeatedly (even though they never indicate any hesitation or frustration with it). Then, to have an upset stomach and nausea on top of the pain and frustration, makes things miserable. She has also struggled to breathe some, though her ventilator numbers suggest that she is breathing very well.

They have ordered chest X-rays to make sure nothing is wrong with her lungs. They ordered an ultrasound of her gall bladder to make sure she doesn't have stones and to make sure her gall bladder is functioning properly. They are testing her stool for possible infection. They may do a CT scan to see if anything is going wrong with her bowels (They will wait and see how she does this morning.), and they are giving her some medication to calm her bowels down. They said that her liver enzymes are up somewhat, which suggests some liver distress. They will watch that carefully to make sure it doesn't get worse.

In the last hour or so, she seems to be feeling much better. Her stomach ache and nausea have subsided, and she seems visibly relieved. It makes everything significantly better for her. The medication they gave her to calm her bowels (Reglan) seems to be working. They also have begun giving her Methadone to replace the Fentanyl they were giving her for pain. They also give her Oxicodone for pain.

One thing that I don't think most people realize is that in some ways this period is more difficult for Heather personally than just about anything she has experienced so far. Everyone around her and everyone who has been following her experience sees how far she has come and how much she has progressed. However, she was asleep for most of that and doesn't remember it. Now, though what she is going through is much less life threatening, she must face the long road of recovery and frustration at not having control over much of anything in her life right now. She can't talk, so she can't call out for help or explain what she needs very well. She can't lift her arms or move her fingers very well, so she can't hit the nurse's button or wipe her own face very well. It is a powerless position to be in, and it gets to be quite frustrating to say the least. She vacillates (as I do too) between feeling hopeful, optimistic, and at peace and frustrated, anxious, and overwhelmed.

Her doctor will take off her wound dressings in about 15 minutes to see how she has done with with the cadaver grafts. He will decide at that point what the next step is and when they will take it. From what the nurses have seen when they have looked at her grafts when they have had to change the dressings on the upper part of her legs because of bowel movements, they feel the grafts are looking quite good and seem to be "taking" as they should. I'll let you know what they find.

Another Day of Rest

Nothing significant is planned for today, just rest and recovery. I'm sure the physical therapist will be in to work Heather's muscles a bit, and the respiratory therapist will take her off the ventilator a bit. Yesterday, they took Heather off the ventilator for an hour and a half to try to build up her lung strength. She did well, but it made her quite tired. She slept much of the day. When she was awake, I read your emails, letters, and blog comments to her. She really appreciated them. Thank you all!

Last night they took her NG tube out (NG = nasal-gastric, it is the tube that goes in through her nose and down into her stomach to pump out excessive gastric juices). It is fantastic to see another tube come out, hopefully for good. So, she only has one tube (the feeding tube) down her nose now and only a few IVs. Her bowels have been a little slow, but are working fairly well. All in all, she really seems to be progressing well.

Her nurses have been great. They have done some kind, non-essential things to make Heather more comfortable. They washed and braided her hair; they painted her fingernails and toenails with bright, glittery polish; and today they are going to roll her bed out to a window where she will have a view of the Salt Lake Valley (just for a stroll so she doesn't feel so cooped up and gets a chance to remember there is a real world out there). I appreciate the special care they have given her. It makes a big difference.

Good Day to Rest and Build Strength

Heather is doing really well today. She again had a good night and slept well. They took her off the ventilator and let her breathe on her own (with oxygen supplementation) for about thirty minutes this morning and will do it again this afternoon. She did okay without the ventilator, but it does tire her out. She has been coughing up a lot of phlegm and gunk, which is good except that she has so much of it. The respiratory therapist was unsure why she had so much. They will watch for possible pneumonia, though that doesn't seem likely at present. All-in-all she seems to be doing really well.

Surgery Went Well

Heather is out of surgery, and it went well. They basically did everything they said they would. The took some pictures of her legs which I got to see. As you can imagine, the wounds are significant, but the doctor is optimistic about her recovery. They will look at how things are on Saturday and Sunday and then look to autograft (graft using her own skin) sometime next week. The doctor said this surgery shouldn't cause her any significant additional discomfort.

Pictorial History

Here are a few pictures of Heather I have taken throughout this process:






This picture was taken the day after Heather's hysterectomy (10/01).













This picture was taken on Saturday afternoon (10/04), the day before her second surgery. Notice how she has lost considerable weight and looks rather wan. This was just before she had a very miserable night.














This was two days after Heather came to ICU (Tuesday, 10/07). I wish I had taken a picture when she was at her most bloated, but it was a rather stressful time and I had other things on my mind.









I included this one to show all the machinery she was hooked up to. She had many other things hooked to her on the other side of the bed too.












They put this "enforcer" on her to keep her from biting through her air tube and to hold it in place.














It was nice to get a hair wash and that nasty "enforcer" off (10/15).














A little bit of exercise with the physical therapists. It is tough trying to keep ahead of the muscle wasting caused by being in bed 24/7. (10/18)















Without the ventilator Heather became quite weak (10/20).



















I took this picture Tuesday night (10/23) after the surgery on Heather's legs and her tracheostomy.

Doing Well and In Surgery

Heather had a great day yesterday. She seemed to be feeling better than she has felt in a long time. She was able to sleep well through the night again, which is wonderful. She seemed really tired this morning, but was able to work with the physical therapist to do a little exercise. Her muscles are very weak, but she seems willing and motivated to work hard.

She was scheduled to go into surgery at 1:30pm today, but they changed the schedule and she is currently in surgery. She went in at about 10:30am and should be in there for about an hour. As I explained in an earlier post, they will clean out all of her wounds and make sure they have gotten all of the dead and infected tissue. They will then cover the wounds with cadaver skin. They use the cadaver skin because skin is excellent at keeping bacteria and infection out while keeping the undertissue moist (I guess it is no big surprise that skin does the best job at doing what skin does.). She will probably go back into surgery on Monday or Tuesday to have the cadaver skin taken off and her own skin put on. They said that they will take her own skin from her flanks and/or back. They said that the donor sites hurt worse than the wound sites for most people and that the wound sites actually tend to feel better once your own skin is placed on them.

Much Better Today

Heather is doing significantly better this morning. She is as alert and clear thinking as she has been in weeks, and she seems much stronger. Her delusional thinking seems to have cleared, which is a huge blessing to me. It is bad enough to see her have to go through all of this stuff, but it is exponentially more difficult when she is feeling persecuted and distrusting. She seemed to have a good night, and said that she was able to get some good sleep (which she hasn't been able to do for some time). Her pain seems well controlled, and her vital signs all seem good.

Her doctor came in this morning and said that he will change the dressings on her legs later on today. He will take her back into surgery tomorrow to clean out the wounds in her legs and to make sure they got all of the dead tissue out. He said that they will dress her wounds with cadaver skin after her surgery tomorrow. He said that he was impressed with how good she looks today. It probably really helped her to get all that dead tissue out of her body.

It is wonderful to see her beautiful smile and to have her communicating relatively normally with us again. Thank you all for your caring, prayers, and support.

Surgery Results...Long Difficult Road Ahead

We just spoke with the surgeon. The wounds on her legs are much, much worse than anticipated. They extend deep into the tissues of her legs, in some cases several inches down to the fascia and muscle. He also said that it is very irregular or marbled in veins rather that affecting broad areas of tissue. They worked to remove as much of the dead tissue as they could. He estimated that they took out between four and six cups of tissue from her legs. This means that she will require extensive wound care and several more surgeries before they will do any grafting. She will likely be in the Burn Unit ICU through the end of the month.

He is optimistic that she will be able to regain full functioning, but not without extensive rehabilitation, likely continuing through the end of the year. After she leaves the hospital she will, likely need to be in inpatient rehabilitation for some time. She continues to be very, very sick. When asked if this is rare, he replied that it is extremely rare occurring at a rate of 1:250,000 to 1:1,000,00.

He said that the surgery went relatively well, considering. Her heart rate stayed constant, and the tracheostomy was placed without complications. They will monitor her hematocrit to see if she requires transfusion. She continues to have a long and rough road to travel. We appreciate your prayers and concern.

Tracheostomy and Surgery This Afternoon

We just spoke to the burn unit doctor and team again. After talking with the ICU team, they all feel that Heather is really struggling being off the ventilator and that she is just getting weaker and weaker. So, they feel it best to put her back on the ventilator and to perform a tracheostomy (i.e., cut into her neck and into the trachea, then insert a breathing tube and sew it in place). Those this prospect is disturbing to us, we feel it will be better for her in the long run. She will likely have it in for a couple of weeks, but there is less chance of problems (e.g., vocal chord damage, irritation of her throat, etc.) with the tracheostomy than with the tube in through her throat. There are also more possibilities for her to improve her strength with the tracheostomy because she will be able to walk with it, where she cannot with tube in through her mouth. In addition, they can disconnect and reconnect her easily with the tracheostomy, which will give her the chance of building up her strength through repeated trials without the ventilator. Obviously, I would prefer that she not have to have it, but it seems the best option.

The doctors also feel that it will be best to perform the surgery on her legs today at the same time they are doing the tracheostomy. They said that the main hesitation they would have about doing it today would be if she was weak in her breathing but improving. Waiting would give her more time to improve and develop strength so that she could stay off the ventilator after the surgery was over. However, if she will just be intubated anyway, there really isn't any reason to hold off on the surgery. Please keep your prayers coming today.

Breathing, Delusions, Surgery, and Heart

Since she got the ventilator tube out yesterday, Heather has been breathing moderately well to poorly at times. Last night she seemed to be working pretty hard (i.e., quick, short breaths - about 35-45 breaths per minute, whereas they would like her down in the teens). They debated whether to intubate her again, but decided to put her on a bi-pap machine that supports her breathing through a mask on her face instead. She does not like it very much, but has kept it on throughout much of the night and this morning.

Something that has made it all more interesting and difficult is that she has been quite delusional since last night. She has been able to talk a little (her voice is very gravely and quiet, but if you get right up to her mouth you can hear what she says), so we have a better sense of what is going on for her. She seems quite confused and scared, believing that the doctors and nurses are out to get her. I really don't think she was feeling that way while she had the ventilator tube in. Last night she thought that they had taken her to laundry room and that they had been performing transplants on her. She felt that they were hooking her to a vacuum cleaner that she had seen an aid using earlier. She plead with me to take her home, where she felt she could heal better and do fine. She refused to have the bi-pap mask put back on. It was really hard to see. This morning she continues to express her suspicions and frustration. I really can't blame her because people are constantly talking about her instead of to her (though they try to speak to her too) and she is continuously having procedures done to her that are out of her control. They doctors say that this happens all the time in the ICU, but that they are investigating for other possible causes (eg., infection, stroke, etc.). They feel it may be related to the dead skin on her legs, which brings us to surgery.

Heather will be going up to the burn unit this afternoon to have the dead skin on her legs surgically removed. They will then put cadaver skin on the wounds to stimulate growth. Then, after about 5 days, they will take the cadaver skin off and use her own skin to graft onto the wounds. They think she will probably come back down to the ICU after her surgery, but are unsure. It is likely, since she has struggled so much with her breathing, that she will likely remain intubated after the surgery.

****News Flash****
As is common here, plans seem to change quickly. Dr. Morris, the doctor that will be performing the surgery on her legs, just stopped by as I was writing this. He and his team just went in to talk with the ICU team to decide whether it is in Heather's interest to wait a few days until she is breathing better and is more settled to begin the work on her legs. So, we are unsure whether she will be going to surgery today or not. We should know shortly.
*******************

One other issue of concern is that Heather continues to have dramatic vagal responses (i.e., her heart rate quickly drops down to the 30's and threatens to stop) to just about anything, but particularly things having to do with her throat and breathing. The bi-pap machine seems to trigger it quite a bit (i.e., a couple of times per hour). The doctors are unsure why that is the case, other than her just being really sensitive to that vagal response. They said they could give her a medication to increase her heart rate, but they gave it to her yesterday it jacked her heart rate up to the 140s. So, they feel it is better to watch her carefully and let her ride these episodes out.

It is tiresome to ride this roller coaster of emotion and worry. Like she does, I wish we could just go home.

So I Lied...

As usual, what I thought was going to happen and what is actually going to happen don't exactly match up. Though Heather currently does not have an NG tube (the suction tube that goes in through her nose to her stomach so that bile and gas don't build up), it turns out that they are going to put it back in...at least temporarily. They have increased the rate of her tube feeds (liquid drink akin to Ensure sent through a tube that goes in her nose, through her stomach, and into her small intestine). As you may recall, in the past the doctors and nurses were concerned that her tube feeds may have been backing up into the stomach where they got sucked out by the NG tube. So, as they are increasing her feeds, they want to make sure it isn't just backing up into her stomach. They will put the NG tube down. If it remains clear of tube feeds, they will take it back out.

Heather has been extremely sleepy today. She can barely respond. She seems exhausted, most likely from having to breathe on her own after two weeks of assistance. The physical therapist came in and could barely get her to wiggle. They say she will get stronger quickly. Her voice is just barely beginning to return. The only intelligible word I have heard is, "No!" when I asked her she needed pain medication. She wouldn't be a good drug addict. The narcotics really seem to make her feel sick.

The Tube Is Out!

Believe it or not, they extubated Heather this morning. We weren't sure it would ever happen, but here she is without it in. She can't talk yet, in that her vocal chords have been abused for the past two weeks. She is dying for a drink, but she can't have water right now. She seems pretty uncomfortable and weak, but indicates that she is really glad to have that tube out. So are we!

Ulcers

They performed an endoscopy and found that Heather has three small ulcers at the top of her stomach. These may be the result of the NG tube irritating the wall of her stomach and/or her prolonged sickness. Either way, this is good news in that it helps to explain some of the blood loss/low hematocrit and is not particularly serious (compared to the many possibilities that could be far more troubling). They said that the ulcers seemed to be healing already, but that they will give her medication to help even more. They also took her NG tube out and won't be putting it back in. Hooray! One more tube out. We haven't heard any word on removal of the ventilation tube.

Heart, Lungs, Stomach, Legs, and Exercise

Today when Heather's sister, Heidi, and I got to Heather's room they informed us that she again had a vagal response while they were suctioning her breathing tube and her heart stopped again. I say let's get that tube out so that won't happen anymore.

Her breathing is doing really well, and she is strong enough to be extubated today (I know. You've heard that before.). There is a catch, however. They have noticed what may be blood coming out of her NG tube (It looks a little like coffee grounds.). So, in order to be sure, they are going to put a scope down her throat and into her stomach to look for potential sources of bleeding (eg., ulcers, irritation in the stomach from the NG tube rubbing on the lining, etc.). They also wonder if it may be old blood that was the reason for her low hematocrit yesterday. (By the way her hematocrit looks good today, between 32 & 34.). They don't want to extubate Heather until they have done the scope and know what is going on with that. Again we wait.

The burn doctor came and looked at Heather's legs this morning, and said that they still are looking to doing surgery next week. He said they have to shave away the dead skin to find out how deep it is and whether/how many grafts will be required. He said they may need to use cadaver skin to stimulate growth, but they will definitely use her own skin which will possibly be taken from the back of her legs, her hips, or sides. If they can, they will likely keep her here in the Surgical ICU, but it will depend on what her needs are as they start working on her.

The physical therapists came in and again had her sit up. She seemed quite tired from her standing up episode yesterday, so they did not push her to stand again. Though more tired today, she seems stronger to me.

CT Results and More Units of Blood

The results of the CT scan did not show any problems with the bowel or internal bleeding. She did have fluid in her abdomen, but it was not as thick as blood. The doctors think it is still fluid left from when she was so bloated. They can't find any other blood loss, but her hematocrit continues to drop. It was 19 when they gave her the two units of blood I wrote about yesterday. The transfusion bumped her up to 24 or 27 (I can't remember which), but this morning she was back down to 22. So, they gave her two more units of blood today. Since they can find any place where she is bleeding, they think it is probably a condition called anemia of chronic illness. Apparently this happens in people who have been through significant trauma or illness. Basically the bone marrow becomes so taxed that it stops producing red blood cells, which leads to anemia such as she has been experiencing. They said that the treatment is to support her with transfusions until the bone marrow kicks in again.

The physical therapists came in and helped Heather to stand up! That is the first time she has done so since October 5th! Of course she was extremely weak and needed help to get up and down, but it is movement in the right direction. They really want to get her moving so that she can build up her strength. She seems very motivated and, despite being tired, frequently asks to do more exercises.

I knew she must be getting back to being herself today when she asked to spell out the following sentence on the speller machine, "I am supposed to teach." She meant that she is supposed to teach relief society in church next week and was worried that she hadn't gotten anyone to cover for her. I just laughed, but she insisted that I call the relief society president, Marion Davis, to make sure it was taken care of. Marion thought it was funny too. Maybe someday Heather will get the ventilation tube out so that she can more easily communicate her needs.

Not Much New To Report

Heather is getting stronger by the day. Yesterday, with the help of the physical therapists, she sat up on the edge of her bed. Despite being very dizzy and wobbly, she was able to hold herself up for a bit. She has also been doing a lot of leg, foot, arm, and hand exercises throughout the day to build up her strength. Her breathing seems much stronger, but I'm not going to make any more predictions about when the tube will come out (clearly, I'm always wrong).

They are taking her for a CT scan this morning because the food they send through a tube that goes in her nose, through her stomach, and down into her intestine continues to come back up through the NG tube that goes in through her nose and down into her stomach. She also had some abdominal pain this morning [Imagine that! It just seems so strange that someone with three intestine joints, a recent uterus removal, and a 12+ inch long incision through the fascia of her abdominal wall would have pain down there. :) ]. They want to make sure she isn't bleeding or leaking somewhere. They had to give her two units of blood yesterday because her hematocrit dropped low. They say that there are numerous reasons that it may have dropped, but they want to rule out any internal bleeding.

Heather got a bit of spa treatment today. Her nurse was kind enough to wash, condition, and dry her hair. She also shaved Heather's legs and plucked her eyebrows. Heather's sister, Heidi, combed out her hair and braided it into a pony tail. I know Heather really appreciated being spruced up a bit. As always, Heather is wearing the latest and best fashion in hospital wear. With the high fashion label, "Central Laundry" prominently displayed on her gown.

Not Today

Heather is too weak to get her ventilation tube out today. Her muscles throughout her body are all just mush. They say you lose 20% of your strength for every week you are in bed. The goal now is to get her doing multiple exercises to increase her strength so that not only her lungs are stronger, but all of her muscles are. The doctors keep saying that she is "very, very close" to getting the tube out, but not close enough. It is kind of maddening to be patient (I mean that in more ways than one.).

Hannah Missing From Blog

Hannah has been noticeably absent from our blog, and I felt we needed a picture of her. So, thanks to my sister-in-law, Janna, I present to you the following:

We love and miss that little girl!

Still Waiting for Extubation, but Probably This Afternoon

The doctors were hoping they could take Heather's ventilation tube out this morning, but she wasn't quite ready. She is very, very close to being strong enough, but the doctors want to wait until at least this afternoon. It is clearly easier for her to breathe.

Heather seems more lucid all the time, but still a little loopy. It is nice to see her sense of humor come back. She expresses quite a bit through body language and facial expressions. The speller machine I mentioned yesterday has been useful, though laborious.

She has been working with a physical therapist to build up her strength. She still can't raise her hands or arms much at all. This may have something to do with her wrists being tied to the bed :). As you can imagine, she is very weak after having been in bed for three weeks. So, it will likely take her a while to build her strength back up.

They are still planning to begin doing the skin grafts on her legs Monday or Tuesday. When they do that, they will move her from the surgical ICU to the burn unit ICU. I'm impressed with her progress.

No Extubation Today, Probably

We were hoping that Heather could get her ventilator tube out today. Unfortunately, her breathing is just not strong enough yet. It is a bummer, but I would much rather wait and have her be ready than take it out and have to put it back in again. Hopefully she will be ready tomorrow.

In the "good news" department, Heather had her first bowel movement without the help of an enema. Apparently it was quite a doosy too. Sorry to those of you who are faint of heart, but let's just say the nurses had to clean her ankles. I guess all the laxatives, stool softeners, and bowel stimulators did their job. Great for Heather, not so good for the nurses that have to clean it up.

Yesterday they put a wound vac on her abdominal incision site. They say that this device will help her close up her wound and heal about three times as fast as she would without it. Her legs are looking really good, comparatively. The dead parts, which are significant, are all turning black. The skin in between the dead parts seems to be healing and recovering quite well. It looks like they will begin treatment (i.e., skin grafts) on her legs early next week.

She continues to communicate through head shakes, eyebrow lifts, and repeated games of "20 Questions." At times she seems really lucid, but most of the time she seems quite loopy. She sleeps a lot. The doctors say many people are a little (or a lot) psychotic for a while after awakening in the ICU. Certainly all the narcotics, etc. that she is taking don't help much with that either. She really seemed to enjoy seeing her parents last night when they arrived (They went home to Jackson for a few days and just got back last night.). She definitely recognizes familiar faces, and seems most attentive and lucid when I talk to her about Hannah.

Heart Stopped Briefly

Heather's scared us all for a moment this morning. The respiratory therapist was adjusting the air flow on Heather's ventilator and noticed that there seemed to be some raspiness in the tube. So, she began suctioning out the tube, which purposely induces a cough to pull out any fluid and/or phlegm down there. As she was doing this Heather's heart stopped. I have never seen so many doctors and nurses coming running all at once in my life. It was VERY disturbing! Before they could do anything, Heather's heart began beating again and she was fine. The doctors told me that, though this is uncommon, the cough reaction can stimulate the vagus nerve which causes a reaction in which the chest tightens up to the point where the heart cannot beat. I do not want to replay that experience ever again. It was reassuring, however, that all those doctors and nurses came so fast. They really seem on top of things.

I have talked with Heather some today, but she seems very tired. She was feeling some pain when I first got here, but the nurses quickly remedied that. In order to facilitate communication, they gave us an electronic device with oversized letters, similar to a large calculator and about the size of a piece of paper. We have tried using this to spell out things Heather wants. The first thing she asked for was, "snack." Unfortunately she can't eat anything with her tube in. She seemed quite frustrated by that. The second thing she asked for was, "date." Though I am not completely sure about it, it seemed that she wanted to know the dates of her various surgeries and the current date (She has a large, daily calendar on the wall.). She also asked to see pictures of Hannah. My sister brought us two large pictures of our family, which Heather has asked to see a couple of times. I also showed her some pictures I have of Hannah on my laptop. That is all she has had energy for today.

They moved Heather to a new room in the ICU. Because they have so few patients right now, they closed down one wing of the ICU. It's kind of a bummer, because she had a really nice, sunny view of the valley in her old room. Now she just has a cold, dark view of construction. Oh well, at least her heart is still beating.

Doing Well!

Late last night before I went to my sister's house to get some sleep I was able to sit down and talk with Heather for quite a while. She was very coherent and definitely understood what I was telling her, even though she obviously could not talk with the ventilator tube in her throat. We were able to work out a better system for her to communicate with me, and it was wonderful to feel like I was able to "connect" with her again. I was able to tell her more about what has gone on, how Hannah is doing, all that so many of you have done for us, etc. It was really nice.

I haven't seen her yet today. They won't let us into the ICU during the nursing shift changes, which are 7:00-8:30 in the morning and evening. However, this morning I called the nurse that was taking care of Heather overnight and she said Heather did really well last night. She said that Heather slept much of the night and has told her that she is not feeling any pain. The nurse was able to reduce her pain medication (Fentanyl) from 140 mcg/hr to 80 without Heather feeling pain. The nurse also said Heather's fever came down to normal, and she was able to have a bowel movement with the help of an enema (Hooray!!!!). The nurse said that it was a good, big bowel movement, and some hard stool came out suggesting that she has been backed up. I'm sorry if this seems too graphic or personal for some of you, but I know many of you want to know and I'm pretty sure Heather doesn't care. The nurse said that immediately after the bowel movement Heather's heart rate dropped to between 70 and 75, which is the lowest it has been in weeks. Her blood pressure has been in the 120s, which is great. In addition, her respirations per minute are down in the teens, while they were up in the 30s yesterday. All in all, it is great news this morning. Please keep the prayers coming! Thank you.

A Fever

Heather has done reasonably well today. It has been really nice to be able to communicate with her, if only a little. She seems scared and distressed to me, which is hard to see. She clearly wants to talk, but it is really hard to guess what she wants to tell me when she cannot say anything. It is also hard to know how much she understands about what is going on. I have tried to explain what she has been through.

The nurses who have seen many people in similar situations as Heather's say that people typically want three things: to get the tube out of their throat, a drink, and to go home. They also say that people don't tend to remember much of what is said while they are in this state. So, it is hard to know if I should explain what has happened to her repeatedly or what I can say to help her gain some sense of where she is and what is going on. She has been awake often throughout the day, but she also sleeps quite a bit. She hasn't needed any sedative, but has been given a lot of the pain killer.

Her bowels are still quite sluggish, if they are moving at all. This afternoon she spiked a fever of about 103 or 104 (39.6). They are unsure what that might be and are running several tests and cultures to figure it out. It could be infection in any number of places, her lack of bowel action, etc. They have given her an antibiotic. They have also given her a medication that counteracts the narcotic they are giving her just in the bowel. Hopefully all of that will help.

Chest Tubes Out

Heather seems to be doing quite well. The doctors took out her chest tubes this morning. These are the tubes that were inserted through her ribs into her chest under her arms. It is nice to have one more potential source of infection gone. She is also down to just two IV pumps, one for her pain medication (Fentanyl) and one for electrolytes. It's great to see all this equipment go. They did add a new gadget yesterday. She is now wearing some really cool, moonboot-looking things to protect her heals from getting sore, tender, and mooshy (Napoleon would be jealous!).

Responsiveness!

Heather is awake and can respond! It is so good to have her be awake enough to communicate, even if she can't talk because of the ventilator tube. She clearly understands what I am saying and can blink her eyes, shake her head back and forth, squeeze my fingers, and move her feet. I can't wait until they can extubate (take the air tube out) her, which may happen today but more likely tomorrow. They have stopped giving her the sedative completely now, which is nice.

Her heart rate has risen a bit (110-120), and she occasionally still has a fever that seems to come and go. Her bowels still aren't working, which is a concern. They have reduced her IV feedings and have been feeding her through the feeding tube that goes in through her nose to her small intestine. However, her bowels haven't been utilizing it as they should. Instead, it has been backing up and coming back out through her NG tube (the tube that sucks out her stomach). Part of the problem is that they are giving her narcotics for pain, but these also slow her bowels down. It is a tough balance. They are trying to get her bowel working by giving her laxatives, suppositories, enemas, and other medications to stimulate it. It is troubling to me to see her here again because this is where we began after the first surgery. Please keep her in your prayers that all of her systems can work well.

Patience Required

Heather seems to be holding steady. There really isn't much new to report. Her numbers are all really good and she is doing quite well, considering. They doctors all seem really relieved and happy with her progress. They hope to lighten her sedation, but every time they do so she seems quite uncomfortable (wincing, rolling her head back and forth, breathing irregularly, etc.), so they increase the sedation again. They say it will be slow and gradual. When she is able to breathe more normally on her own and respond to commands (eg., hold up two fingers, lift up your head, etc.) they will take her off the ventilator. It is clearly uncomfortable for her (as it would be for any of us), as she tries to bite it and use her tongue to push it out when they let her wake up at all. Her arms are tied to the bed so that she cannot reach up and pull it out. Last night, because she was biting the tube so much, they put a device called an "enforcer" (pleasant sounding, isn't it?) on her face. This looks like some kind of orthodontic headgear. It is a plastic mask/mouthpiece that prevents her from biting through her tube. It looks worse, but seems like it would be far more comfortable. Before, they just had a ribbon that looked like a horse's bridle that cut into her cheeks holding the tube in. Heather has had a bit of a fever, so they are doing cultures of her blood to find out if the elevated temps are due to infection.

The hard part for me right now is being patient, while we wait for her to be well enough to come off the sedation and to get off the ventilator. I know I should be grateful that she is doing so well (and I truly am), but I also want her to be well NOW! I'm sure regaining consciousness will not be a pleasant experience for her.

All Closed Up

We just talked to the surgeons (12:10pm), and Heather is all closed up! She still has a large wound, but the peritoneum is closed. They said that closing her up is a big step, because most people seem to really make big improvements once the body is closed. We asked them why that is, and they said they don't know. I guess the body just likes to be closed...imagine that! They again said that she will have a bandage that has a vacuum-type thing attached to it that helps wounds like hers to heal (Clearly, I don't fully understand how it works but I will try to clarify it as I understand it better.). The other advantage to being closed up is that they can begin to "wake her up" and can work towards getting her off the ventilator, the NG tube, and the feeding tube.

I also spoke with the burn doctors. They said they will likely begin treating her legs (i.e., She will get skin grafts for her legs) at the end of this week or the beginning of next week. They said that it doesn't seem to be too serious and that most of the wounds on her legs will heal by themselves.

Surgery Bumped for a Bit

Heather was scheduled for surgery at 8:00am; however, a trauma patient was flown in and bumped her to later on this morning. She will probably go in around 10:00. She is almost back to her normal appearance (minus all of the bazillion tubes coming out of her body) and is not losing nearly as much fluid as she was before. They will probably give her more diuretic to get more of the fluid out of her body as the day goes on.

In most ways it is really great to see her back to her normal appearance, but in others it is harder for me. Now that she looks so much more like herself, it feels like she should be able to just wake up and talk to me and to go home. I miss her.

Many people have asked how I am doing. Obviously, last Sunday and the early part of last week were extremely hard for me. It was almost unbearable to consider her not being a part of my life and Hannah's life anymore. It seemed like a really bad dream, and I definitely was in shock. I have been amazed at her consistent improvement and surprising lack of significant setbacks. As she has continued to do better, it has, obviously, been much easier on me. I'm very optimistic about her recovery. I get good sleep at my sister's apartment (Shalisa and Mike have been very generous to open their home to Heather's sister and me.) every night. Really, I just spend a lot of time sitting in Heather's room, holding her hand, and reading or working on the computer. I have a lot of support. My parents are here almost every day, and Heather's parents and her sister, Heidi, have been here since last Sunday. My sister, Tiauna, has generously been watching our little girl, Hannah, (and our dog, Greta) and brings Hannah up to the hospital for a few hours about every other day.

Friday night Heather's sister and I took Hannah and Greta home for a night. I hope to do that again soon, so that Hannah can remember what it is like to be home. We had fun hanging up all our Halloween decorations. I have to admit, though, that it was really hard for me to be home without Heather (especially when I put Hannah to bed and went through our usual nighttime ritual of prayers and songs).

People have been so kind and generous to us. I can't believe the number of people who have prayed and fasted for us. Many have driven long distances to come and visit us and/or to bring us kind gifts or things we need. People like Tiauna and Marion Davis have been great at being information relay points. Ginny Johnson has made several trips to bring us stuff (including a late night trip before Heather was moved to ICU to bring her some rubbing lotions when Heather's back was hurting her so much) and worked hard to harvest, distribute, and even can the vegetables from our garden. Mark Johnson made a special trip to bring me his cell phone when he heard the minutes on mine were gone (I have more minutes now). Someone mowed our lawn. Someone "stole" our Jeep along with the registration renewal form to get it inspected and ready for the required annual registration (I have heard that it was the Jarretts.). My sister-in-law, Janna, created the blog header. The young women in our ward all wrote cards to Heather, and others have sent cards, flowers, and other gifts. I'm sure that there have been many, many other things that people have done that I'm not yet aware of. I am so grateful to everyone. It amazes me (and doesn't) how much people care about Heather. I really appreciate everything people have done and have offered. Thank you!

A Little Bit of Closure

Heather went in for surgery this morning. They closed up her abdomen about 2 inches on either side of her incision. They did not use the velcro option (It's called a Whitman Patch.), but instead sewed her up using an interrupted stitch (At least I think that's what he called it.). Basically, they sewed individual, disconnected stitches so as to avoid cutting off blood supply to the area of the cut. The surgeon said that in normal cases they would sew up the person using typical stitches in which they are all connected (i.e., one single thread), but with her post-septic state they want to maximize blood flow. He also said that they do not actually sew the skin together but the tough peritoneum, which is the membrane that surrounds and protects the abdomen. They let the skin heal itself from the inside out.

The surgeon said that she looks good, and there were no leaks in her bowel. They washed her out again, and plan to take her back into surgery tomorrow (10/12) and possibly Monday unless they are able to close her up completely tomorrow. He said that her blood is now similar to that of a regular, bad, ICU patient instead being the sickest in the ICU. Her breathing tube will likely come out towards the end of next week. Onward and upward!!!

P.S. She is down to 202 lbs. It's quite a weight loss program that can bring you down 18 pounds in one day!

Surgery Tomorrow?

I spoke with the ICU surgeon this morning. He thinks they may be able to go in tomorrow (10/11) to begin stitching up her belly. He said that she seems to be draining the fluids fast enough that he will be able to begin mending her wound. They may still wait until Sunday or they may operate on both Saturday and Sunday (or possibly Saturday and Monday).

During her surgery yesterday they inserted a feeding tube through her nose and down into her stomach. However, they were only able to get it to the bottom of the stomach when it needs to go about a foot farther so it reaches into her small intestine. They will bring an X-ray machine into her room later on today that will show them where the tube is as they snake it down the rest of the way. After it is in place they will give her a little bit of food (something like Ensure) to see how she handles it and to see if the intestine leaks. They said that the food they give her must bypass the stomach so that there is no chance of it coming back up through her esophagus and aspirating into her lungs.

Heather has been moving around more. They took her off the sedative she has been taking. As a result she rolled her head around a lot and grimaced while chewing on her air tube. The doctors want to maintain a fine line between Heather being sedated enough that she doesn't thrash around and hurt herself or upset her wounds and being "awake" enough that she can come out of the sedation as soon as possible. Therefore, when the doctors saw the way she has been rolling around, they sedated her more. She is sleeping again. When she was off the sedation, she would respond minimally to me (i.e., She would noticeably blink when I said, "Heather, blink if you can hear me.").

Heather has what looks like a deep gash in her thigh, where they cut her open to take a biopsy of her leg when all the red sores were beginning to form. It looks quite bad, so I asked how they will treat it. They said that the cut isn't as bad as it looks. She was so swollen with fluids when I first saw the cut, that it made it look much worse than it is. The doctors said that when the swelling goes down, the cut will easily heal itself.

A Little Bit of Movement

Heather seemed to do well overnight. Her vital signs are holding where they have been (eg., heart rate = 85-95, blood pressure right around 125/75, oxygen level that they are giving her = 40% [this is as low as they will go while she is on the breathing tube], pressure in lungs after exhaling = 5.0 [They want it at between 4 and 5. This is down from 8 last night.]. She is down to 5 IV pumps (from 13). She lost three liters of fluid last night and is rapidly losing more; however, I found out she still weighs 220 lbs. I can't imagine what she must have weighed at her most bloated!

As they have taken her off the paralytic and sedatives, she has begun to move a little. She occasionally wiggles her head or feet and grimaces a lot. For a while this morning she seemed to be trying to chew through her air tube. I can't imagine that it is very comfortable. The nurse came in and raised her pain medication level, and she seemed to calm right back down. They want her to wake up and be able to respond to commands.

Talked to the Surgeon

I talked to the surgeon (actually his resident), and he said that the surgery went really well. They stapled her intestine back together and did not see any other problems in her abdomen while they were in there. He said that her next surgery will be on Sunday, when they take her in to begin sewing up her belly. He said that they will only sew her up a little at a time and can only begin doing so after she has lost all of the excess fluid that has build up in her body. So, they are currently working on getting all that fluid out. I can already see that those efforts are working, as her face looks more and more like the woman I remember as my wife.

The surgeon said there are a number of ways they can go about closing up her abdomen. They may just stitch her up, but they may sew a velcro-like material to either side of the cut and slowly velcro her together. If they can use stitches, staples, and velcro it seems like a zipper might be handy as well :).

There is still always the possibility for complications (eg., abscesses, hernias, other infection, etc.), but she is really doing well. Even since my last post they have taken her off several of the supports she has been on and have lowered others. She will probably "wake up" in the next day or two. It will be interesting to see how she responds to that. The surgeon told me that she has really "turned the corner." He explained that when she first came to the ICU, she was the sickest person in the ICU (That's saying something for a hospital that has the sickest patients in the region!). He also explained that "turning the corner" means that her condition is still serious, but that instead of worrying about whether she will survive through the night or not, they worry about much more routine matters that they treat with regularity here in the ICU. Hallelujah!

Out of Surgery

Heather is out of surgery. We haven't talked with the surgeons yet (apparently they tried to find us, but we were in the wrong waiting room). They will find us later to give us the full scoop, but from what I can see (sitting next to her) and from what the nurse has told me she is doing really well. In fact, she is doing better than she was last night. She looks more like herself than ever (i.e., the swelling is going down), her heart rate is at 89 (It hasn't been below 110 in days), her blood pressure is at 125/74 (normal is 120/80), she is not taking any heart medications, and they are only giving her 40% oxygen.

All I know about the surgery is that they did reconnect her bowel and they washed out her abdomen again. I will try to post again when I know more, but I'm thrilled with the news I'm getting!!!!

Surgery Today

Heather went into surgery this morning at 7:30am. They will be reconnecting her intestine. After I posted yesterday Heather continued to do really well. She improved in every way. They took her off all the medications that were supporting her heart, and her heart continued to perform really well through the night. Her blood pressure has been around 105/65, and her heart rate was in the 110s. They reduced her oxygen level to 50% (from 80% the day before), and the pressure in her lungs after exhaling came down to 10 (from 16 the day before). Her liver is performing better, and her kidneys continue to perform well. On Tuesday night they were using 13 different IV pumps, and now they are using only 7. Her white blood cell count was much higher yesterday than it has been. They are only using one antibiotic (they were using 4). They are continually reducing the amount of fluids they give her. Basically she is doing better in almost every way.

They expect that she will have some set backs in her progress after the surgery, but they still plan to slowly bring her out of the paralysis and the sedatives after the surgery is over. They will wash her insides out again (Dr. Hatasaka told me last night that during the first ICU surgery they used 12 liters to wash out her abdomen. He also explained that they pour the liquid in, kind of slosh it around, and then suck it out.).

I spent about 1/2 hour with Dr. Hatasaka again last night. He mostly just explained all the progress she is making that I have discussed above. He said that the OB/GYN Department will be having their 2-hour conference today (about 30 doctors will attend) where they will be discussing Heather's case.

I wish I could remember everything I hear, so I could keep you all informed, but it comes fast and furious. Thank you all for your concern and prayers. She really needs them this morning as she is in surgery and recovering from it.

Developments

Monday morning (10/06) at 3am the ICU called to ask for consent to put breathing tubes into her lungs because they were filling with fluid. They called again at 7am to ask for consent to take her back into surgery because she was not responding, and they feared that there may be additional infection or an addition perforation in her bowel. This, of course, was extremely upsetting.

Since that point her progress has been very slight and tenuous. We have consistently worried that she won't be able to recover. Since Tuesday she has required less medication, less breathing support, less fluid, etc. This has begun to feel encouraging; however, her progress is very slow.

A burn specialist looked at the sores/damage to her legs and said that she will likely require skin grafts, but that her condition could be much worse (the doctor said that if it extended to her hands and feet it often requires amputation).

The ICU doctors say that she is doing much better. Her heart rate is down (from the 140s to the 110s), the oxygen they need to give her is down from 80% to 60%, the pressure in her lungs after she expels air is down from 16 to 12 (lower is better), the amount of fluids they are feeding into her is down about 1 liter overnight, her ph has been quite acidic and has returned to normal, etc.

The surgeons plan to take her into surgery again tomorrow morning to reconnect her intestines, barring any down-turns in her condition. They will also insert a feeding tube at that time. They will not begin feeding her through that tube for 24 hours and will watch for leaks in her intestine for 5 days. Unless her condition is significantly worse after the surgery tomorrow, they will try to take her off the medications that keep her paralyzed and will try to bring her back to consciousness.

They will not sew her belly up until the swelling, caused by the tremendous amounts of fluids they have pumped into her body, goes down. They said that when the body stabilizes the fluids actually come out quite quickly. When they do sew her up, it will likely involve several surgeries in which they will sew up either end of the cut a little bit at a time.

I have been impressed with the medical staff here in the University of Utah Hospital. As a teaching hospital there are always dozens of doctors attending to Heather's needs and consulting with each other on how best to treat her. They have been very kind and considerate of my needs for information. It is shocking to me how much time and caring they offer to me.

Heather's OB/GYN doctor (Harry Hatasaka) and all of his department are extremely concerned about this situation and have been surprisingly attentive to what is going on. Dr. Hatasaka visits Heather at least twice per day. He spent 1/2 hour talking with me last night. Heather has multiple monitors that track everything that her body is doing. All the doctors in the hospital have access to this data. Dr. Hatasaka said that he practically has her numbers as his computer desktop. This was very evident when another doctor came in as we were talking and Dr. Hatasaka spouted all of her data trends for the day. He also explained that he has been so concentrated on her situation and how it happened that he went the wrong way while driving home the night before. He said that the OB/GYN Department will be having one of the biggest conferences ever today to discuss Heather's case.

We are pleased with her improvement. Thank you for your prayers and concern. Please keep them coming!!!

The History

Based on what I (Mark) remember, this is what has gone on with Heather:

Heather went in for a hysterectomy on Tuesday (09/30). The surgery went well, and there were no complications initially. The day after surgery went relatively well, and she was sleeping and feeling okay.

However, following surgeries such as this, people often take a day or two to get their bowels working again. When the bowel is moved around during surgery, it can get irritated. This can make it spasm irregularly and disrupt the usual coordination of muscle contractions that are required for peristalsis to take place. As a result, gas cannot move through the digestive system, and it builds up and often causes significant pain. This was the case for Heather.

Her belly became huge and bloated with gas. Everything was so swollen that her lungs were compressed and she had trouble breathing, particularly when lying down. She was quite miserable for several days. When her bowel did not recover as it should, the doctors became increasing worried. They ended up inserting a NG tube that went in through her nose, down her throat, and into her stomach so that they could relieve some of the intense pressure she was experiencing. They immediately drained 1.5 liters of bile from her esophagus and stomach (there was significant risk that if she did not get that drained off, it would begin to go into her lungs), and she continued to have significant amounts of bile sucked out over time.

With this bile drained off, she felt immediate relief and was able to get the first sleep she had had in days. However, this relief was short-lived and the pressure began to build up again. She felt tremendous pain on the right side of her chest, over her right shoulder, and down her right shoulder blade to her ribs. This turned out to be referred pain, probably from the gas and other pressures in her abdomen and under her diaphragm. This pain made it extremely difficult for her to breath.

Sleep was impossible and, not having eaten or slept for multiple days, she began to be very weak and delirious. The doctors were baffled by what was going on and performed multitudinous tests to try to figure it out. After an extremely miserable night, on Sunday morning (10/05) her heart rate was extremely high (135-155), she was having a terrible time breathing, and there were several worrisome test results and vital signs. So, the doctors decided that she needed to go to ICU and should get another CT scan to find out what was happening in her bowels.

They wheeled her down to the ICU and immediately decided that she need to be on a ventilator because her breathing was so compromised. She has been under anesthesia ever since. They wanted to continue with the CT scan, but needed to inject the bowel with tracer dyes which would take a couple of hours to get in place.

My dad had come up to support me on Sunday morning, because after spending several sleepless nights with Heather in the hospital, I was a little fragile myself. (We gave her a blessing early that morning.). While we waited for the CT scan, my dad and I went to get something to eat. As we were returning, the doctors called saying they needed me to sign consent forms for them to go into surgery immediately. When we arrived back at the ICU, the surgeons informed us that, though they could not be completely sure without operating, it appeared that Heather had some kind of flesh-eating bacteria that was quickly destroying her body, and that they needed to operate immediately to try to stop its progress. They informed us that she would likely lose her bowels, large sections of her legs (if not her legs completely), her buttocks, and other organs in the abdominal cavity if she survived at all (which was not likely). They said that her chances of surviving this were very small. They did explain that it may be a perforated bowel, but that it seemed more likely to be the flesh-eating bacteria based on the signs they were seeing in the skin on her legs and belly (deep red marks that seemed to be growing very quickly). This of course was a tremendous and devastating shock.

We spent the next three or four hours waiting to find out that it did not appear to be the flesh-eating type bacteria that they had feared, but that she had suffered a perforated bowel and resulting sepsis. This was tremendously relieving news, but the doctors pointed out that she was still extremely and critically sick and that there was a long way to go for her to be "out of the woods." When the bowel is perforated, the contents of the bowel leak into the gut, resulting in systemic infection that enters the blood and sends the entire body into a reactive shock state. The body tries to protect itself by shutting down cells, etc. The surgeons informed us that they were able to clean out the infection or treat it with antibiotics (about four of them), but that the body continues to have the reaction even after the threat of the infection is gone. This is extremely dangerous because the body is then fighting and damaging itself even though there is no real reason to do so anymore.

The doctors are unsure what caused the perforation in her bowel. They said it was star-shaped rather than a slit, suggesting that it burst rather than being cut. There are many possibilities of why this may have occurred, including that there may have been some scar tissue on the bowel from a previous surgery that weakened it or that the pressure in her abdomen burst the bowel at a weak spot. During the surgery they cut out the perforated portion and three other sections that were dark or gray, for a total of about 24 inches of the 27ish feet of intestine. They left the intestine in three separate sections, which will remain disconnected until she is more stabilized. They won't put them together until she is more stable because otherwise the connections would not heal and would result in a greater risk of infection.

The surgeons also informed us that they will be keeping her abdomen open (They put towels in the cavity and cover it with a shrink-wrap type bandage that they call a vac-pac.). This allows them to take her in repeatedly for additional surgeries or to clean out additional infection that may arise without having to cut her back open every time.

Heather also has ugly red blotches that are bleeding and blistering on her legs. They cover nearly all the skin from just below her waist to her knees. The skin is dead or seriously injured in these areas from toxins secreted from the bacteria or from tiny clots in her capillaries. It is probably the most visually disturbing result of this whole process, but the doctors see it as a low priority for her recovery.

One of the effects of the sepsis is that the cells and connections between them become porous, causing them to leak everywhere. To compensate for this the doctors have pumped massive amounts of fluids into her body (multiple liters each hour). As a result she has become incredibly bloated. It appears as though she has gained over 200 pounds and is pregnant as well. Her face is not recognizable.

So, since Sunday the doctors have been working feverishly to maintain her body and organs, until this reactive process turns itself around. This includes significant medications and observation of all her major organs to make sure they are not failing or functioning improperly. Her situation has been extremely serious (eg., On Tuesday, one of the ICU doctors said, "To be honest, yesterday I wasn't sure that we were going to be able to stay ahead of it.").

Slowly, slowly Heather has been improving ever since. The doctors seem much more optimistic today (10/08). She still has a long, long way to go, but she seems to be either holding steady or improving in every way.