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10/15/2016 Latest post:
On the evening of Thursday October 13th Bob was in a serious bicycle accident near his house in San Francisco.
Anne had been at a park with the dog and had picked up our veggie box and Bob had been out for a bike ride. They were going to meet up at home and go to a movie. Anne talked to him while she was at the park and knew where he was in his route home. As Anne drove home she saw some folks out of their cars in the right lane of a 4 lane (2 each way) boulevard city street. She saw that a cyclist was down and thought, "Hope that's not Bob," realizing that he might have taken this road home. Then she saw that it was him. This was just a couple of minutes after he had been hit. The driver fled. It was obviously a high impact crash. He was slammed into a parked car and was thrown forward. The police have opened a case on this and Anne left a message with the detective Saturday morning. We do not have much more information at this time. The first two people who got to him were a doctor from UCSF (an ob/gyn) and her neighbor, in front of whose house the accident occurred. They had already called 911. Anne was able to be with Bob through the relatively short wait, and all the initial (rapid) assessment and back-boarding. Then Anne went home to drop off the dog and veggies and go to the hospital.
Right now Bob is in the neuro ICU at San Francisco General Hospital and is stable and heavily sedated. The most serious injury is to his brain, with the left temporal and frontal lobes being the most affected as far as anyone can tell. The first 5 days or so after a brain injury are critical and things can change quickly. On Thursday night doctors removed a pretty large blood clot from outside his left hemisphere (from a subdural bleed). They temporarily removed part of his skull (the opening is covered by skin) to accommodate any (inevitable) brain swelling that will happen over the next couple of days. They put a drain into his ventricular system (fluid cavity inside the brain), but there has not been much output from that, which is good.
They have a sensor in the cortex to monitor oxygen to the brain and that has been good. To keep the oxygen levels good they have had to modulate his blood pressure, keeping it up in the normal range. Fortunately they have been able to back off the "presser" medication as Bob's own system takes over keeping his BP normal. The most promising thing is that he is making purposeful motions in response to stimuli, especially when his sedative levels are lowered. He works his left arm a lot. The right arm is more quiet, but it will move too sometimes, and his right leg is more active than is right arm (all classical neuro anatomy showing itself here). Of course another promising thing is that Bob was in fantastic physical condition prior to the accident. In addition to the head/brain stuff, he has a fracture of one of his vertebra (T10) which is unstable. Since he is not moving around much this can be left alone until later, but this is the second-most concerning thing for the neuro team.
He has pelvic fractures, which can result in bleeding, but there doesn't seem to be much blood loss going on. He did get some transfusions Thursday night, but none needed since and his red cell count is stable. The pelvic fractures themselves are not a huge concern at this point. The bottom line is that this is really serious; he may not recover. It is also possible that he may recover significantly. It is highly likely that he will have some type of permanent brain damage. The next few days will tell us a lot.
There has been a tremendous out-pouring of love and support from family and friends! Thank you all so much for the calls, texts, facebook messages and hospital visits. We will update this site with more information as we get it. We will also post more specific ways you can support Bob and his family.