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October
4
2019

October 3, 2019

9:28pm
Diagnosis: arachnoiditis/leptomeningitis.  Can you say that 3 times fast?  This is the diagnosis of dad's infection in the spine.  Here's an anatomy lesson of the central nervous system.  Imagine a peanut-covered M&M.  The peanut represents the brain and spinal cord.  The thin translucent film over the peanut is the "pia mater."  The chocolate is the "arachnoid mater" and the hard candy shell is the "dura mater."  These layers are surrounded by spinal fluid and protected by the spinal canal.  Dad's infection was within the "chocolate" and "translucent" layers of his central nervous system.  The doctors are unsure of the etiology(cause) of the infection and have considered a superficial skin wound that got infected, but also considered the urine or lungs as a possible source. 

I had the privilege of reading dad's medical records this evening and I was shocked to see that for 6 days at UNM, the leading diagnosis was malignancy (cancer) based on the findings of his MRI that was done upon arrival.  It was not until Dr. Allen examined my dad that she was honest and forthcoming about this possibility, whereas the doctor from the night before only reluctantly mentioned cancer when my dad pushed him for his "gut" feeling about the cause of his symptoms.  And in those 6 days prior, we were left to wonder if it was musculoskeletal vs infectious (my leading diagnosis due to his fever, neck pain and back pain, since he was in Taos).  As I poured through each progress note and consult note, I could see the uncertainty in their thought process as other diagnoses were being considered including malignancy, but also mentioned was discitis, pneumonia (though there was never any clear radiographic evidence for this) and other serious infections including tuberculosis.  Dad's clinical presentation had the doctors stumped (thanks for not reading the textbook, dad!), and it was only with time and some serious detective work initiated by Dr. Allen did that picture start to come more into focus.  The internal medicine team was astute to change dad's antibiotics he got in Taos to a regimen that was more in line with meningitis while Dr. Allen guided the lab and fluid testing to optimize the antibiotic regimen, with helpful input from Neurology and Neurosurgery.  

As I reflect on this past two weeks, I feel like I have traveled around the world twice.  The emotional and physical toll it has had on my dad is hardly noticeable as you see in the photo below.  When I told him the medical diagnosis, he responded with "It's tough being a man baby," and he leaned back with a swagger and raised his arms to the side.  Really dad?  The patients here are going to think you're just here for the free food!  Today he has looked his best, and most like his old self.  He painted my mom's nails (a favorite activity) and even tried to do the "floss" (it was EPIC).  He likes to joke about picking up his walker when he walks in the halls and only puts it down when he is walking across a nurse or doctor (seriously dad, you're going to get kicked out of here!).  We enjoyed another meal from El Patio in Albuquerque, and as mom says, "it is the closest to a home cooked meal."

Dad continues to make friends in rehab as when he was at the hospital.  The nutrition aide calls dad "hito" but I think she is younger than him.  His night aide is from Cuba, is Navajo, and has a zest for her job with sincerity emanating from her personality and empathy for her patients.  His nurse Jessica recently moved from Michigan and she is looking forward to the milder NM winters.  His roommate is healing from a brain bleed, and in his younger years was a successful trial lawyer who once had Donald Rumsfeld as a plaintiff witness for a client he represented in a worker's compensation case. He won the case, needless to say. He also went to grade school with Vice President Joe Biden, and you can guess who he is voting for in 2020.  I shared a lovely time with him and his wife, visiting about the Iowa caucuses and the freak show that is our current political system.  We debated the pluses and minuses of each of the candidates and they are active consumers of the political news landscape, with a keen eye on the upcoming election.  Dad makes every person feel like they are the only ones in the room, giving them respect and sharing much about himself as well.  As his roommate's wife left for the night, she thanked me for the nice conversation and she is grateful to have met dad, that in the short time they have known one another, she knows we come from a special family. 

I will be traveling back to Iowa tomorrow to be with Zeferino, Joaquin and Elias. Wow, I have missed them so much.  But I also have thrived here in NM.  I have been sustained by the green and red chile, the sopaipillas, the crisp Fall air and the love, care and friendliness of those around us during this time.  Being with my nuclear NM family has strengthened me in ways that will carry through as I travel across time zones and state lines.  I know I am blessed to have a wonderful and funny and loving father, mother, brother and sisters, and the love expressed from all of you during this journey has kept my cup overflowing.  I will return to Iowa with a renewed sense of purpose and energy, not that it was ever lost or depleted, but something about being home allows my batteries to recharge both emotionally and spiritually.  I am so proud to be able to advocate for my dad and other loved ones in my capacity as a physician, but I am as equally proud to come from a family that taught me how to be the person I am today. 

Thank you for reading, for walking this path with us and for keeping my dad and our family in your thoughts and prayers.  For this, we are grateful.

Lisa

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October
2
2019

October 2, 2019

11:59am
Dad is at Lovelace UNM Rehabilitation Hospital, room 203-1. 
Today he has been visited by Speech and Language therapist Mindy, Occupational Therapist Lauren, and his nurse Toby, along with patient care tech Mia.  I met Dr. Sloan, the Physical Medicine and Rehabilitation physician.  He had a shower today and is optimistic to be starting his therapy. , 

As dad was transferred, I knew that I wanted to get a gift for the floor nurses at UNM-HSC 5 South for all their care of dad.  I looked up suggestions online and learned that writing a letter to the hospital CEO is also a way to extend our gratitude so that it becomes a form of public appreciation, which often means that nurses get recognized within the institution.  I mailed the letter yesterday and some highlights are seen below:

"He arrived on the 5-South Neuroscience floor and was admitted for inpatient therapy.  He was cared for by the Internal Medicine Green Team and admitted by Dr. Peck, resident in Internal Medicine.  We were very frightened about his medical condition as there was mention of meningitis, pneumonia, spinal cord damage and ultimately a concern of malignancy.  The subsequent days were filled with new teams of nursing staff, nursing aides, patient care technicians and the medical teams including Neurosurgery, Neurology and the Internal Medicine Green Team.

Since you haven’t yet met my father, it’s important to know a little about him.  He is a self-taught woodworker and artist, well-known in New Mexico for his northern New Mexican hand carved furniture and church work including the altar screen of the Sante Fe Cathedral. He has lived his whole life in Taos, New Mexico and he is known for his humor, humility, humanity and compassion.  This hospitalization was his first hospital stay for any medical condition, as he was otherwise very strong and healthy. 

He made every effort to learn the names of each staff member he came into contact with, from the housekeeper who cleaned his room daily to the Internal Medicine Green Team resident and attending doctors (Dr. Stoltze, Dr. Miller, Dr. Redford, Dr. Kelly, Dr. Peck and medical student Jon Rostas), Neurology (Dr. Abbas),  Neurosurgery (Dr. McKay and Dr. Ricks) and Infectious Diseases (Dr. Sarah Allen)  He also formed special relationships with the nurses and many other staff on 5-South.

Each staff person (from housekeeping to the physicians) showed my father care, kindness, compassion, patience and respect.  They all soon learned that he had a tireless sense of humor, and despite being in 10/10 pain, he was treated with the same care I would give to my family members. My dad made each person feel comfortable and acknowledged, and they returned the sentiments in words and actions. They were patient with our questions, and soon the staff on 5-South came to know our faces, as we spent most of the day with my dad, hoping to speak to any of the doctors about his evolving condition.

We soon understood that communication between teams in a busy academic center is important, and it was inevitable that there would be transmission of different information from different teams.  This was challenging, but as a Family Medicine physician, I was present to help advocate for my father and interpret the medical information, but also to encourage the physicians to communicate with one another between teams.  They were gracious to heed my concerns regarding improving his mobility and basic functions including bowel and bladder care and I felt they trusted my input regarding other questions about his medical care.  I was particularly grateful to Dr. Redford with Internal Medicine and Dr. Sarah Allen with Infectious Diseases, who welcomed me as part of my dad’s care team, keeping me in the loop of any new medical information, with my father’s consent, of course.

In addition to advocating for him at the bedside, I also interacted with other personnel at the hospital, including Mae in Medical Records, and various other employees in the Pavillion Café to the cafeteria.  We did not cease to be impressed with everyone’s kindness and hospitality.  You should be proud of the team of personnel, staff and medical professionals that have been cultivated and whom you have helped support in your role as CEO of UNM-HSC.

My father received excellent care from his physicians and nursing and support staff team, and by the grace of their medical training and our faith in God, he has made a remarkable recovery.  He was discharged to Lovelace UNM Rehabilitation Hospital here in Albuquerque to build up his strength and return home to Taos. 

This experience has united our family in more ways than we can imagine, and we are so proud to know that the University of New Mexico Health Sciences Center was where he received his care, which not only helped him recover, but also allowed us to be active participants on this journey.

With gratitude and appreciation,

Eleanor Lisa Lavadie-Gomez, MD (daughter)

Carolyn Sainz Lavadie (spouse)

Jose Lavadie (son)

Anita Bulnes Lavadie (daughter)

Celina Lavadie (daughter)"

In addition to the letter, we attached a photo of dad wearing the UNM Hospitals teal t-shirt.  I hope this makes waves to bring congratulations to the nursing staff for their excellent care of dad.  

Mom and I found a fabulous chocolate shop in Albuquerque called Chocolate Dude and we gifted the 5-South nursing "family" with a box of fancy chocolates, along with a card and a copy of the letter, and dad's photo, just so they remember who dad is (how can they forget?!).  Mom presented the gift to the charge nurse Cecelia and she was so touched, displaying a big smile and she hugged both mom and me before we left.  There's nothing like the feeling of paying forward gratitude, it's really a true gift for us too.  

May you all find those daily pockets of gratitude in your lives!  
Lisa

October
1
2019

October 1, 2019

11:09 am

This will be a quick post but dad’s tests have all come back normal or improving. There is no evidence of malignancy (cancer). Dad’s clinical course has made the greatest improvement since he’s been on antibiotics.  He should be discharged to rehab today with Lovelace-UNM. Dad has a peripheral IV line called a PICC line for the IV antibiotics he will get for at least 2 weeks. He will have an MRI in 1-2 weeks to get another image of his spine. His OT and PT will occupy 3 dedicated hours per day in rehab. 

Mom and I are taking Celina to Portales today. Jose stayed back in Taos to work in the shop. Anita and the family are in Santa Fe and we look forward to a few more visits together before I head back to Iowa on Friday. 

Jose and I shared a blessed day at San Geronimo in Taos. I’ll update the post later with details. 

I had great run in Rio Rancho this morning as the sun rose. 5000ft elevation is no joke, and as I neared the end of my short run, I remembered the “blessing is in the discomfort.” 

May you all find those blessings today! 
God is good!
Lisa

September
30
2019

September 29, 2019

9:11pm
Dad got some fresh air today!  He had not been outside in over a week.  I wanted him to get outdoors sooner, but logistically it can get complicated on a busy inpatient floor.  He continues to feel better, stronger and the most like himself.  He remains off oxygen, and bowels and bladder are working well.  He was visited today by Dr. Stolze with Internal Medicine, and Dr. Allen with Infectious Diseases.  So far, we know that dad had an infection in his spine with symptoms consistent with meningitis.  The cause of this infection remains uncertain, and does not appear to be an infection in the lumbar disc, per radiology.  Dr. Allen continues to want to search for possible causes, and some additional labs were ordered in addition to another blood test and urine test.  The doctors are honestly stumped, and dad has inadvertently become the most interesting patient on the service (no one wants to be the most interesting patient because of diagnostic uncertainty), but I would argue he's the most beloved by staff and doctors. 

Today his nurse was Cathy (who is getting excited about retirement so she can go traveling with her husband), and Angelique from Penasco was his nurse (whom dad calls Hijita -- "NM true!"), Eugenie was his medical assistant from the Congo and she was great.  Dad was moved to a different room on the floor due to newly arriving patients that will need to occupy his room.  He will have a new roommate. In the short day that dad had a roommate after his tocayo Robert left, he shared the room with a nice man named Richard who lost the ability to speak and swallow.  His daughter and son were at his side, and he communicates now by writing on a pen and pad.  His son says it was such a difficult disease because his dad spent his whole life as a communicator.  They were not aware of a diagnosis at this time and his son Rick was dutifully getting dad's info about getting his assets in order.  There's nothing like a significant illness to trigger motion towards advanced care planning. 

We had a nice visit today with Max and Charlotte from Taos with their daughter Alexia.  We all "broke bread" together, rather, we gnoshed on ribs, barbeque chicken and fried chicken with all the fixings.  Thanks Golden Pride!  We enjoyed the meal outside in the courtyard off of the North Pavilion and it was a beautiful afternoon.  It only took the first 1-2 minutes for dad and Max to start talking about hunting and preparing len~a for the winter! 

We headed back up to the floor and shared some down time in the room, while the nurses prepared for the transfer to another room. Dad requested a room with a window, so hoping he gets his request.  the sunshine and light are so important when being cooped up inside all day.  Most of his day, when inside, is occupied by getting infusions of IV antibiotics, some of which take 2 hours to be infused.  The steady stream of visitors has helped fill the minutes and hours, and Randy spent a good part of the morning with dad and the rest of us. 

For many of you it will be back to work, school and the routine of "regular" life.  I plan to be here through Friday.  Mom will likely take Celina back to Portales tomorrow. Jose and I had dinner in Santa Fe with Anita and Gabriel (pinto beans, pork roast and tortillas), and arrived in Taos by 9pm.  I came to bring Jose back to Taos, and to pick up some comfy clothes for dad once he is discharged to rehab for PT/OT.  San Geronimo starts tomorrow early AM at the pueblo, and Jose and I plan to see the foot races.  I look forward to the cool, crisp air and the steady shuffling of the men and boys' feet on the dirt path, running to keep their traditions alive, buoyed by the "ulu-lu-lu-lu" of the women.  It has been many years since I was at San Geronimo, and I think the last time was with Dad.  Jose and I will try not to get thrown into the river by the chufunetes! The symbolism is not lost on me that as dad takes his next steps forward, we are all behind him, our prayers nourishing his spirit as the sun rises. 

I will likely head back to Abq after the races to arrive in time to see some doctors and hopefully get some more results.  Dad will likely be in the hospital through Tuesday, but information can change any time, so I'll keep you posted.  

Abrazos,
Lisa

September
30
2019

September 29, 2019

September
29
2019

September 28, 2019

9:47pm

Today marks the 7th day that dad has been at UNM Hospital and the 12th day since his symptoms first began.  The hope from yesterday has spilled over to today, as dad's symptoms continue to improve.  Dad was standing to greet us upon our arrival to the hospital and he says the Green Team had just left.  He was happy to report that one more of the tests came back *negative*, specifically looking for abnormal looking cells in the cerebrospinal fluid.  There is one more test pending and we are optimistic we will have the information by Monday or Tuesday, but in the meantime we are preparing for discharge to the rehab facility one of those days.  Dr. Redford, the Internal Medicine attending, came by and spent extra time in the afternoon, sitting at ease and expressing his frustration that we don't have a formal diagnosis (radiologists still don't confirm disc infection based on MRI results, however the labs and quick recovery point to infection as the likely culprit) but he is hopeful that dad will get to discharge soon. He put orders for another analysis of dad's blood cells (called a peripheral smear) and is awaiting a similar test for the cerebrospinal fluid.  He is also planning to consult the hematologist to review dad's chart and make sure no stone is left unturned.  He was very kind in including me as an active participant in the conversation, and said "I'm happy to entertain any further suggestions or concerns you have."  He was sincere and dad has really taken a liking to him.  Dad's foley catheter was removed, and he can both void and empty his bowels on his own!  (Yay for poop!)  He was also weaned off oxygen and has been breathing well on room air.  Hallelujah!  

I saw Dr. Allen and she was kind to spend extra time discussing the next steps for dad, likely plan for re-imaging in 1-2 weeks to compare his first MRI to this last image, and repeating some labs.  If we go forward as planned, dad will be on IV antibiotics for 6 weeks which is the traditional duration of therapy for infection in the bone or lumbar disc.  He would have to come to UNM Hospital once weekly for labs and medication administration.  His rehab will be less than 2 miles away, and his stay will take as long as the providers feel is needed for him to be safe at home.  The doctors don't like not knowing exactly what they are treating, and sometimes this is where the "art" of medicine comes to play.  There is an oft-spoken recognition that being an astute medical provider means venturing off the paved path to consider alternate diagnoses or make unlikely connections to explain someone's illness.  It means saying "I don't know" more often than we are comfortable admitting, but using one's "gut" instinct can often lead in the right direction.  

Dad had a busy day with amazing visits from Randy Giron, also known as "Viejo" and he and dad have been lifelong friends since about 1973.  We heard stories about how they first met, and fun stories about being in college and adventures they shared.  Tia Diana, her daughter Audrey and son-in-law Jose and their children Kyomi and Mateo came from Santa Fe and shared some special moments with dad as well.  A eucharistic minister happened to visit dad while Tia Diana and Audrey were in the room, and we all shared in communion and prayer.  There has been no end to the spiritual nourishment needed for dad's healing.  Mike and Noella also stopped by with Zach and were kind enough to lend us their car for the next few days we will be in Albuquerque.  We do not cease to be amazed at the kindness and generosity of our dear friends and family.  

We have taken more time to reflect on the remarkable events that have transpired these last 12 days.  We have coursed through the emotions of fear, dread, sadness, frustration, desperation, anger, confusion, inspiration, hope, courage, determination, gratitude, happiness, joy and optimism.  We are emotionally exhausted, physically tired, but spiritually fulfilled as you have joined us in this journey both in thought and prayer, phone calls, text messages, voicemails and visits. 

The quote below is one of Joaquin's favorites, written on his chalkboard wall at home.  It seems appropriate to acknowledge that we see God in all of YOUR love and support during this most amazing time in our lives.  All of our lives are infused with daily challenges, obstacles, sacrifices and victories, both big and small--but we don't walk this path alone, and that is beautiful. 

With blessings and gratitude,
Lisa

September
28
2019

September 27, 2019

10:14pm
Another long day with a lot of emotion.  
We arrived at the hospital around 8am and dad had a new nurse, Christi, who we found out is from Cali, Columbia, and has lived in NM for most of her life.  
The contact and droplet precautions remained in place as guided by the primary team due to concern for risk of tuberculosis, but once these tests came back negative, the precautions were dropped and we no longer had to wear masks and the providers did not need to gown up and wear masks/gloves. 

We pretty much knew it was going to be another day of waiting for any new results, so we passed the time visiting with dad in his room.  He was proud to report he did not require any opiate medication overnight (wow!) and his pain was much better controlled overall.  He was able to walk from the bathroom to the bed, the night before, and was also able to eat lunch while seated!  We didn't expect much fanfare from the rounding doctors, and the medical student was present to visit with dad. Anita and Jose joke that I am now known as Dr. Cucuy since I've scared the other physicians who don't come by the room anymore.  

As the medical student was leaving, a new person arrived in the room, wearing a face mask per protocol.  Dr. Sarah Allen is the attending doctor for Infectious Diseases.  She was asked to see dad based on this history of his presentation.   She had a gentle demeanor, was kind and introduced herself to dad and the family.  She was wearing an IronMan lanyard so you know this physician means business!  She stated the reason for her visit and she allowed dad to re-tell the story, in his own words, again from the beginning.  As he told the story, she would kindly interrupt for clarification and she took copious notes, just like an investigator trying to crack a code.  She asked about any potential past history of infectious exposures, tracing all the way back to when he was in the Navy on a ship in the Philippines and Vietnam, and if/when he traveled to California, Texas, Arizona or Ohio.  You see, there are some infectious diseases that can originate in soil, bird poop, and when inhaled can find themselves finding a host in our lungs, for example, and wreaking havoc later on.  She was patient, and asked the questions while sitting down, and as dad said "you make me feel like I'm the only person in the room."  She spent at least an hour with dad, asking more and more questions, and providing alternate explanations for his symptoms.  She postulates he may have had an infection in the disc of his vertebral lumbar spine to account for his localized back pain, and the surrounding inflammatory response could have been meningitis.  She was less suspicious that he had tuberculosis and all other infectious diseases were not likely (and subsequent testing for sarcoidosis or West Nile disease were negative).  She found it also very interesting that his pain is improving, as well as other markers of inflammation since he has been on the antibiotics at the doses typically given for meningitis.  She went back and requested records from Taos to compare the imaging done there with the new imaging here at UNM-H.  She was very thorough and she listened to dad, mom, Jose and myself, all with patience and respect.  This was a different interaction than with any other provider to this date, and we all collectively felt more at ease knowing that possibly there was another explanation for dad's symptoms.  She also provided the caveat that she is looking through the lens of her specialty, as an infectious disease doctor, and is aware that this can potentially blind her to other diagnostic possibilities, but her explanation makes the most sense.  Overall, we are still awaiting the results of the cytology from the lumbar puncture to help further guide treatment. 

On the brighter side, dad got a visit from some close friends from La Madera, and he was also able to visit with Lillianna, Samuel and Emma.  Our prima Loretta stopped by and every family visit (and phone call) brings dad more and more joy.  I hope you enjoy the photos of the family. 

There was a woman from Lovelace rehab who came to provide dad with info about transfer to a rehab facility, *possibly* as early as 9/30, Monday.  The rehab place sounds like a great transition to help dad regain his strength.  There will be a therapeutic pool, a zero gravity setup to help dad builld strength as he starts to walk again, and 3 hours of PT and OT daily, until he is safe to be discharged home.  This all sounds wonderful, and I know he is ready to be discharged, but we also are eager to get a formal diagnosis, if possible, before he is discharged, as this can also dictate what his treatment will include.   If the doctors agree with infection, then he will get IV antibiotics for 6 weeks with a peripheral IV called a PICC line.  we are hopeful to help transition away from the use of the foley catheter and wean off oxygen as able.  

We are aware that information can change from day to day, but as of right now, this is the most recent info we have. 

Dad is in much better spirits and has a strong desire to work on lung strength as he practices his incentive spirometry often.  He got another outing in the main lobby on the 5th floor and had some much needed hugs from the grandchildren.  

Dr. Allen provided some hope with her visit, and her calm bedside manner and thoroughness inspired much respect from us as a family as well.   I was very grateful she gave me her cell phone number and asked me to text her anytime.  She also gave me a copy of her consultation report.  No other physician has offered this collaboration up front, since otherwise I would have to go to medical records daily with a newly signed record release to get that day's lab results.  It's the little things that people do to help bridge the divide and instill trust and respect. 

She said that we may never know exactly what happened to dad, especially if the cytology is non-conclusive, and this could also be due to the fact that dad had already been on antibiotics for 5 days before the lumbar puncture was obtained.  It's possible that any infection is less likely to be found if adequately treated.  There are a few more diagnoses the doctors would like to rule out with cytology, which is why we will wait in the hospital likely through Monday, and then determine what steps need to be taken based on the results. 

As she postulated the different causes, I caught dad's eyes and he motioned them toward the sky, believing that some divine intervention had a strong role, of which I have no doubt.  Don't get me wrong, the antibiotics were not a placebo, but mom and dad's faith in God also gave him the determination to keep working on his bedside PT exercises, use the incentive spirometer frequently, and keeping his attitude always on the positive side.  I am amazed at dad's resilience and belief in all of those care providers, again, from the doctors to the nursing assistants, as playing a critical role in his healing.  Your prayers and support have also lifted him up and continue to buoy our hopes for a recovery.  

Thank you for your prayers, well wishes and for following us on this journey.
Hasta la manana,
Lisa

September
27
2019

September 26, 2019

9:28pm
Dad returned from his lumbar puncture at about 10:30am.  When we arrived at the hospital this morning, around 8:30am, he was already gone from the room for the study.  The Internal Medicine Green team arrived around 11am and it was Dr. Stoltze and the medical student wearing a Green Bay packers bow tie (dad noticed this through the yellow paper gowns the medical providers still have to wear upon entering the room).  I reiterated my disappointment in the way things happened, but also reminded the doctors that they need to hold themselves to higher standards (basically I repeated my declarations from the day before, but to the rounding doctors today, since Dr. Redford from last night had already left for another commitment).  They were in agreement with starting the new medication for his prostate, and adjusting the dose of another medication for his nerve pain, in addition to helping him get more mobile.  They were basically the only doctors we saw today.  The neurosurgery team likely signed off since they decided against surgery.  The neurologists did not show up (not sure if they signed off or were really busy or rounded after we left at 8pm).  Anita and Celina joked that maybe I scared away the other doctors after yesterday.  Maybe so!  Dad thanked the Internal Medicine doctors for letting me be a part of the team.  I joked with Zeferino that I felt like I was the Internal Medicine attending (it really felt that way because no one else was willing to take the lead!) Otherwise, it was a very low key day, as we knew that there would be no new findings to report since the cerebrospinal fluid from today's sample would be sent for further analysis.  

The neuroscience floor is busy.  There are patients who have had strokes, seizures, hydrocephalus (too much fluid around brain), and other ailments, and the nurses and staff are always busy.  Dad's nurse have changed each day, but each nurse has been very nice and helpful.  Dad remains the only patient in his room, which is nice to have the extra space. 

I really feel something special has changed from yesterday.  Dad had some help with colonic transit last night (he finally had a bm, what we also affectionately call a "spiritual movement!!"), and he was also given a diuretic treatment to help decrease some fluid buildup in his lungs (called pleural effusions).  His pain medications were adjusted, and the antibiotics have been continued.  You may also say that dad is on a tincture of time.  His pain was MUCH better controlled today, as you can see he was able to sit up in bed (he has not sit up since Saturday 9/21), and he did not require nearly as many opiate medications.  We took him on a wheelchair ride around the unit and as far as the lobby.  He transferred to the wheelchair with minimal guidance (he's pretty weak though, in his legs and arms from so much sitting), and he requested a mid-day snack (ice cream sandwich).  We all celebrated the achievement of getting him out of the room by eating ice cream treats.  Despite continuing to require oxygen, his lung function is improving, as objectively measured by the incentive spirometer that shows us how much air he can inspire into his lungs.  He shows both objective and subjective improvement!  The spinal fluid analysis will still take 2-3 more days, but the observed improvements are substantial and we are cautiously optimistic.

The composition of families visiting the unit changes daily.  We have been aware of patients discharged, either to home with hospice or home to continue recovery.  You see familiar faces after a week on this unit, and you wonder what other families are also experiencing with their loved ones.  You see tired faces, and the nurses start to recognize you as you arrive at the start of their day shift and leave after their shift ends.  You are aware that residents round early in the morning at the start of the nursing shift, and may return with the attending later in the morning, but you are not sure when. The routine of it all is monotonous and tiring, (imagine being confined to the same room and bed as dad has) and we fill the moments with strolls to get coffee on the first floor, or to the lobby past the unit, and back to dad's room, hoping for another opportunity to be present for when a cohort of doctors arrives.   As I contemplate this, it sure would be helpful for doctors to let the families know when they might plan to arrive, or if they plan to return.  Regardless, we got to spend great moments with dad today, whether it was being silly with the face masks, or having lunch in the cafe with Daniel and Gabriel, the moments of being together as a family have been a precious gift, especially when time seems to be in "slow motion".  I probably would not wish for a significant illness to occur for all of us to come together like this, again, but it has shown me how precious time is amidst our "busy" lives, filled with work, home, school, etc.  It is as if someone has pushed the 1/2 speed button and allowed us to contemplate bigger things like our health, our relationships with our family and what really matters in this life.  I wished it didn't take a big illness or health condition to force us to slow down, but if my musings help you to try and slow down too, then there is the silver lining.   

The quote I have listed below is one of my favorites when I was a medical student.  I have always carried this quote close to my heart, as being a healer does not mean that you cure someone, as some illnesses cannot be cured.  Our job as healers is to relieve suffering when we can, and always to provide comfort.  

May you all find that comfort in your lives, with your family and loved ones.
Until tomorrow,
Lisa