Today was another very blessed Sabbath.

A trauma doctor came in and said that there is absolutely nothing concerning about the drainage from Hans' leg.  

Hans is off of antibiotics as of tonight. The doctor wants to take the drain off of him tomorrow. He suggested that Hans leave the hospital and go to rehab on Monday. He said that he looks forward to me and Hans walking in for our followup visits.  

A few things today helped his body to feel better:

A contrast foot bath that I gave him, 1/2 hour of sitting outside in the sun, more activity- several walker walks, stretches, and some upper body exercise. When he layed down to sleep, he said that his legs and feet felt great because he felt like there was good circulation in his muscles.

Hans' uncle Gary visited for yesterday and today. It was so nice to have family with us. We played Scrabble. He is a trainer, and he said that gradually Hans will get his gait back after his muscles come out of their tight, protection mode.  

Again Hans impressed a nurse by maxing out the incentive spirometer. She said, "I have never charted that value before!"

Nomi and Melody and several friends came today. We sang so very many hymns and shared the blessings of God's provision and protection. All of the medical workers who came in and out of our room were happy to hear the music and see the people. Shortly before Sabbath ended, I spotted a rainbow out the window covering Hans. Isn't it promising? 

This morning, we read Psalm 88, which seemed so relevant. Then we prayed that we were at the mercy of the doctors and that God would give them wisdom and unity of decision. We finished up by singing "There's no Other Name Like Jesus." Right after we finished, the doctors started coming in and out checking different things and were all in agreement with what they planned to do, so we felt safe with the next step.  

The physician's assistant who checked his wound said that it looked considerably better than yesterday. She explained that soon he could accelerate healing by getting a skin graft or prolong healing by using a silver coated sponge called a wound vacuum which will allow it to heal naturally without getting infected.

This morning, Hans got a drain put into his right leg. When the doctor who put the drain in saw the fluid, he said, "This definitely isn't infected." It was old blood. They still have him on precautionary antibiotics, though, and are waiting for the culture to be completed.  

This evening, I went to Walmart and ran into the first physical therapist that came to us in the ICU while Hans still had the ventilator on. Earlier today he saw us while Hans was taking a walker walk with another therapist.  

At Walmart, the physical therapist told me that Hans was recovering really well and that he would be good as new because the titanium rods have no limits. I asked him, "even with the tendon and muscle tear?" He asked, "they're fixed, right?" I said, "yes." He repeated that Hans would be as good as new. He said that it is really encouraging to see a big, strong guy recovering so well. I told him that that was encouraging to tell me. I hope it comes true.

June 12 Updates:

Hans woke up early and ate breakfast at around 6:00 AM. He had a lot of energy and did situps and dips from a seated position with his legs resting in front of him. He went for a walk with the walker with someone from physical therapy.  

Hans’ white blood cell count is still elevated. It is about 19. The trauma doctor showed us the CT scan of the area of concern in his right leg. It showed fluid on the inside of his thigh, close to the knee. They do not know if this is benign fluid or infected fluid. The trauma doctor said that there might be one of three scenarios: 1. there is a pocket of infection in his leg that the current antibiotics (Zosyn) cannot reach in circulation. 2. the infection is from MRSA and needs a stronger antibiotic (Vancomycin). 3. the infection is from a different organism altogether.         

Tomorrow morning, interventional radiology will put a drain in his right leg to get the fluid out. They need to culture the fluid, and it will take about 5 days until they see if something grows. Then they can identify it and adjust the antibiotic if needed. In the meantime, they have started him on Vancomycin. This antibiotic will require his kidneys to be closely monitored because it is metabolized through the kidneys. They keep it at a safe level and do not expect his healthy kidneys to be overloaded. 

I was scared for him to take the strong antibiotic Vancomycin, but, after getting all of my questions answered and having a season of worship with Hans, I now believe that it is the right thing to do. Hans is at a high risk for infection because of his large open fracture wound. MRSA is naturally found on our skin. After a day of hard work during which he got sweaty and dirty, he received the wound which became contaminated with plant matter. It might have taken 2 hours to get him into surgery. The surgeon told us that he spent 40 minutes removing plant matter from Hans’ leg. This wound received a lot of exposure. Even though doctors clean wounds, it is hard to get them totally clean. 

Hans’ right leg is much more swollen than his left leg. The swelling does not hurt, and the wounds do not appear to be infected. (I’m not sure if they consider it one wound or multiple wounds.) He does not have a fever. He has lots of energy and a good appetite. This tells the doctors that, if there is an infection in his leg, it is contained. The antibiotics prevent it from beginning to circulate in his blood. This is vitally important and standard procedure, and the doctors expect him to recover well. None-the-less, pray.

What the doctors are looking for is a drop in his white blood cell count. When it starts trending downward and getting closer to normal, I was told that they will give him an antibiotic pill.  

It seems we will be here for at least 6 days longer.  

On the day that he got the CT scan, we were told that they would see if the blood clot moved to the lungs, but yesterday or today we were told by someone else that CT scans are not used for visualizing blood clots. After seeing the CT scan image today, it doesn’t look like a blood clot could be seen with it. Hans will continue to take Eliquis and Aspirin for 6 weeks to dissolve the blood clot.  

It is so interesting to ask questions to ascertain the understanding of the different levels of medical people. There are techs, different levels of nurses, nurse practitioners, physicians assistants, doctors, surgeons, and perhaps more. They all seem to know what they know , and they all seem to know their limitations. I have rarely encountered a discrepancy, and when I have, it was minor, like this one about seeing blood clots on the CT scan. 

Someone came in and informed us that we were approved for skilled nurse rehab at a place called The Palace in Red Boiling Springs which is 14 minutes from our house. He will sleep there and receive about 1 hour of physical therapy per day. No one is allowed to sleep there besides him. Since it is so close, the girls and I can go there as often as we need. The intensive inpatient therapy would have given 3 hours of physical therapy per day, and this one gives 1 or a little more. I asked a few doctors and physical therapists if this would limit his recovery, and they said “No” because, for one thing, it runs for a longer duration, and the next reason is that he is young and motivated. I hope this works out well for us. I guess, if it isn’t going well, we can look into other options.  

Hans cannot eat or drink after midnight in preparation for getting localized anaesthesia and conscious sedative (I am pretty sure about that) to get the drain inserted.

I have been reading Psalm 90 over and over again for two days. I find comfort in it. Thank you for continuing to pray for us.  

Psa 90:1 A Prayer of Moses the man of God. Lord, thou hast been our dwelling place in all generations.

Psa 90:2 Before the mountains were brought forth, or ever thou hadst formed the earth and the world, even from everlasting to everlasting, thou art God.

Psa 90:3 Thou turnest man to destruction; and sayest, Return, ye children of men.

Psa 90:4 For a thousand years in thy sight are but as yesterday when it is past, and as a watch in the night.

Psa 90:5 Thou carriest them away as with a flood; they are as a sleep: in the morning they are like grass which groweth up.

Psa 90:6 In the morning it flourisheth, and groweth up; in the evening it is cut down, and withereth.

Psa 90:7 For we are consumed by thine anger, and by thy wrath are we troubled.

Psa 90:8 Thou hast set our iniquities before thee, our secret sins in the light of thy countenance.

Psa 90:9 For all our days are passed away in thy wrath: we spend our years as a tale that is told.

Psa 90:10 The days of our years are threescore years and ten; and if by reason of strength they be fourscore years, yet is their strength labour and sorrow; for it is soon cut off, and we fly away.

Psa 90:11 Who knoweth the power of thine anger? even according to thy fear, so is thy wrath.

Psa 90:12 So teach us to number our days, that we may apply our hearts unto wisdom.

Psa 90:13 Return, O LORD, how long? and let it repent thee concerning thy servants.

Psa 90:14 O satisfy us early with thy mercy; that we may rejoice and be glad all our days.

Psa 90:15 Make us glad according to the days wherein thou hast afflicted us, and the years wherein we have seen evil.

Psa 90:16 Let thy work appear unto thy servants, and thy glory unto their children.

Psa 90:17 And let the beauty of the LORD our God be upon us: and establish thou the work of our hands upon us; yea, the work of our hands establish thou it.

This morning Hans feels good. He is getting back to his usual schedule and ate breakfast around 6:30.

Last night was the first night that Hans got himself into bed on his own wiithout me having to lift his legs for him.

This morning, Hans woke up at around 6 AM. when he woke up, he got out of bed on his own without me having to lower his legs to the ground. He was very hungry but they didn’t serve breakfast until after 8 AM. He believes that this made him really drained. After walking around, he was tired and light headed. He had lost all his energy. His white blood cell count went from 13 yesterday to 16 today. it should be 11. He began to get a slight fever, and his heart rate increased. Also, there was something having to do with lactic acid in some labs. All of these things could possibly indicate an infection. Inflammation also could be the cause of these symptoms, and he did move around a whole lot yesterday which could have inflamed his legs. Maybe also the interrupted and lack of sleep caught up to him because today I felt really tired, too. They did a CT scan on his chest and legs to check on the fluid in his lungs that they saw on an xray a few days ago before taking a diuretic IV, to check for infections, and to check on the blood clot. We have not heard the CT scan results yet. He was feeling so very drained and also hungry when physical therapy came in and commanded him to get up and walk around and use his strength. He was so drained of energy! The doctors took action:

Even though he has been drinking a lot of water, they gave him some kind of IV fluid to hydrate his cells. (This brings up a question: a few days ago, they wanted him to release excess fluid, but today they gave him fluid. Are the outgoing fluids unwanted and the incoming fluids wanted? How does the body know which fluid to keep and which to release? I will ask and find out.) He also took a nap with ice packs. When he woke up, he was feeling sooo much better, and his fever lowered. He got up with his usual energy and sat in the recliner to do some work. He was happy and talkative. The nurse said he looked 100 times better. Still, not denying that he was very tired, the doctors wanted to follow through with their prevention of a possible infection because of those other indications. After all, the surgeon told us that he spent 40 minutes removing plant matter from Hans’ open wound.  

Today his bloodwork showed adequqte hemoglobin, but they gave him more blood anyway to support his body along with another antibiotic just in case. I discussed the antibiotic with the nurse for a while. She said that she understood that we didn’t want to take antibiotics for just no reason, but with a high risk of infection, the best way to combat it is to get rid of it at the first possible signs. She said that gut flora can be replenished, but an infection can be life threatening and needed to be eliminated. While he was getting the blood and the antibiotic, he ate.  

He moved better and felt good and energetic until bedtime. The nurse thinks that we stopped a beginning infection with the interventions, but I think he just needed rest and maybe the fluids since he felt so much better after his nap with the fluids IV. I told that he's like a hummingbird. He uses his energy all the way up until it runs out, and he needs to rest and eat.

Nomi and Melody visited today. They watched while the nurse cleaned Hans’ wounds and stitches and changed the bandages. It was a learning experience. We played Scrabble. They also watched out the big window while ambulances and helicopters came and left, saving people all day and all night long. Man, what important work it is. The undivided attention that they give to anonymous strangers who come into the emergency room reminds me that:

In the parable the shepherd goes out to search for one sheep—the very least that can be numbered. So if there had been but one lost soul, Christ would have died for that one. COL 187.2

We have been discussing and understanding every medicine Hans has taken and every procedure that they have performed. We didn’t take every medicine. The ones we didn’t take have to do with digestion. That is because Hans’ digestion has been working as normal. Hans also hasn’t found it necessary to take all of the pain medications. The doctors and nurses are so happy and willing to answer all of my questions and discuss how everything works. It is so interesting. They are very good at communicating at this hospital. Did i tell you that they are even serving pretty nice plant-based meals to Hans?

I'm hoping for good ct scan results. He's feeling good.

The wound doctor came today to examine Hans' wound. Said it's not infected, needs time to heal and get rid of dead tissue, said he will need a small skin graft. They covered it with antibiotic ointment today and will change it daily.  

Earlier in the day, his clot speed had not reached therapeutic yet but was increasing. Doctors expect the medicine to dissolve the blood clot, but there's always risk of it detaching and traveling.

Our insurance is United Health Care, Tenn Care. Our insurance plan does not cover inpatient rehab, so we will not get that. Our case manager is trying to find someone to accept him for skilled nurse rehab. Our insurance does cover the emergency visit and everything he is getting as a patient. Phew! Since the helicopter ride is third party, nobody here knows yet if our insurance will cover it. We will find out.  

He is feeling great, not tiring, eating well, talking a lot, and moving around much better. He walked about 200 feet with the walker, stretching his legs with every step.  

After lunch time, they moved us out of the Progressive Care Unit and into the Ortho Unit room 710. It is a room with less monitoring and less worry. (They are less worried about him.)

In the evening, his blood clot speed reached therapeutic level, and they took him off of the heparin IV and put him on Elequis, the replacement pill.  

My heart was thrilled because he was moving his legs all around and bending his knees while sitting in a chair.  

He used the walker and walked to the bathroom and, for the first time since before the accident, saw himself in the mirror and touched flowing water. He put his head and face under the water for several minutes.

Yesterday was an amazingly blessed Sabbath day. It was the first day that Hans felt "normal." He had no loss of appetite and no fever, nausea, excessive thirst, dry mouth, or exhaustion, all of which he had before.  

Ortho visited and approved of his progress. She also said that if we don't get approved for intensive inpatient therapy and need to accept skilled nurse therapy instead that he would not be limited in his recovery because he is strong and motivated. Please continue to pray for inpatient therapy since the doctors think it is best.

He was ordered to get out of his bed and sit in a recliner chair for one hour a day. He ate a meal in his chair. On his last bite, a very determined Brazilian physical therapist showed up to get him walking down the hallway. He was so comfortable receiving the benefits of the first of his daily reclined sits that he tried to resist going for the walk. I sided with the Brazilian Therapist, and he reluctantly agreed to walk. So far, Hans had been putting most of his weight on his arms while he shuffled to the commode. The therapist told him to put all his weight on his legs. He did and walked down the hall. Here are his very words:

“I just had a good meal and went for a 30’ walk in the hallway! It felt great! Before I was only able to stand up, turn 90deg, and sit down again.”

He did not think he could do that.  

After his walk, he was able to breath the entire volume of the incentive spirometer. Prior to this he was able to breathe only half of it.  

He also began taking the recommended medicines to reduce pain and inflammation to get him moving more. The movement is what really promotes healing.  

Just before lunch, he had the idea that, to promote healing, I give him a contrast foot bath in his recliner. This was approved by ortho. I did it, and he liked it. Other refreshing deeds of hygeine were done after the walk, and he looked like he was in a spa.  

Three sets of friends from our local Lighthouse church visited today, and we sang hymns, thanked God, and prayed together. Nomi and Melody came with the family they are staying with! We had such a good time. The nurse who we have had a few times made a thoughtful suggestion to wheel Hans outside in his recliner! While we were approaching the elevator, a lab tech said something like, “Well, that’s weird.” I asked our nurse, “Is this unusual?” She said, “Yes. This doesn’t usually happen!” Nomi, Melody, and our friends went outside. Hans was so happy.

We spent time alone with Nomi and Melody eating and talking and watching a nature video. Our nurse taught them what she was doing with Hans’ medicines and allowed them to help. An ultrasound tech came and did an ultrasound on the blood vessels in Hans’ legs. She was unable to properly examine his upper right leg by pushing on and closing the veins because of his painful wounds.  

Around midnight, we were notified that a veinous clot was found in his lower right leg. They put him on a drip IV of Heparin which will get rid of the clot. I spoke to Hans’ aunt Annika in the early morning hours, and she told me that at this stage after such a trauma, the blood coagulation is out of whack, and there is a high risk of veinous blood clots and that this is the right thing to do.  

The IV is continual, until his blood reaches a “therapeutic” level and then maintain it there.

They will soon exchange the IV Heparin for a pill and continue taking it for 6 weeks. He will also take an aspirin for 6 weeks. The nurse told me that this won’t make him feel sick, and he isn’t on any monitors for vitals (heart rate, pulse oximeter, temperature, and blood pressure).

We met with a trauma doctor today who told us that he is healing exactly according the map.  

Because he has good base line health, he not "meandering" from the map of trauma healing.

I am learning that it is a long process of healing from such a trauma. The hospital is doing an amazingly thorough and tailored job treating him through all the stages.

More great friends visited today. Hans walked 55 feet today.

God's many assurances yesterday will not be forgotten by me today.

We have great Sabbath blessings. Hans has been feeling good and eating his meals with an appetite. This morning was his last time getting fluid to reduce the CK levels. Also, last night just before sundown, we were notified that his hemoglobin was good enough so that he does not need any more blood transfusions. Now their priority is to get him moving! Please, this Sabbath, pray that our insurance will cover intensive inpatient rehab. Thank you so much for your prayers and care for us.

Yesterday, Wednesday, Hans felt so much better. He wasn't nauseous. He didn't have a fever until he got a small one in the evening before falling asleep. He talked a lot and took a lot of naps. It was very calm in the room today.  

His blood work and vitals are also continuing to improve. Very slowly and with much help from physical therapy, he stood up and put all his weight on his legs. It hurt to bend his knees and move his legs but not to put weight on them. He is on the high frequency list for physical therapy. The surgeon stopped by and explained the details of his injury and repair. He spoke quickly, and I can't remember exactly the names of what he said, but I'm supposed to get the surgery notes. In the right leg, the vastus lateralis was disconnected from where it attaches above the knee, and some other tendon was torn. I think it had the word patella in it. The surgeon fixed them. Everyone thinks that Hans will recover really well. They are going to order him to do rehab after the medical stuff is over.