Journal entry by Todd Boudreaux —
At least twice a month somebody tells Nikki, "you should write a book." She just laughs.
For five years Nikki has been telling me, "you should write a book." I don't laugh. She usually makes this remark as I am falling asleep at night. Its just one more thing on my "to do" list that would keep me awake.
So here it is. The first chapter of "the book"
Why now? It is five years to the day, almost to the hour, that she went into surgery. This first effort describes a portion of that day, the most terrifying day of my life.
Why put a Chapter on here? As an attorney, I am hopelessly controlled by deadlines. If there is no absolute deadline for doing something, that project sits in the very back seat of a very long bus with deadline driven issues seated in front. By putting it on here, I am intentionally creating an environment of shame so that anytime someone asks about the progress on the book I will be forces to stare down my feeble effort and get back to work.
Will you put all of the Chapters on here? No- in the words of the infamous Bill Clinton "Oh yeah, i gotta pay our bills." At some point there may be a product worth selling. Probably not $500,000-per-speech type money, but if that clown from Arkansas can scratch out a living telling tall tales, maybe this Cajun from South Louisiana can too.
Will you shamelessly accept input from anyone else for stories that need to be included in the book? Absolutely. Tom Sawyer is my idol. Anyone who has a memory, story, anything that touched them, please email it to me. ToddmBoudreaux@gmail.com Hopefully I will remember most of the important events of the last five years, but I will welcome everyone's memories as well. You may even get recognized in a footnote. Who doesn't want to be a footnote?
What does Nikki think about this first Chapter? I have no idea because she doesn't yet know anything about it. If history is a good guide, she will either absolutely love it or violently hate it. I have that special affect on people that way. "Too high or too low, there ain't no in-betweens." "I Go to Extremes" William Joel; Storm Front, 1989.
What about your references to the NFL? I didn't get permission.
What about the medical facts? Largely made up.
Will you use peoples real names? All characters in this story are purely fictional. Any resemblance to people, real or fake, alive or historical, is coincidental.
Why did you copy and paste the entire file below instead of attaching it as a separate file? What am I, 10 years old? Give me a break will ya!
Ok- so I've gotten home and asked my 15 year for help. You can access a pdf of the chapter through my brand spanking new DropBox account.
https://www.dropbox.com/s/8s7j27uklm7g2iw/And%20so%20it%20begins.pdf?dl=0
And so it begins....
For five years Nikki has been telling me, "you should write a book." I don't laugh. She usually makes this remark as I am falling asleep at night. Its just one more thing on my "to do" list that would keep me awake.
So here it is. The first chapter of "the book"
Why now? It is five years to the day, almost to the hour, that she went into surgery. This first effort describes a portion of that day, the most terrifying day of my life.
Why put a Chapter on here? As an attorney, I am hopelessly controlled by deadlines. If there is no absolute deadline for doing something, that project sits in the very back seat of a very long bus with deadline driven issues seated in front. By putting it on here, I am intentionally creating an environment of shame so that anytime someone asks about the progress on the book I will be forces to stare down my feeble effort and get back to work.
Will you put all of the Chapters on here? No- in the words of the infamous Bill Clinton "Oh yeah, i gotta pay our bills." At some point there may be a product worth selling. Probably not $500,000-per-speech type money, but if that clown from Arkansas can scratch out a living telling tall tales, maybe this Cajun from South Louisiana can too.
Will you shamelessly accept input from anyone else for stories that need to be included in the book? Absolutely. Tom Sawyer is my idol. Anyone who has a memory, story, anything that touched them, please email it to me. ToddmBoudreaux@gmail.com Hopefully I will remember most of the important events of the last five years, but I will welcome everyone's memories as well. You may even get recognized in a footnote. Who doesn't want to be a footnote?
What does Nikki think about this first Chapter? I have no idea because she doesn't yet know anything about it. If history is a good guide, she will either absolutely love it or violently hate it. I have that special affect on people that way. "Too high or too low, there ain't no in-betweens." "I Go to Extremes" William Joel; Storm Front, 1989.
What about your references to the NFL? I didn't get permission.
What about the medical facts? Largely made up.
Will you use peoples real names? All characters in this story are purely fictional. Any resemblance to people, real or fake, alive or historical, is coincidental.
Why did you copy and paste the entire file below instead of attaching it as a separate file? What am I, 10 years old? Give me a break will ya!
Ok- so I've gotten home and asked my 15 year for help. You can access a pdf of the chapter through my brand spanking new DropBox account.
https://www.dropbox.com/s/8s7j27uklm7g2iw/And%20so%20it%20begins.pdf?dl=0
And so it begins....
Silence and darkness. Nothing but cold, silent darkness. Other than the shivering cold, I could not feel, see, or hear anything. Sitting in the corner of the room, against the wall, on the cold, hard, plastic chair to which I had been exiled, I felt disoriented from the lack of any sensory stimulation. After the rapidly cascading events of the last week, I would have guessed that a quiet, dark room would be peaceful. It was terrifying. I have never been so terrified in my life - - heightened by the lack of any sensation...except for the cold.
Nikki was scheduled to endure a crainiotomy at 2:00 p.m. on Thursday, October 6, 2011. The surgeons would cut open and temporarily remove a portion of her skull bone to gain access to her brain so that they could attempt to repair the damage caused by an “Ateriovenous Malformation” (AVM) that had ruptured one week (to the day) earlier. In a normal brain, arteries move oxygen- rich blood from the heart to deliver the oxygen to the brain tissue, then veins bring return the depleted blood back to the heart and lungs to be “re-oxygenated.” Before the blood is exchanged from the arteries to the veins, it flows through increasingly small blood vessels and capillaries to reduce the pressure of the blood being pumped from the heart. It is the difference between washing your driveway with a high pressure washer and gently watering new seeds in a flower pot. This process also prevents the blood from ever actually touching the brain tissue that is protected by a “blood brain barrier.” Although the brain relies upon regular blood flow for nutrients and oxygen, and waste removal, blood and particles in the blood are toxic to brain tissue; it is rendered permanently impaired in the event of actual contact.
In less than 1% of the population (one in 200 - 500, more men than women) an abnormal tangle of arteries and veins divert the arterial blood directly into a vein. Because the AVM by-passes the normal pressure reduction process, the vein into which the high pressure blood is pumped becomes weakened, eventually leading to the vein rupturing and bleeding into the brain. The chance of a person’s AVM rupturing is 1% - 3% in any given year. If the AVM is noticed and removed before it ruptures, the results can be less than catastrophic. If it ruptures before it is found and removed, all bets are off. Nikki’s brain and her AVM had peacefully co-existed for over forty years. She had no warning of the AVM time bomb in her head before it violently exploded one week earlier.
Starting at midnight the previous night, the nurses in the neurological intensive care unit (N-ICU) had to withhold from her iv most of the anti-inflammatory and pain medications that had kept her relatively comfortable. By the time they wheeled her out of N-ICU at 1:30 p.m. to bring her to a “holding” room to await surgery, the pounding in her head was unbearable. Any light, any sound, any sensation sent more searing pain to the forefront. The best the nurses could do was to wheel her bed into the dark, cold holding room and place a cold compress on her forehead until the surgeons and a surgery room were available to take her.
The brain is divided into two hemisphere’s. If you have never looked at a brain, picture two loaves of un-sliced french bread pressed side-by-side next to each other. Each loaf representing one of the brain’s hemispheres. In the natural state, the “crease” formed by the touching sides of the two loaves runs down the center line of the human head. These loaves all protected by the outer shell of the skull, with spinal fluid surrounding the soft gel-like brain tissue between the brain and the skull to ensure that “...never the twain shall meet.”
The National Football League has recently brought to the forefront of the public’s consciousness the dangers of suffering a concussion. A concussion is considered a minor brain injury, and can be caused by a single blow to the head or even just a single, violent head shaking or whiplash. During this type of traumatic event, the “loaves of bread” are jostled around inside the skull. A severe concussion often involves the brain moving enough that it presses against the skull before returning to its normal place. The brain movement and contact with the skull can bruise the tissue and cause concussion symptoms.
Every NFL team is required to have neutral physicians on the sideline to look out for potential concussion events. The officials “in the booth” also look for these events, and can require a team to sideline a player if it looks like the “might” have taken a hit that might have caused a concussion. Under the NFL protocols, a one time “jostling” of the brain, with or without involving compression against the skull, invokes the NFL’s “concussion protocol” that could sideline the player for a week or more. Doing so prevents the player from suffering additional concussions while attempting to recover from the initial episode.
The NFL’s “Return to Play” process involves a five-step process without any set time-line for a full return to playing football. These steps are:
1. Rest and recovery: Until a player returns to the "baseline level of signs and symptoms and neurological examination," only limited stretching and balance activities are recommended. Electronics, social media and team meetings are all to be avoided.
2. Light aerobic exercise: The NFL recommends 10-20 minutes on a stationary bike or treadmill without resistance training or weight training. The cardiovascular activity is monitored by an athletic trainer to "determine if there are any recurrent concussion signs or symptoms."
3. Continued aerobic exercise and introduction of strength training: Increased duration and intensity of aerobic exercise with strength training added. An athletic trainer will supervise to watch for recurrent concussions signs or symptoms.
4. Football specific activities: The cognitive load of playing football will be added and players will participate in non-contact activities for the typical duration of a full practice.
5. Full football activity/clearance: A player returns to full participation in practice, including contact without restriction.
An AVM rupture, unlike a concussion, is considered a sever brain injury. In Nikki’s case, the massive blow-out in the left hemisphere of her brain had dumped enough blood into her skull to push the “crease” of her brain to the right of mid-line, pinning the right hemisphere of her brain against her skull. I watched an angiogram recorded a couple of hours after the initial rupture. With every beat of her heart, more toxic blood sprayed into the left side of her brain, causing more damage each time. Because of the severe trauma to the brain tissue, its defense mechanisms cause it to swell, pinning the left-hemisphere of her brain against the left side of her skull. This condition remained until surgery a week later. In every minute, every second after the bleed, her brain remained pinned against her skull on both sides. Unlike the NFL player, this is not a one shot injury, but a constant re-injury. There is no“concussion protocol” that could have stop the recurring injuries and let her get “back into the game” a week later. Imagine a football player who suffers a massive concussion one Sunday that leaves him unable to walk, talk, or feed himself. Instead of taking a week or more off, he continues to pound his head every day for a week after his concussion - day and night nothing but pounding. Imagine the mess that would be left in this player’s head? On this day, Nikki could only wish her condition more closely mirrored that of the untreated concussion football player.
For a week after she suffered the massive brain hemorrhage while waiting for the inevitable surgery, we tried to re-teach Nikki the alphabet. We tried to teach her to count to ten...making it only to seven. Any success that we gained was realized only after we resorted to sing-song childhood rhymes. We showed her pictures of close friends and relatives in a futile effort to have her associate names with familiar faces. Even when her eyes indicated recognition, her mind could not translate those memory into words, only uncontrolled tears.
Her speech therapist eventually helped her make progress verbalizing some of her thoughts. Some of what she expressed had only a passing semblance to actual words. She talked of having “feggs” and “cloaks” for breakfast. She tried to tell us about drinking some new-found favorite breakfast beverage that was neither coffee, tea, milk nor juice. We gave up guessing what she meant.
Before the end of the week she was able verbalize thoughts in sentences that can be described as “word salad.” In these “conversations” some of the sounds that she verbalized were actual words. However, they were all tossed as in a bowl, and we could only struggle to interpret her meaning, leaving her frustrated and visibly humiliated. A couple of days before the surgery she scared our children with a passionate, dire warning to watch out for “singing atm’s.” She seemed to know what she meant; we did not.
The surgery involved temporarily removing a section of her skull bone, repairing the malformed veins, removing the “blood ball” from the hemorrhage area, removing the brain cells that were irretrievably damaged, and replacing the “bone flap.” The surgeon warned us that there was no guaranty that Nikki would retain even the minimal gains of the last week. Worse, the massive bleed occurred on the outer portion of her temporal lobe near the intersection of the parietal lobe, deep inside her brain (not in some more convenient location on the brain’s outer covering). The surgery location meant that there was a significant chance that her brain could be further damaged by the surgery itself- - if she survived it at all.
After the nurses left the two of us in alone in the holding room, I couldn’t talk to her, hold her hand, or make any effort at providing comfort. Any such effort only caused more pain. All I could do was move away, sit perfectly still, make no sound, and not let her even be aware of my presence. All I could do was absolutely nothing.
Even after several minutes of my eyes straining against the darkness, I still saw nothing in the windowless room. With no light from around or under the door, I couldn’t even make out shapes or shadows. Nothing. No sight. No sound. No smell. Nothing.
We did not leave that room until some time after 5:00 p.m. I have no way of knowing at what time, but at some point between 1:30 and 5:00, out of nowhere, a weak, whispered voice arose from the middle of the room - - saying something that I could not understand. Just a faint, haunting, ghostly whisper.
Then silence.
Then another whisper.
Then silence.
Just like my eyes straining to see shadows in the dark, my ears seemed desperate to break the silence - - to the point that I initially thought that I had imagined the voice. But once again, the disembodied voice arose... then disappeared. Then returned...
Todd...?...
Jack...?...
Ashley...?...
Courtney...?...
Did I hear that correctly? The words were weakly whispered as questions, not answers. The voice lacked any cadence, any certainty. But why? Though these words were stated more clearly than anything I had heard from her all week, I could “see” her puzzled face, as if she was trying to figure out the meaning of the words she recited.
Todd...
Jack....
Ashley...
Courtney...
A little louder this time. Still in a broken cadence, but more as statements than questions, the relevance of the words now dawning upon me.
Todd...
Jack....
Ashley...
Courtney...
This time recited more like a grocery list being checked off at the register.
Todd
Jack
Ashley
Courtney
Now with confidence and pride, like a spelling bee champion who had finally outlasted all other competitors.
Todd, Jack, Ashley, Courtney.
I could hear the smile on her face and I could not help feel one forming on my face as well ... silently and without pain-inducing movement... when I understood exactly what she was doing.
For all of the surgeon’s knowledge and skill, he failed to understand the extent to which this player would fight to recover. Not for a football team, not for herself, but for her children. She continued repeating the names of her family members over and over again. First with uncertainty, then with steeled determination.
Even through all of her mental confusion and excruciating pain, she realized that she would never have full use of every part of her brain. But she also knew that she wouldn’t need full use of every part of her brain to preserve the memory of her children. She only needed one part of her brain on which she had stamped one copy of that memory to survive the surgery. By forcing herself to first think of the names, then verbally say the names, and then allow herself to hear those names out loud, she was activating different parts of her brain and therefore storing those memories in different parts of her brain. For the first time since entering that cold dark room, I felt warm hope instead of only cold helplessness.
Finally the mental energy required to maintain her determined focus depleted her reserves and she slipped into unconsciousness. But by that time, those names would be indelibly imprinted on as many different areas of her brain as possible, leaving her fully prepared for whatever would go right or whatever would go wrong during the surgery.
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