Day 28 (Sep 22)

 

Katja and I visited the third and final LTAC today.  It left us with a good impression, but there is no clear winner.  All of them have puts and takes.  The selection process may be a moot point, however, because there is a two- to three-week waiting period before LTACs can take new patients.  Due to the Covid situation all of the LTACs have lost nurses to larger hospitals to treat Covid patients and they can't staff all of their beds.  The LTAC we visited today has 40 beds, but they can only fill 20.  Tobias is making progress every day and by the time a bed in the LTAC opens up, he may be ready to get the bone replaced in his head.  By this time, Tobias may be ready to be admitted to the rehabilitation hospital so the LTAC may not be in his future.  Of course, he may require a much longer recuperation time so it's possible that he'll still have a long visit in the LTAC.

The rehab hospital doctor visited us again today and they would like to induct Tobias into a specialized program for promising, but low-responsive patients.  They are checking with the insurance company to get the go-ahead to bring Tobias in.  They only take two patients at a time and they focus on getting his sleeping patterns back to normal.  They use the brain-stimulant medications to jump-start his cognition and they have specialized tactile tools to engage his muscles as much as possible.  It sounds really interesting and we are hopeful that he'll be admitted to the program.

Tobias has been very stable today.  His progress has been pretty linear over the last several days.  Today he had his eyes open roughly every two hours and he stayed alert for 10 - 15 minutes each time.  At lunch time I was stretching his fingers and he seemed particularly alert so I asked him to move his thumb and for the next 30 minutes he moved his thumb almost every time I asked him to move it.  It was the best session that we have experienced together.  At some point his rate of change needs to accelerate, but his brain is still recovering and he doesn't have his cranium put back together yet.  We heard today from two sources that patients often make substantial improvements when their skull is fully intact again.  The nurse practitioner explained to us that the fluid mechanics work better when the skull has the bone around the brain and so the patient show more progress under those conditions.

Hope over fear.