UPDATE #2: TUESDAY 7 SEP 10:00pm
The hospital’s COVID policy does not allow for visitors staying overnight so we’re back in Buckhannon getting a night of rest.
This afternoon was a long game of waiting by the bedside for brief minutes of consciousness between long periods of sleep. In her responsive moments she seems to understand who we are and respond to some yes/no questions. She is passing neuro exam with flying colors - squeezing fists, pushing and pulling with toes and fingers, and even giving two thumbs up on command. But we’re disappointed that she is still not breathing on her own.
Please continue praying that tomorrow she will improve enough to come off the vent. Getting the endotracheal tube out will allow her to speak and then we will have a much better idea of her level of cognition and memory.
UPDATE#1: TUESDAY 7SEP 11:30am
Writing from the NCCU (NeuroCriticalCare unit) in the UniversityHospital WVU.
Since I last wrote 11 hours ago—here’s what I know.
She’s had a total of three Head CT scans. Essentially, the reports are “no change” — which is quite good news. No progressive bleeding. There’s also no evidence of worsening swelling (edema) of the brain. So, the imaging data is encouraging.
That said, there are still a couple of big issues. Her mental status is still quite impaired. She ranges from “somnolent, but following commands”—opens eyes and moves extremities to commands—to “responds to pain only”. She is still on the ventilator and has failed a couple of attempts to allow her to take over and breathe entirely on her own. This seems to be normal experience in the ICU. But we really need her to wake up more and start breathing actively. She has been completely off sedation for the past 12 hours so that does not really explain her impaired mental status. Once she gets off the vent, it will be easier to evaluate where she is at cognitively.
Second major problem is the right eye. The ophthamologist was able to get her to cooperate enough to follow his finger to evaluate her eye movements. She has impaired ability to gaze medially, upwards and downwards — which in combination with the dilated pupil and droopy eyelid indicates involvement of the third cranial nerve. Not sure where. This nerve originates deep in the midbrain and snakes up through the brain to the eye. Is there a collection of blood impinging or irritating this nerve—or could it have been injured from the extreme deceleration forces? We don’t know. When she is extubated, the eye docs can better assess what vision she has in that eye as well.
- The “no more bleeding” prayer. Check. Thank you, God.
- Still need prayer for getting off the vent; for preservation of cognitive function; and for the right eye.
All for now. Hope for another update later today.
While out on a bike ride this afternoon —our last day in West Virginia before heading to our Area Director meeting in Philadelphia—Jennifer had a terrible accident. She flew over the handlebars landing on her head on the pavement—but she was wearing a helmet and that undoubtedly saved her life. Thankfully a number of Good Samaritans stopped to help stabilize her. Thank God for Emergency Medical Services. Medical Ambulance and Fire Rescue vehicles were on the scene within 15 minutes. Due to some abnormal neurologic signs (dilated right pupil) an immediate decision was made to bring a Medivac helicopter to take her to the Regional Trauma Center at the University of West Virginia in Morgantown. That arrived another 10 mins later — transporting her 65 miles north in a matter of minutes.
It’s been a long six hours. She’s had 2 CT scans showing a subarachnoid hemorrhage. Her responsiveness was deteriorating after arrival in the ED so she was put on a ventilator and continues to have ventilatory support. She’s gotten hypertonic saline and mannitol to reduce brain swelling.
The dilated right pupil is very concerning. It’s a sign often indicating pressure on the brain from a hematoma putting pressure on the brain—which she doesn’t have. There is some evidence on the CT that there is bleeding involving the optic nerve. The outcomes here include permanent blindness, return to normal vision or something in between.
The care has been outstanding. The ED Trauma Team is a coordinated machine. Efficient, calm, professional, competent. And caring.
We are so thankful for the outpouring of love, concern and prayer.
It’s a battle. The outcomes are uncertain.
- getting off the ventilator
- healing of her brain—and no more bleeding
- healing of her right eye
- a complete return to normal cognitive function and memory
Thank you all.