Journal

Journal entry by David Stanley

Kaylee had a horrific car accident around 9:30am on her way to her classes at Patrick Henry Community College. She flipped her car and rolled it on a backroad coming to rest upside down against a tree. A 911 call went out incredibly fast for a back road with no cell signal. We can not even begin to thank whoever made that phone call for her. This summoned police and rescue faster than you could expect in a rural county like ours.

The rescue squad sedated her and put a breathing tube in onsite and a Wake Forest Baptist Hospital helicopter flew her to Roanoke Memorial Hospital. She sustained devastating injuries to her neck and head. She was admitted through the Emergency Room and immediately assessed. She fractured her skull, multiple facial bones and her jaw. She damaged both carotid arteries, which carry blood to the brain. A CT scan showed brain swelling and bleeding, so she was immediately taken into the operating room to remove one side of her skull to allow room for the swelling. Later that evening, she developed a hemorrhage on the opposite side of her brain requiring the surgeons to remove the other side of her skull. They found the hemorrhage and removed the hematoma. This removal gave her more room for swelling.

She was sent to the Neurological Trauma Intensive Care Unit for more evaluations and recuperation.

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Journal entry by David Stanley

We did get some good reports this morning. The brain swelling is in check, so they are putting her on blood thinner to keep her carotid arteries working. Because of bilateral dissection of the carotid arteries, the blood thinner should help the blood flow through these arteries easier. The fear is that the ridges/tears in the layers of the wall could cause platelets to get caught and possibly start forming a clot. These clots could either start to block off the artery from delivering blood to the brain and shut it down, or release the clot into the brain causing strokes. By thinning the blood, it should flow more easily through these arteries as they try to heal. The worry there is the blood won’t clot as well and lead to bleeding out with her injuries.

Kaylee is unconscious, but she started responding to some commands, which is unbelievable! When the nurse told her to give a thumbs up, she didn't do it, but when the nurse pinched her right arm or trap and gives her that command, she slowly lifted her hand and then extended her thumb. She is moving her legs and feet. Especially when she is uncomfortable.

The doctors said they can’t believe how well she has done since yesterday. It’s a long way to go and a lot of things can still go wrong, but that was good news. We don’t want to get too excited because there are still so many bad things that can happen, but we really needed some good news.

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Journal entry by David Stanley

She is doing the same. Still responding to stuff. They are happy with her progress.

The entire team of doctors, surgeons, and nurses met to discuss next steps. They will need to do a tracheotomy to move her breathing tube and also put in a feeding line into her stomach which will be the first steps toward the surgeons being able rebuild her face and jaw. They feel good about her progress and want to start taking steps forward. There are risks with these next steps due to the damage of the carotid arteries during surgery since the blood thinner has to be stopped ahead of surgery. That window of time, along with the procedures will be a scary time.

There are still worries about clots, and the carotid arteries clotting or shutting down, along with brain bleeds because they will have to take her off blood thinners for surgery. So she has made progress, but there are many scary things to come also. 

During the rounds, they used the word "remarkable" about a dozen times!

The doctors have been reminding us that severe head trauma cases will be a rollercoaster. We will have downhill swings on this journey, so we can't get too excited with the good news and we can't get too depressed with setbacks.

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Journal entry by David Stanley

We have had a set back.

Kaylee’s brain has started swelling again in the frontal lobe area. They are monitoring it tonight and will give her a sodium treatment (hypertonic saline) to try and absorb as much excess fluids as possible to see if that can help. If it doesn’t help overnight, they may have to go in and remove part of her brain to allow more room. This will be the frontal area that doesn't carry long-term memory or commands like breathing and your heartbeat. But it does carry personality, problem solving, language and other things. They will do a CT scan tomorrow to see what is happening.

We knew there would be set backs, we were just hoping we wouldn’t already be facing one.

She also had a seizure this evening. The doctors said this was not unexpected. They are hooking her up to an EEG to monitor the brain waves and to see if they capture any seizures. It will be a 30 minute test.

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Journal entry by David Stanley

The CT scan came back and showed no additional swelling, so there will be NO BRAIN SURGERY! I can't even begin to tell you the relief that is.

The surgeons are going to perform the tracheotomy and feeding line into the stomach tomorrow at 3:00 pm. This is in preparation for facial surgery on her open fractures on Friday. We are worried since the blood thinner has to be stopped several hours before the surgery and won't start again until a couple of hours after surgery. I just hope the blood keeps flowing through those damaged arteries during the procedure.

The EEG didn't capture any seizures, so they are now doing a 12-hour EEG on her. Kaylee had a few minor seizures during the day, so they put her on anti-seizure medicine. They decided to extend the EEG testing after the CT scan. They will be monitoring her an additional 12 hours. Then tonight, she had a longer seizure that required additional anti-seizure medicine. Her heart rate reached 150 beats. It started with some jaw movement and then a convulsing, almost coughing action. She actually stopped just before the additional medicine was given, but they administered it to try to prevent any others tonight. She has started moving her legs a little more again after not moving them as much yesterday. When they drew blood during their regular tests, she moved her hand, showing that she is still reacting to pain. A good sign.

With the additional medication, she is resting soundly.

Journal entry by David Stanley

This journey is up and down for sure, but today was a good day! Kaylee's day didn't start out great, but it definitely worked out that way. She had a few seizures over night, but she was moving more throughout the morning than she had been the last day or so. She gave the neurology team a couple of "thumbs up" movements. They said her movements were energetic and definitely a thumbs up. And she moved her legs a lot more.

They took her off the blood thinner this morning to get her ready for her tracheotomy and feeding line, or Percutaneous Endoscopic Gastrostomy (PEG). The surgery started around 2:00 and the surgeon came out around 2:30 to tell us that the tracheotomy had went smoothly and she did great. Then they began preparing her for the PEG and about an hour later came to the waiting room to tell us that she had went through that surgery great also. It was such a relief, even knowing that we have many more things to come.

This evening, she is still drowsy from surgery, but is starting to move some. She is on the ventilator, but she is actually doing all of the breathing. The machine is helping as a backup and letting her lead. It's also so GREAT to see her face, where it has been hidden behind the breathing tube and neck guard.

Her left eye has reduced swelling enough to see that her eye is responding to light when they lift her eyelids. Her right eye is still too swollen and isn't responding to light yet. They are not concerned about that right now.

We are trying not to get too excited, even when we have great days because this is continuing to be a roller coaster. We still have some things coming up that will be scary and this journey is going to be a long road. But when we get good news, we have to grab onto it and hold it dearly.

Thank you all for your love and prayers. It has been amazing. Kaylee has been a warrior and I still can't believe such a little woman has so much fight in her. She has always amazed me and continues doing that.

Journal entry by David Stanley

Kaylee has had another pretty good day. She had no obvious seizures, but the EEG picked up seizure activity. We met with the doctors during their rounds and they are happy with her progress. She has been breathing above the ventilator, and she actually starts the breath for each one and the machine was just on a CPAP-like setting. They decided to take her off the ventilator for part of the day and then put her back on it overnight. That way she can get used to that again and not completely tire herself out. They took her off of it around lunchtime and she stayed off until about 6. She is back on the ventilator but with the same minimal settings.

They took the catheter out. At this point, they want to take as many things out as possible to cut down on infection-prone items. Especially ones she is showing she doesn't need. These are great steps.

They aren’t going to operate on all of her facial bones tomorrow and are just going focus on fixing her broken jaw. Neurology decided they didn't want to take her off of the blood thinner again after surgeries yesterday. They said those procedures were needed where some of the facial ones are more cosmetic, and none of that is more important than her brain. The jaw has to be fixed, so they are going to perform that surgery Friday, but while she is still on blood thinner. I'm so thankful for the decisions being made for her life currently and her long-term possibilities. Her nose will also have to have the ridge fixed or bridged, but not sure that will happen tomorrow. These are all things that can be worked on later. It would be way easier doing them now, but her safety is more important than these.

She has been moving even more this evening. They took the restraints off of her arms, and she has been moving them around quite a bit. She is picking up her right arm and flexing her fingers, like she is reaching for something around her head. She picked her left arm up and moved it around and then rested it on her belly. She hasn't been moving her left arm at all for several days, so this is new. And we love it. The nurses said she has been so active, which makes them excited.

Tomorrow is her birthday, so we hope we continue having good days and that the surgery goes well. Not sure how we are going to celebrate her birthday yet, but we're just so incredibly happy that she is here for us to celebrate it!

Thank you all for the love

Journal entry by David Stanley

Happy Birthday Kaylee!! Spending a birthday in an Intensive Care Unit is definitely not how you would choose to celebrate the anniversary of your birth, but I am so thankful that she is still here for us to celebrate it. Things have been a true rollercoaster for us this past week, but Kaylee had a good day today for her 19th birthday. She has been getting birthday cards and get well cards all day. She has had stuffed animals, a HUGE teddy bear (last night from some classmates), balloons, and other items delivered. It has been so wonderful to see this much love for her. We have a ton of love for her, but to see how many people's lives she has touched has been amazing.

She wasn't quite as active during the day, but she did well. She had surgery early this evening to fix her broken jaw. They went in and put posts in the upper and lower parts of her jaw, then wired the lower jaw (mandible for anyone wanting the medical terms) horizontally to pull both sides together since they had been separated in the middle by the break. They ran the wires up to the upper jaw (maxilla) to pull her jaws closed and then criss-crossed the wires. This will be closed for 4-6 weeks to allow it to heal back to its typical position. She lost one tooth completely and one tooth is now loose, but they hope it will settle back in and be OK. With the impact to her face, I can not believe that she only lost one tooth.

Another awesome "side effect" of the jaw repair is that she now sits properly in the neck brace. The broken jaw couldn't hold her up in the brace, so she had been slumping almost turtle-like into this brace, obscuring part of her face. Now that she is sitting up a little higher in it, we can see more of Kaylee when we look at her. It's a beautiful site!

Just after midnight tonight, Tabatha and I walked back to see her, kiss her hand, and tell her we love her before trying to lay down for sleep. When we walked in, the nurse is excited and tells us we won't believe what Kaylee just did. She said she has been giving the thumbs up on command without any pinching, just telling her to do it. She asked Kaylee to do that for us and she does. So she decided to mix it up and said "Kaylee can you raise two fingers for me?" But Kaylee didn't respond at first and the nurse said, "Oh, now that your parents are here you're going to make me into a liar?" So she asked her again to do it, and Kaylee gave a peace sign with her index and middle finger! This is definitely a first. The nurse said earlier that she went about her work after getting Kaylee to do that, and came back 15 minutes later and said "Kaylee, can you raise three fingers for me?" And Kaylee raised her pinky, ring finger, and middle finger, while holding down her index finger with her thumb! Which is EXACTLY how she shows three. We are just beyond ecstatic! Those are not reflexive responses. She heard those commands and did them. Tabatha and I both cried happy tears in her room.

Thank you to everyone who reached out for her birthday, and sent cards, and dropped by to see us on her day. We celebrated it with her, but it will be so much better when we can celebrate it with her.

Journal entry by David Stanley

Kaylee was on the ventilator last night to rest and then came off the vent at around 4am. And she has stayed off of it all day and all evening. They are going to let her keep going and see how she does, but so far she has shown no sign of slowing down on it. That is scary because I don't know her strength, but exciting that they feel like she is doing so well in her two trial runs that they are just letting her keep on going. Her vital signs are still good. Her heart rate is a little high, but again, they said this is totally expected in such a traumatic experience.

For the first time, her right pupil reacted to a light test. Her left eye has been doing great with that, but the right hasn't reacted to light yet. It isn't much, but it reacted a little. Her head has leaned to the left today, so her left eye has swollen and they couldn't test it tonight, but there's no reason to think it wouldn't react just like he has been.

She is raising her right hand and rubbing the top of her head. I don't know if it is because of the staples on the incisions from the skull removals or because her hair is growing back already. It's kind of fun to watch her raise her arm and then rub the top of her head. It's the little things! The nurse put medication on one of her cuts on her forehead, and right after she was finished, Kaylee raised her hand and rubbed the medicine right off. With purpose. I said to the nurse "Did you see that?" and she just glanced at Kaylee and said "I sure did."

The one issue that has come up is that they are testing her for C. Diff (Clostridium difficile). They said that this is common for patients that are on antibiotics for this long. The antibiotics kill off a lot of good bacteria in the gut also, and C. Diff is an opportunistic bacteria that grows with this deficit of the good bacteria that keeps it at bay. We won't know results until sometime tomorrow afternoon. So right now, we have to put on a hospital gown and gloves to go in and see her.

Thank you for the texts and calls today, and for the people who came over to see us from all over, from Patrick County, NRV, and all the way from Virginia Beach! We love all of you who are reading this and messaging with us. You can not begin to know what your love and support has meant to us during this time. We can never repay all of you for your strength and love. Anyone who wants to visit, please come to the 9 South waiting room on the 9th floor. If you check in at the lobby, they will tell you her room number, but that is inside ICU, so you should visit the family in the waiting room near the elevator lobby.

Journal entry by David Stanley

We will start with the not-so good news, but it's not terrible news. Kaylee tested positive for C. Diff. They weren't surprised at all about this and said probably 95% of ICU patients will get it. They are treating it now. The surprise was that the blood culture from the other day came back positive for MRSA (Methicillin-resistant Staphylococcus aureus). This is also not uncommon, but hearing MRSA made my heart sink. They are treating it with a higher powered antibiotic. She is coming off all of the other antibiotics tonight at midnight except for the new ones for C. Diff and MRSA. They said they wouldn't consider this a setback. It's always possible in this setting and they are now treating it.

Now to some good news. She is raising her left arm now. She hasn't been moving it, but she is now. She lifts it above her head and then lets it crash back down onto herself. When we raise our arm and then lower it, we know gravity is going to pull it down faster as we let it fall, so we actually work to hold it up while it lowers. She doesn't do this yet, so when she goes to lower either arm, they just crash down onto the bed or her lap. She scratched her nose with her right hand last night, but I also saw her scratch her nose with her left arm today. She has went from no movement, to some pretty fine motor skills on that scratch. It's nice to see her moving it.

The nurse told us that she also gave a thumbs-up on her left hand. This is also a first for her. She was sitting with her legs crossed and the nurse asked her to straighten her leg, and she did. Then she said she was done, and Kaylee pulled her leg back into a crossed position. She then told her "Your Dad is in the doorway, can you wave at him?" and she lifted her arm and flapped her fingers down to her palm and extended back into the air and back down multiple times! That was so great to see.

The nurse also asked Kaylee if should could open her eyes, and she tried to raise her eyelids! She could barely open them due to swelling and the moisture gel they are using on her eyes, but she tried to lift them. That was awesome to hear.

She is still breathing totally on her own and they have now removed the ventilator from the room. I was scared a little at the idea of going all day and night with no backup, but she has done great with it. The respiratory person said she has done perfectly. Her breaths per minute started out at about 33, so they were more frequent and more shallow, but she is now at about 22 breaths per minute. I just can't get over all of the things she can do.

Thanks again for the visitors today. We even had a couple who were there with her right after her birth down in Charlotte. Thanks for the love and prayers that are still going up. You all mean so much to us.

Journal entry by David Stanley

Kaylee's schedule this morning was completely packed! She had Occupational Therapy from 9-10, then Speech Therapy from 10-11, Physical Therapy from 11-Noon, with Recreational Therapy in one of the sessions with Physical Therapy. She had Music Therapy at 3:30 as the only afternoon session. She took one nap right after lunch and then didn't have another nap until this evening. She was a trooper today, and she only took headache medicine once this morning. 
 
Breakfast is always interesting to see what Kaylee gets and then what she will "eat" from the tray. She had milk, ensure and then a little yogurt. She drank all of the milk and ensure and Tabatha tried to get her to eat some of the vanilla yogurt. Kaylee said she didn't like the smell of it. Tabatha pulled the spoon back to smell it and Kaylee saw her pull it back and then said "don't even act like it's an airplane" and start making noises while you're feeding me. She didn't end up eating much of the yogurt.
 
Occupational Therapy came in and they played Rummikub, which some friends of ours brought for her. They read through the rules, but she did simplify it just a little for the first time. They focused on making "runs" which are just getting numbers lined up in order, like 1,2,3 and so on. There are multiple layers to the game, but they just started it a little simpler to learn the game and see what she thinks of it. She enjoyed it and she did really well with it.
 
Speech Therapy then came in and took her to the little gym. She worked with her and then played Kanoodle. She did really good with this and she said she will add more things tomorrow to add more difficulty. The last little bit of her therapy focused more on words and their relationships. She gave 4 word groups and then name the words listed that matched what the therapist wanted. An example of that was when she gave her the words "coal, snow, teeth, and grass" and then asked what things were not white. Kaylee had to remember the words given and then give the ones that didn't match. Of course, Kaylee had to make a joke and said not everyone's teeth were actually white. The therapist laughed and said that's true but Kaylee gave her the correct answers. After going through several of those, the therapist then started giving her 5 words and she had to pick out ones that fit the question or didn't fit. She did great with these too.
 
Physical Therapy had Kaylee play volleyball with a balloon, which is cool since she played volleyball for so many years. They had her concentrate more on playing with her left hand. She also had a lot of fun laughing with, or at, the therapist assistant who wasn't very good at playing that. She batted a ball while she named animals, but had to alternate using different letters of the alphabet. She again climbed the flight of stairs, but she did have one issue where she reached for the rail and missed it and started leaning forward like she might fall, so the therapist had to grab her hard and pull her back. I think it scared all of them, but the therapist said she didn't think Kaylee would actually fall, it was just enough to get everyone on high alert! She also played a little kickball, but then they had her focus on the left foot. She definitely had more trouble remembering and controlling it with the left foot. She then had to walk forward and backward while throwing and catching a ball. Sometimes, she would talk too much that she would forget to throw the ball. I have no idea where she gets all of this talking from...
 
The plastic surgeon who operated on her jaw came in today to see her. We had an appointment scheduled with him tomorrow, and had transport setup already, but he was in the hospital anyway, so he went ahead and stopped in to check on her. He hadn't seen her since she moved over to rehab, which is now almost 3 weeks. He said he was floored by how well she is doing. He was genuinely excited about her progress, so he scheduled an X-ray of her chin to see how the healing was going with her jaw. We will find out more about that x-ray in the next few days, and that will dictate when she gets the wires taken out. She will be so incredibly happy about that.
 
We met with the patient care coordinator and social worker this afternoon. They relay everything that is said in the doctor's rounds on Tuesdays and also what the new goals are and tell us what the therapists have been saying about her. They said one word they heard several times from the therapists was "awesome." Physical Therapy said she is doing great, Occupational Therapy said she has great attention and is doing well, and Speech Therapy said her attention is so much better. She needs to work on getting her attention span even longer when she is reading, and also slowing down. They said she is doing almost all of her own balancing and at worst now, they are doing 20% of the balancing for her, but that is after a lot of walking or work. Everyone feels like she is doing so good.
 
We love hearing these great reports. We know she has a long way to go and a lot of things to work on and improve, but she is meeting and exceeding her goals as they work with her. There are a new set of goals now and I can't wait to watch her tackle them.
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Kaylee’s Story

Site created on December 10, 2019

We will be posting updates about Kaylee so that we can point everyone to the same source of information. We can not even begin to thank everyone for their love and prayers since Friday, December 6. This has been a nightmare for us, and we have a long way to go.

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