After my long craniotomy surgery to remove a tumor, it felt good to finally sit down at my desk and prop my feet up. The majority of the tumor was removed, buying the patient more time, but we could not remove it all. The tumor was complex and threaded throughout the occipital lobe and around the brain stem. It was a very emotional post-surgical discussion with the patient's loved ones. The outcome was in God's hands now.
I was enjoying a large coffee, a bottle of water, and a chicken and vegetable stir fry dish, compliments of the leftovers from my refrigerator. I noticed I had one 'missed text' message, so I opened it, read it, and considered my reply.
Due to the length of our first surgery, my only other procedure was a lumbar puncture to test spinal fluid for meningitis in a toddler. I was not a fan of lumbar punctures because the patient remained conscious and the procedure was painful. I did however understand it was the best test for the diagnosis and would do what was needed. We did end up using a form of oral sedation for the youngster, because he simply couldn't calm down and hold still. Thank goodness that's complete. I also felt better because he did indeed have meningitis and the procedure steered the care team in the right direction for the best course of treatment.
Back in my office, I was finally able to respond to Kynlee's text.
Dr. Wam Teton: For long term stability of the cervical spine, surgery would be the best option. That being said, there are multiple approaches that can be taken to repair the area. Unfortunately it likely won't improve function, but will decrease the chances of further injury to the area and improve stability. Does this answer your question?
Exhausted from the long, emotional day, I gather my belongings into my bag, and leave the office for Hal's room. He was now out of ICU and the seizures appear to have stopped. His mood and affect were improving slowly. "Good afternoon Hal. How ya doing?" I said with a smile.
"Hi Uncle Wam. I'm okay, just tired," he answered.
"Well, now that your seizures are controlled and your head is healing, I'll talk to Yank about Physical Therapy. PT will work with you so you can get out of this bed. After that, the next step will be to get you home. Sound good buddy?" I asked.
Hal nodded and the corners of his mouth turned up slightly before his lip began to quiver, "I miss mommy, daddy, and Kara. I'd love to go home."
"Okay, I'll talk to Yank and get the ball rolling for PT then. You have to listen to what they tell you and work hard though okay?" I ask patiently.
I study Hal's response, which is completely serious now. He nods slightly before his face becomes more animated. "I got cards from my class. My teacher even sent me one. I don't know how I'm going to ever catch up in school..." Hal looks down at his hands as he fidgets with his fingernails.
I put my larger hand on his to stop him from picking at his skin around his nails. "It'll be okay Hal. Your teacher will work with you to get you caught up, but your main focus should be to get stronger now, okay?" Hal nodded but didn't look up. "Hey, how about we make a goal that you work hard to get stronger and Ill try to come take you trick or treating since your mom is laid up this year. Deal?"
This caused Hal to meet my eyes and brightened his face. "That's a deal," he exclaimed. "I'll work hard, I promise Wam." This was the closest thing I'd seen on his face since prior to the accident.
"I know you will Hal. You're a hard worker, just like me," I said as I pushed his button nose with my index finger.
We had played this game since Hal was a baby, and in true Hal fashion, he said, "beep," in response.
I couldn't help but smile. Just then, Mona walked in the door with a bag of food from a local fast food restaurant. "Hi Aunt Mona," Hal said excitedly. "Did you bring me a treat?" Hal sat up straighter and watched Mona as she came closer.
"Hello gentlemen. Hmmm, what kind of treat would I bring you Hal? A little birdy told me you haven't been eating well, so I thought I'd give your favorite kid's meal a try," Mona said with a huge smile.
Hal reached for the brown paper bag, "you brought me chicken nuggets with apple slices?"
"I did, but I think maybe I should keep the toy. You don't need it, do you?" She teased.
I couldn't help but laugh at their interaction. Mona was so good with kids. I really hoped someday she could meet a nice man and have a family of her own. She has had her heart broken a couple times already, and it's so hard to watch. Thankfully she bounced back both times and was an exceptional aunt to Alec and Wanda's two children.
"Okay, this is my cue to go send a message to Yank, and then head home." I placed an arm around Mona's waist and kissed her head before kissing Hal's cheek with a parting, "I love you both, and enjoy your food. I'll see you tomorrow morning Hal."
"Love you too Uncle Wam. Thank you for helping make me stronger so I can go home," Hal said as he dunked his chicken nugget in sweet and sour sauce and popped it in his mouth with a "mmm."
Yes, Hal was improving daily, and it did my heart good to see it. I sent Dr. Yankton a quick text about starting PT, and he agreed wholeheartedly. Yank's answering text said:
Yank: I'll get the order placed for PT and check in on him tonight. Thank you and have a good night Wam. I'm so glad Hal is now improving. That's why I chose Neurology. It's so rewarding to watch people improve once we get the issues under control. I feel a little like Sherlock Holmes or maybe Dr. Gregory House. (Laughing emoji)
Dr. Wam Teton: I may be biased, but I agree Neurology is rewarding. Just don't become insane like Sherlock or a drug addict like House, and it's all good.
Yank: I'll do my best, scout's honor! (laughing emoji).
Once home, I walked in and immediately went to feed Sammy. She wasted no time letting me know I was later than usually with her "roowwww," and "puuurrrt," repeatedly. Once the foood was in her dish, she began to eat and purr. I stroked her fur from the top of her head to the tip of her fluffy, furry tail.
"There you go baby. Maybe now you won't starve," I said as I laughed. A couple more strokes of her fur, and I moved to the sink to wash my hands. I pulled out ingredients and made myself a large chef salad and grabbed two water bottles. As I ate, I noticed a return text from Kynlee.
Kynlee: Kedron is attempting to forgo surgery and go to the rehabilitation facility without it. (Crying emoji). I'm so worried Wam.
Dr. Wam Teton: Would you like me to talk to him or try to push the issue with Dr. Adams? I cannot force him to have the surgery, but I can give him the grim reality of what may or may not happen without it. If he ever wants to live without the external halo brace, surgery is the only option. Without the halo or surgery, he likely won't even be able to hold his head up. I'm sorry Lee. (Hug emoji)
Kynlee: (crying emoji) I'd rather know the truth than have you sugarcoat everything Wam. Thank you.
A little time went by but I saw dots show up on the screen, so I waited for the message. I was unsure if it was a long message or she typed and deleted and typed again, but finally the message popped up with a vibration to alert me.
Kynlee: How can Dr. Adams allow him to be transferred before the surgery is done?
This was a grey area. How do I diplomatically explain this without putting myself in a tough situation, not make it harder on Kedron, and not throw Dr. Adams under the bus? Finally I decided to respect Kedron's wishes and try to get Kynlee to as well.
Dr. Wam Teton: Lee, Kedron has the right to refuse. Dr. Adams is not allowed to force surgery or any other treatment on a conscious patient. I completely understand why you want him to have the surgery, but ultimately it's his decision. I'm sorry Lee. I'm sure that's not the answer you want to hear. I'm here if you need to talk.
Kynlee never did answer, and I went to bed feeling quite melancholy about the situation. I fell asleep stroking Sammy's soft fur.