Day 45 (Oct 9)

 

Tobias had another calm night and the occupational therapist had him in the wheel chair already when we arrived this morning.  The OT invited us to watch the CRS (Coma Recovery Scale) evaluation.  Originally they told us that we are not allowed to be present because we may influence his reactions, but it appears that the therapist is sufficiently comfortable with us that we can be flies on the wall during the test.  He did remind us not to say anything and to stand so that Tobias is unaware of our presence.  Emily came with us this morning and I let her take my place since I get to spend so much time with Tobias.  I’ll see the CRS at another time.

In just over 30 minutes they brought Tobias back with a new high score on his CRS evaluation.  Today he received 13 points, but my celebration for Tobias finally reaching "consciousness" was short-lived.  I had read somewhere during my internet research that a score over 10 qualified as conscious, but I must have misunderstood the explanation.  Tobias is officially "minimally conscious minus".  Emily was excited at Tobias' responses during the test, however, because she has never seen some of his post-injury reactions.  Tobias was able to "push-back" to an irritating stimulus for the first time during the test.  He had this reaction before, but never during the evaluation.  Emily also reported that Tobias was able to move his head and focus on the requested item when two items were placed in front of him.  I haven't seen this development yet, so I'm looking forward to giving Tobias more practice for his growing talents.

Tobias hasn't stormed since we've been here today.  His heartrate is back in the range from a few days ago before the outbreak of his latest storming episodes.  My unqualified opinion is that the brain stimulant (amantadine) was causing his storming.  The doctors didn't expect this to cause storming episodes, but once in the ICU and now in the rehab hospital, the introduction of amantadine coincided with the advent of storming and the elimination of it coincided with the remission of his storming.  The doctor will be back on Monday and I'm interested to hear his opinion.

It's been a week since Tobias' last shower and we've been asking for another shower since Wednesday.  For one reason or another the nurses and aides were unable to shower him.  Today I made it my personal goal to make it happen.  Our nurse today is a very competent lady who has been his nurse several times.  She said that she would send the aide to shower Tobias, but that he was at lunch at the moment.  When he showed up an hour later, he said that he only had 20 minutes left in his shift, but the next aide would shower Tobias.  He brought in the towels, shampoo and soap to make sure that it was as easy as possible for the next shift.  We waited patiently, but still no one appeared to get Tobias into the shower chair so when I saw the nurse and asked her about Tobias' shower, I was none too happy to hear that there were several new admits today and they were short-staffed, but she would see what they could do.  I put my foot down and told her that we've waited four days for a shower, Tobias is supposed to be showered every other day and that she needed to help us make it happen.  I try to be as friendly as possible because I know the nurses and aides that have helped Tobias have been, for the most part, caring, hard-working and conscientious, but today I wasn't going to let anyone stop Tobias from getting a shower.  His shower last Saturday resulted in several hours of the most relaxed posture and lowest heartrate that Tobias has enjoyed since his injury.  Long story short... the nurse sent three aides shortly thereafter to come in and shower Tobias.  Tobias didn't help matters at all by waiting until he was lifted off the bed to relieve himself, but the aides are well prepared for such contingencies and aside from the clean-up drill the shower came off as expected.  Tobias has been resting quietly and composed in his bed.  We haven't done any therapy practice with him because he has been sleeping and we have been busy helping the nursing staff, but it has been a good day.

I look forward to tomorrow.  He has been trending such that I predict that he will have a good day and we will be able to interact with him.  Slow and steady wins the race and we are grateful to have been spared the affliction of storming.

Hope over fear.