The doctor's discourse...

When we arrived at the hospital this afternoon, we discovered that Dad had had a busy morning: today's consultant had decided to do an endoscopy after all - just to see if they could get any further insight into the cause of the blood in Dad's stoma bag. The camera didn't reveal any source of bleeding, other than a little irritation in the stomach lining, and so they are continuing to treat him for gastritis for the time being. The doctor asked to speak to us, as it had been quite a while since we'd been given an "official" update by one of the consultants. He said he wanted to speak to us to give us the current prognosis on "the risks" to Dad and to the whole family at this point in time. So he took us off to a little private room where he spoke to us for more than half an hour...

He began by saying that he, and all the medical staff on the ward, are amazed that Dad has made it this far. Just a few weeks ago, most people felt that he wasn't strong enough to survive and that he probably only had a few hours left to live. Today, the doctor's position was that, "Now he has a much better chance of ever coming out of hospital than he had three weeks ago." Just about everything is heading in the right direction now and Dad might be on the way to recovery, "as long as there are no further steps backward." There's hope that they might be able to wean him from the ventilator within the next couple of weeks, and then the main challenges would be waiting for the wound to heal, for the infection to clear totally, and for Dad to start building up his strength again.

The doctor told us that it is very unusual for someone to be in intensive care for as long as my Dad has been (although they do have one patient at the moment who has been there for nearly a year!) and so there are very few families who have had to face the sort of long-term uncertainty and trauma that we've been through over the past few weeks. He proceeded to give us a rather long speech about research that had been done on the longer-term consequences for family members who have had to live through the roller coaster ride of having a family member so close to death for such an extended period of time. Exhaustion, depression, sleeplessness, mood swings and poor nutrition were among the things that have been documented, and he wanted to encourage us, the other family members, to consider seeking  a GP's help if we noticed that we were suffering from any of these symptoms. (When I think of all we've experienced as a family over the past month, I can understand that family members of long term ICU patients could be affected in this negative way, especially if they don't know the Lord and can't draw on His peace and strength during such a difficult and uncertain time. I can see how incredibly hard this time is for my Mum, even though she knows she is being upheld by so many people's prayers.)

The doctor also spoke to us about the possible long term effects on the relatively few patients who manage to survive what Dad has been through. (Fewer than 20% of patients survive multi-organ failure caused by severe sepsis, and that statistic is even lower for the very young or the elderly.) Some struggle to come to terms with the long term weakness and tiredness that they experience; it can take up to a year to get your strength back, and patients will never totally be as strong as they were before the toxic shock. Some patients may lose interest in life and struggle with depression, with post-traumatic stress or with flashbacks like those known by Vietnam war veterans. Some may have memory problems or may struggle with confused memories of what they have been through.

In fact, Dad has already spoken to us about how painful and terrifying the hallucinations were. He said it was so frightening that he thought he was going out of his mind, and he couldn't understand why people were coming and were doing terrible things to him. In some of his memories, he was on a boat (one nurse told us that many patients report this, and that it may be caused partly by the movement of the air mattress they are on) and was being chased and attacked by wild animals. "You were there too," he told my Mum.  "Was I chasing you?" she asked. Then he smiled and quipped, "Oh, you stopped chasing me a long time ago!"  He's not having any flashbacks, though, and seems to be fully aware that what he experienced wasn't real. His main struggle is with the tiredness and the constant discomfort. Tomorrow is his 83rd birthday, and I so much hope that he can have some relief from the pain on that day.

As things stand at the moment, doctors are not yet at the point where they'll say that Dad will definitely recover and will ever come out of hospital. But they are saying openly that they are all amazed that he managed to survive those first weeks and that he has come this far and managed to make so many improvements in recent days. The two main sources of concern at the moment are:

• that Dad has no appetite and hasn't really been eating for more than a month now. (He's being fed by a tube through his nose.) It would be really good to see him begin to eat one or two things over the coming days.
• that he is still so very weak and doesn't yet have use of his arms and legs. He's having physiotherapy every day, but is making only slow progress because he's so weak. We pray that he will begin to get more control of his arms and legs and perhaps even be able to stand up (with help) over the coming week.

The other things that still need to happen are:

• for his wound to heal (this will take a long time, because it couldn't be stitched closed and has to heal slowly from the inside out.)
• for the underlying infection, and any hidden source of bleeding to clear up completely. Doctors were giving him another blood transfusion tonight because his haemoglobin count is still low, and that's a source of concern.

We don't know what lies ahead for Dad or for us... and it sounds as if the doctors really don't know either. But what we do know is that God is good and can be trusted in every situation. If you are one of the people who has been praying for Dad and for us during this time, we want to tell you how thankful we are for your support, and we pray that the Lord will also bless and encourage you in whatever situations you might be facing in your own life during these last weeks of 2011.

Scotland and Spain: hospital, home and hotel...

The weather in Spain can be very unpredictable at this time of year: sometimes we get bright sunny days, but often we get days on end of strong winds and torrential rains. So when we planned to hold our KKI leadership conference this week in a beachfront hotel, it gave no guarantee at all that the weather would be conducive to taking walks on the beach during the conference's mealtimes and coffee breaks.
Well, despite the fact that this morning's weather report said Torremolinos was only one degree warmer than Falkirk, the overall weather picture is quite different this week. Here in Scotland, where we're commuting daily from home in Falkirk to the hospital in Larbert, it's raining non stop and our temperatures are dropping from daytime "highs" of 13 to night-time lows of 4 degrees. In Torremolinos however, our international guests are enjoying bright sunny days of at least 19 degrees and, when weekend temperatures soared to twenty eight, some of our conference attendees from Latvia even went into the sea for a swim!
After working all year to prepare the conference and liaise with the hotel, it seems very strange to me to be here in Scotland and not actually to be in Torremolinos to welcome our group of youth workers from all over Europe. With my Dad's condition not being stable yet, I felt it was important for me still to be here with my family. The conference is is good hands, however, as it's being led by three or four of our other KKI Europe leaders, and we're trusting God that the group will have a fruitful week together.

As the conference draws to a close, I was supposed to be house-sitting for friends in Spain: looking after their dog and cat while they went to Canada for three weeks. My being in Scotland meant that they had to begin searching for someone else to stay in their house while they were gone. For four weeks, they couldn't find anyone at all, and I was praying so hard that someone could be found to take my place. Praise God, at the eleventh hour (they leave today) they have found a young man, a friend of a friend, who will be able to stay with Brandy and Simba during December.

Upstairs, downstairs...

We had a double hospital visit this afternoon: while Mum was upstairs visiting Dad in intensive care, I was downstairs at accident and emergency. I have absolutely no idea what I did - whether I jerked my back opening the garage door, or whether I twisted it when leaning back to pick something up in the car. But somehow I had given my back such a twist that I couldn't move or even sit without gasping at the stabbing, excruciating pain. It felt kind of similar to when I had torn a disc in 2006 (and had to lie flat on my back for six weeks) so I went into the minor injuries unit to find out if it was another disc injury (which would mean that I wouldn't be allowed to sit for weeks.) Turns out, however, that it was simply mechanical back pain, probably caused by jerking or twisting something in the area where I already have lumbar degenerative disc disease. It's incredibly painful at the moment, but the doctor in the hospital said that the pain will probably last around two weeks (as opposed to two months with a damaged disc.) He sent me off with a bag full of pain killers and anti-inflammatories. As I hobbled into the hospital this evening, and my brother limped in on his stiff knee, we must have looked like a bunch of old crocks.

Dad, however, continues to improve slightly from day to day, although he also complains of having aches and pains nearly all the time. He chatted to us this afternoon, and it was nice to see that he was getting his sense of humour back. In the evening, though, he was tired and sleeping again. He often asks us if we think he is looking any better, or if we think that there is hope for his recovery. Feeling tired and achey much of the time, he can't see his little steps of progress as much as we and the nurses can. So tonight he asked us to take a photograph - so that we can show him later what he looked like when he was propped up in bed and surrounded by machines. 

Slowly moving forward...

After six very exhausted days, where Dad simply slept all the time and didn't have any energy to speak to us when we visited, he finally looked just a little brighter yesterday and was able to talk to us in the afternoon. He was sleeping again by the evening, and it's obvious that his body still needs a lot of rest. He can't really move his arms and legs yet, and he says that all his limbs feel as if they're laden down with lead.

I spoke this week with the surgeon who did the original operation, and asked him how things are going with the various infections (wound, lungs and abdomen) that Dad has been battling over the past weeks. He said that the wound is doing okay on the whole: because they couldn't sew it up after the third surgery, they're waiting for it to heal from the inside out, and that's going to take a long time. As for the underlying infection in Dad's abdominal cavity, infected pus is still draining from it, but blood tests for infection indicators seem to suggest that Dad is doing just a tiny bit better from day to day. The sore lungs and cough are still a trial for him, but hopefully will also continue to improve as Dad gets a little bit stronger. He's not really eating yet, and so his nutrition is coming mainly through a feed line through his nose to his stomach. He's lost quite a bit of weight.

As for me, I can hardly believe that I've been here in Scotland for nearly a month. It will be four weeks this weekend, and some of those weeks were rather traumatic ones. I'm so thankful to see Dad making some small steps of improvement now but, with things not yet being very stable, I haven't yet made any plans to return to Spain.  I spend my afternoons and evenings at the hospital, and I spend my mornings and later evenings answering phone calls and catching up on computer work for ministry. The leadership training course that I should have been working with in Malaga is drawing to a close this weekend; I've been helping out (over the internet) this week with filling in the paperwork for the University and with the grading of the students' assignments that were written in French. As the strategic leadership school comes to an end, our KKI leadership team meetings and the biannual leaders' conference will begin in Torremolinos this weekend. After working all year to liaise with the hotel and communicate with the conference participants, it seems very strange for me not to be there to host the fifty or so people arriving for a leadership summit in "my" part of Spain. This morning I'm working to complete the last of the admin and paperwork that I'll need to pass on to the others who'll be leading the conference in my absence.

Tired, but turning the corner...

Dad has continued to feel weak and exhausted today. It's so hard to see him looking worn out and hear him complaining about being in pain all the time. (Dad's not usually the complaining type.) He's been so tired lately that he has no appetite and doesn't want to eat anything, although he seems to be thirsty all the time. Trying to persuade him to take a few spoonfuls of yogurt, Mum said, "It's not like you to lose your appetite." Dad just shook his head weakly and said, "But I'm in a bad way this time." It's heart rending to watch him like this. He keeps saying that his lungs, chest and back hurt (and having had pneumonia four or five times myself, I can see that some of the symptoms he describes are very typical of an acute lung infection.) Physiotherapists are helping him bring up loads of infected phlegm every day.

The doctors who told us last week that he had no hope of making it have been giving us a wide berth this week. I think Dad's amazing comeback has surprised everyone, but no one is really sure whether he's strong enough to sustain it. During the first two weeks, doctors spoke to us every day, so one of the hardest things about this past week is that we've seen Dad make a few steps of progress, then sink into fatigue, and no doctors have been coming any more to give us an update on how he's really doing.

Today we met one of the doctors who had been there four weeks ago when my Dad first checked in for his operation. Mum remembered him because he had been so kind to Kasey and had answered a lot of her questions about Papa's operation. He came up and introduced himself to us again, and then he said, "We thought that we were losing the war... but now he seems to be coming out of it."  Our hearts leapt: this was the first time that any of the medical staff had given us any indication that they believed Dad might survive the things that had happened to him.

I asked the doctor about all the exhaustion and pain Dad has been experiencing - whether it was a bad sign or an indication that he was losing the battle with the underlying infection in his abdomen. He replied that it's normal for Dad to be so tired, and to be stiff and sore after all that he's been through at his age... but the blood tests and other indicators for organ recovery and healing are beginning to head in the right direction now. He still has a long haul ahead of him, but this doctor was hopeful that the antibiotics will continue to help him overcome the infections he's been battling.

As for us, we continue to pray with Dad every time we visit and we're trusting God to keep touching him with strength and healing too.

Week four in intensive care...

Tomorrow it'll be a month since my Dad first went into hospital for surgery, and this is the beginning of his fourth week in the intensive care unit. In case it's been a while since you heard an update, let me summarise where things are at.

This time last week, after fifty one heart stoppages over the previous four days, doctors were basically telling us that Dad had only a few hours left to live and that we could expect him to go at any moment. Although it was now established that the brachycardia had been caused by a drug they had given Dad to regulate his heartbeat, there was concern that having his heart stop more than fifty times would just have weakened him too much and that he wouldn't be strong enough to fight the underlying abdominal infection. One doctor even told us rather bluntly that there were nine consultants on the ward and none of them believed that Dad would ever leave the ICU alive. I asked whether there was any chance that Dad could come off the ventilator so that we would be able at least to speak to him before he died... and the consultant replied, "I very much doubt it."

Well, three days later, the heart episodes had stopped, Dad was off the ventilator for a while, and was sitting up in a chair, eating ice cream and talking to us about what he remembered of his experiences. He has been off the kidney (dialysis) machine for a week now, and blood tests show that his kidney function is improving slowly but surely. One day he was even off the ventilator and breathing on his own for nine hours.

Since then, however, he has been feeling exhausted and in quite a bit of pain. Nurses tell us that he was doing so well after his dramatic turnaround, that perhaps medical staff tried to take things too fast and didn't wean him from the ventilator slowly enough. He's been feeling so tired that he hasn't been eating again over the past few days, although he still keeps asking for things to drink. Yesterday they decided just to let him have a day in bed to sleep and rest, rather than working to help him sit up or breathe for too many hours on his own. 

The plan now is to take things a little more slowly: to put him overnight on a ventilator mode that will really give his body a good rest, and to continue working during the day to give him some hours of breathing on his own and sitting up in a chair. He'll continue to have line feed overnight, but they'll stop that during the daytime to see if he'll start eating a little soup and yogurt again. He'll continue with physiotherapy for his lungs and limbs, and he'll get morphine for the pain whenever needed.

The difference between last Sunday and this Sunday is nothing short of miraculous, and we know that we have been held up by the prayers of many of you around the world. As we begin week four in intensive care, here are the things we are all praying for:

• that Dad will begin to build up strength again and will not feel so weak and exhausted all the time.
• that he will know relief from the pain and discomfort which contribute towards his feeling so exhausted.
• that the antibiotics will continue to do their job and that he will be able to overcome the underlying infection in his abdominal cavity.
• that his kidney function will continue to improve from day to day.

We are incredibly grateful to God, and to the many people who have been praying, for the amazing improvements we've seen in my Dad over the past week.

A tired day today...

Dad was breathing on his own for more than nine hours yesterday, only going back on the ventilator around midnight. Today, however, he was feeling very tired and weak, and experiencing quite a lot of pain and discomfort. So he wasn't speaking to us much today, but was sleeping on and off while we were there to see him. Medical staff say that perhaps they need to take things a little more slowly, as even the simplest of everyday tasks - breathing, eating, sitting up, etc - are quite exhausting for him. Concerned about his constant pain today, they prescribed a little more morphine this evening, and a sleeping pill that will hopefully help him to have a deep, pain-free sleep.
The good news, however, is that blood tests are beginning to show a decrease in Dad's underlying infection, and we pray that this trend will continue. Tonight, though, we're especially praying that he can get a really good night's sleep and not feel so weak and exhausted when he wakes up tomorrow.