D-Day!! (otherwise known as Discharge Day)

Grace Patti is being discharged from rehab today!!! The past month has been quite the roller coaster for her. We are amazed at how fast and clearly God answered our prayers. Earlier we kept suggesting that Patti would have a long, painful recovery ahead of her. She IS recovering faster and less painfully than any of us or her doctors could imagine. Last Sabbath (the 11th) Patti and Thatha celebrated their wedding anniversary, we celebrated Thatha's birthday last Tuesday (the 14th). I've included some fun family pictures over the past week. Look for one more post following this one!

All in the family-July 2009


Ernest & Ambi with Patti

The idea was to make crazy faces---apparently only Ranjini, Nelita, Nilmini, and Rathyna can follow directions...

Update 7/9/09

Greetings! Patti has daily been doing daily regimens of Physical and Occupational Therapy. She tells every therapist that walks in her room to let her go home immediately!! She has really been doing well sitting up and walking around. She is still a little shaky on her feet but that is expected, all things considered. The rehab facility at LLUMC-East Campus is quite nice. Patti has a little outdoor seating area, which is quite convenient when large groups of people are visiting Patti. She has again been blessed with wonderful nurses and therapists (although she would prefer to be able to do things on her own...). Her rehab team will have a meeting next Tuesday, July 14, 2009 to discuss her length of stay at rehab and issues regarding transition to home life.

Update - 7/6/09 -> DISCHARGED TO REHAB!

Grace Patti has reached a great milestone! At approx 6pm PST she was discharged from the hospital to the acute inpatient rehab program at Loma Linda University East Campus. Patti is very motivated and is planning on getting strong quickly. Her smile and sense of humor is definitely coming back as well. When she stated she only planned on staying 2 or 3 days and I mentioned maybe 2-3 weeks I received a scolding and a scowl! Hopefully Patti is right!

Update-7/5/09

Sorry for updating so late folks! Patti has been making huge leaps everyday. Within the past three days Patti has been sitting up for longer hours, walking minimally (with a walker) with limited assistance, and (my personal favorite) joking around quite a bit! We have all been overjoyed to again experience Patti's contagious smile and laugh! Hopefully we'll get a picture up soon (with Patti's consent) so Patti's supporters can see how far their prayers have gone! Patti has been eating normally--although she claims the hospital food makes her nauseous (Thatha however enjoys the hospital food!!). Her daughters have been providing a steady stream of good home cooking and plenty of fruit. We have daily been incredibly amazed by the progress that Patti has made. We thank you for your prayers and ask that you keep Patti's continued rehabilitation and transition from the hospital in your prayers. We will be reducing daily updates to approximately 3-4 times a week.

Update-7/2/09

Grace Patti is currently in intermediate care and doing well. She has been upgraded to pureed foods (think pureed cheese ravioli--bleh). She is talking and staying fairly alert during the day. She is still in a lot of pain and very weak. Her physical therapists have been working with her to teach her ways to sit up, stand up, and walk on her own (we hope she'll be able to do this soon). For all that have sent cards and wishes to Patti, we have done our best to take them to her in the hospital and read your thoughts to her. Thank you for your prayers and encouragement!

Update 7/1/09

Patti is doing very well off of the ventilator (breathing machine) for almost 24 hours now, she's needing very little oxygen, has sat in a chair twice, took 2 steps, and had a sip of water! She also complained that she couldn't sleep well because her neighbor in the next bed was too noisy (always a good sign of recovery when one starts to complain again!). She still has a chest tube into the left side of her lungs but hopefully that can be removed soon as well. She may be able to leave the Intensive Care Unit soon! Please continue to pray and thank God for Patti's continued healing.

Update-6/30/09

Good News!! Grace Patti was extubated today around noon. When Thatha and Nelita (her grandchild) went to see her at around 12:30 she was wearing an oxygen mask and breathing slowly and deeply (good thing!). Dr. Nguyen mentioned that he hopes she continues breathing in this manner and also said that the next few hours are critical. Throughout the day various family members sent text messages to each other saying that Patti was sitting up in a chair (she has not been able to do this since June 14th). By evening Patti was still extubated and breathing well with some oxygen. We are profoundly thankful as a family for the progress that we've seen in just one day. Many of you have lifted Patti in prayer and we are so happy to say that so many prayers have been answered. Patti still has a long recovery process and still needs continued support. We will do our best to keep you updated!

Update 6/29/09

Today Patti rested for most of the day on the ventilator, they also continued her sedation/calming medications. She tolerated again several hours of 'cpap' (weaning exercises to strengthen the lung muscles). Will have another meeting with the doctors this week to get a 'big picture' update.

Update 6/28/09

This weekend has been very hard on Patti. On Sabbath afternoon without telling anyone and without warning she "self-extubated" -> which means she forcefully pulled out the breathing tube (possibly due to confusion). They watched her to see how she would do, but soon it was clear that she needed the help of the ventilator which was then quickly resumed. Due to her confusion she was given medications again to keep her calm and more sedated if needed. No further attempts at weaning were attempted this weekend. The doctors are telling her (and us!) to be patient. We'll provide more updates once we hear from her doctors again.

Update 6/27/09

Today Patti again has been doing most of the breathing on her own with the machine providing a little assistance, however based on several predictors of successful weaning -> while improved from yesterday, it seems Patti will still need 1-2 more days before attempting to remove the breathing tube. Today will continue to exercise her lungs & breathing muscles and rest at night, then will try again 6/28/09. The doctor is hoping that after the fluid is completely drained that the lung will expand better and allow her to breath on her own.

A pleasant suprise -> Without being asked Patti's 2-year old great-grand daughter Jasmine prayed for Patti during dinner time "please help 'pootie' well, ribs hurt, amen." Patti smiled when hearing about her little prayer. Please continue praying for Patti's encouragement during her expected long road to recovery.

Update 6/26/09

Today was going to be the day to try and extubate Patti, however it was too difficult to attempt as her lungs still could not be fully expanded. It was decided then to proceed with placing the chest tube on the left side. This allowed about 400mL of blood-tinged fluid to be removed. Next attempt to extubate will be 6/27/09.

Update 6/25/09

Grace Patti looked much more like her normal self today. They have removed the restraints and she is visibly much more calm. She was very alert and communicative (sign-language and notes!). Padmini read her Tamil bible to her at noon and Ranjini did leg exercises with her in the evening. When asked if she was lonely she nodded yes, she seemed very grateful for all her visitors. Her medical team did a CT scan on Patti today and noted some fluid in her lungs. They specified that it did not appear that surgical steps were necessary (chest tubes), the hope is that she will continue to expel those fluids with the help of diuretics. The doctor informed us that they are interested in attempting to extubate her again on the 26th. We are praying that this time she will be successful in breathing deeply on her own.

Update 6-23 to 6-24

Medical Update:
The last 2 days have seen many encouraging improvements. On 6/23 Patti's sedation was decreased significantly so that she was less confused and also able to write some notes on paper to the family! The diuretics to remove her extra fluid around her lungs and body have also worked very well (eliminating liters of extra fluid over the last 48 hours). So much fluid was expelled that for several hours today (6/24/09) she was able to do most of the breathing on her own ('cpap' mode)! The team was so encouraged that they extubated her (removed the breathing tube) and she was able to speak with Thatha and several others (She asked if she could go home!). However she was still too weak to continue breathing on her own and within hours had to be re-intubated. The fluid in her lungs is still present but improved from several days ago so they're still hopeful to try and get her off the ventilator as soon as possible.

Written by: Bates Moses, MD (Grace Patti's grandson)

Update- 6/22/09

Grace Patti is still in ICU--however she has made some important improvements. Our last medical update noted that Patti would need a chest tube to help drain out some fluid. Her medical team did not need to take that step because she has been expelling a lot of fluid with the diuretics. Monday morning Patti looked very swollen. By Monday evening Patti's swelling had reduced significantly and she looks considerably better. The hope is that with some of the pressure released from her abdomen her lungs will have more room to expand. Monday afternoon and evening also had Patti communicating a lot more with us, she is wiggling her feet, squeezing our hands, and nodding her head. Ranjini (Patti's granddaughter and a Physical Therapist) did some leg exercises with Patti. They have reduced Patti's sedation and have also taken her epidural out (don't know if that is the correct medical way of writing that...). Anyways, Patti was pretty restless on Monday trying hard to pull out all the tubes attached to her. She does have soft restraints on her hands to prevent her from doing this--it is pretty hard watching her trying to get out of them. We kept trying to talk to her and calm her down assuring her that though she is uncomfortable she needs to try and sleep etc. We are hoping that in the next few days we will have more good news to share with you. We ask that everyone continue lifting Patti up in prayer--she has a long road ahead of her and there are still some concerns in the ICU (weaning her off the ventilator etc.).

workbee for patti (6/21/09)

We have all been spending a lot of time waiting in the family room right next to the ICU. We figured that this did not really make sense because, frankly, Grace Patti is not really the sit- around type. So, we decided to put our heads together and do what Patti does best-WORK!! We spent most of Sunday working in Patti's gardening and doing some housecleaning that we did not want her to have to worry about once she got home.

I must add that being in Patti's house without her feels so strange, Patti and Thatha together is what make their house so fun to visit--but, despite those feelings we had a great time going over stories and doing our best to keep up all the hard work Patti does.
It's amazing that it took so many of us to do what Patti does by herself!!!

Patti, I hope you get a smile on your face when you see these pictures--we love you!!

Update 6-21-09 8pm

Medical Update:
Grace Patti's ICU physician called for an urgent family meeting this evening. Apparently, last night and into this morning the breathing machine (ventilator) was noted to be dealing with higher and higher lung pressures. A CT Scan of the lower part of her lungs and abdomen showed an increased amount of fluid on the left (about 1/2 of the lung) and new fluid on the right (about 1/3 of the lung). Patti also has a severe ileus (her bowels have not worked very well today) as a result they have had to stop feeding by the feeding tube. Grace Patti is also very swollen head to toe. The main cause for the swelling appears to be all the fluids she needed while in shock and during blood transfusions. In addition to trying to get her bowels working again this evening they will also be giving Patti diuretics (meds to help remove extra fluid). However her doctor does not feel these measures are enough on their own so he has changed the settings on the ventilator so it will not damage her lungs with too much pressure. He has also recommended bilateral (both sides) pediatric chest tubes to remove the extra fluid surrounding the lungs. After discussing this it was decided to proceed with a chest tube on the left lung, then on the right lung IF Patti does not respond to all the other adjustments to remove the extra fluid and extra pressure on the lungs.

Written by: Bates Moses, MD (Grace Patti's grandson)

Update 6/20/09-8:01 pm

Grace Patti is still in the ICU, although she has made some important improvements. Our concern yesterday was her low blood pressure. Today Grace Patti is off the norepinephrine and her blood pressure has remained relatively stable (we are excited about this!). Last night Patti was given a blood transfusion and calcium. Grace Patti was also fed through her NG tube. Her medical team is still working on keeping her lungs clear and for now keeping her sedated. They did however reduce her sedation to check neurological function and asked her to follow various commands--which she did. One of the ICU nurses asked Dharmaseeli (Grace Patti's daughter) if Patti sews. After confirming that Patti is an avid seamstress, Dharmaseeli inquired as to why the nurse asked. The nurse told Dharmaseeli that Patti had been making sewing motions with her hands today. Even though it is difficult to see Grace Patti lying in a bed with a ventilator it is exciting to know that she is still thinking and dreaming about her hobbies! We are all anxious for her to be able to do the things that she enjoys. The past few days has definitely been an emotional journey. But, as a family, we have daily seen God's promises being fulfilled in Patti's progress. We would again like to thank all who are lifting Patti up in prayer and ask that you continue your vigil as she has a long road of recovery ahead of her.

Siblings...

Thinking about seeing this smile on Patti's face again, can't wait!

Update 6-19-09 3pm

Medical Update:
We just had a large family meeting with Grace Patti's ICU doctor. She remains stable but critical. Unfortunately they are still unable to remove the medicine keeping her blood pressure up. They have looked into infections, fluid volume, heart, lungs, kidneys, adrenal glands, thyroid, and other causes of low blood pressure and, so far, everything is coming back normal. Overall this is good news and nothing serious has been identified yet, so hopefully they will be able to remove the blood pressure medicine with time. The breathing machine is still doing most of the breathing for her however the rate is less than what she required for the previous 2 days. She is only requiring about 30% oxygen (we generally breathe room air of about 21%) so the main issue is just how deep a breath she's able to take on her own (which is limited due to the rib fractures).

She is still on continuous medications to help keep her calm and pain free. She will be given nutrition by a feeding tube starting today and they have a physical therapist to help her with exercises to help keep her muscles from becoming stiff.

This weekend they will continue to work on looking for causes for the low blood pressure as well as trying to remove the blood pressure medication. They will continue looking for possible sources of infection, thankfully all cultures from the lungs, urine, & blood have all been normal so far. Once the blood pressure is stable, they will slowly try and wean her off the breathing machine.

We will continue to try and meet with her doctors this weekend and keep everyone informed of her progress.

Written by: Bates Moses, MD (Grace Patti's grandson)

6/19/09-11:46 am

Grace Patti is still in critical condition, but stable. We are not able to visit her at all today because Patti needs to rest. We've received a lot of calls and inquiries as to Patti's condition. Unfortunately, we have not received a detailed update as yet. The medical team is planning to have a family conference with us later today. We are hoping to provide a more detailed medical update very soon. Thank you for your prayers.

Update 6/18/09, 1:15 pm, Pacific Time

Family and Friends,

We are all camped out in the family room of the ICU. We've all been blessed with the constant prayers and words of encouragement. We will do our best to provide another medical update later today. The medical team has asked that we do not excite Patti by talking to her or attempting to wake her up. Thatha has done his best to heed this advice, but he was very excited when Patti squeezed his hand and attempted to open her eyes. He has been sitting by her side all day today. I think he appreciates being away from his chatty, bossy grandchildren. Please continue in lifting Grace Patti in your prayers.

Update 6-18-2009 8:30am

Medical Update:
Grace Patti is still critically ill but improving steadily. Overnight her acid level (pH) was fluctuating and finally normal by this morning! The doctors, nurses and respiratory therapists have been working hard all night long. They were trying to wean her off the medication to keep her blood pressure up but were only able to do so for a few moments, but overall this is a good sign they are able to even attempt it. Also they're slowly lowering the amount of sedation so Patti is able to open her eyes and move her hands/feet a little on command. Due to anemia (which is common to see when this sick) she was given a transfusion which will help provide more oxygen and allow her lungs and heart not to work so hard. Compared to the prior 24hrs her improvement is remarkable. Today the goals for her care team are to continue to try and wean off the blood pressure medicine and continue resting on the breathing machine. Thank-you for your prayers and words of encouragement.

Written by: Bates Moses, MD (Grace Patti's grandson)

Update 6/17/09, 4:00 pm (Pacific Standard Time)

Medical Update:
Patti is still very sick. We just met with her ICU doctor, Dr. Nguyen who is trying several approaches. Her body is very acidic, her pH (acid level) is around 7.1 (normal 7.4). Dr. Nguyen is adjusting the ventilator to help with that. Grace Patti is also in shock (low blood pressure) but responding very well to norepinephrine (helps increase blood pressure). Her heart and kidneys are still responding very well to treatment. Her lungs are clearing up after intubation (to help re-expand her lungs) and her oxygen level has improved as well (the lungs were unable to expand due to the severe rib fractures). Grace Patti has also undergone aggressive suctioning today and a bronchoscopy (camera to look into the lungs) has helped. Dr. Nguyen started antibiotics to cover for both possible pneumonia and kidney infections but none proven yet. She also has an ileus (bowels not working) and that is likely a side effect of pain meds but is also making it harder for her to breath due to abdomen being very tight. Prognosis is very guarded (too early to know) based on apache score (severity of illness) >20 but aggressive interventions were started just a few hours ago so it's hard to interpret the score at this time. If her pH improves in the next few hours it'll be a good sign since that is the only thing that has yet to improve with the initial changes made so far today.

-Written by: Bates Moses, MD (Grace Patti's grandson)

Update 6/17/09

Dear Family and Friends,

We are putting this blog together to keep you all posted on Grace Patti's progress.

On Sunday, June 14th, Patti fell from the top of her stairs leading to her garden. She managed to pull herself up and walk into the house and call for help. We soon found out Patti broke 6 ribs, 4 of them were broken in 2 places.

Patti was admitted to the hospital and since Sunday her condition has worsened. Patti is currently in ICU and has been intubated. The doctors and nurses are doing their best to clear the fluid from her lungs and help her breathe.

We ask that you please remember her in your prayers. Those of you that know Patti well know that she is a deeply spiritual woman and she has always been faithful in lifting all her loved ones in prayers. It is now our turn to lift her up in prayer. We ask that you also pray for strength for Gomer Thatha as he is standing by Patti's side.

We will do our best to update daily. Feel free to leave notes of encouragement that we can read to Grace Patti.