September 1999

Day Before Yesterday, Thursday September 3, 1999

Belinda informed me that an x-ray on Sammy's right shoulder shows a fracture. Apparently the fracture has healed. My nurse sent for the x-ray reports from Sammy, with my signature on a release for records form. I worry about the healing on that fracture site. Should it had been set and/or fixated? Was it displaced? Could it have caused nerve damage?
This confirms our reconstruction of the injuries, which included hitting the ground with his right shoulder. Other tell tale signs were the road burns on the dorsum of his right hand knuckles and finger joints, the abrasions on his right forearm, and the bruise on his right scapular area. He probably hit the road with the right side of his head, causing countrecoup injuries.

Yesterday, Friday September 4, 1999

Yesterday I brought Sammy a red Texaco airplane. Initially he seemed to like it, but then he hit his face with a wing. He tried to taste it. Then did not want anything else to do with it. Ilde hung it from an unused curtain cord off the ceiling, and used some tape to have it perfectly balanced.
More from yesterday:
- Sammy is able to flex his right elbow on command.

Saturday September 5, 1999 7:59 AM

I slept in the bed next to Sammy last night. Last night I helped the nurse change Sammy's diaper.
This morning he wants to sleep over, but continues his mental improvement, with sentences well formed, appropriate, and totally original, in response to a question ( about whether he wanted to sleep, eat ). Explained why he did not want to eat.
The nurse feels he is not hungry because he has not had a bowel movement in three days. Although she means to give him a rectal suppository, she cannot find one on the medication tray.

Saturday September 5, 1999 1:18 PM

When I came back to the room, Belinda had taken Sammy to the cafeteria. The ensuing search for them at 62002, the main and children's cafeteria, the lobbies, was fruitless.
Sammy has trouble with the names of things. Can't switch from Banana to Muffin and vice versa, unless he hears the word. He cannot access his vocabulary by subjective/internal feeling/thought. He can reach his vocabulary stores via auditory stimulus only. Visual stimulus fails. To point to the picture corresponding to the name he hears is difficult, even though what he hears appears to be meaningful to him. Assuming that his vision is adequate, which most likely it is, he has difficulty clicking visual with audio input. He cannot link audio input, audio output, and visual input.
He speaks often by full phrase/short sentence. Some favorites are "Get away from me." and "I don't want it.". He can be instructed to substitute these generic sentences with one specific for the situation at hand. He will use the specific situation sentence if he agrees that the phrase expresses his feelings, and is filled with satisfaction. But then he will use the new phrase for anything he would use the generic, even though the specific circumstance has changed.
Yesterday while his uncle Jose prayed, Sammy said "amen" when Jose prayed that Sammy would continue to improve as he had done so far.
Sammy loves to kiss.

Saturday September 5, 1999 11:54 PM

Sammy has not had seizures at any time. He has no tremor, except some clonus of calf muscles when either foot is dorsiflexed, but this is not evident when the calf muscles are relaxed and fully stretched from therapeutic mobilization
I would like to check his reflexes.
Sammy can lift his left foot off the floor while sitting on a wheelchair. He can make only the effort on the right. Extension of the knee while sitting down is better on the right, but even then, only to about 55 degrees. Flexion of knee is nearly absent bilaterally.
Looking back to detect trends, some areas show definite improvement, while others show a nagging persistence. When tired or sleepy, Sammy shows a persevering speech, but nowhere near as pervasive now as it was three weeks ago. Every week he shows more threads of spontaneous thought. He is quicker to respond. His answers are more likely to correctly represent his thoughts. He corrects his mistakes, thus assuring correct communication. Even if his communication is crude at times, he uses that limited communication skill effectively.
When Francisco Saucedo's boy, Frankie, asked whether Sammy was learning to talk, I had a sense of deja vu, maybe because of the pain it caused me to hear the boy say that about Sammy.
The nurses are very understanding with Sammy. They talk to him as if he could understand everything, and he responds to it well. On the other hand, my children tend to treat him like a baby. I find it hard to do so. Even when he was a baby, I talked to him as if he understood complex thought. He responded to it back then and he responds to it now. Yet he loves to be treated as a child. It may be a turning back of the clock to the time he was a small child interacting with his older brother and sister.
Sammy will void when prompted. Jeah, the elder of his nurses, wants him to be offered the urinal every two hours. She feels he is about ready to learn continence.

Friday September 11, 1999 1:48 PM

Flexing elbow more readily when prompted
Abducting right shoulder when irritated.
Flexing right fingers when prompted, a range of about 10 degrees
Adducting thumb a few degrees when prompted
Could not say my name until he was prompted with "P..."
Then said "He's my dad".
When unable to find the word he wants to use, will say the word if it is spelled out to him.
Most common short words spelled out to him, he can figure out and say aloud.
Not having persevering speech.
After I kissed him on his forehead, he wanted me to continue kissing him repeatedly, until I hurt him by pressing on where he had his surgery, then he told me to quit. Refused any further attempts at kissing him.
Right leg jerks occasionally.
Left thigh may hurt unexpectedly, cramping?
"Get away from me!" when I annoyed him. Meant he wanted to be alone? Or get up from the bed. Had just told me to get off him when I sat so close I was pressing on his knee, but although I had moved away from his knee I was still sitting on the bed.
Had the PEG tube removed yesterday. It had to be yanked out hard. Today he has a fever and does not want to eat. At least some of this might be blamed on constipation ( 3 days since his last BM ).
Sammy is tired, yet cannot sleep. He now has a roommate, who keeps a loud TV.

Friday September 11, 1999 7:38 PM

Sammy has not eaten all day.
Can recite the answers for 3+3, 4+4, 5+5. Unable to do 10+10 ("2")
BP at 120/70 P 81 T99.1
Able to see off OS.
Aware of door being left open or closed. Complained when the nurse left the door open
Tries to use his right hand to scratch his head, helping it with his left hand.
Unable to recognize letters, even if he is able to spell the name of an object on a picture shown to him simultaneously that starts with that letter. ie Can spell Monkey aloud even though he is unable to name the letter M.
Had a BM. Being cleaned now.
Joseph is gently assisting him in moving his right hand. Sammy is cooperative. Counts along ( supposed to count to 30 repetitions. Forgot to stop at 30. Got to 39.)
Earlier this afternoon, Sammy enjoyed a visit from Tio Junior and cousin Abimael. Sang along some. Spontaneously loudly said "No peques mas" at the end of a song that ended on that phrase.
Clapped right hand against with his left hand, moved his right foot to the song ( "If you're happy and you know it [ clap your hands ]". Is able to clap audibly.
Tamara his nurse wants to give him his weekly bath as soon as she gets a nurse to assist her. Belinda and Joseph volunteered to help.
Belinda and Joseph noticed that Sammy no longer says "Ouch Ouch". He used to use this all the time, as recently as 9/6/99, meaning for people to be careful, and for any discomfort. Now he uses sentences, whether totally accurate and correct, or not. Similarly stopped complaining "You are 'eweing' me, you are 'eweing' me."
Still repeats the question asked of him, followed by his answer:
"Do I want another one?, Yes."
"Do not talk about me!", he said repeatedly, when Joseph and I were discussing Sammy's vision, how he appeared to be able to see to the right with his left eye.
While taking a bath said determined, "I want to be great."

Sunday September 13, 1999 9:36 AM

I have been thinking about something that Sammy said yesterday.
- "I don't want to disappoint you.", Sammy echoed off the Sabrina cartoon on TV. After silently watching TV he repeated what Sabrina said aloud and firmly, watching the cartoon oblivious to my presence. Sabrina was the fourth generation on a chain that prior to her had become the High School student of the year. She feared disappointing her family, when she expressed her feelings of not wanting to disappoint her parents. Sammy seems caught up on not wanting to disappoint his parents. I need to work on modulating this. I do not know how much of this fear of disappointing his family applies to his relationship towards his late mother. Some applies to Belinda, I believe. Belinda may be passing on to him the spirit she had as a child of pleasing and performing. I do not believe I instilled that on her. I may have put some of that on Sammy as the child who wanted to be like his dad.
When at occupational therapy, Sammy did a tool shapes wooden cutout puzzle well. He put up some blocks. Although when he started the session with some colored cones he did not have motivation, he got an obvious high off his accomplishments. The satisfaction became evident as he wanted the tower of blocks to be perfect. He responded to Belinda's prompts that he always wanted to do things perfect. He said he was good at everything. Seeing the shape he was in and the seemingly insurmountable road ahead hurt me. He proceeded to drawing circles, lines, squares, barely hanging on to the marker with three weak fingers. When I tried to help him grip the marker better, the therapist said that he was holding it well. Most people out of a brain injury instead start by holding the marker in the hollow of their hand, which is more primitive. She saved his drawings to show her supervisor. Even though at first she seemed frustrated with Sammy, by the time he finnished he seemed to have impressed her. The fact that he could say words that were spelled out to him aloud made an impact as well.
To see Sammy in the shape he is discouraged me this weekend. He is awake, yet unable to deal with the names of fruits or foods. He does great remembering the way animals are called just by hearing the first consonant Macaw, cheetah, zebra, tiger, frog, fox, and so on. Even the names of therapists he meets on the hall. New faces, new names to learn. When he is questioned, he is totally unsure. He lacks a sense of certainty. But he does discriminate, as long as he is not put to the test.
Sammy seems to be calm when I am around. Two weekends now that I hear how he had been agitated, then while visiting him I hear comments on how calm he is now.
I bought Sammy a book on the southwest, of the places I had been wanting to take him to before he got hurt. I am glad that at least once we saw some of it, when we took a plane ride over the Grand Canyon.

Saturday September 19, 1999 1:05 PM

Sammy is sleeping more during the day today. He was most alert while watching a Hardy/Laurel silent movie on the computer DVD with Ilde and Rosie this AM. Although last night he ate well for supper, and had some snacks afterwards, this morning he ate little. He would rather sleep than eat the Spaghetti Factory's food we brought him.
I don't understand why he is disliking food so much. Virtually dislikes everything but Hagen-das ice cream. It is peculiar how he expresses wanting and not wanting the food. He speaks out against almost any food he has just tasted. Even food he asks for. Even food he feeds himself, he may follow with "Don't do that." Is he dicotomized? Or does he have some sort of dysesthetic taste sensation?
I hope he does not become depressed.
He is moving his right little finger the best of all the fingers on that hand. This amounts to barely flexing/extending the MCP joint over a range of about 20 degrees. He can abduct/adduct his right thumb as well. His left hand has a greater range of motion than it had last week. He can easily reach to scratch himself at the nuchal area. He can dorsiflex the right foot some, as of yesterday. He can extend his knees on the bed against gravity, the left better than the right. He can lift his food off the floor slightly, when sitting on the wheel chair. He is improving on his ability to lift his left knee without extending his foot, and displays a great deal of interest in the process of figuring out how to accomplish this.
He continues to love to kiss and be kissed. He is aware of who is where in the room, and easily locates them whenever he intends to, regardless of whether the person happen to be to his left of his right.
He can complete "The Dallas quarterback is Troy ... Aikman" and "And their running back is Emmet ... Smith" quickly.
He no longer hesitates when referring to me Calls me "my dad". No trouble saying "Papi". Last week he answered "Ildefonso" without any help when he was asked what my name was. Normally he remains speechless or says he does not know. Previously, he would say "Papi. Hi Papi!" when prompted with "P ...". But this time he did better than we were expecting of him when he got us off guard saying "Ildefonso" before we prompted him with "P...".
He loves to sing along with Belinda.
Today is Sammy's cousin Abimael's birthday. We got Abi Pokemon's cards, a binder, and miscellanei. Sammy smiled when he saw the presents. He nearly got Pokemon right, when he said "Pomon". Later he said it right after hearing it said correctly.
My daughter, Belinda, loves to see progress in him. She is good at congratulating him, make him feel good about his accomplishments, make him be aware of what he has begun to do right ( or at least better), and at encouraging him to try to accomplish things.

Saturday September 26, 1999 1:06 PM

My daughter expressed concern about the possibility that Blue Cross might not continue to approve Sammy’s hospitalization. The occupational therapist read on the chart a note by someone expressing this concern. Sammy’s progress is gradual. The reviewer at the insurance company might not consider this rate of progress as enough to justify the degree of intervention. A review is due on October 13th.
Sammy is improving. His course is variable; so, sporadic checks may show no progress, or even a negative slope, even if actually there is a definite progress trend.
Going back to Casa Colina is not logistically possible for Belinda. She is considering looking at a home for rent here in Loma Linda. All the floors are wooden, which would be ideal for a wheelchair. The house is very close to the hospital, on Barton Road, the most convenient access to the hospital.
I believe Sammy is best in the hospital. His brain scan shows only a change on the hue of the brain tissue. There is no talk on the reports of loss of normal architecture otherwise. No talk about infarcts, hematomas, asymmetric ventricles, midline shift, or atrophy.
Presently he is on Baclofen 50mg po q8h and Buspar 10mg po bid.
Sammy is very concerned about his right hand. He plays with the fingers on that hand, using his left hand to feel and move them. At the same time he becomes overly preoccupied with pain felt on that hand ( either that or he has dysesthesia ).
He is still very happy with company. He was very happy to see me yesterday and again this morning. Specially this morning. His eyes opened wide and he wanted me to go over and kiss him.
Yesterday he recognized Mr. Larsen whom he had not seen since prior to the accident ( Mr. Larsen on the other hand saw Sammy months ago while Sammy was in a coma. ) Sammy new Mr. Larsen's name, only needed "Mister … " as a prompt. Another teacher that came in Sammy also named with the same prompting ( a Mr Wilkis? ).
This weekend I have seen improvement on Sammy’s eating behavior. He will ask for food he sees. Interested in many kinds of foods. Ate very well for breakfast. Unfortunately, he refused lunch. He now will appropriately express that he wants to finish what he is chewing on, not "get away from me, don’t do that again." He rarely repeats a word or phrase twice. He is using more sentences, words, and phrases.
It is interesting that when he was asked to name the body part when his big toe was being touched, he had trouble saying the name, finally saying "finger". Yet later when the bed sheets were pressing on his toe, he said "Get it away from me, it is hurting my toe.".
He had trouble today tolerating the upright posture during physical therapy. His face turned pale while his feet turned red. Subsequently he appeared exhausted and sleepy, and had to be put in bed. Fell asleep until awakened by the noisy neighbors on the next bed.
He puts more pressure against the floor when prompted to, or when being moved to/from the wheelchair. He can extend his feet better when prompted to do so. He can push back with his torso with significant strength.

Day Before Yesterday, Thursday September 3, 1999

Yesterday, Friday September 4, 1999

Yesterday I brought Sammy a red Texaco airplane. Initially he seemed to like it, but then he hit his face with a wing. He tried to taste it. Then did not want anything else to do with it. Ilde hung it from an unused curtain cord off the ceiling, and used some tape to have it perfectly balanced.

More from yesterday:

Sammy is able to flex his right elbow on command.

Saturday September 5, 1999 7:59 AM

I slept in the bed next to Sammy last night. Last night I helped the nurse change Sammy's diaper.

This morning he wants to sleep over, but continues his mental improvement, with sentences well formed, appropriate, and totally original, in response to a question ( about whether he wanted to sleep, eat ). Explained why he did not want to eat.

The nurse feels he is not hungry because he has not had a bowel movement in three days. Although she means to give him a rectal suppository, she cannot find one on the medication tray.

Saturday September 5, 1999 1:18 PM

When I came back to the room, Belinda had taken Sammy to the cafeteria. The ensuing search for them at 62002, the main and children's cafeteria, the lobbies, was fruitless.

Yesterday while his uncle Jose prayed, Sammy said "amen" when Jose prayed that Sammy would continue to improve as he had done so far.

Sammy loves to kiss.

Saturday September 5, 1999 11:54 PM

Sammy has not had seizures at any time. He has no tremor, except some clonus of calf muscles when either foot is dorsiflexed, but this is not evident when the calf muscles are relaxed and fully stretched from therapeutic mobilization

I would like to check his reflexes.

Sammy can lift his left foot off the floor while sitting on a wheelchair. He can make only the effort on the right. Extension of the knee while sitting down is better on the right, but even then, only to about 55 degrees. Flexion of knee is nearly absent bilaterally.

When Francisco Saucedo's boy, Frankie, asked whether Sammy was learning to talk, I had a sense of deja vu, maybe because of the pain it caused me to hear the boy say that about Sammy.

Sammy will void when prompted. Jeah, the elder of his nurses, wants him to be offered the urinal every two hours. She feels he is about ready to learn continence.

Friday September 11, 1999 1:48 PM

Flexing elbow more readily when prompted

Abducting right shoulder when irritated.

Flexing right fingers when prompted, a range of about 10 degrees

Adducting thumb a few degrees when prompted

Could not say my name until he was prompted with "P..."

Then said "He's my dad".

When unable to find the word he wants to use, will say the word if it is spelled out to him.

Most common short words spelled out to him, he can figure out and say aloud.

Not having persevering speech.

After I kissed him on his forehead, he wanted me to continue kissing him repeatedly, until I hurt him by pressing on where he had his surgery, then he told me to quit. Refused any further attempts at kissing him.

Right leg jerks occasionally.

Left thigh may hurt unexpectedly, cramping?

"Get away from me!" when I annoyed him. Meant he wanted to be alone? Or get up from the bed. Had just told me to get off him when I sat so close I was pressing on his knee, but although I had moved away from his knee I was still sitting on the bed.

Had the PEG tube removed yesterday. It had to be yanked out hard. Today he has a fever and does not want to eat. At least some of this might be blamed on constipation ( 3 days since his last BM ).

Sammy is tired, yet cannot sleep. He now has a roommate, who keeps a loud TV.

Friday September 11, 1999 7:38 PM

Sammy has not eaten all day.

Can recite the answers for 3+3, 4+4, 5+5. Unable to do 10+10 ("2")

BP at 120/70 P 81 T99.1

Able to see off OS.

Aware of door being left open or closed. Complained when the nurse left the door open

Tries to use his right hand to scratch his head, helping it with his left hand.

Unable to recognize letters, even if he is able to spell the name of an object on a picture shown to him simultaneously that starts with that letter. ie Can spell Monkey aloud even though he is unable to name the letter M.

Had a BM. Being cleaned now.

Joseph is gently assisting him in moving his right hand. Sammy is cooperative. Counts along ( supposed to count to 30 repetitions. Forgot to stop at 30. Got to 39.)

Earlier this afternoon, Sammy enjoyed a visit from Tio Junior and cousin Abimael. Sang along some. Spontaneously loudly said "No peques mas" at the end of a song that ended on that phrase.

Clapped right hand against with his left hand, moved his right foot to the song ( "If you're happy and you know it [ clap your hands ]". Is able to clap audibly.

Tamara his nurse wants to give him his weekly bath as soon as she gets a nurse to assist her. Belinda and Joseph volunteered to help.

Still repeats the question asked of him, followed by his answer:

"Do I want another one?, Yes."

"Do not talk about me!", he said repeatedly, when Joseph and I were discussing Sammy's vision, how he appeared to be able to see to the right with his left eye.

While taking a bath said determined, "I want to be great."

Sunday September 13, 1999 9:36 AM

I have been thinking about something that Sammy said yesterday.

Sammy seems to be calm when I am around. Two weekends now that I hear how he had been agitated, then while visiting him I hear comments on how calm he is now.

I bought Sammy a book on the southwest, of the places I had been wanting to take him to before he got hurt. I am glad that at least once we saw some of it, when we took a plane ride over the Grand Canyon.

Saturday September 19, 1999 1:05 PM

I hope he does not become depressed.

He continues to love to kiss and be kissed. He is aware of who is where in the room, and easily locates them whenever he intends to, regardless of whether the person happen to be to his left of his right.

He can complete "The Dallas quarterback is Troy ... Aikman" and "And their running back is Emmet ... Smith" quickly.

He loves to sing along with Belinda.

Today is Sammy's cousin Abimael's birthday. We got Abi Pokemon's cards, a binder, and miscellanei. Sammy smiled when he saw the presents. He nearly got Pokemon right, when he said "Pomon". Later he said it right after hearing it said correctly.

My daughter, Belinda, loves to see progress in him. She is good at congratulating him, make him feel good about his accomplishments, make him be aware of what he has begun to do right ( or at least better), and at encouraging him to try to accomplish things.

Saturday September 26, 1999 1:06 PM

Sammy is improving. His course is variable; so, sporadic checks may show no progress, or even a negative slope, even if actually there is a definite progress trend.

I believe Sammy is best in the hospital. His brain scan shows only a change on the hue of the brain tissue. There is no talk on the reports of loss of normal architecture otherwise. No talk about infarcts, hematomas, asymmetric ventricles, midline shift, or atrophy.

Presently he is on Baclofen 50mg po q8h and Buspar 10mg po bid.

Sammy is very concerned about his right hand. He plays with the fingers on that hand, using his left hand to feel and move them. At the same time he becomes overly preoccupied with pain felt on that hand ( either that or he has dysesthesia ).

He is still very happy with company. He was very happy to see me yesterday and again this morning. Specially this morning. His eyes opened wide and he wanted me to go over and kiss him.

It is interesting that when he was asked to name the body part when his big toe was being touched, he had trouble saying the name, finally saying "finger". Yet later when the bed sheets were pressing on his toe, he said "Get it away from me, it is hurting my toe.".

He had trouble today tolerating the upright posture during physical therapy. His face turned pale while his feet turned red. Subsequently he appeared exhausted and sleepy, and had to be put in bed. Fell asleep until awakened by the noisy neighbors on the next bed.

He puts more pressure against the floor when prompted to, or when being moved to/from the wheelchair. He can extend his feet better when prompted to do so. He can push back with his torso with significant strength.