Welcome to Alex’s Caring Bridge. Let's catch you up to speed on this living nightmare. Having your support and prayers make everyday a little bit brighter and Alex stronger.
(I am Elisa, Alex's little sister and a Cardiovascular Nurse Practitioner and will be updating this page. I will explain his condition and prognosis break it down to terms to help explain this terrible and extremely unexpected series of events.)
Lets start on a wonderous Happy note! Alex and Amanda welcomed their second child Arrow Bucholz into the world on Monday, December 5th. Alex was excitedly present at the bedside catching Arrow as she flipped into the word. She is a beautiful baby girl and the apple of his eye and love at first sight (the profile picture is the first time Alex held her). Arrow was a healthy baby girl and Amanda's recovered quickly, and they were happily discharged home the following day. Alex stated as they drove home how happy he was and how great it was to be bring their new baby home. Alex is a wonderful father, true one of a kind, rare type of father; he has always been extremely hands on and vigilant raising Ayden and he was ecstatic about having Arrow.
December 8th: A real nightmare: In the morning Amanda awoke to gurgling noises coming from Alex (about 6:50am). He was unresponsive, had no pulse, and EMS was called as Amanda proceeded to do CPR until they arrived.
I did not get to review the official report from EMS but the Intensivist reports she was able to get some unofficial information: he was found to have cardiac arrested, they performed 4 rounds of cardiovascular life support (which is suspected to breakdown to about 20 minutes of no profusion (oxygen) to the brain). During life sustaining measures his heart rhythm converted to PEA (pulseless electrical activity), and he was transferred to ER. In the ER, He was placed on rhythm controlling medication, sedated, and intubated. He was transferred to the CV-ICU for further management.
Testing had indicated low potassium, Echocardiogram (sonogram of the heart) with significant abnormalities: ejection fraction is 20% (normal is 55-65%) and indicative signs of Takostubo syndrome (stress induced cardiomyopathy). Alex fortunately had an echo a year ago to compare that at that time, was normal.
December 9th: Stabilize the body-the prognosis
Cardiac wise Alex was taken off the dobutamine (a medication that helps control blood pressures and enhances cardiac output) early in the day and has been in normal rhythm. Alex was stable from a cardiac standpoint.
Now the concern is brain. How much damage has occurred due to the lack of oxygen? (The longer the time without oxygen the more extensive the damage). The pitfall for Alex is we do not have a clear time of when Alex's heart stopped as this occurred while he was asleep, so we don't know how long the brain was truly without oxygen. So, let's talk neurology. Alex has continuous EEG (electroencephalogram), monitoring to his brain for seizure activity as this can occur from the hypoperfusion (lack of oxygen). As they began to re-warm his body (he was placed under therapeutic hypothermia to preserve neurologic status as soon as he arrived to the ICU), he began to have seizures; this is not good and a telltale sign of poorer prognosis. Alex was started on 1 anti-seizure medication in hopes to cease the activity. As the day endured, despite medication, the seizures prevailed and 2nd anti-seizure medication was added, his maxed dose of versed was overridden and increased and he was medically paralyzed (to ensure cleared eeg readings). All of this worsening his prognosis. His seizure activity did stop. Unfortunately, the hospital policy does not allow visitors after 6 pm so we sadly had to leave Alex's side and praying for an uneventful night for Alex.
God is present: As many may and may not know the Bucholz family is Catholic and believes strongly in the power of prayer. We had requested early in the day for Chaplin services. By chance, as the Head of Chaplin services stopped by the room to introduce herself and discuss what services they offered, the Catholic Preist who works in the department was walking by and was available to come and provide Anointing of the Sick for Alex. For those of you who are not Catholic, this is one of Seven Sacraments that is administered to an individual to bring spiritual and physical strength during illness, especially when they are near death. My eyes welled with tears, my body shook with grief, as I clung to my mother as we prayed over him with the priest. My heart was sinking as I repeat words that I have only recited when praying over my loving grandparents at the end of life, nothing I ever imagined I would do over my big brother. As we prayed, my gaze diverted to the monitor above his head, and I watched as his heart rate rose along with his blood pressure. God does work in mysterious ways, and I do believe there is power in prayer as does my family. The Wagner Family has created a space via Zoom in which we all can connect from anywhere in the world to pray the rosary for Alex. (All are welcome to this space to come pray, share memories, and heal. I will provide the link and post what time the meetings are).
December 10th: Day of rest Upon arrival to the ICU in the morning it was reported that Alex had had no further seizure activity over night, this was good news. Alex's treatment plan for Saturday was changed to a day of rest. The plan originally this day was to wean medications but due to his physical assessment by the neurologist she found the promising sign of pupillary reflexes, which resulted in a change in treatment plan to let the brain rest and allow more time to heal. The focus of the day is no seizures and maintain his status at this point. The day proceeded as planned, Alex assumed no changes to his treatment plan and had day of rest and healing.
December 11th: Pray for no seizures Sunday was a day of pins and needles as this was the true test of prognosis. Alex was to begin weaning off the versed (a medication used for the treatment of acute seizures and induce sedation). The weaning process the neurologist chose was a lot slower than the usual, she wanted to go extra slow as Alex required a higher-than-normal dose of the medication to control the seizures in the first place, this process was going to take 20 hours. Sunday was going to be a long day... He began his weaning process from 20mg at 7 am down to 18mg....and the clock began. Time ticked by slowly as Amanda and Karla stayed at the bedside with Alex and kept all of us at house updated praying for no seizure activity. 1pm came around and text was received! No seizures, Alex was weaned again down to 15mg and to clock began to tick again..... A second text at 3pm, No seizures, he was weaned to 10mg. Around 4:30 pm the neurologist returned to the room. She reported at 10mg of versed Alex's EEG was showing a propensity toward seizure activity, our smooth weaning process halted. Due to the concern of a seizure the neurologist decided to halt weaning overnight as he had also spiked a small fever. 6pm arrived and visiting hours ended and Amanda and Karla had to sadly once again say good night and goodbye, praying for an uneventful night. To our Suprise, they did end up weaning him down to 5mg at 3 am and the versed was turned off at 7am.
December 12th: A day watching and waiting. We arrived punctually at 9 am the start of visiting hours. I broke the rules today as I had only visited with the neurologist, Dr. Espanosa, over the phone due to the strict "2-person policy" enforced by the ICU and I wanted to meet with her face to face as today she was going off shift and a new provider would be assuming Alex's care. We were welcomed with news that Alex was completely weaned off the versed at 7 am and has continued to have had no further seizures, the plan was to watch him till noon and plan from there. Around 1pm was the "change of command" the intensivist and the neurologist introduced their replacements. I am sad to see them go as they have impressed me with their bedside manner, empathy, and flexibility to communicate with us. Plan this afternoon, continue to stay off versed, continuous eeg monitoring will be stopped, and MRI will be done later today. The MRI will give us an idea of the extent and type of damage sustained to the brain. Discussion for prognosis with be tomorrow.
December 13th: MRI results This was a pivotal day. I have stood at beside with providers when telling family bad news, it hurts to watch them breakdown, but the ability to think, process, and rationalize is still intact when you're the provider. I am not a provider in this situation, and I am numb and having difficulty typing this update, so I apologize for the incompleteness of my note, but I do not feel like typing this, but I feel a duty to all of you who are so loving and caring in Alex's situation that the least I can do is try. The MRI shows significant damage to the cortex (our Alex will not be the Alex we used to talk and interact with). Whether Alex does wake up at all is unclear, likely he will be in a vegetative state. Today Alex will rest, no decisions will be made. Please keep him in your thoughts.
You all know how strong and intelligent he is, how motivated and driven he has always been, and how compassionate and empathetic he is to ALL. I do not understand how something so terrible happened to someone who was all good.
We ask for prayers; we truly need a Christmas Miracle and God does work in mysterious ways.
I will have to continue doing updates via the "update section" as I have hit the max characters for his "story"
This is a brief update as I am hoping it will reach many and send more prayers.
Alex’s respiratory status has worsened, his body is fighting himself. Alex will not survive without sedation and paralytics as he will go into respiratory arrest.
His DNR (do not resuscitate) was signed this morning.
Alex had wished to be an organ donor.
Arrangements have been made.
Alex will be transferring to the Operating Room at 10pm standard pacific time to give others a chance at a happy and healthy life.
Please pray for his soul, pray for our family, and pray for those who are lucky to receive one of his last gifts for a safe and healthy recovery.
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