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!

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.

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.

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.

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.