Thursday, July 30, 2009

Swallow Test follow up - A happy result and happy reunions

Wednesday July 29, 2009: It was on Tuesday, July 7th (see my previous post dated Wednesday, July 8th), almost four weeks since entering the hospital and since he last ingested food through his mouth, that Tesfaye received a conditional pass on the swallow test allowing him to eat soft textured foods and drink thickened liquids, with the further restriction that he turn his head to the right as he swallows; unfortunately, it appeared that some damage (likely temporary) to his vocal chords from the second time insertion of the breathing tube had affected Tesfaye's swallowing ability. Notwithstanding these restrictions, this was certainly fantastic news for Tesfaye (you can imagine receiving your nutrition for four weeks solely by way of liquids administered through a feeding tube inserted into your stomach through your nose). Nevertheless, after faithfully following these restrictions for over three weeks, we were hoping that he would now be able to fully pass the swallow test and have all restrictions removed. What gave us hope that he was ready was the fact that his voice had steadily progressed over the last couple of weeks, to the point it was very strong and seemingly back to normal.
At 8:30 Tesfaye and I arrived at the hospital and received a lovely welcome from a number of staff members, who all remarked how great Tesfaye was looking. While waiting for John the OT, we were with Lise and then saw Brian, the spine surgeon from Ireland here on a Fellowship, who was part of Tesfaye's spine surgery team during the June 12th operation. Brian was pleased to see how good Tesfaye looked, and answered a few questions that Tesfaye had; Brian is on his way back to Ireland on August 5th. We then met up with John and made our way over to the Swallow Test X ray room that we had previously attended on July 7th, whereupon the team of John, Catherine the Speech Therapist, Dr.Salat, Ramen, and Vanessa conducted the repeat swallow test on a wide range of foods and liquids, with the result that: Tesfaye received a 100% pass! Tesfaye was now free to eat or drink anything he pleases and without needing to turn his head to the right as he swallows; he was most looking forward to drinking normal, unthickened water, and I no longer would always be thinking he was looking at me for some reason as he ate.

Successful Swallow Test Video
So all in all it was a happy return visit to the hospital, as much for the nice reunion as the successful swallow test. While it was nice to see so many familiar faces of the truly wonderful Spinal Unit staff, many of whom I have mentioned in previous postings throughout Tesfaye's hospital stay, before leaving Lise said that there were two operating room nurses, Patsy and Fiona, that heard that Tesfaye was going to be at VGH this morning and were very keen to see him; they both had been with Tesfaye throughout the marathon 14 hour back surgery on June 12th but had not seen him since then. Because they were also occupied in the Operating Room this morning we had to wait some time for them to be able to make it up to the Spine Unit for the visit, but Tesfaye and I were very happy to wait for them. When they arrived they really appreciated the opportunity to see the marvellous outcome that the surgery had for Tesfaye, because not only was this a unique case, but they also remarked how they never before had the chance to see their patients after they leave the operating room; by the same token, Tesfaye and I appreciated the opportunity to thank them for their role in the outcome. I certainly remember that moment when I first met Patsy, bright and early the morning of June 12th, as she wheeled Tesfaye away to the OR for the surgery - we have been through so much since that moment, it now seems so long ago.

Before leaving the Hospital there was one more visit that I really wanted to make with Tesfaye if possible. Without advance notice I took a shot at seeing if Anne Sutherland Boal, Chief Operating Officer of Vancouver Coastal Health, might be available to Tesfaye, since as far as I knew she had not yet had the opportunity to see Tesfaye up and walking and looking as strong and upright as he was today. Anne was a critical part of the approval process for Tesfaye's surgery at VGH; as it was a unique undertaking for Vancouver Coastal Health, not to mention a very complicated surgical procedure requiring a certain medical expertise, it required both a skilled and willing surgical champion (Dr. Marcel Dvorak and his team) and an open and innovative mindset at the top administration executive level. Without Anne's support and desire to have VGH undertake this life changing surgery for Tesfaye it could not have happened. I was so pleased to hear that indeed Anne would take a few minutes to step out of a meeting she was in to say hello to Tesfaye and me. It was my first opportunity to get a picture of the two of them, and with that we were on our way home to spread the good news about the swallow test.

[Thursday July 30, 2009
: Tesfaye flies up to Kelowna through Monday August 3rd for the long weekend, away from Vancouver for the first time since arriving from Ethiopia.

Friday July 31, 2009: Tesfaye is anxiously awaiting his midnight appointment to talk to his mother for the first time since the surgery.

Details and pictures about these events and Tesfaye's Kelowna experience will be posted over the next couple of days as time permits, so please revisit]

Friday, July 24, 2009

Update from Ho Chi Minh City Vietnam - Motorbike madness

July 20 to July 25, 2009: It's Saturday here in Ho Chi Minh City Vietnam. If Detroit is Motor City, then this is Motorbike City. Little motorbikes, mostly cheaper Chinese made ones, outnumber cars by at least 10 to 1. With the way they weave in and out of cars and each other in seeming chaos, I am amazed that I did not witness any accidents. That's a good thing, as you often see these little bikes with 3 or 4 family members, including little children on them. Anyway, it has been a whirlwind week of travel and factory visits - something like 7 cities in 6 days in 2 countries. I won't go into many details about my trip here, except to say it has been extremely hot and humid everywhere (record heat in Shanghai), I got to see part of the solar eclipse, I have visited many factories that we are either dealing with already or about to deal with, I haven't slept much, and I have had some very good Chinese food on this trip but I am ready to take a break from it.

Tesfaye this week - These are are few of the highlight that I have heard of regarding Tesfaye's week:
- Generally I have many reports that he has had a great appetite and is eating well. It seems he has discovered and developed a fondness for Nando's.
- He has been feeling so good there are some days that he doesn't take any of his medication.
- The night of the fireworks he went for Ethiopian food to Fassil restaurant with Brandon and Stephanie, and then to my parents' house for a safe view of the fireworks. He was very excited to see fireworks, as he had never seen them before.
- He has been practicing some newly learned computer skills and regularly works on his English grammar books.
- Erica Leyland very kindly took Tesfaye on an outing to the Aquarium and he emailed me that it was amazing.

Well, I am now catching a 6 am flight from Vietnam to Vancouver via Hong Kong and I am very much looking forward to seeing the whole extended family. Cheers!

Monday, July 20, 2009

Shanghai - mission accomplished

Monday July 20 (China)/Sunday July 19 (Vancouver), 2009: It was nice when I landed to be greeted by my first email message, which was from Tesfaye, asking me how is China and telling me that he misses me. The next nice thing was that it did work out in the end that I could see Justin. We were able to coordinate meeting for seven or eight minutes after he checked in and we exited the baggae area. It was great to see him after 6 weeks or so, and he looked terrific. Unfortunately I will have to wait another week to hear some of his crazy and humorous stories told in his own inimitable style. After checking into our hotel we were driven to the Stylecraft Factory where we had some initial meetings with our partners and then went for a very nice "modern" Chinese cuisine dinner. My associates and I were fading rapidly by the end of dinner and couldn't wait to get to bed.

In the meantime, I did receive some regular updates from Nanci. On Sunday Erica came over for a 2 hour visit and met Tesfaye. I understand she will take him on an outing this week. The other unfortunate news that I heard was that Adam was badly bitten on the nose by our bird Mango; I just don't understand the "love/ hate" relationship they seem to have. Anyway, he went for a stitch, but is fine.

I am off to our Shanghai factory now. Later.

This week - Gary's Journey

Sunday July 19, 2009: I left Sunday morning for a week long business trip to China and Vietnam. Any updates this week regarding Tesfaye will have to be long distance and indirect reports. Well, I guess that's not totally true, as Nanci has set up a Gmail account for Tesfaye and he has learned how to send emails.

So I was sad to be leaving Tesfaye's smiling face for a week and, of course, the rest of my family. I said my goodbyes to Tesfaye Saturday night even though he did want to get up and say goodbye. Nanci drove me to the airport and I got there reasonably early (for me). It was a very comfortable flight. Justin is going to be flying back to Vancouver a couple of hours after we land, so I was really hoping to somehow be able to coordinate seeing him at the airport for even a few minutes so that I don't have to wait an extra week to see him. We'll see.

Saturday, July 18, 2009

Getting word to Tesfaye's mother at last

Friday, July 17, 2009: After lunch I had a nice surprise visit from Nanci and Tesfaye at my office, which was his first return visit since the surgery. As everyone in the office had certainly been getting updates from me on Tesfaye's progress, they appreciated the opportunity to see him in person. The highlight later in the day was successfully connecting through to Meheret in Gojjam Ethiopia at midnight our time. Meheret owns a shop in the town near the village where Tesfaye's mother Yeshi lives. It is about a 2 hour walk from her village, the village where Tesfaye was born and grew up until making his way to Addis to find help; as they do not have any telephone service ( nor electricity or running water), the method whereby Tesfaye can reach his family is to reach Meheret and have him relay a message to his mother and/or set up a time for her to walk to his shop to receive a telephone call from Tesfaye. The last time he did this was a week or so before his surgery, and unfortunately Melaku and I unsuccessfully tried to provide an update in this manner after the surgery. Amazingly, on our first or second try we got through and Tesfaye was so happy to be able to tell him that the surgery was a success and that he is doing very well now. They in fact had been anxiously awaiting to hear how the operation went. Meheret will communicate the good news to Yeshi, and Tesfaye told him that he will call back to speak to his mother at the same time in two weeks from now.

Friday, July 17, 2009

Suture removal - a reminder of how far we've come

Thursday July 16, 2009: We were all looking forward to the 3:00 pm appointment at VGH to have the remainder of Tesfaye's sutures removed. Tesfaye was also looking forward to his noon haircut with Karen at Sweet Pea. Tesfaye came on May 20 with very close cropped hair, but it was now around two months since he last had his hair cut (not counting the snipping Stephi did one day in the hospital to get some glue out of his hair where the electrodes were attached).

So at 3:00 pm I met Tesfaye, Haley and Nanci at the hospital for our suture removal appointment with Lise. This was Tesfaye's first return visit to VGH since coming home last Friday, and it would be interesting to see everybody's reaction. Well, everybody thought Tesfaye looked terrific and that his face appeared to have filled out a lot over the last six days; his voice was also noticeably stronger; by the way, it was also a great haircut. We first bumped into pain specialist Doctor Mike Negreaff and discussed Tesfaye's pill regime and told him that Tesfaye had stopped taking the strong pain killer hydramorphone. Doctor Mike told him what other pills he could also start modifying accordingly.

Lise then found a room she could use to remove Tesfaye's sutures. After having Tesfaye sit on a raised bed with his back to her, Lise then began the somewhat time-consuming process. She removed around 25 of the blue sutures, and then found another couple of them that eluded her the first go around. There were also another 25 or so sutures that had been removed two weeks earlier from the upper portion of his incision. The incision, which probably measures 18 inches or so and extends down virtually the whole length of his back, has healed very well. I took pictures of it so that Tesfaye could see how it looked. Looking at him both sitting and standing there with his shirt off and remembering what his back looked like before the surgery, it really was truly amazing to behold and hard to believe just how straight his back is now. With the stitches now out, even though it was probably unnecessary, Tesfaye wanted the area to be re-bandaged with some small strips and Lise did a precision job of doing so. In the process of saying our good byes on the way out we bumped into John the OT, and he also was duly impressed with Tesfayes marked improvement since coming home. As his voice was also significantly stronger we talked about moving up the time when the swallow restrictions may be abandoned, to maybe 10 days from now. The other things still to be scheduled are a follow up xray and pulmonary function test. As we exited the hospital we had an opportunity for Jim O'Hara from the VGH foundation office to get his first look at Tesfaye upright and walking post surgery.

Later in the evening when I got home from the office and my workout, Lis was over visiting for a while but could not stay for dinner, but Jim and Haley were staying. Tesfaye's appetite has been growing so nicely we bought him his own special fork and spoon set ; ). We all enjoyed the warm Vancouver summer evening by having a light BBQ chicken meal seated outdoors on the patio. Ever since Tesfaye's arrival on May 20 our weather has been unbelievable; he certainly has brought sunshine into our lives.

Enjoying the mundane

Monday July 13 to Wednesday July 15, 2009: Tesfaye continues to eat well and to diligently follow the instructions to avoid thin liquids and turn his head to the right while swallowing. As his voice seems to be improving maybe they will remove these restrictions before the original estimate of three weeks from now. Nanci has been taking him with her on various errands and lunch outings, and on Monday had him fitted for a couple of pairs of shoes. In between outings Tesfaye spends his time around the house either reading, watching TV (he started following the Bachelorette before and while in the hospital), resting, or learning his way around a computer. Tesfaye has been very good about looking up any English words that he does not understand in his English/Amharic dictionary. His English is improving, and to further assist in the process I am contemplating finding an English tutor for him in the next couple of weeks when he is a little stronger.

Thursday, July 16, 2009

Getting Out and a Taste of Home (Ethiopia)

Sunday July 12, 2009: I had a morning golf game scheduled with Brandon and his father Jean, so we arranged to meet up for brunch at the Club after our game with Nanci, Tesfaye, Stephanie and Randi. Tesfaye and I reflected back to the first and last time we had lunch at the Richmond Country Club on May 24th, before his surgery, and how after lunch I gave him his first introduction to golf by having him putting on the practice green (he was surprisingly good at it by the way).

Later, as reliable as ever, Lemlem called to see if it would be OK to come over to visit Tesfaye this afternoon. Lemlem is a young Ethiopian woman, a student at UBC, who heard Tesfaye's story on Melaku's Sunday morning radio show on May 24th. Tesfaye and I subsequently met Lemlem when we were invited by Melaku to come to an Ethiopian community barbeque in Burnaby one Saturday before the surgery. Lemlem took my phone number at the barbeque and from that point on, out of a genuine concern and sincere interest, would regularly call me to ask how Tesfaye was doing all the way through the surgery and recovery process. Lemlem herself is dealing with health issues resulting from a serious car accident she was in. Today Lemlem wanted to see Tesfaye but wasn't sure if she should, as this morning when she listened to Melaku's radio show and he gave his regular update on Tesfaye, he said that with his weakened voice Tesfaye wasn't ready for visitors yet. I asked Lemlem where she was right now and she told me that she had bussed from her apartment at UBC to an Ethiopian restaurant in the Commercial Drive area in order to bring Tesfaye an Ethiopian meal of injera and lamb - how considerate! I told her that of course she can come, and as she was already on a bus heading in our direction I said I would be happy to pick her up at a bus stop near us. Tesfaye was happy to see Lemlem and really enjoyed the meal of injera. Typically, Lemlem brought a get well card for Tesfaye and a thank you card for us. After a nice visit I offered to drive Lemlem back to UBC and asked if Tesfaye wanted to come for the ride and then drop in to see my parents. Tesfaye was up for it and so that is what we did. I was very happy that my parents had an opportunity to see how good Tesfaye looks after the successful surgery. They were truly impressed and happy for Tesfaye, and we had a wide ranging discussion about many things, including touching on his life story again and talking a little about what his future may hold.

By the way, it seems that with each day his voice is gaining a bit more strength.

There's No Place Like Home

Saturday July 11, 2009: The first full day for Tesfaye back at our house. Tesfaye has started settling into his prescribed regimen of pills, walking and exercises to strengthen his supporting limbs and his breathing. Tesfaye is very disciplined about doing everything he is supposed to do, and is very independent in terms of managing his daily needs. Nevertheless, Nanci does a great job of mothering him and making sure he does not go hungry; definitely no risk of that around here -- trust me. Until the sutures come out, "Nurse" Nanci also will be taking care of changing Tesfaye's dressing after he showers.

After a fairly relaxed day for Tesfaye and an afternoon workout for me (I've been missing so many the last couple of months), rather than go out with the Goldbergs we decided to stay home and have them over for a casual barbeque dinner, and Stephanie and Brandon joined us as well. This was Ben and Nancy's first opportunity to see Tesfaye post-operation and we had a great time; I must say that I barbequed the salmon, steaks and broccolini (so I'm told) to perfection. Our dog Ziggy also had fun with their dog Maccabee.

Friday, July 10, 2009

Day 28 of Recovery - Four Week Anniversary: Coming Home!

After Surgery

Before Surgery

These two images only give a bit of an idea of the dramatic change the surgery has had on Tesfaye's spine and torso. The clothing hides the fact that before surgery Tesfaye had a
90 to a 100 degree bend which had him totally folded over, compressing all of his internal organs, with his neck perpendicular to, rather than in line with, his back. He had no waist to cinch his pants to. He now can see his "belly button" for the first time since he was around 8 years old.

Homecoming Friday July 10,2009:
I cannot believe that this day, the day that Tesfaye is released from the hospital, has finally come. It was four weeks ago today that I was driving Tesfaye to the hospital at 5:15 am to undergo his surgery. Although both Tesfaye and I were well briefed on what the operation and post-operation recovery involved, when Tesfaye was wheeled away from me to the Operating Room on that Friday, June 12th, I could not know for sure what lay ahead in terms of surgical outcome and the recovery process.

Looking back today I can say that the 14 hour corrective spinal surgery done under the lead of our world class surgeon, Dr. Marcel Dvorak, together with his expert spinal team was an amazing success, and Tesfaye's recovery process, though affected by a few (mostly predictable) complications, was masterfully handled by the skilled care teams at our first rate Vancouver General Hospital. I cannot say enough about the manner and level of care and attention that Tesfaye received here. Based on what I have personally witnessed on essentially a daily basis over the last four weeks and have been told by experts, Tesfaye was lucky that the anaesthesiologist wisely declined to conduct the surgery in Ghana, where equipment and facilities are just not as sophisticated and able to deal with complications as here.

2:30 pm Friday, July 10, 2009: After a meeting filled morning and a lovely "catch up" lunch with Anne Campbell I hurried to pick up Melaku's daughter Emebet, who kindly offered to serve as interpreter in place of her Dad, and met up with Nanci at the hospital for the discharge information sessions.
Over the course of the next hour and a half or so Tesfaye, Nanci and I were briefed by the Occupational Therapist, Physio Therapist and Dietician about any physical restrictions, recommended exercises, and nutritional requirements and limitations, followed by a concluding session with Lise about Tesafaye's ongoing medication and pain management program. After all those sessions and with no more questions on our part, it was time for a somewhat emotional farewell. Of course we will be back for check ups and follow up appointments, including stitches removal next week, a repeat swallow test in four weeks, and a throat/vocal cord check up in a couple of months,but for the last month Tesfaye's life has totally depended on and revolved around the VGH and its staff - and I must say much of my own life over that period has likewise been consumed by Tesfaye and the hospital.

As we left the Spinal Ward on floor 9 I took a side by side shot of a before and after xray of Tesfaye's back, which really highlights the really unbelievable d
egree of transformation the surgery has achieved for Tesfaye's previously severely curved spine. As we exited the main floor doors of the Centennial Pavilion to finally return to our house, I had to have Emebet capture that moment in a picture. Emebet came back to our house with us for the homecoming moment, a very happy moment for all which Nanci made sure to mark with celebratory balloons. Stephi's smiling face was there to greet Tesfaye at the door. When it was time to take Emebet back to her house Tesfaye came along for the ride. The dramatic difference in Tesfaye's posture and height was immediately noticeable by the fact that he could now sit upright and see out the car window without adding a thick pillow. After dropping off Emebet we enjoyed a lovely Shabbat meal back at our house. Tesfaye was so happy to be back home and was his usual clowning self, and we all savoured the moment and gave thanks. I always look forward to and enjoy our Friday night family dinners, but this was one Friday night family dinner that had extra special meaning.

Thursday, July 9, 2009

Day 26 and 27 of Recovery - Home soon/Meeting two of Melaku's children

6:00 pm Wednesday, July 8, 2009: I had no time in the morning to visit Tesfaye, but Melaku and I arranged to meet at 6:oo pm at the hospital, and he was bringing his son and one of his daughters. With Melaku having been so kind with his time and support since Tesfaye's arrival it was very nice for me and Tesfaye to have the opportunity finally to meet a couple of his children, his son Mikael and daughter Emebet.

In the meantime, the best news of the day was that we were told that Tesfaye had been given the clearance to come home to us this Friday July 10th, four weeks to the day that he had the surgery! After all that he has been through, it is hard to believe that day has come.

Thursday, July 9, 2009: When I stopped in around 9:30 am Tesfaye was standing by the window looking very fine in some nice basketball style sweat pants and top. This is his last full day and night in the hospital before coming home. I had to chat with Lise about something so we walked over to her office. He brought his favourite Canuck monkey with him, tied around his neck in a playful manner. I confirmed with Lise that 2:30 tomorrow afternoon is fine for the Hospital departure session where we would go through in detail what Tesfaye has to do when he comes back to live at our house. I will bring Melaku's daughter Emebet to translate into Amharic so that he is clear on everything, as Melaku will be at work.

Later, at 11:00 pm i dropped in for one last hospital "goodnight". Tesfaye was half asleep but I told him I would not see him in the morning, but most certainly will at 2:30 pm.

Wednesday, July 8, 2009

Day 25 of Recovery - The corner has been turned!

10:00 am Tuesday, July 7, 2009: I went for what I thought would be a quick morning visit, but when I asked Tesfaye what was up for the day and if he knew whether a swallow test had been scheduled, he told me that he was going for a back x ray and then he thought he was supposed to have a swallow test around 10:45. He wanted me to be there for it, so I said I had a couple of things I had to do in the meantime but would come back. Upon my return at 10:45 I saw John the Occupational Therapist, one of the people in charge of the swallow test, about to enter the elevator. I asked him if the swallow test was happening and he said that is where he was off to and Tesfaye is on his way there, and that I am welcome to attend it with him. I was keen to attend for a couple of reasons: I was anxious to see if Tesfaye would pass and be given the green light to start eating; and, I was interested in seeing the actual barium swallow test which traces the path of the food or liquids as it goes down his throat.

As John and I waited at the x ray unit for Tesfaye's arrival, it turns out that he is friends with Daniel, a server at Quattro's that I had come to know well over the years, and when they were out John was surprised that he knew the story of a young Ethiopian (Tesfaye) that had come over for major spine corrective surgery at VGH - one of those "it's a small world" stories. Finally, Tesfaye arrived at the unit and preparations began for the test. After putting on our lead lined protective gear for our bodies and throats, we entered the room for the test. I really found it quite fascinating as you first see the skull, jaw and throat on the screen, and then track in real time view the path the various food or drink items given to Tesfaye to swallow take as they make their way from the mouth down through the throat. John and Tracy, the Occupational and Speech Therapists, guided the testing - he was tested on food and drink items of various consistencies, ranging from thin to thick, and with Tesfaye trying out different positioning of his head for swallow purposes, from straight on to turning his head sideways.

Video of Swallow test: interesting to watch

After completing what appeared to be quite a positive swallow test we made our way back to the spine ward to await the official decision from John and Tracy. Their conclusion was that he can now start eating and drinking so long as his head is turned sideways when swallowing ( this seems to operate as a better safeguard against potential aspiration) and so long as he does not consume thin liquids for now! A follow up swallow test will be done in about a month to see if the thin liquid restriction can be removed. The good news was carefully explained to Tesfaye and he was told the feeding tube extending through his nose down to his stomach could now finally be removed and he could start eating. For some reason, at that time, Tesfaye did not display as much outward happiness towards the news as Lise and I may have expected, but he did later. It was such a great feeling for me to see Tesfaye with the feeding tube removed, so I can imagine how wonderful it had to feel for Tesfaye. I just had to get a picture of Tesfaye without the tube as well as see him walk without needing to have the fluid machine as a walking companion at his side.
Soon thereafter, his first meal to be ingested through his mouth since June 11th, the evening before surgery, was brought to his room: an egg salad sandwich, accompanied by thickened water or juice. Maybe not too exciting for you or me, but Tesfaye probably savoured it as though it were a meal fit for a king.

6:00 pm Tuesday, July 7, 2009:

I returned at 6:00 pm with Melaku and met Nanci and Haley there as well; they had not seen Tesfaye as yet without the feeding tube. Tesfaye looked terrific all dressed up in civilian clothes instead of a hospital gown. Tesfaye had just started eating the hospital dinner, but Nanci also brought some home made pasta for Tesfaye to eat and I am pretty sure (wink,wink) that Tesfaye enjoyed it even more than the hospital meal. Melaku also made sure to go over in Amharic all of the rules for eating that Tesfaye must abide by until the next swallow test.

Haley drew on the white board a couple of pictures showing how Tesfaye is going to look once he comes home to Nanci's cooking, as compared to his current extremely thin state. This certainly drew a chuckle from all of us.

When he finished eating I made sure to get my first picture of him standing up in normal clothing. Thumbs up - we've turned the corner!

Tuesday, July 7, 2009

Day 24 of Recovery - A new week: what will it bring?

9:30 am Monday, July 6, 2009: As usual, now that I am back in town I stop in for my morning visit to Tesfaye, but it will be brief as I have to get a number of things done and my afternoon is going to be occupied by the ZLC Charity Golf tournament which I usually play in because it is put on by my good friend Garry Zlotnik. The sky looks foreboding for a golf tournament, but maybe we will be lucky and the rain will hold off. Tesfaye looks even better this morning, with a big bright smile on his face as Nurse Merlita attends to him. However, his voice still remains a mere whisper. I am wondering if the throat specialist will see him soon so that it can be determined if another swallow test is in order. It is my good fortune to bump into Lise before I leave, and I ask her if a throat appointment had been set up. She said not to her knowledge (she was also off the last few days), but she would check and find out and give me a call.

11:00 am Monday, July 6, 2009: Lise gives me a follow up telphone call to advise that, indeed, the throat specialist is going to make a special appointment to see Tesfaye at 12:30 as he will be going out of town for a few weeks; Lise also thought it would be useful to have an Amharic language speaker at the appointment if possible. As I knew that I was unavailable at that time, I was fortunately able on short notice to arrange for Haley, Nanci and Melaku all to be there. The outcome of the appointment conveyed to me by Haley was that one side of the vocal cords had some paralysis, which apparently is quite a rare byproduct of intubation, but it should heal with time. They usually give it a few weeks, failing which they can inject the vocal cords with silicone to try to compensate for the problem. However, this problem was also impacting Tesfaye's ability to safely swallow without risk of aspiration, so in his case in order to speed up the recovery process and try to allow him to start eating solids they decided to do the injection through the throat into his vocal cords. Just writing about this makes me kind of queasy but, naturally, Tesfaye handled the needle in his usual stoic manner. Later that night Jim and I went to see Tesfaye and his whisper seemed a little bit stronger. I left hoping that as a result of the injection they might do another swallow test tomorrow and that he would now be able to pass it. We'll see.

Days 22 & 23 of Recovery - In good company

Saturday July 4, 2009:I needed this few day break in Kelowna, but I miss not seeing Tesfaye and witnessing in person how he is feeling each day. Nevertheless, I knew that my children and their partners would continue to make a point of visiting and keeping him company, and by all reports they were extremely diligent in doing so. Be it wheeling him to the outside patio, walking with him, talking and playing games, or just keeping him company watching TV or a movie, Tesfaye knows he has a big support group that really cares about him. From what I hear, there could be some small improvement in his voice and chest clearing. This may bode well for him if they do try a repeat swallow test in the next few days.

Sunday July 5,2009: While I have certainly enjoyed spending time in West Kelowna, I am due to return to Vancouver this Sunday evening and I look forward to it and seeing Tesfaye. Today I hear that Tesfaye is in stable condition and is in a good and playful mood, with his usual sense of humour, as he also anticipates Nanci and I coming back to Vancouver and seeing us again. Although it is quite late by the time we land and get back to our house, I went to the hospital to see Tesfaye even if just for a few minutes. When I got there Tesfaye was sitting up nicely in a chair, and we chatted about what he and I had been doing the last few days. Tesfaye looked a lot better to me than when I last saw him on Wednesday. There was a nice nurse on duty who actually grew up in Afghanistan but left with her family when the Taliban came to power and started taking away their freedoms, including not allowing girls to attend school. When the nurse asked if Tesfaye wanted to go to bed now, Tesfaye said no, he wants to go for a walk with me. Besides being a typical display of being conscientious and determined to improve, I was happy to have another opportunity to see what progress he had made since I last saw him walk. Well, I was impressed with the increased strength and stability that was evidenced in his walking, and how upright he held himself. Now if only we can get that darn feeding tube out of his nose and stomach and move him on to actually eating through his mouth; seeing how stable he is getting in and out of his chair and walking, that seems to be the last real obstacle in accelerating and completing Tesfaye's recovery. After our walk he was ready for bed and so we bid each other goodnight. I asked the nurse if an appointment had yet set up for him with a throat specialist to look at Tesfaye's vocal cords, but it did not seem to be set up yet in his chart. Maybe I will see Lise tomorrow morning and find out the plan in that regard.

Saturday, July 4, 2009

Days 21 - Three week anniversary!

Friday July 3, 2009: By all reports Tesfaye did well today. He did some walking , nurses took him outside in a wheelchair where he picked some lavendar, which he gave to Stephi when she came to visit with Brandon. In the evening Melaku also went for a visit and so he then joined up with Haley,Jim and Adam for dinner, as they were going to visit Tesfaye as well. No major changes from before, but each day it appears has some minor incremental improvements. Three weeks since the surgery now seems like an eternity. I do believe we are turning the corner and the day for Tesfaye to be able to leave the hospital and return home to us, I hope, won't be far off.

Thursday, July 2, 2009

Day 20 of Recovery - Lucky to be at VGH,Swallow test results and more

10:30 am Thursday, July 2, 2009: Well this morning I am anxious to hear the results of the barium swallow test being conducted under the guidance of Tesfaye's occupational therapists John and Tracy. My daughter Haley and her husband Jim were going to take my place and be with Tesfaye in my absence. Before the swallow test I received a call from Dr. Marcel Dvorak to advise me that after looking at the bottom part of Tesfaye's wound they decided as a precautionary measure to do a procedure in the OR to clean it out to avoid any more serious potential complications later; it would be either tonight or on Friday. Marcel told me he explained it to Tesfaye and felt he understood him, but I told him that in any event Melaku would probably be coming later to visit and could repeat it in Amharic.

Haley and Jim waited for the completion of the swallow test and right away called me and told me that unfortunately the way his throat is currently operating he is not yet in a position to swallow properly when ingesting food through the mouth without the possibility of asperation occuring. Haley also said that Tesfaye knows that the minor surgery to clean his wound is no big deal, but Melaku will come and reiterate that later in the afternoon. To quote Haley, Tesfaye " is in good spirits,smiling with that big smile we love! Of course he is annoyed about the swallow test, but he understands that it is a slow process that will take time and patience." Haley reminded him how far he has come with his back and physical rehab, and to further quote Haley: "He's a fighter! So positive and strong. We had fun with him today."

6:30 pm Thursday, July 2, 2009: Jim told me he would be having the wound clean-up surgery around 7/7:30 pm this evening, and I asked them to give me a report when he is out. They would likely have to use a breathing tube again, though a more shallow one. I waited a little anxiously for a report, and Dr. Dvorak called me just after 9 pm to give me a report. The surgery to clean up the bottom wound area went well, and they were able to determine that the area they were concerned about was really a superficial irritation, that the underlying layers including the fascia were in very good condition. He said they were also able to scope the vocal cords and saw that both sides were basically in good condition, better than they expected, and so he feels the voice should start coming along by itself over the next few weeks. Marcel also feels that they may be able to retry a swallow test in the next few days and perhaps figure out a way to get Tesfaye to be able to eat through his mouth successfully. I sure hope so.

I know from the many pre-operation sessions that I attended with the spinal team at VGH, first as part of the approval process and subsequently as part of the pre-operation preparations with Tesfaye, that most of these post-operation complications that Tesfaye has been going through are possible and predictable. That may be, but as we go through them and I see the tremendous care and attention that Tesfaye is receiving from the various departments and staff at Vancouver General Hospital, I am so thankful Tesfaye is here at VGH recovering from major back surgery rather than going through it in Ghana or Ethiopia, where they just don't have the same kind of ability to deal with these kinds of complications. In the face of disappointments (in Tesfaye's case he was twice turned down from surgery in Ghana) I always say things have a way of ultimately working out for the better, but in this case you could say it may have been a difference between life and death for Tesfaye.

Wednesday, July 1, 2009

Days 18 & 19 of Recovery - Waiting for Swallow Test Thursday

Tuesday June 30, 2009: This morning's visit with Tesfaye found him in good spirits. Lise was there and told me because of the Canada Day holiday the special barium swallow test would not be occuring until Thursday morning, July 2nd. Nothing we can do except wait for then and hope that the swallow test is successful so that Tesfaye can start actually eating without the feeding tube. I will be heading out of town for a few days, but Tesfaye and Lise know that my children will be around to visit and that I plan for Haley to attend at the swallow test. Of course, I am always available by cell phone and I will be close to Vancouver. For Amharic translation Melaku will generally make himself available.

Later this morning Melaku and I try to connect with the shop owner at the town near Tesfaye's village to try to get a message to his mother that Tesfaye is doing fine and had successful surgery. The last time we were able to talk to her was before the surgery. We have tried a few other times but it is difficult making a connection. It was very frustrating earlier this morning when we were able to connect, but in the end the lady never came to the phone and it disconnected after about 10 minutes. No luck this time either -- we will try again later tonight.

After a busy day at work I went to my scheduled workout at 6:30 pm, then went back to the office for final "leaving town" cleanup. Melaku and I then tried by conference call to connect with Ethiopia around 10 pm to pass the message on to Tesfaye's mother. After many failed attempts over the course of almost an hour, we finally did get through and left a message to be passed on. After finishing my work cleanup just after midnight I decided to look in on Tesfaye for the last time before leaving town for a few days. He was sleeping peacefully, and Kerry told me that things were pretty much status quo: good mobility but the same issues with clearing of his chest. It will be strange not to be around to visit Tesfaye until Sunday, but I know that my children and Melaku will continue to visit and give me updates.

Wednesday July 1, 2009: Happy Canada Day! Haley and Jim gave me a good report that Tesfaye was getting in and out of a chair well, had been sitting for a couple of hours, and they were able to see him walk for the first time. He is walking very well on his own, only needing someone beside him because of the feeding tube still attached to him. It does mobilize secretions in his chest, a good thing, but Tesfaye's ability to cough strongly enough on his own to clear them still needs to develop. Looking forward to tomorrow's swallow test.