Tuesday, June 30, 2009

Day 17 of Recovery - Eating Day?

10:30 am Monday, June 29, 2009
: I stopped in between appointments knowing that I only had a few minutes, but I am so used to what by now has become a weekday routine for me - a morning visit folowed by a late afternoon or evening visit to Tesfaye. I was really hoping to hear good things about his lungs, his voice, and the swallow test/eating situation. Nurse Kerry said the lung clearing was still pretty good, though he requires a therapeutic assist from time to time, and the secretions are still clear; the standard swallow test had not yet occurred. Before they were about to attend to the dressing on his back Tesfaye wanted me to take a picture of his back with his gown open, and I was very happy to do it. Though a long thin strip of dressing extended down his spine, the straightness of his spine certainly stood out in stark contrast to what I know he lived with for so many years before the miracle of his surgery. Another "thumbs up" from him when he saw those pictures. I had to leave but told him I would return later with Melaku. When I saw Kerry on my way out I commented that I was hoping for improvement in Tesfaye's speaking but it was still at whisper level, and she was of the same mind and intimated they were going to be assessing that.

When I got to my office and thought about it further I was concerned and curious enough about the voice that I decided to call Lise, but before I actually did have a chance to make the call I received a call from the hospital on my cell phone that I knew would be Lise. The main thing she wanted to tell me was that they were going to do some exploratory testing on Tesfaye's vocal cords and would hold off on the swallow test until then. Mid-afternoon Lise got back to me and said that the testing had shown some damage on one side of his vocal cords, likely from the breathing tube. This is quite common and when it happens it normally will repair itself over the period of a few weeks. She was happy to hear that I would be coming back to visit around 6 pm with Melaku, because she said she would step out of a meeting to come and explain to Tesfaye,with Melaku there to interpet, what is happenning with his voice and lungs.

6:00 pm June 29, 2009: Melaku and I arrived at six o'clock and they informed Lise, who then stepped out of her meeting to join us. In her calm manner Lise explained that, likely from reinsertion of the breathing tube, part of his vocal cords had suffered some trauma and were not able to function properly, and that this is not an uncommon occurrence and would probably get better with time. She told him not to be discouraged, and also advised him that because of the vocal cord situation as a precaution they would be scheduling a special swallow test that accurately traces the exact path of the food he is given to swallow, to ensure that the lungs are not put at risk of aspiration. Though certainly not feeling full of joy under the circumstances, Tesfaye,as always, appeared to take everything pretty much in stride. Kerry and Lise then jointly gave Tesfaye one more good coughing assist (the Vancouver Canuck monkey comes in handy for that) before Lise went back to her meeting. Melaku and I tried to leave Tesfaye on as positive a note as possible. I left hoping to hear that they may be able to schedule the swallow test for Tuesday, as I would be going out of town for a few days.

Days 15 & 16 of Recovery - Progress and Delays

Sunday June 28, 2009: I dropped in to visit Tesfaye mid-afternoon and the very nice Nurse Kerry told me that after working on Tesfaye to clear the lung secretions he again was doing well, and his walking was getting stronger every day. However, his voice was still limited to a whisper level, which I was continuing to wonder about. Nevertheless, he was in a good mood and he wanted to take a picture of me standing next to the "sunshine" balloon that Adam had brought him, so thought it only fitting to reciprocate; I guess as a reflection of his fighting spirit he assumed a boxing pose lying in bed. After bringing him up to date with whatever was going on in my life and practicing some more Amharic language phrases on him, I went back to the Soccer Festival to see how the playoff games were going. Melaku called me to check up on Tesfaye, and when I told him that I was at the Soccer Festival he decided to come meet me there. I eventually had to leave while he planned to stay on through the closing ceremonies. Then I went for a surprise drop-in to see my parents, hurried home to get Nanci, then went out for dinner with our friends Michael and Debbie Smith from Montreal. Watching the sunset in Stanley Park was a nice finish to the weekend. Living in Vancouver I sometimes neglect to do those things. Anyway, hoping for a good swallow test for Tesfaye tomorrow.

Saturday June 27,2009: Today was a late afternoon visit to Tesfaye, after my workout and after dropping in to the Vancouver International Soccer Festival organized by my friend Adri Hamael; the Festival is an annual weekend amateur event with people forming teams representing a number of different countries (including Ethiopia). Proceeds go to support a very interesting and worthwhile charity, Peace it Together www.peaceittogether.ca, co-founded by Adri and Reena Lazar; its mandate is to promote peace and dialogue amongst Palestinian and Israeli teens through film making. The soccer event certainly is a good display of Vancouver's multi-cultural nature, and I bumped into a number of people that I know. Adri kindly supplied me with a souvenir t-shirt and sweatshirt representing team Ethiopia and Peace it Together to give to Tesfaye; the only complication was deciding what size to get, now that Tesfaye is no longer hunched over in a compacted position causing him to wear a large size. Given how slim he is, size small probably would have been a good fit, but I went with the medium to allow for possible shrinkage. When I showed Tesfaye the clothing he appreciated it very much and gave it a smile and a "thumbs up"! While the lungs were a little clearer today his voice was still a whisper; I keep looking at his slight frame and hope that they can finally remove the feeding tube; they were now hoping to do a swallow test on Monday to see if he can start eating. Nanci and I went downtown for a nice but noisy dinner with two other couples - if only I could transfer some of my caloric intake to Tesfaye!

Friday, June 26, 2009

Day 14 of Recovery - Happy Two Week Anniversary!

1:00 pm, June 26,2009
: Seeing is believing! Due to meetings I could not stop in during the morning, and Melaku wanted to see Tesfaye again so I made arrangements to meet him there at 1 o'clock. When I arrived at his room and asked about how he was doing today, Nurse Jennifer told me he was doing quite well:though the clearing of fluid in his chest still was a challenge, she told me that earlier he had been up walking down the hall to the nursing station and back. I commented that I was sorry that I missed that , as I still had not seen him walk since the surgery. I asked Jennifer if there is any chance that he may do another walk while I am around, and she said if he feels like it he could do it right now. Tesfaye was game to walk again with me there and I was so excited when I heard that.

I waited anxiously as they started unhooking some of the tube connections in preparation for his walk, and then watched in amazement as I saw Tesfaye stand up and then begin to walk, carefully escorted by Nurses Jennifer and Judy. He walked quite slowly at first but then began to gain speed and confidence with each step. With coaching from the nurses he concentrated on walking tall and breathing correctly. As I thought back to Tesfaye's totally bent over condition before the surgery, I was truly overwhelmed to see him holding himself erect, with his head and eyes looking forward in a normal position like you or me. I captured him walking and standing erect both in movie mode and still photography mode. I figured that Tesfaye may not yet have a full understanding or appreciation of the magnitude of the change, so I played back the video footage of him walking, showed him some of the just taken still images of him standing next to me, and then found some pre-surgery images of him standing next to me. I don't know if that was his first realization of the immense difference in height and posture that the amazing surgery accomplished, but I could tell from the big smile that suddenly emerged on his face that there was no question that realization had hit him now. Melaku then had to leave to get to work, but Nanci was on her way also to see Tesfaye, so I waited for her before I left. When it came time to leave, the feeling of elation from having witnessed Tesfaye standing erect and walking was indescribable.

Late afternoon I received a call from Lise bringin me up to date about Tesfaye's condition, and while Tesfaye was making good overall progress she did mention that they still had to work hard to assist him with the clearing of his chest and had to get that under control to avoid a return stint in ICU. While she is confident that it will keep improving, she wanted me to be aware.

11:15 pm, June 26, 2009: After another wonderful Friday night dinner at our house with our friends the Smiths who are visiting from Montreal, my daughter Stephanie asked me to drop her off at her friend's house. After dropping her at a location only blocks from VGH I decided to pop in for a quick bedtime visit, even though he would likely be sleeping. Nurse Christine with her lovely bedside manner (all the nurses here in step down seem so nice) said that they had worked some more on improving his coughing and clearing of lung secretions and good progress was made in that regard. He looked like he was sleeping peacefully so I left after a very brief visit. All in all, I would say it was a very satisfying two week anniversary.

Thursday, June 25, 2009

Day 13 of Recovery - Moving Day

10:00 am, June 25, 2009: I knew I would be cutting it close for my next appointment, but I really wanted to at least spend a few minutes with Tesfaye this morning to make sure he is on a path of continuous improvement. My plan for a quick in and out visit was thrown off a bit by having to wait for the "rounds" to leave his bedside. When I was able to enter I was greeted by a lovely smile and he looked terrific, the best I have seen him looking since the surgery. Though it is still difficult for Tesfaye to talk because of soreness from having the tube for so long, he said he feels good and he thought he will be moved back to the step-down unit later. He also gestured and said that he liked the way I was dressed. I did happen to be wearing a new tie and pocket square - leave it to Tesfaye in the middle of everything to notice and comment on what I was wearing. Though my visit was "short but sweet" I left feeling good about how well he looked. With my schedule today I would likely not be able to see him again, except perhaps later tonight.

11:00 pm, June 25, 2009: After a busy day of meetings as well as attending a nice lunch hosted by David McLean on his birthday (happy birthday David!) for Michael Ignatieff and a dinner gala for the Whistler Film Festival, on the way home I dropped in to get a glimpse of Tesfaye back in the Spine Step Down Unit, though I figured he would likely be asleep. Nanci did drop in to see him with her sister Julie this afternoon and she told me she ordered the TV hookup for him and wanted me to check that the TV was indeed functioning. All was quiet on the ward but, sure enough, when I went into his room Tesfaye was asleep with the TV turned on to the CNN news channel (Michael Jackson's death being the story of the evening) and the headphones still wrapped around his ears. I untangled the cord from the various tubes still attached to Tesfaye so that I could remove the headphones, and turned off the TV; he remained fast asleep throughout. As I left I asked Nurse Christine how he was faring and she said he was doing well and had done some walking earlier that afternoon. She said they were happy that Tesfaye was out of ICU and back in their Unit -- so am I.

Wednesday, June 24, 2009

Day 12 of Recovery - On the road again

11:00 am, June 24, 2009: Now that Tesfaye is off the ventilator and has the bout of pneumonia under control, he is back on the road to full recovery and anxious to get there. When I stopped in to see Tesfaye for a short visit this morning he was sitting upright in a chair and looked alert and stable, but for some reason not smiling much. Just before I was leaving he said something that surprised me and caused me some concern: he asked for the breathing machine. I couldn't imagine that he might possibly want to go back to being on the breathing tube and ventilator which were causing him such distress the past week. I told him that although breathing now without the machine might be a little difficult, it will improve every day. As I left I mentioned it to one of the nurses, but she was surprised he might be feeling that way, since he is doing well .

A somewhat funny story: With Tesfaye's request for a breathing machine lingering in my mind, I called up Lise to see if she had seen him and could perhaps give me an update. Lise returned my call promptly and told me that she had seen him and he was doing quite well. I mentioned my concern that he was not his usual smiling self with me in the morning and had requested the "breathing machine"; I commented that I could not believe he could possibly want to return to that condition, but maybe he meant an oxygen mask. She said that he already had oxygen tubes through his nose and his readings were good; she also found it inconceivable that he would want the ventilator again and reassured me that Tesfaye had been smiling a lot when Stephanie was there and had also been able to walk from his bed to the nursing station and back. Lise said she would talk to Tesfaye and get back to me.

Well, Lise soon phoned me back and told me not to worry - the "breathing machine" Tesfaye was referring to was in fact something that is actually called an "incentive spirometer", a breathing apparatus that was discussed with Tesfaye and me at the pre-op meeting we had with the physiotherapist. The apparatus requires him to breath in to a tube and try to keep some little plastic balls elevated in their respective chambers for a short period, encouraging the right kind of breathing. He was told by the therapist that doing this after the surgery would help in his recovery.

I was again reminded of something that has impressed me more than once over the course of getting to know Tesfaye the last month: Tesfaye is a bright and determined young man, has a good memory, and is always observing and thinking. My misunderstanding of what he said this morning was generated by Tesfaye's mind being a step ahead of the rest of us and consistent with his strong desire to make up any ground he may have lost on his road to recovery by being back on the ventilator the past week.

6:15 pm, June 24, 2009: [Wish I had photos] I had time for a half hour visit with Tesfaye before heading off to an evening commitment. When I got there I found him lying on his side in a different bed in the ICU unit. Chances are that at some point tomorrow he will be moved back to the spine ward step down unit. Tesfaye and Nurse Louise told me that he had again walked up and down the corridor and had managed well. I still have not really had an opportunity to see Tesfaye standing and walking. I do look forward to witnessing that myself in the coming days and getting it photographed.

Day 11 of Recovery - Extubation accomplished: onwards and upwards!

9:30 am, June 23,2009: I meet up with Nanci at the hospital to see what this morning might bring. Nurse Karen and the Respiratory Therapists Brian and Deirdre are doing their thing. The amount of breathing assist that the ventilator was programmed for was still in a reduced mode and Tesfaye was stable and looking pretty good and alert. "Nurse" Nanci (my wife would have made a great nurse) and I had an upbeat chat with Tesfaye. Nanci had brought another little stuffed animal, this time a colourful parrot to symbolize our pet cockatoo Mango. We succeeded in getting Tesfaye smiling behind his tube as we did a little Mango imitating with the stuffed animal as a prop.

Dr. George Isac came by and was quite optimistic that they would be in a position to remove the breathing tube in the next day or so, possibly as early as this afternoon. They told Tesfaye that was the plan, and that he would now feel the breathing become a harder task for him as they were going to reduce the machine breathing assist to a negligible level; at the same time the pain medication was going to be altered so that he would be able to stay more awake. As they were going to get him seated upright in a chair very soon, he received a boost of pain medication through his tube, which again seemed to trigger some nausea in him. Accordingly they were going to give him some gravol type medicine and defer the sitting physio for about an hour, so there was no point in me waiting any further.

5:45 pm, June 23, 2009: I called the ICU unit to see if they had perchance managed to remove the tube yet, and I was pleased to actually have Lise get on the phone and tell me that in fact the tube was out! Lise said he seemed a little on the quiet side under the circumstances, and she hoped that he wasn't concerned about anything, because he was doing well with the tube out. I told her that I would be coming back to see him late afternoon with Melaku and would reassure him that what he has gone through is normal and that every day should get better from here. I made arrangements to meet Melaku at 5:45, excited to be seeing Tesfaye without the tube again.

When we walked in it was such an amazing and pleasant change to be able to see Tesfaye's handsome features and winsome smile again. He was happy, and we were both so happy for him; I felt better just looking at him, so I could imagine how much better he must feel. I wished I could stay longer to savour the moment, but I had to attend a volunteer appreciation bbq at Louis Brier seniors home and hospital to say a few words of thanks on behalf of the Board. Just as I was leaving my son Adam, now back from his trip to Europe, showed up with Brooke to say hello for the first time in a couple of weeks.

Seeing Tesfaye with the breathing tube out certainly put me in a good mood, and I really feel that with the kind of determination that Tesfaye possesses we should start seeing marked improvement in his condition on a daily basis going forward.

Tuesday, June 23, 2009

Day 10 of Recovery - Reason for Optimism

Monday June 22, 10:00 am: Today is a noteworthy day for a couple of reasons -it is my daughter Stephanie's 22nd birthday, and this is the day the doctor's determine if Tesfaye is showing signs of soon getting off of the ventilator or whether other options need to be implemented yet. When I get to Tesfaye's bedside I don't know if it is my imagination, but he seems a little down in spirit this morning. I know that the breathing tube removal and phsyio are foremost on Tesfaye's mind, so I am anxious to find out the plan in this regard. Nurse Patty and Respiratory Therapist Deirdre advise me that the equipment settings and medication have remained status quo.

At that moment I am happy to see a familiar face, surgeon Dr. Marcel Dvorak, coming to look into Tesfaye's current status. I discuss with Marcel my concern that Tesfaye seems a little down and that they have increased the amount of breathing that the ventilator is doing; Marcel then tracked down Dr. George Isac, who is in charge of Tesfaye's case in ICU at this time. Dr. Isac has been away and so was just getting up to speed on the case, but based on what he sees he is fairly confident that they can wean Tesfaye off the ventilator with in two or three days. He decides they should start increasing the amount of breathing generated by Tesfaye and adjusting the medication so that he is able to be more awake. This is encouraging for me, and we communicate to Tesfaye that we are doing things to try and extubate in the next couple of days. Marcel also wanted Tesfaye's position adjusted to become flatter, and indicated that he should be taken out of bed to sit in a chair two or three times a day. In anticipation of that they give him a dose of pain medication through his tubing but he proceeds to have a vomiting episode shortly after that. It is difficult to watch him go through that while he has a breathing tube down his throat, but he manages to remove most of it by way of his suction tube.

In the meantime I am running late for a meeting and so I reschedule it for later in the week. I made it for my lunch appointment with Mark, the gentleman who came to my house on May 21st to meet Dr. Rick Hodes while he was here and who was so taken with Rick's story that in very short order he arranged a presentation by Rick the next day at Vancouver College (see my post discussing Day 2 of Tesfaye's first 23 days in Vancouver). Mark's sincere interest in helping find support for Rick's humanitarian work in Ethiopia most welcome, and we discuss a number of ideas in that regard over lunch.

6:15 pm, June 22, 2009: Late afternoon I got a call from Lise saying that she had seen Tesfaye and felt that he seemed down, the same impression that I had earlier in the morning. I told her that I was planning on coming back to see Tesfaye around 6 pm with Melaku, and she wants us to explain things to him in Amharic that would make him feel better. Lise was happy to hear that Melaku was coming and she would make sure to stay and give Tesfaye some words of encouragement translated into Amharic. We met her there around 6:15; my daughter Haley and Jim were already there in the midst of trying to amuse Tesfaye.

Jim and Haley brought him some books and a Rubiks cube, which will either occupy him for a long time or drive him crazy. With Melaku translating Lise explained to Tesfaye that what he is going through is normal, that the doctors think he is improving, and that they hope to be able to remove the tube in the next couple of days. He understood and did not have any questions. Tesfaye looked tired and so we left, hoping that tomorrow may be the day for extubation.

Sunday, June 21, 2009

Day 9 of Recovery - Happy Father's Day!

Sunday June 21, 2009, 12:30pm: Father's Day, potential sleep in day, but I woke up before 6 am without my alarm; I guess my subconscious knew that if I am going to play golf today I should get it over early, seeing as we are having around 65 family and friends over for a BBQ this evening. Of course my wife Nanci always has everything under control and ready in advance, but I do have a few errands that are my responsibility to do today.

In between errands I stop in to see my Tesfaye. I am hoping for some significant progress, but the ventilator machine is still in the same mode as yesterday and everything else is pretty much the same. However, he is looking better today and has some of his old spirit and smile back; I hope this is an indicator that the progress we are looking for is soon to be on its way. We had a very nice visit with some joking back and forth, and when I mentioned that it is Father's Day he asked for the clipboard. He then wrote out an impromptu card for me with a drawing of a bone on the bottom, which actually took quite a bit of effort under the circumstances. I am not sure of the meaning of the bone, but I do know that basic hand drawn Father's Day card meant so much to me and I told him thank you from "Abbat" Gary.

Saturday, June 20, 2009

Day 8 Recovery - Frustration

June 20, 2008, 5:45 pm: Made my way to the hospital to meet up with my daughter Stephi for my first chance to visit today. Earlier in the afternoon Jim and Haley went to visit, so I contacted Jim on my way to see how they found Tesfaye's condition during their visit. Jim said that to him Tesfaye seemed a little bit down, both from the tube in his throat and not being able to have physio. I would momentarily see for myself.

When I got to Tesfaye's bed he was communicating with Stephi in writing using his clipboard. I first got an rundown from Nurse Jeanette, telling me that he still has a bit of a fever, that he seems to be in a fair amount of pain, as much due to the breathing tube in his throat as anything else, and that they decided to put his breathing back to more of a machine boost than before as he seemed to be tiring. They decide to also reconnect the self-administered pain medication pump.

Stephi and I try to keep Tesfaye's spirits up and tell him that it won't be long before he gets strong enough for the tube to be removed, and remind him that it has not been very long since he had his surgery and that what he going through is quite common. Stephi is very good at trying to get his mind off of things by playing a game where they jointly draw a funny face as well as playing x's and 0's. At one point Stephi also attempted to remove some residual glue in his hair from the spine monitoring attachments. The good news, you may be pleased to know, is that the glue they use must really keeps those things attached during surgery; the bad news is it does not come out of hair too easily. But in the end, after all the distractions,Tesfaye's mind can't help but refocus on his current plight. In English quite well written he expresses that he wants physio 2 to 3 times a day, and he feels it was better before they put the breathing machine back on full assist - less soreness and coughing. He is happier, though, with the self-administered pain medication pump set up for him again. I leave so that he can get some rest, wondering how much closer to breathing tube removal we might be tomorrow.

Friday, June 19, 2009

Day 7 Recovery - Happy One Week Anniversary!

Friday, June 19th,2009: It is hard to believe that it was one week ago today that I was waking Tesfaye up at 4:00 am to get ready to be at VGH Admissions by 5:30 am. I remember how tense it was waiting for the surgery updates throughout that very long day. Well, thanks to our wonderful VGH Spinal Surgery team, Tesfaye came through that very complicated corrective back surgery with remarkable, life-altering results. Now he just has to get through this temporary bump in his road to recovery, and I believe he is on his way.

9:45 am visit: I really have to start getting to bed earlier; I don't think I have gotten to sleep before 3;30 am anytime this week. Anyway, as planned, Melaku called me around 9:00 to arrange to meet up with me for a visit to Tesfaye at the hospital. I quickly showered and hurried off to meet him there, hoping to see another day of improvement for Tesfaye. When I called into the ICU unit to get approval to enter, they asked me to wait a while as the physiotherapist was there working with him. I abide by the request, but at the same time was concerned that I had to get downtown to a meeting and did not want to miss an opportunity to perhaps finally see Tesfaye sitting up if not standing. So I called back after waiting around 10 minutes and pleaded that I have to leave soon and would dearly love to have a chance to see my son going through some physio before I go; happily, they said to come in. Melaku and I gingerly approached Tesfaye's bed and lo and behold he was sitting up in a chair beside his bed! Nurse Mary, who was on day duty with him again, and the physiotherapist Jocelyn helped him manoeuvre into a sitting up position in his chair, but eventually he starting slipping in his chair,and so they stood him up and put him back in bed. Overall, he was doing quite a bit better today - he was breathing with even less assist from the machine, his temperature was down. bowels were moving. Tesfaye also communicated to Melaku in Amharic wrtitng with his clipboard about something that was ailing him. As we bid Tesfaye goodbye and walked down the long corridor towards the elevators, Melaku commented that Tesfaye is unique, not your typical Ethiopian male in terms of communicating personal things; he is actually quite intrigued by him.

Late in the afternoon I was very happy to get a call from Lise with an update. She confirmed that he is doing better and while not over the hump, they are hopeful can get the tube out by Monday. The sitting and standing earlier in the day definitely was quite tiring for him, but he is a strong and determined young man.

7:10 pm June 19: On our way for a rare Friday night out dinner alone with, Nanci and I stopped at the hospital to see Tesfaye. As the 7:30 nursing changeover from Nurse Mary to Nurse Terry was about to happen, they admonished us that we could not stay too long, so we had a short but sweet visit with Tesfaye and told him that we would return after dinner. Nanci had brought his ipod for him to listen to, and so we set it up with the portable ipod speaker unit and put on some Amharic music for him to listen to, which he seemed to enjoy and appreciate.

10:30 pm June 19: After a very good dinner at Quattro's we went back to VGH to say goodnight to Tesfaye. Nurse Terry was on top of things, with an assist from Nurse Angela.We had a very nice visit with Tesfaye for almost an hour. He kindly asked about how Nanci's mother Rhoda is doing; Rhoda is recovering from serious heart surgery she underwent a couple of days ago in Montreal. Nanci told him that she has something in common with Tesfaye in that she too has a breathing tube down her throat and is not very happy with that. Tesfaye also tried to communicate some other things with us, initially by hand gestures which was then augmented by him trying to write things in English on his clipboard. The experience was somewhat reminiscent of the few times I played the game of Charades many years ago, but eventually we deciphered what he was trying to say. Most noteworthy were two requests that he had: he wants a mirror to see himself, and he wants physiotherapy. In terms of a mirror, as a substitute I showed him a number of pictures I had taken of him on my camera, which seemed to satisfly that request. It is good that he is keen to have physiotherapy (it is not the first time he has specifically asked for it), but we really have to get him weaned off the breathing machine to be able to go full bore with the physiotherapy. But it is a good sign that he is anxious to get it underway.

Day 6 Recovery - Turning the Corner?

Thursday, June 18th, 10:30am: When I arrived to see Tesfaye, I was glad to see Lise there and she brought me up to date on his current status. In summary, his fever was a little better and he was managing lately with less of a breathing boost from the machine; he needs to get his bowels moving. Dr. Marcel Dvorak is now back from being away the last few days and I was happy to be able to chat with him on the phone. He saw Tesfaye this morning and feels that in spite of the infection Tesfaye is not doing too badly and is hopeful that with the current treatment regime he can be weaned again from the breathing tube by the end of the weekend. If not, there are other alternative approaches to consider, but we will cross that bridge if we get there. Nurse Mary is the one assigned to Tesfaye's care for the day shift, and it also happens to be the first day on the job for recent nursing graduate Chivon (sp?). Tesfaye was in decent spirits, and communicated through pencil and paper a few things, including a desire to see the physio therapist. I couldn't stay too long as I had to get to the office to prepare for a number of meetings that would preclude me from returning to see Tesfaye until after 8:30 pm.

8:45 pm June 18th: Milestones After four long hours of meetings relating to some of my non-profit activities, I was looking forward to seeing Tesfaye again. Earlier Nanci told me that she had a delightful one and a half hour session with Tesfaye, during which, amongst other things, they together watched some of the musical "High School Reunion" which got Tesfaye tapping his fingers to the music. Jim and Haley also dropped in a couple of hours before me, but he had just been sedated in order to put a baloon into his chest to measure some of his diaphragm function. However when I was there he was quite awake and looked pretty good, and definitely felt cooler to the touch. Nurse Louise is on duty tonight, with Nurse Sarah, a Brit, on duty with the adjacent bed, lending an assist where required. The good news I heard was that his bowels had started operating, and the great news that I heard was that he had stood and taken some 10 steps earlier in the day with the physiotherapist. Oh how I wish I had been able to witness that milestone event myself! I know that there will be many more opportunities, in fact a lifetime of opportunities, to see that and more.

Wednesday, June 17, 2009

Day 5 Recovery - Back to ICU/Staying Positive

10:15 am Wednesday,June 17 2009: Lovely Lise called me to say that Tesfaye was being well attended to in ICU as they treat his pneumonia, and she explained to me what is going on. As we had discussed the previous day,since he was fairly awake she would like to arrange a time for me to come in with someone who can explain to him in Amharic what is going on so we can be sure he has no worries or unneccesary fears. I called up Sosina and,fortunately, she is able to meet us at 1:30 pm to explain things in Amharic. In the meantime I popped in late morning by myself just to say "hi" and see how he is doing, and although he is all tubed up again and somewhat weak, he sure looks better than he did yesterday afternoon.

1:30 pm June 17th: After catching up on some work, voice mails and emails that have been piling up like crazy and having a very quick bite to eat, I drove to VGH to meet with Lise and my wife Nanci and the translator I lined up, Sosina. When we got into the ICU and Nanci and Sosina were speaking with Tesfaye, I received an update from Lise and Dr. Boyd, one of the surgeons who operated on Tesfaye. They advised me of the steps they were taking to treat the infection and to get Tesfaye's lung functions up to speed, and explained why the particular complications, although predictable, arose. In any event, the plan is to get his breathing functioning satisfactorily within the next few days or else alternative solutions will have to be explored. Lise, with the assistance of Sosina, then explained to Tesfayer in Amharic language what he is now going through and the reasons for it - the ultimate goal being the restoration of his breathing without the need of breathing apparatus.

Tesfaye indicated his understanding throughout and his natural poise under adverse conditions shone through. After the explanations were over, Nanci and I had some time to talk and joke around with him, and his sense of humour and smile were evident notwithstanding the tube down his throat. He the playfully wanted a picture taken with the new "stuffed flower" toy that Nanci brought him posed atop his head. We then said our goodbyes and reassured him that we would be back later or tomorrow. In fact, I am off to see him in the next few minutes to say goodnight. (11 pm)

11:30 pm, June17: Tesfaye has been given a sleeping pill and appears to be sleeping comfortably. Jennifer is the nurse on duty with Tesfaye tonight, and each nurse I meet seems to be as nice as the next; Anita was the nurse for the afternoon shift, and apparently she was the one who selected the movie "Men in Black" for Tesfaye to watch this afternoon. I am sure he found it both unusual and amusing. Nurse Ashley from last night stopped by to see how Tesfaye is doing and say hello. I am told that my son-in-law Jim was in earlier and had Tesfaye communicating through pencil and paper. Anyway, although he felt a bit warm, Tesfaye's readings were steady and reasonably good, so we are hopeful that he will overcome the infection in short order. As Tesfaye was having a good sleep I did not wake him, so I had the opportunity to chat with Jennifer at length about Tesfaye, his treatment and his story. One thing about Tesfaye, with everything that he has been through in life he is a battler and of strong character and, in spite of everything he has been through in life, he is a very positive person. Both those traits will serve him well in overcoming this current setback.

Day 4 of recovery - Disappointment

10:00 am June 16: Today is my parent's 61st wedding anniversary. Hopefully it will be a good day for them and for Tesfaye. Unfortunately, when I arrive at the hospital I soon find out that Tesfaye is struggling a bit today. He is quite tired and still in substantial pain, and his lung functions are below target. They decide to give him an oxygen mask and to also use some medication through the mask to help expand his airways. The oxygen appears to bring up his levels to where they should be, but Tesfaye is bothered by how cold it feels. All of the Unit personnel are tied up in Round discussions, so I ask them to have Lise call me when she can.

Lise calls late morning and says they are concerned about how tired he is and the amount of pain medication he appears to need, which reduces his ability to move around and to cough;in turn this also exacerbates his lungs' still reduced functionality in their new position. She warns they may have to put back his breathing tube and send him to ICU, as they fear he could be developing an infection in his lungs.While they would like to avoid it if possible, it could be a case where "short term pain for long term gain" is what the doctor ordered. Then, while having a late lunch,I receive another call from Lise confirming what I hoped not to hear, that they decided to sedate him and reinsert his breathing tube and send him to ICU for monitoring.

2:30 pm: I tried to get there as quick as possibe with an interpreter in order to reassure Tesfaye, and since Melaku could not make it he referred me to a relative of his, Sosina that lives near the VGH; I called her and arranged to meet her. In the meantime, my wife who had arrived for a visit a little before me was very disturbed to see a team around Tesfaye. When I got to the room with Sosina,Tesfaye was already totally out of it and they wheeled him to ICU. As he was going to be pretty much asleep for the next many hours, we left. After work I managed to fit in an abridged work out, which felt good since I have been missing so many over the last while. I then stopped in to see Tesfaye in ICU around 9pm for about an hour. The nurse on duty with him through the night is Ashley, and she is very sweet.She had heard a little bit about Tesfaye's background and I filled her in on some more details, albeit in an abridged fashion. Tesfaye was very tired and sedated, and again he was not happy with his breathing tube reinserted. He made some hand gestures trying to say something, but I could not figure out all of it.I reassured him that everything will be fine and when the breathing tube is ready to come out he will be a lot stronger and will then get better faster. Stroking his head and squeezing his hand,I wished him a good sleep and told him I will be back in the morning.He seemed as peaceful as could be expected.

Day 3 of recovery: evening visit

6:30 pm June 15: Melaku calls and I make arrangements to meet him at the hospital so that he can see Tesfaye and explain anything important in Amharic.Melaku really is a gentleman and so willing to give of his time in support of Tesfaye whenever I need to call on him. In fact, from the day of Tesfaye's arrival there have been so many Ethiopians expressing appreciation for us helping Tesfaye and offering any assistance we may need or want.

Melaku walked from his Chinatown apartment. When we arrived at the hospital and he saw Tesfaye, he was also pleased to see him looking better and able to talk. Tesfaye seemed a little more awake and aware while we were there and he was able to communicate. Tesfaye wanted me to record him saying some things on video as a reminder later on in the process and so I did,but his voice is fairly faint. After bidding Tesfaye goodnight, I took Melaku for a bite to eat at nearby Sabra's restaurant and Melaku seemed to enjoy his Chicken Matzah ball soup, and I my Shwarma.I then took Melaku back downtown and went home, looking forward to more improvement when I see Tesfaye next morning.

Day 3 of recovery - 1st day in Spinal Step Down Unit

Monday am, June 15:Before heading into the office I stopped into the Spine Step Down Unit to make sure that Tesfaye is doing OK now breathing on his own withouth the tube. He looks like he has better colour and more relaxed without the tube. He is able to talk with a little bit of strength, though it is still a bit hard to hear or understand some of what he is getting at. Nevertheless, I am sure today is the beginning of a good recovery and that we should see daily improvement. I leave for the office feeling encouraged by what I saw, and plan on going back later, as other family members will visit in between.Melaku is supposed to call me early evening and he may come with me for a visit as well.

Tuesday, June 16, 2009

Recovery Room:Day Two - breathing tube comes out?

Sunday June14,7:30 am: Life seems to get in the way of getting much sleep these days. Got up to get ready to take my 18 year old son Justin to the airport to catch his flight to Shanghai. He is interning with a real estate company there for around two months. My son-in-law Jim came along to say goodbye. Justin was tired but in good spirits and ready for his new adventure. After saying our goodbyes Jim and I went for some breakfast. I then dropped Jim off and headed to the hospital, where Jim would meet me later.

Tesfaye colour was looking a little better, but his CO2 levels in his blood were still not at a point where they were prepared to take out the breathing tube. Again it was clear that it was very uncomfortable for Tesfaye with the breathing tube inserted. Rather than having Melaku come all the way to the hospital I called him up on the telephone and had him communicate to Tesfaye that if he can try to reduce a little the frequency of the pain medication and stay awake a bit more it may speed up the lung functionality and allow the tube to come out sooner. He understood what Melaku was saying and I believe was going to try to do that. Eventually Jim and I left as we were going to meet up with Haley to attend some house viewing appointments and other family member were going to come visit during the afternoon.

Later that afternoon I received the good news that Tesfaye had progressed to the point where they could take out the breathing tube and they were moving him to the Spinal Step Down Unit. My daughter Stephanie and Brandon visited him and brought two cute stuffed animals that Nanci had bought for him: a Lion for being brave and strong, and a Giraffe representing being tall. They performed a quasi puppet show with the stuffed animals as props, which Tesfaye apparently did find amusing. I managed to see him later, and he looked much more comfortable without the tube, but still drowsy from the pain medication. Looking forward to a steady path of improvement from tomorrow on.

Recovery Room:Day One

6:45 am June13: Well so much for extra sleep. After going to bed sometime after 1 am I leave my cell phone on next to my bed in case the Hospital calls and needs me to come in. That call comes at 6:45, saying that Tesfaye is starting to awaken and they think he would appreciate a familiar face and perhaps could use an interpreter for some of the questions they need to ask him.

I decide that before bothering my friend Melaku at such an early hour on Saturday I would first shower and head to the VGH myself to see what the situation is and whether interpretation would be needed yet. When I arrived there I saw that the Recovery Room had thinned out and that Tesfaye was barely awake and aware. We did make eye contact and he clearly recognized me, but he was in pain and most uncomfortable with the large breathing tube down his throat. They were going to attend to his wound dressings and told me to go have breakfast and then come back. After walking around the neighbourhood I ended up on Broadway and ate a pretty substantial breakfast at the Holiday Inn.

I walked back to see Tesfaye at the Hospital; it's such a long walk down long corridors from the elevator to the Recovery Room. Tesfaye is heavily drugged and sleepy from the pain medication, and it seems to be having a negative effect on the CO2 elimination abilities of his lungs. This is compounded by the fact that his previously restricted lungs have to learn how to operate in their radically new position in Tesfaye's more upright chest.The same will apply to the rest of his organs that have now been freed up from their bent over and compressed state.

The great news is that Tesfaye's feet and hands and fingers and toes are all responding to touch and he is clearly able to wiggle them. But Tesfaye is also gesturing that the big breathing tube is bothering him and he wants to know when it will be out. They hope to be able to start removing it around 1 pm that afteroon, so I call Melaku to come to the hospital for around noon. Melaku is doing it just as a friend, as he is not an official interpreter. Melaku is the Ethiopian journalist whom we met at Fassil restaurant the second night after Tesfaye arrived in Vancouver;he is the one who broadcast on his Sunday morning Amharic language program an interview that he did with me and Tesfaye.

In the meantime, Dr. Marcel Dvorak pops in to look a Tesfaye looking rested,relaxed and casual in his shorts; he talks to Tesfaye and there appear to be no issues, so after chatting for a while he has to head off to Surrey for a "pony" party for one of his children's birthdays. Marcel really has such a nice manner about him. Melaku eventually arrives and it does make conversation or questions for Tesfaye somewhat easier, but Tesfaye is still drowsy and anxious for the breathing tube to come out.However,his CO2 levels are still not where they need to be. Melaku and I go to Earl's to grab some lunch. It's another beautiful,warm and sunny day in Vancouver; Haley and Jim end up joining us for a drink there, and we have the opportunity to learn more about Melaku and about Ethiopia from Melaku. It is very interesting to hear his political perspective on Ethiopia; as an outspoken journalist he has been imprisoned a few times before he left Ethiopia, the longest stay being one year! Anyway, we left around 4 pm as they said it was unlikely that they would be able to remover the tube until much later, if at all, and I had to get to a haircut and then go for an early farwell dinner to Gothams as my youngest son Justin was leaving for Shanghai on Sunday, followed by a wedding reception for a young relative of mine that had eloped.Justin and Stephanie go to see Tesfaye after our dinner while Nanci and I make our way to the wedding reception. Around 11:30 pm after we leave the reception, Nanci and I stopped by the hospital to say goodnight to Tesfaye. He had the Recovery room area all to himself. He still could not wait to get the breathing tube removed, but that would have to wait now until the next day.

Saturday, June 13, 2009


7:00 pm June 12: Nanci and I went out for dinner with Garry and Lis to await word on the final outcome of the surgery. I'm not sure if I will even have any appetite as I have been so anxious all day and trying to manage on only 3 hours of sleep; at least the periodic updates from Clinical Nurse Specialist Lise Belanger as she went in an out of surgery did give me some interim comfort and reassurance during the course of the day.

9:15 pm: Finally, the call we have been waiting for -- Dr. Marcel Dvorak says the surgery is finished and it has been successful.The surgery itself has gone on for approxiamtely 14 hours from when the cutting began (about 16 hours from when I took Tesfaye in at 5:30 am), a little longer than planned, but Tesfaye and his vital signs and spinal cord monitoring stayed stable throughout. I asked him if he was happy and if he achieved the correction he expected. He said he was happy and thought that it perhaps even went a little better than expected. When he mentioned he was going to go for a beer and a bite to eat with Lise and John the OT, I asked if I perhaps could join up with them and he said "sure".

9:45 pm:Nanci got a ride home with Lis, and I met up with Marcel at Earl's; it was great to have the rare opportunity to go over things in some detail in person with the surgeon right after the surgery. Basically, it was very tricky and took a lot of surgical "finetuning" to get a satisfactory correction as a result of some of the complications from Tesfaye's Ankylosing Spondylitis, but in the end he was pleased. Marcel also said that Dr.Giffin's Anaestheliogy team did a great job going without the need for a blood transfusion even with the large blood loss. I cannot tell you how amazed I am that these guys can do what they do in the Operating Room. I asked Marcel if he has any trouble sleeping or if he worries knowing he has surgery the next day, and he said "no";I asked him whether it was different with Tesfaye's case and he said that it was more compicated that normally seen here, but the main reason he did probably feel a little different about it than the usual case was the increased number of calls and attention the case attracted.

10:45 pm:Call to Dr. Rick: I took the opportunity while sitting with Marcel to try to reach Dr. Rick Hodes in Ethiopia to tell him that the surgery was completed successfully. I was thankful that I was able to reach him and that Marcel could directly give him his surgical summary. Of course, Rick was so pleased and grateful that it all went well for Tesfaye.

11:30 pm:The Perfect End to the Day: Seeing Tesfaye lying on his "new" back Lise kindly took me up to the Recovery Room to see how Tesfaye is doing. Naturally, he is in a deep sleep post surgery. Although they warned me that his face would probably look quite swollen and bruised after beging pushed on while face down for 14 hours,in fact, in spite of that and all the protruding tubes, I thought Tesfaye's face looked remarkably good - still handsome and angelic looking. But he now had a new frailness about him with his clearly longer and straighter torso, and his now visible yet railthin stomach. I was just so ecstatic and relieved that the delicate surgery was finally over, even though I know that a long road of healing and recovery lies ahead. It was so remarkable to see Tesfaye lying flat on his back, with just a thin pillow under his head - a position that he probably hasn't been able to sleep in since he was around 8 years old. As I leave, the Nurse says they will call me when Tesfaye starts arouse and will let me now if they want me to bring an interpreter. I escorted Lise to her car and then walked back to mine, finally looking forward to a longer night of sleep than I have been able to muster in recent days.

Friday, June 12, 2009

4:45 Surgery Progress report

Tesfaye progress report: I just had a call from Lise, who has been in and out of the OR during the day. Everything is apparently going well. Tesfaye and his spinal cord have been stable throughout the process. They are now through the bone removal segment and into the straightening segment. A large selection of instrumentation supplied by Medtronics, i.e., titanium screws,rods,etc. of different sizes to choose from. I guess surgery is part "art" and part "science". Probably at least another 3 or 4 hours until they are done. So far so good.

Tesfaye's journey from Addis to Vancouver to surgery today (June 12th)

Well I cannot believe that today has come - they are operating on Tesfaye as I write this. I took him in at 5:30 am, and stayed with him until they wheeled him out to the OR at 6:50. Although he appeared calm and mustered a few smiles, I could sense perhaps a little trepidation that hadn't appeared before, which would only be natural and expected; I can only imagine what I would be like if it were me.

When I think back to March 2008 and the night that I had Dr. Rick Hodes and his entire "foster " family come to the Sheraton Addis for the buffet dinner, and my spontaneous decision to try to find help for Tesfaye in Vancouver after I learned that Tesfaye was twice turned away at the last minute from life-changing surgery in Ghana , little did I know how long the process would take and all that the process involved. We will leave that part of the story for some other time or place for now. The last few weeks with Tesfaye finally arriving and staying with us have been somewhat surreal, but today as we wait for the surgical outcome it is all too real.

Thursday, June 11, 2009

Life withTesfaye during his first 23 days in Vancouver

Day 1, May 20,2009: I first have an early meeting at VGH, then pick up Dr. Rick Hodes at airport late morning. As a precaution we talk to Customs and Immigration to try to preclude any potential complications for him due to possible language issues. I then get Dr. Rick settled in at our house and fed, then we find out that Tesfaye is landing early, so we hurry back to the airport for Tesfaye's afternoon arrival. Lucky that Tesfaye made it on his scheduled flight; the visas arrived with not even a day to spare.
Tesfaye comes out of customs relatively quickly and on the same flights from Addis through Amsterdam was an Armenian mining guy,Vic, that I had met over drinks last year at the Sheraton bar in Addis and he remembered me. Tesfaye looked happy, calm and alert after such a long trip on his own for the first time, almost halfway around the world. It was great that Rick could coordinate his travel to be here as well at the same time, which must have been comforting for Tesfaye. Made our way to our house where Tesfaye was greeted by Nanci and then Stephi and Brandon and balloons. People were going to be coming within an hour to meet Dr. Rick Hodes. Tesfaye enjoyed the pizza we ordered. People who came seemed captivated by Rick’s story – he tells it so well no matter how many times he has repeated it. His quiet passion and sincerity comes through. Most were able to stay to watch a short film about Rick and his work.

Day 2, May 21, 2009:One of my guests from the previous night,Mark,was very taken by Rick's story and so he went this morning to Vancouver College Catholic boys school and sets up a 2 pm talk for Rick in front of around 150 senior grade students. We bring Tesfaye as well. The students and staff seem interested in getting involved. We will see where it goes. Before that Rick, Tesfaye and I spent the morning at the VGH. I am always impressed with how professional and nice all the staff in the various departments are. Rick and Marcel go over matters and are able to also examine Tesfaye in person. The whole morning is taken up at the hospital, but Tesfaye is very patient and takes everything in stride. They want us to make sure that Tesfaye eats well and get “fattened up”.

After the presentation at Vancouver College,Tesfaye and I took Rick to the airport and said goodbye. Tesfaye also said “pray for me”.That night Nanci and I took Tesfaye to Fassil Ethiopian restaurant so he could experience a local taste of home and perhaps also meet the owner and some other Ethiopians that have been hearing about the impending arrival of Tesafye for some time.Well, when we got there we did not notice a sign on the door advising that the restaurant was closed for a private function and so we just walked in only to see about 20 or so Ethiopians sitting around a long table.As we walked in somewhat unexpectedly they saw us with Tesfaye and immediately burst into spontaneous applause and gave us all a very warm welcome.Tesfaye was very happy with the friendliness of the people and felt at home with so many coming over to talk with him in Amharic.At the end of the meal, one of the Ethiopian gentlemen introduced himself and said that he broadcasts a one hour show in Amaharic on Sunday mornings and would like to interview me and Tesfaye about his story for the show, so we exchanged telephone numbers.Later Thursday night we ended up at Richmond General Hospital to deal with an emergency situation involving Nanci’s sister, so we ended up being up most of the night.

Wednesday, June 10, 2009

Stay tuned

With only 2 days left until the big surgery, stay tuned for a summary of what has gone on in Tesfaye's life in Vancouver over the last 3 weeks, and for updates post-surgery.