Wednesday, June 6, 2012

Anatomy of a Skull Fracture

Anatomy of a Skull Fracture from the Perspective of a Care Giver: Me

Saturday, April 21, 2012, 4:10 PM: I was on a Wyncote Audubon Society field trip in southern Delaware. We had just finished counting Black-crowned Night-Herons (over 50, we estimated) at Bombay Hook NWR when Martin’s cell rang. My phone had been “searching” in that rather remote area, so I’d turned it off. Martin listened to the message and then handed the phone to me. It was Russ, Bob’s son, telling me that Bob had taken a fall at the tennis court at 11:30 AM that morning. He had suffered a skull fracture, having evidently caught a toe and fallen backwards on his head. He had been taken to the trauma unit at Abington Memorial Hospital. We immediately called an end to the field trip (Lynn was leading the field trip and also driving, so it was her option to do that.) We notified the other participants and started the 2-hour drive home.

My mind started racing. Of course I wanted to get to the hospital as quickly as possible. Martin offered to take me straight there. I considered that option, and had several changes of mind as we headed back. A huge traffic jam (car fire) didn’t help my state of mind. Finally Martin said, “Wait till we get on the Blue Route, I-476, to make up your mind.” So I stopped talking and began to think what to do. By the time we got on I-476 I’d decided to have Lynn take me home so I could get my car and head for AMH on my own.
When I got to our house, Bob’s RAV4 was in the driveway, and at the front door I found Bob’s tennis gear, his car keys and some other stuff. At that time I had no idea how they got there. As it turned out, Ray had been among the group who were playing tennis when Bob fell. (I found out later that, after the EMT’s had come and taken Bob to AMH, the tennis players cleaned up the blood on the court and continued the game.)

Probably one of the key factors in how this all turned out was the speed at which the EMT’s arrived at the tennis court. Ray said one of the tennis guys had a cell with him, called 911, and the emergency vehicle was there in 5 minutes. Ironically, the gate at that tennis court is too narrow to handle a gurney, so four guys carried Bob out on a board. Ray said later that he felt like a pallbearer. Grim humor.
Russ had told me on the phone that Bob was in the ICU trauma unit on the third floor of the Toll Building. I was unfamiliar with that hospital, an enormous, spread-out facility, and I wasn’t even sure where to park. I knew that one of the entrances was off Highland Avenue, so I headed for that. I entered the lot and parked the car. (On subsequent days I got to know that parking lot very well.) At street level I asked someone how to find the Toll Building, and she directed me to the main hospital entrance. I followed signs, and walked down endless corridors, found the appropriate elevator and made my way to the trauma unit.
By then it was about 6:45 PM. Russ and his wife Ellyn were still there. Bob was lying on his back in a hospital bed. I think he recognized me. His right eye was swollen up like a plum, and blood was dripping out his left ear. We found out much later that fluid seeped out the “contra coup” fracture over his eye and caused the eyeball to pop out.

My first thought was, “This is the end of my life as I know it.” I couldn’t imagine that he’d be able to recover from the trauma and become his “old self” again and that we could ever get back to “real life”.  Bob and I had previously shared most of the household chores, and we’d had a vigorous schedule of travel as well as cultural and outdoor activities. So I began to accept the idea that things would be different from then on.
Russ and Ellyn stayed there with me for a while, and then headed home to their three young boys. I stayed till 9:00 PM, and then went home to listen to phone messages – all well-wishers. I called a few back, and made notes to return the rest of the calls the next day. Bob has a very devoted group of friends. My final note that day says, “He seems to be doing OK, considering.”

Sunday, April 22: I got to the hospital around 9:00 AM. Bob was very uncomfortable and pretty much out of it. I went home around noon, had a little lunch and dealt with phone calls and emails. I went back around 2:00 PM. Bob was miserable, and in a lot of pain. I can’t imagine what it would have been like without the morphine drip. I left at 6:00 PM, too agitated and miserable to eat dinner.
I cancelled our Magee Marsh bird trip for early May. Everybody understood.

Monday, April 23: I spent the whole day at the hospital. In the afternoon Bob got moved from the ICU to a private room in the Widener Building. The move to a private room seemed like a nice idea, but there was only one nurse for several patients, and I felt that I had to be around to be his advocate. It was very cold in his room. I should have thought to bring a blanket from home. The hospital’s skimpy cotton blankets were not close to adequate, and the standard pillows were hard and uncomfortable for his damaged head. Back home in the evening, I returned more phone calls and answered more emails. I’d thawed out some frozen lasagna, but I couldn’t manage to eat it.

Tuesday, April 24: I got to AMH around 9:00 AM. Bob was slated to be sprung that day. The papers were finally signed at 3:00 PM, and we left the hospital with discharge papers. The nurse said Bob should take Tylenol for pain. It did not occur to me to ask for a prescription for pain killers. This failure haunted me/us for the next several days. The car trip home was very hard for Bob. Every bump (who knew there were so many?) created a splitting headache. He made it up the stairs at home and went right to bed. He got up later, and showered and shaved. He hadn’t showered or shaved since the day of the accident.

Wednesday morning, April 25:  Bob had an intense headache (“10 out of 10”). I called everywhere to get a prescription for oxycodone with no luck. The bitterly ironic thing: Bob’s family doctor had retired just before Bob’s accident, so he was unreachable. No other doctor in the group was willing to write a prescription. So the only recourse was to head for the ER at AMH. Another bumpy ride. They reviewed his case, did another CT scan, and 4 hours later, wrote a prescription for oxycodone. A bright spot: Ellyn and Aaron had been in the area and stopped in to visit Bob. Aaron was very much interested in all the hospital paraphernalia. Russ came over to the house to visit later on.

Thursday, April 26: Bob was miserable all day again. Severe headache. People called and wanted to visit, but I had to head them off. I’d planned to go to opera class, and Bob said, “Go!” so I got in the car and started out. I got a few blocks away and changed my mind. I hated the idea of leaving him alone that long (a couple of hours). In the evening his head felt warm. I took his temperature and it read 100.4. At just this time Ashley Angert, an old friend, called to check on Bob. I told him about the fever, and he said, “Get him to the ER! It could be an infection.” So I called friend and neighbor Martin, who’d said he wanted to help. “Now’s your chance,” I said. Bob said, “No!” but I said we had to go. It was another 4 hour stay in the ER. A very fine trauma surgeon studied Bob’s case (by that time his temperature was normal). He gave us a very reasoned assessment of Bob’s condition, after another CT scan, and said there was no reason to admit Bob. So we bundled him up (poor Bob – he was so miserable) and took him home. I guess we got in around 12:30 AM.
Each night for the first week or two he got up around 2:00 AM and went downstairs to make coffee and sleep the rest of the night on the couch. Of course that woke me up (I was sleeping in the guest room) and each night I got up to check on him. I was terrified that he would trip on the stairs and fall. Our house is a split-level – all stairs. He was very careful, and used his cane for balance, but still … I got an email from JoAnn Raine who said, “Don’t let him wander around at night. He might fall.” Apparently her husband fell and hit his head, and JoAnn thought that triggered his eventual dementia. One more thing to worry about.

Friday, April 27: A better day. Bob was still “out of it” but the pain seemed to be less. He slept most of the day, but did talk on the phone with Linda Hoffman, Adrienne and Zoe. I finished reading In the Garden of the Beasts by Erik Larsen while Bob was sleeping. It’s a remarkable book. Thank goodness for books.

Saturday, April 28: This day started out badly. Bob hadn’t made it all the way to the toilet to pee when he got up at night, and hit the bathroom floor instead. Afterwards he’d tried to balance with his cane and clean it up with tissues, but that didn’t work out too well, and I slipped on it when I went in there in the morning. It took a lot of water and Spic ‘n Span to clean it up so it wasn’t sticky and smelly. To make matters worse, right after that I flooded the kitchen with coffee. I hadn’t seated the basket in the coffee maker correctly. The first of the visiting nurses came. She said Bob was doing well. Russ, Ellyn and the boys turned up for a visit, and Russ went out and got a WAWA sandwich for everybody. Biz arrived from Maryland around 11:00 AM to help out. It was pretty hectic, but Bob really enjoyed seeing the boys. When he wanted to go back to bed (he was exhausted) I had to run upstairs to make the bed for him. I’d had to wash the sheets and the mattress pad after the pee episode. We needed more pain medication (I’d forgotten to request it at out last visit to the ER) and went through a series of phone calls to see what we could do. I called the visiting nurse and she contacted the physician’s assistant who called in a prescription for hydrocodone. It wasn’t what we wanted but that was the best he could do. Biz went out and picked up a pizza, and Bob ate a slice for dinner! His first food since the accident. He had eaten nothing while he was in the hospital. He’d been smelling like acetone – starvation smell. Scary.

Sunday morning, April 29: Bob got up at 3:00 AM, came downstairs and made coffee. He had a severe headache. I led him back to bed, with pills and vitamin water, which he knocked over with his cane. More clean-up. After more phone calls Biz and I took him back to the ER for more oxycodone. This time we were there 3 hours. Biz was a great moral support. She did a little grocery shopping for me, and provided much needed quiet company. She left for home around 2:30 PM.

Monday, April 30: An up and down day for Bob. He felt awful first thing in the morning as usual. PT came and put him through some paces, then Buck came, and then Marvin, then the visiting nurse. Exhausting. He wanted to take a walk down the path behind our house. Unrealistic, and it didn’t happen. Later, he said he wanted to get back on a “regular schedule” so he got out the ingredients for some sort of gumbo (goodness knows what prompted that) and then lay down on the couch and went to sleep at 7:30. I put everything away. He went to bed for the night at 9:30 PM.

Tuesday, May 1: A quieter day, though Bob got up at 2:00 AM to make coffee. He decided to take himself off oxycodone (hallucinations). So from now on he’d be on extra-strength acetaminophen for headaches. Ivan came to visit. Bob walked down the sidewalk, with cane, as far as Pam’s driveway. He made the Creole dinner, finally. A good sign.

Wednesday, May 2: The first narcotics-free day. It was raining. Bob got up a few times during the night. PT people came in the morning, put him through more exercises. We went to see Dr. Urbanski, Bob’s new family doctor, at Ambler in the afternoon. Bob’s case was totally unfamiliar to him, and the visit was long and tiring. Bob was exhausted. His hearing and eyesight are improving slowly. We watched a little TV after dinner (the first time it was turned on since the accident – he still sees double) and were in bed by 10:00 PM.

Thursday, May 3: Not a bad day. Still no narcotics. We’ve been living on Safeway soup (Biz introduced us to it – it’s about the only thing either of us can stomach with all the stress and discomfort). Bert came over for a visit. Visitors wear Bob out. When he left, Bob and I took a walk down the block – a little farther this time. It was very tiring for him. We decided to scuttle our planned late May-early June Alaska trip, and told Ann and Mac Scott, who would’ve traveled with us. We went to bed at 9:30 PM.

Friday, May 4: An OK day. Bob’s not allowed to drive. I drove him over to Bert and Les’s (It was Bob’s first outing that didn’t have to do with the ER). Bob wanted to loan Bert one of our GPS’s for their trip to Magee Marsh. Bob had it all equipped with appropriate coordinates. Ann and I had a talk about Alaska. It looks like friends of theirs will take our place. All good. It’s relief not to have to worry about that. Bob and I took a short walk.

Saturday, May 5: I went outside and did a little yard clean-up. It’s starting to look like Jurassic Park here. Russ, Ellyn and the boys came over for a short visit. We all took a short walk down the block. We watched the Kentucky Derby, and had a quiet evening.

Sunday, May 6: We did“dry run” to all the locations for doctors’ visits this coming week. We found all of them. I did some more yard work in the afternoon. Martin came over to visit. We watched some TV and went to bed early. I’ve been sleeping badly this whole time. Every time Bob wakes up I wake up too, even though I’ve been sleeping in the guestroom.

Monday, May 7: A crazy day. Bruce and Frank took delivery of our new dishwasher and range, and began installing them. It didn’t go smoothly. In the midst of all that I had a Wyncote Audubon meeting in the front room transferring responsibility for publicity for our chapter. Bob hobbled about with his cane, giving advice to Bruce and Frank. He’s doing much better.

Tuesday, May 8: Another crazy day. The PT person came in the morning, in the midst of Bruce and Frank and my trip to Produce Junction. Bruce and Frank pretty much finished up in the afternoon. Bob and I took a walk to the mailbox and back. Sammy called to tell us about the bird’s egg he found.

Wednesday, May 9: We went to see Dr. Lam, the eye doctor. Seems Bob is doing as well as can be expected at this point. We learned then about the “contre-coup” fracture over his right eye, along with the primary fracture on the other side of his head. This was news to us. Getting information from the AMH people was not easy. The OT person came. She was very good. She suggested that Bob play solitaire and other games, and also play the piano to strengthen eye-hand coordination. We did a few errands together after lunch. I was worn out. So was he.

Thursday, May 10: We went for the required CT scan. We had to wait 2 ½ hours to get a properly written script. The physician’s assistant at the hospital had not specified “head” on the script, and they couldn’t do it without that. Very aggravating. We saw the ENT guy, Philip Rosenfeld after that. It turned out he had been a classmate of Bob’s at Elwood Elementary, Wagner JHS and Central HS in Philly. He got some of the dried blood clot out of Bob’s ear and said the rest would disperse of its own accord in time. We hung around home in the afternoon. I started reading The Best and the Brightest by  David Halberstam. It is a remarkable account of the run-up to the Vietnam War. I’d been meaning to read it for years.

Friday, May 11: We went to see RJ Meagher (pronounced “Mahr”), Bob’s neurosurgeon, for his final check-up. Bob was given a clean bill of health. Meagher said Bob can do whatever he wants, including drive. That’s a relief. He did say, though, if Bob vomits he has to go to the ER right away. That made me glad we cancelled the Alaska trip. I sent refund forms to insurance company for Alaska trip reimbursement. We started watching the PBS production of Bleak House, the book for this year’s Dickens Universe in early August. Bob’s reading the novel now. I read it earlier, and will reread it before the Universe.

Saturday, May 12: We went to Ethan’s baseball game. Bob was wiped out afterwards. Too much. We went to the cemetery with Mother’s Day flowers. Bob’s worried about his eyes – still seeing double sometimes.

Sunday, May 13: Bob’s doing much better. I worked in front garden.

Monday, May 14: Visiting nurses all done. Bob is allowed to drive and there’s no need for them to come.

Tuesday, May 15: Bill Mann came over to visit. Bob enjoyed the visit, but took a nap afterwards.

Wednesday, May 16: I went to Peace Valley for Ann’s bird walk – my first bird trip since Bob’s accident. David and Debbie Bell came over for an afternoon visit.

Thursday, May 17: I went to Opera Class. The Ring Cycle. “Real life” is coming back.

Friday, May 18: Crisis over Wyncote Audubon program – speaker for Friday night had to cancel. Cliff Hence filled in. Bob stayed home this time.

Saturday, May 19: Bob and I walked FWSP in morning and went to “All Star Little League Game” in afternoon. Ethan’s team lost 12-2.

Sunday, May 20: On our walk at FWSP we ran into Stephen Decker, Bob’s retired physician at Ambler. I told him he picked a terrible time to retire. He gave Bob the name of a nearby neurologist.

Monday, May 21: Bob went to the tennis court with Bill Murphy to say hello to all his tennis buddies who have been missing him. More “real life”.

Friday, May 25: Bob played 5 holes of golf.

Wednesday, May 30: Visit to Dr. Lam, the ophthalmologist who examined Bob at AMH. Everything checked out well except for double vision in one little area. Dr. Lam could not explain that. Maybe it’ll improve in time. Bob played all 9 holes on the Flourtown course.
Since then we’ve been taking walks, almost daily, at Fort Washington State Park. Bob’s been playing some golf, too, sometimes only 5 holes.

During the first rough weeks, many friends offered to visit or to help. In most cases these offers were gratefully acknowledged and refused. Any sort of excitement or noise was very difficult for Bob to deal with. Even visiting family was warned, “Keep it short, and keep it quiet.”

Wednesday, June 6: Update. Advice from family doctor: No tennis for the foreseeable future, no bike riding until double vision clears up. Otherwise, resume normal activities. So far, so good.

A final note: It’s pretty ironic that the laws make it so difficult to obtain opiates for legitimate pain relief, and so easy, apparently, for abusers to get them.