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last updated 8:20pm Eastern Time, 2/5/2001 Week Three Journal In the third week, David continued his steady improvement. By the end of the week, we started taking various tubes and equipment out of David and out of the room. He was moved to a sunny room and was even taken off of the ventilator! |
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9:30AM Pacific Time, 1/28/2001 Good morning, gang! I apologize for not getting an update out to you earlier. We had a very nice evening last night with Jack and Mary Barber and Mary's sister Sarah. After a wonderful dinner and glass or two of wine, I was just too sleepy to compose a message. It should be noted, however, that I beat Jack at a game of HORSE on the 4-foot basket in the back yard. All you have to do is get inside his head... David has had a good weekend. His temperature is steady, his ICP's have stayed very stable in the low teens, and he is now initiating each of his breaths (although he is still on a large amount of ventilation support). His is totally off of the morphine, except when needed. His Atavan (this is the correct spelling) is still at 2mg/hr, and we will continue to reduce this dosage very slowly. Being this far off of his sedation allows David to move around quite a lot, and it gets a little uncomfortable to watch sometimes. His favorite pose seems to be the "Heisman" position with his left leg pulled up and left arm extended behind him. He is moving his left arm enough, and "localizing" enough with the left arm, that they have tied down this hand to prevent him from pulling out his breathing tube. "Localizing" means that he can direct his arm to a specific target. He can lift his right leg, and he has both extended AND flexed his right arm. This demonstrates continued improvement in the left side of the brain! In the doctor's own words last night, "I couldn't be happier." We met with Dr. Manley and Dr. Andre Campbell yesterday. They informed us first and foremost that there were several misspelled words on the web site. I apologized. The doctors wanted to be very clear with us about David's prospects. We thanked them for their directness and the various future scenarios, and then focused our attention on the positive things that they had had to say. David has surpassed any and all expectations. When this incident happened two weeks ago, they did not know if he would survive the weekend. After he stabilized about 72 hours after the accident, his progress was a bit slower than they anticipated, and they were afraid that he was plateauing. In the second week, however, David has demonstrated slow and steady progress, with more and more reaction and movement on the left side, and even the beginnings of movement on the right side. This demonstrates continued healing in both halves of the brain. There are three areas of focus for us coming out of the meeting. First is the wires in David's body. The more wires we can get out of David, and the more equipment we can get out of the room, the better things are. So, over the next three to five days, we may begin taking the brain and ICP monitoring equipment out of David's head. His ICP's are incredibly steady, and he seems to have found ways to manage his own internal pressure. Second is the ventilator. We would like to get David off of the ventilator - this is a big step towards getting him out of the ICU. He is still on a lot of ventilator support. The ventilator provides several levels of breathing support, and they just dropped David down to a lower setting. In this setting, David initiates each breath and then the ventilator kicks in to blow in a very deep breath. We are going to watch him carefully to see how he responds to this new level of ventilation. There is still a possibility of chest infection, so they have started a new antibiotic. His chest X-rays look pretty good, though. Third was a new CT scan completed yesterday. We were not anticipating the results until today, but Dr. Manley popped in to see us late yesterday afternoon. It was at this point that he told us that two weeks after an accident like this, he could not be happier. The swelling seems to have gone down quite a bit, which is good, but all of that fluid has had to go somewhere. It seems to be filling up the two ventricles in his brain, and it seems to be pooling between his two lobes and elsewhere. This is the "water on the brain" scenario. We want to drain off this fluid as much as possible, so the doctor gave the order to drain David as soon as his ICP reached as high as 10 - so he is more or less draining constantly. We want to get as much of this fluid out as possible, because even an ICP of 10, while good, is a bit deceptive because we have not enclosed David's skull yet. Once we put the cap on, all of the excess fluid would cause the pressure to go up dramatically. So, drip drip drip. We may do another CT scan early in the week to see how well he is draining, and then we may or may not need to put in an additional shunt of some kind to drain the fluid directly off the brain. The primary message (that we took in, at least) is that we simply cannot predict David's progress or degree of recovery. David has exceeded all expectations so far. In our minds, this means that David's complete recovery is within our grasp - after all, why not? It will take the hard work and love of all of us, including Dave. But we know that he's got it in him. Mr. Competitive, right? There is much more to report, but you will have to accept what you've got. Dave had a stable night overnight, and was on basically a constant drain. We've got to get to the hospital soon. We will try to get a TV in the room with Dave today. What better than the Super Bowl to wake Dave up? A number of his friends have placed bets on the Giants in Dave's name. If you know what a Redskins fan David is, you will know how incensed he will be when he finds out. Thank you all. We had a HUGE crowd with us yesterday, and it was great! Many folks are racing home for the big game, and know that we'll be watching, too. Below is Oakie's latest installment. Enjoy! There will probably not be another update until Monday morning - Jay's taking the red eye to Orlando overnight. All of our love,
January 27, 2001 It is Saturday and the enormous crowd is just beginning to thin at 5 p.m. San Francisco time. As Jay has filled you in on the details about Smot's condition, I will offer a quick thought: If you are contemplating a visit, contemplate no more. Just come. Smot needs your support. The family needs your support. We need your support. We think he is responding to us (ICP normally goes up). How great would it be if your presence contributes in inspiring him to wake up and get `out of the woods.' Keep the faith. God bless Smot. Oakie Doakie 8:00PM Eastern Time, 1/29/2001 David has opened his eyes. Got your attention, didn't I? Please pass this around to others, and surprise them, too. www.intellistar.net/~smetty/david.htm I did not get a chance to send out an update last night or this morning, and I apologize. Now we have a lot of ground to cover. We'll start with the big news, update Mirna's progress, and talk about a project that we can all do together. Mom called this afternoon to tell me that David opened his eyes today. He is under a mild level of sedation, but even so, there was a light to his eyes that has not been there before. He seemed to be a little alert. Mom said to him, "If you can see me, squeeze my hand." And he squeezed. Mom moved her head from side to side, and she thinks that David seemed to follow it with his eyes. The nurse stepped in for some tests. "Show me two fingers." David did not - that's a little too much so far. "Follow my finger with your eyes." No tracking was demonstrated. Mom stepped in again, "Squeeze my hand, Dave." Squeeze. He is responsive and semi-alert. This is huge. To step back for a moment, remember the old Glasgow Coma Scale? A patient is measured in three areas - Vision, Physical Responses, and Speech. (These aren't the real titles for them, but hey, I'm improvising here.) During the tests, the patient is given a Vision score from 1-4, a Physical score from 1-5, and a Speech score from 1-6. The three scores are added up to a total of between 3 and 15 - three being extremely unresponsive and 15 being pretty close to normal human activity. David arrived two weeks ago as a 3. Last week, he was bumped up to a 4. Today, he reached 5. The primary area of improvement so far has been his vision. Of course, we cannot begin to test the speech until he is off of the ventilator - the ventilation tube prevents all vocalization. So, to be realistic, David is not totally alert yet. He opens his eyes and they are not the glassy globes that they have been before - there is some light in there. He opens them of his own accord, not in response to a command. So far, he has not passed the official test in which he will focus on an object or person in front of him and track its movement with his eyes. But then again, it's Monday, and we all have trouble focusing on much of anything on Monday... His head is on a constant drain - we are trying to get as much fluid as possible off of the brain. This makes measuring the ICP's difficult, but we know that they're pretty stable. He continues to lose water-weight, which is good. His hands are back to normal-size, down from the big puffy mitts they were last week. Mom gave him a leg massage today, and was startled to see how just two weeks in bed have allowed his legs to get smaller. Here are a couple of notes from Mom: "Dr. Holland wants to take him into the OR to take new stitches
on that one Dr. Smot has not many any official reports recently (to my knowledge), but my guess is that we have seen about nine straight days of positive scores. It will be interesting to see how Dr. Smot creates his daily evaluations as more and more machines are taken from the room.
Mirna's adoring parents showed us pictures of her this weekend. She is
21 years old, beautiful, and tiny. The difference in size between Mirna
and David will make them look a bit silly when they dance together at
the recovery party! I've put a couple of pictures of Mirna on the web
site. She continues to fight, so please send her your support.
So here is what we want from you: Please send all of this to Kathy Bell at the following address: This will help us create a magnificent document to remember this genuinely astounding outpouring of love and support for David Smethurst. I know he is thriving on it now. But it will be even more astounding to David himself once he gets through this and looks back at all of the people who have been fighting for him. Please send us your photos. Putting faces to all of your wonderful voices (as transmitted through e-mail) will be wonderful for both David and us, his family.
All our love, Mirna Franco's Parents - 1/30/2001 I just received this from Mirna Franco's parents. I could not help but send it along.
Joe and Bonnie Padilla (Mirna's Parents) 11:15PM Eastern Time, 1/30/2001 This will be a brief update, but a generally good one. David continued to strengthen today. His Glasgow Coma rating has been increased to a "T9". On the vision scale (1-4) he rated a 4 - the top score. He is opening his eyes on command and can focus on an object and track it. Physically, he rates a 5 (of a possible 6). This means that he is "localizing", or able to direct his left hand to specific sources of discomfort - specifically the breathing tube if we would let him. What he is not yet able to do is respond to the command "show me two fingers". This is much more complex than it would seem. He appears to be struggling to comply, but is unable. Once he can "show two fingers", then he will have received all the points that are possible while still being on the ventilator. (Because he still has the ventilation tube in his throat, he can not respond verbally, and is therefore given the rating of "T".) Hence 4+5+T = a rating of T9. He is moving his right hand more and more, achieving complex flexing movements, but no localization yet. Again, this is a dramatic improvement for David, but again, please recognize that we have a very long way to go. By the tone of some of your messages today, I am a little concerned that I might have overstated David's progress to date. We are very excited by how far he has come, but I also realize that I have been sharing with you almost exclusively the positive side of the story. David is still on life support, and still quite dependent on it. David is not yet "fully awake" and has a long way to go before he truly regains full awareness. Opening his eyes is a very important step, but we are still some time away from even being able to evaluate what kind of rehab will be necessary. David is entirely off of the Atavan and the morphine. David is now initiating ALL of his breaths, and the ventilator is merely supplying each breath with an additional 15-lb. burst of air to help out. Dave's blood gasses (the amount of oxygen in the blood) look good. Today David was visited by a Buddhist healer and a physical therapist, who began some stretching and massage to loosen up some of his unused muscles. Sunday we rolled in a TV so that David could watch the Super Bowl, but he slept through it... just like most of America. When Dr. Smot and Mike Acee were discussing... oh, probably girls or something, it is possible, although highly suspect, that David tried to wink and smile in appreciation of some comment or other. The source of this observation, Dr. Smot, admits to some potential bias in the report... That's the report for tonight. I will share more when I learn it. I hope all is well for all of you. We continue to receive increasing numbers of messages from people who have never even met David - about how inspired they have been by David and all of his many friends. We could not agree more. We are inspired as well - every day, every hour, by every e-mail, message, visit, thought and prayer. Thank you. Below is a message from Brian O'Callaghan to David. All of our love,
Smotty: It's O. Understand you opened your eyes yesterday. Nice work. I am proud of you. Everything you have accomplished in fighting your way through this debacle is inspiring. You would be glad to know it has brought out the best in the people closest to you. You should be proud of everyone including that amazing family of yours. While I am in awe of what you have accomplished, don't stop now, you have more healing to do. It has been difficult to leave you, especially as you are making such amazing progress, but don't worry, I will be back soon. Each time I am by your side, holding your hand and talking about our trip to Ireland, it is like sharing a month together. If you only knew what your progress means to everyone. I will tell you all about it when we first speak and I am sure we will recount this for the rest of our lives. People are rediscovering themselves and reaching deep into parts of their heart they did not know existed. Maybe Stills will write a screen play about this some day... I have been thinking a lot about all of the wonderful times we have spent together. They are countless. But right now, one is sticking in my memory. Remember the 1999 Fall Classic golf tournament up at Sankaty Head? I swear that was our best weekend together ever. It was such an excellent Smot/Oakie event. I will replay the scene for you quickly: H (you know, my father) and I sat down for the Thursday dinner both excited for the weekend. You and I were entering our `umpteenth' tournament together which started with The 1995 Bedford Golf & Tennis Club Member-Guest tournament, which we won of course. It was a crisp, clear Nantucket October night. The club house was buzzing with energy. H and I talked about how excited we were too see you. He knew he would take at least $75 from you on the gammon board. I couldn't wait to hang for three solid days on the golf course betting, drinking, eating and sharing laughs with Smotty. You showed up late because of cross country flight delays underdressed in jeans and a wrinkled, stained dress shirt. The moment I saw you, I jumped out of my seat and ran up to the bar and we gave each other a big hug. Stop there Smot. This is friendship in its purest form. A moment close friends live for. And I promise you, we will experience this again soon. We smiled, ordered a beer and went right into our predictable repertoire. What a great feeling to hug a close friend, someone you really care about, someone you can't wait to see, someone you look forward to growing old with. We had some dinner, laid down several bets, had a couple of beers and went back to 42 Orange for some gammon. We called some people that night including Fass and Dan O'C. That night I broke a rule I swore I would not break and told you a secret. While you re-set the board, I ran up to my room and grabbed Suzanne's engagement ring. It was exactly seven days before I took a knee. I had to share the news because you are my close friend. This is the kind of stuff we do in addition to the shits and giggles. We share moments together that some people are not lucky enough to ever experience. When I finally collected the courage to lay the ring on the table, you, of all people, sprang up with a huge smile on your face, told me how happy you were for me, and gave me a big hug. Priceless Smotty. You made my year because you were truly happy for me. In addition to the thousands of other stories I could recount about our awesome relationship that would inspire both laughter and tears, this is the one I wanted to tell you today. Before you know it, we will be hanging out in Nantucket again to play in that tournament, we will appreciate every single moment together, and after golf, we will join our wives on the beach for a cook-out and watch our little kids beat the crap out of each other. Can't wait. Oakie 10:00PM Eastern Time, 1/31/2001 Good evening, all! I hope you all are doing well. David had another good day. Thanks to the hard work of Charley Biggs, we have a new web address for
you to use. You CAN STILL USE THE OLD ADDRESS, and it might be a little
bit faster. However, so that more people don't have to quest for the "~"
key, the new address is: Thanks, Biggsey! So, earlier in the day, the doctors got a little ahead of themselves. At one point, they were considering taking David off of the ventilator altogether today. They have since reconsidered. David is doing very well, but they want to remove his levels of support more slowly. Plus, he still is fighting off some of the pneumonia and needs to have his lungs drained from time to time. They would prefer to leave a tube in there for a couple of more days. They will reduce the amount of air that they blow into his lungs from 15 pounds to 10 to 5 and then off. This should take a few days. David is showing more and more signs of awareness, although we will not be able to really tell how much rehab we will need until we get the tube out of his lungs and test how well he speaks and responds to speech. David could still not show the doc's "two fingers" on request, but he did manage a thumbs-up. He repeated this later for Dad. Yesterday, at one point he looked around a bit, and his eyes seemed to well up with tears. Dad and one of Dave's buddies quickly moved in to talk smack and cheer him up. Another time, Mom requested that his left arm be untied, and promised to prevent him from taking out his breathing tubes. He kept trying to free his hand from hers, and she let his hand loose a little bit (while keeping a hand around his wrist, just to be sure...). David raised his hand, and stroked her cheek to comfort her. Even in his condition, David is helping others to feel better. They have removed the "bolt" from the front of David's head - this was one of the ICP-measuring devices. All that's left in there is the drain. They were supposed to take CT scans later today to see how much fluid is left. Once the CT scans look good, they may even take out the drain. Thank you all again for your continued support. The last few days have been extremely exciting, and we really enjoy the excitement in the messages that you send to us. Below is perhaps the strangest Dave story that I have received. I will be sure to post the photo on the web site when I get a chance.... Thank you all so much. All of our love,
6:15PM Eastern Time, 2/1/2001 Good evening, folks! Please pass this message on to your friends and relatives who are rooting on David Smethurst. Also send them to the web site: www.smotty.com This message is an easy one for me: Mom wrote it. She wrote it this morning, so most of the news is from yesterday (Wednesday). Today, David has been sleeping most of the day, and has shown much less activity so far. (The did give him a dose of Atavan earlier this morning.) At any rate, Mom's narrative is great. So, heeeeeere's Mommy! Hello from San Francisco! The sun is shining again. The pigeons continue As you have already gathered, this is no longer the voice of Jay or Dr. Yesterday Mike Putnam and I were in charge of the evermoreactive left
hand Slowly, slowly David's hand approached his face, fingered the tape that "Nothing else is hurt. Your face is fine. That neck brace is just
there His eyes rolled up to look at the flashing monitor overhead; he felt
the A little bit later, I was holding Dave's wrist gently when Neill Redfern
left the He can readily respond to the request for a "thumbs up", but
when asked to By the end of the afternoon, David evinced growing agitation. His gaze In any event, it's obvious Dan is right. We need to limit the stimulus Doctors and nurses are astounded and thrilled by his progress and don't I am scared to death right now. Dave is living a miracle as we watch
him Some practical third grade advice: "These are some things that I
like to Dave will love all the e-mails and stories and pictures and hopes for Thanks to all of you from Bob, Kathy, Jay, David, and me. 2:00PM Eastern Time, 2/2/2001 Just a quick morning update. Overnight David was quite active - he kept trying to interfere with the nurse. This shows increased awareness of his discomfort and increased ability to do something about it. It also earned him a small dose of Atavan. David's new game is the "bite on the breathing tube" game. Periodically, the nurses run another tube down into his lungs through the breathing tube. This allows them to suction off any fluid from David's lungs. Naturally, this causes a bit of discomfort. David discovered that by biting down on the softer breathing tube, he can block the suction tube from entering his mouth and throat. Always resourceful, the nurses quickly learned another game, called the "trick David into letting you put something solid between his teeth" game. "OK, Dave. I'm just going to suction out your mouth." This requires a small, dentist-like hard-plastic device to be stuck in David's mouth. Once it's between his teeth, then they can fill him in on the trick and suction out his lungs. Overnight, David was moved to a double room with a window. The double room is good, because it means that he is not in sufficiently critical danger that he needs a room of his own. The sunlight is good because David can only exist for ... oh, maybe a couple of days before he starts to miss it. When Mom called the hospital this morning, the entire ICU team was debating whether or not to "extubate" David immediately (take the breathing tube out). The nurses and respirator folks believed that he should be, but it is, naturally, the doctor's decision. We won't know what they decided until later. Once they take the tube out, then they can start to test the third scale on the Glasgow Coma rating thingie. Will David be able to speak? How will he respond to different people, different commands, etc? So, really, right now - this period of waiting for the tube to come out - is one of the scariest parts of the whole process. Very soon we will discover how much damage really has been done. We cannot thank you enough for all of the love and support that you all have shown us and David. Today we need it still. All our love, 5:30PM Eastern Time, 2/2/2001 So it seems that they decided to extubate David after all! The tube is out, but David is a little groggy - they had to sedate him a bit for the procedure. He is wearing an oxygen mask for the next day or so, then they will drop him back to one of those oxygen-through-the-nose tubes. He has had tape on his upper lip for a while now, and Oakie reports that Dave has a cheesy little moustache growing. That's it. No report on Dave's levels of awareness or speech. Guess you'll have to tune in over the weekend... All our love,
12:00PM Eastern Time, 2/3/2001 Good morning! Please pass this message along to others, and don't forget the web site: www.smotty.com I have been informed that it is quite important to include the "-ty" part of smotty. The web site with the address smot.com is actually some sort of Texas swinger's personals ad sort of thing. We don't think that this has anything but coincidence to do with David's nickname, but then again, there may be stories that we haven't heard yet... It appears that I was overanxious yesterday about David's speaking. From having the breathing tube in his throat for almost three weeks, his vocal cords are very swollen and will not be functional for days to come. He HAS been trying to make some sounds, which is remarkable according to the nurses, but he has not come close to making anything like word sounds. Indeed, the doctor informed us that this will probably be an increasingly frustrating week for both David and for his friends and family. David is becoming more and more aware of his situation, of his environment, and of his restrictions. He cannot communicate except through one-armed hand gestures, and we even have his hands tied down. He is aware of the tubes, the neck brace, the staples in his head, the soft area where his skull should be, heat, itches, sore muscles... the list is endless. He can really do nothing about them, unless we untie his hands, and he is to the point where his left arm is now stronger than Mom. So he is becoming aware of all sorts of things, but we are not at all sure how much he understands. Or if he does understand, he cannot communicate his understanding, and not being able to communicate might be as frustrating for David as not being able to understand in the first place. David is not yet "back". This has been frustrating for many of us, and seems to be frustrating or even embarrassing for David. We do not know who he does or does not recognize. When he gets annoyed or tired or embarrassed or frustrated or most anything, he tends to look away from whoever is in the room. This is his only way of disconnecting from something that he finds displeasing for whatever reason, so we cannot tell why he turns away on any specific occasion. So for those of you headed out to see David, we need to set your expectations in the right place. We love and appreciate that you are taking the time and spending the money to come support David in person - you yourself are a tribute to what an incredible friend David can be. We would not be here today without your love and messages and phone calls and stories and support. With David becoming more and more aware of himself and his surroundings, however, we need to change the way in which we interact with him. When he was in a coma, it was appropriate and wonderful and good to joke with, poke fun at, and badger David. This is the world we were trying to bring him back to, and laughter and humor were some of the greatest tools that we had. Now that he is back in this world, aware but unable to respond, we need to change the tone of our conversations with him. David has always been at the center of a group when it comes to sarcastic banter and clever, loving put-downs. Right now, though, he doesn't respond well to that tone, for any number of reasons. It is possible that he doesn't understand the words. It is possible that he wants to respond, but cannot. It is possible that he cannot think of the clever responses that are his "go-to's", and THAT might be frustrating him. It is possible that he does not recognize the person talking to him but thinks that he should. No matter what the reason, David seems to get frustrated and confused by too much interaction with too many people. So if you're headed out there this weekend or next, please be aware that we are focused on doing what is best for David. We may need to restrict the number of visitors and the length of their visits. We may ask you to take a certain tone with David that you might not have ever used before. Please support us in this. We know how much you want to see David and to help him. We know how frustrating it might be to not see David, or for David not to recognize you. Please know that this is part of the healing process, and that it takes a very long time. I have only gone into such detail because I might have given you a false expectation in previous messages. Indeed, this is a pretty difficult shift for me to make myself. But rest assured that no one has done anything wrong - we're all just learning together. We have made tremendous progress so far. With love and patience and most of all, your continued support, we can get our Dave back! Thanks you to all! All of our love, 3:30PM Eastern Time, 2/3/2001 Hi all. I have not had a chance to send this out, but I really need to. This is from Ken Sadler, Dave's uncle. He has expressed very well what we have all been feeling. Thank you, Ken! "I, like many, have been so moved by the outpouring of love and
support that "So...I am taking this opportunity to send huge heartfelt kudos
to David's "Thanks, Ken Sadler (Brother in law)"
7:15PM Eastern Time, 2/3/2001 This message was sent quite happily by Ann Reeves. Thanks! I found out, quite by happenstance, that today Feastday: February 3 Patron of Throat Illnesses -- Ann C. Reeves
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