Going to Baltimore

After what will be a 31 day stint in the ICU, Yale will be leaving NY Downtown on Monday morning, bound for a residential rehab program at Hopkins in Baltimore. He has been off the vent for several days now and doing just fine. We would have had him moved down here sooner, but we couldn't get a bed until Monday. The folks at Hopkins will be focusing on getting his pulmonary function back up to snuff as well as general physical rehab to overcome the effects of a month in bed. We are sure that in a few weeks, Dad will be up and about and getting back to a normal life, having put this episode thoroughly behind him.

My favorite indicator of the craziness of this past month: I just got my cell phone bill and I exceeded my plan allotment by 1,684 minutes and 210 texts, resulting in a bill of over $700!! Verizon was nice enough to bump my plan allotments up retroactively, fitting me in a $109 plan - sure beats $700.

Get me outta here!

The delay since the last post only reflects that Yale is doing better and better and we have been engaged with catching up a bit on our own lives and planning for the next step in his recovery. He is all but weaned from the respirator and may well be discharged this week to an inpatient rehab facility. As we said early on, when he starts giving the staff hell, we'll know he is back. Yesterday, the nurse told me that he told her she had no right to keep him there and yes, he'd happily sign himself out AMA. We were able to talk him down for the moment...

I am currently looking into rehab facilities. Perhaps soon, he will be on a laptop and we can fold up this blog in favor of direct emails.

David

Progress, Progress

Sorry for the delay in updates. All continues to go well, if a bit slowly (especially for him!), for Yale. He was indeed sitting up, cheering along with the inauguration speech. After agitating for coffee a few days back, we have moved on to non-stop demands for ice cream and diet coke. He is also asking to get up, sit up, go for a walk, go home and, if not go home, how 'bout some ice cream?

The reality is going to be a bit slower. Dad and I talked with the attending pulmonologist today, and he laid out the following timeline: Weaning from the respirator will take through the weekend. After getting off the vent, he wants dad to stay in the ICU and get up and going for probably another week. After that, he expects that dad will need a residential rehab setting for another two weeks or so. So, it's going to take time, patience, diligence and hard work.

Very soon, I think Yale would enjoy some visitors, so feel free to drop me or Matt an email if you'd like to come by and we can figure out a good time.

David

The one we've been waiting for!

So, dad had the tracheotomy at bedside today at about 2:00 pm. At 6, I got a call "Your Dad is awake. He wants you." I ran down there and he was wide awake, fully alert and trying hard to make himself understood. He can MOUTH words much more clearly now, but still can't really vocalize at all. I struggled and struggled to get what he was trying to say. Finally, somewhat exasperated, I tried "You want a coffee???" Emphatic nodding, smiling, "Yes you fool, I want a COFFEE!". "Dad, you can't have a coffee yet. Doctors orders." A strong "Bullshit!!" came the reply! Yes, he's back! After some negotiation, I was able to get him, and the nurses to agree on some ice chips, which he thoroughly enjoyed. I had to fend off many requests for getting out of bed, going home, going for a ride in a wheelchair, etc. etc. I told the nurses, great job nursing him back - now, God help you!

Obviously, we still have a ways to go, but I now really have every confidence that this week will be spent gaining strength, weaning from the respirator and really getting on with healing from this frightening episode.

It is a pleasure to be able to make this post!

David

8:00 PM 1/17/2009

Elana and I came in this afternoon in the frigid weather to help David keep Yale engaged. He was definitely back, surprised at what at happened to him over the past two weeks and asking for more water (through a sponge that he could suck) and asking for dinner. He will not be allowed to have any food until some X ray results come back to make sure the surgery was successful - or something like that. Anyway, for all of you who have sent your support and are following Yale's progress I think we can say he is out of the woods and heading for recovery.

I would encourage all of you who may read this to send e-mails to Yale and to stay in touch over the next few months even if Yale does not always get back to you. Dad has done surprising well over the first year of his retirement - but the last few weeks tells me that he need a structure to get more of his old friends, proteges and collaborators back into his life...so plan to write and to visit in the weeks and months ahead.

Thanks!

Matthew

No Trach Today

Cindy, Arlo and I are all back in NY for the weekend.

Yale did not have the tracheostomy today. Given some of the particulars of an unusual pre-existing hematological condition that my dad has, the doctors just wanted to be sure that they had done everything possible to minimize the risks of the procedure. They do feel that they got all the bases covered today and have scheduled the procedure for tomorrow morning. Now, he has to have an uneventful, stable and afebrile night in order to go through with it in the morning.

As I mentioned earlier, having the respirator connected through the trach will free dad of the tube in his mouth, make him more comfortable and help facilitate the respirator weaning process. Again, hopefully this will all get underway tomorrow. The doctors have also told me to expect dad to be pretty wiped out all day from the procedure and extra sedation and pain meds, so tomorrow promises to be a bit of a lost day.

I'll update in the morning with where we stand with the trach.

David

Morning Update

By all accounts (I'm in Baltimore, but will back in NY this afternoon), Yale is making great progress right now. His fever has all but abated and he is alert and responsive. The big remaining issue (of course, infection continues to be a risk, but he really seems to be turning the corner on all that for now) is getting his lung function to improve to the point where he can adequately oxygenate himself without the respirator. This is not imminent, as they will be performing a tracheostomy today. As he continues to gain strength, he will be able to participate more actively in the process of getting weaned from the vent. This will take several days, so he will remain in the ICU into next week, at least. Currently, we are motivating him that he has to be sitting up, alert and attentive as Obama is sworn in on Tuesday. From how things are going now, he may well be cheering along.

I'm antsy to get back to the City and see my dad later today. I'll try and update tonight on how the trach went and how he is doing on it.

David

Some steady progress

The news this afternoon is pretty upbeat. Yale continues to be alert, aware of his surroundings and able to respond to questions and commands. He is watching TV as I write. He continues to be febrile on and off, but it is a bit less than a few days ago. His white blood cell count, which had been bouncing around between 18 and 25 the whole time is now down to 13.5, the lowest since he has been in.

This morning I was contacted to give consent for a tracheostomy, which will move the respirator tube from his mouth to a direct connection to a temporary incision in the trachea. This will certainly be more comfortable, less damaging to his mouth, throat and trachea and will give the respiratory therapists more options with his weaning protocol. But it does indicate the he is not ready to be weaned and that the process may be quite extended. It will just take patience. (As of 3:30 pm today - Thursday - they had not yet done the tracheostomy).

Subjectively, Dad seems to be making good progress and to be much better these past few days. We just need to start getting his lungs functioning a bit better and he can truly begin weaning from the respirator.

I look forward to posting more postive news soon.

David

Brief morning Update

Really nothing new this morning. Dad spent an uneventful night, stable with a bit of fever on and off. I may have more to add after morning rounds.

David

Good visit

Friends and Family-

I just got back from what was really my first true "visit" with my dad these past 11 days. He was alert and responsive for most of the day. He clearly nodded his assent or dissent on many topics. I asked if he needed more pain medications or sedation and he nodded that off decisively, which was heartening. He seemed to clearly grasp when I showed and read him a card my son made for him. I explained several times what was ailing him and how he came to be in the ICC, which he also seemed to process.

This is certainly an excellent development! While he is still running a fever, he seems to have weathered the worst of whatever flare up sent him backward over the weekend. That being said, dad still has many hurdles to overcome. He remains intubated and on fairly high respirator settings. He does not appear close to being weaned from it. He remains febrile and is clearly still fighting infections, perhaps on several fronts. Days in the ICC and on the vent just take their toll. We remain optimistic and hope with a bit more recovery he can start seeing more visitors. Please stay tuned.

As always, we are touched and buoyed by everyone's kind words, thoughts and wishes.

David

Back on track

It seems that dad's recovery may be getting back on track this morning. After running a pretty high fever and having to receive more blood pressure support meds and more aggressive respirator settings over the weekend, things have settled down again. His fever has abated and he is notably more alert, although still sedated. He was able to respond to simple commands such as opening or closing his mouth and eyes. This is a first.

We are hoping that he will be well enough soon to again start the respirator weaning process .

I will be talking to the attending physician soon, and will report back later.

In light of yesterday's article in the Times about recovery from the ICU http://www.nytimes.com/2009/01/12/health/12icu.html?_r=1&em it is going to be a long climb back to health for Yale.

The obvious concern and care that I have felt from so many of my dad's friends and colleagues this week has been a great boost to me. Thank you all.

David

Yale is missing the Giant's game

We visited the hospital this morning and received a mixed message. Yesterday Yale was making good progress and was having the amount of oxygen and the level of respiration help reduced. Then, overnight he developed a new infection, his temperature went up and they had to rely more on the respirator. The doctors were not happy. After some discussions this morning the thinking is that the new situation is probably a routine GI infection that Yale picked up yesterday. They are treating this and when they get it under control everyone will get back to managing the pneumonia and moving him off the oxygen.

Dad's sedation is up a bit, so he is missing the stress of the Giants - Eagles playoff game. Given the way the Eagles drove down the field before the half, this is probably just as well for now.

We continue to be impressed by the level of care and respect that Dad is getting at the Downtown Hospital and the concern from his Mt. Sinai doctors. There are many connections and we are finding attending doctors here who know of Yale's work, have studied under Yale or with some of his Mt Sinai doctors.

Vivienne and Bill (Goodman) are coming in tonight. David and Andrea will be staying on through tomorrow and Matthew will be heading back to New Haven tonight.

Yale Nemerson is ill

I write this post from Yale's New York apartment where David, Andrea and I have spent the weekend.

For those who don't know, last Saturday morning - January 3, 2009 - Yale was found on his apartment floor . He was brought to New York Downtown Hospital at Beekman and Gold Streets, where he has remained in the ICU for the past week. Yale's many friends and doctors from Mt. Sinai, plus the excellent staff of the Downtown Hospital have rallied to his side.

He is completely sedated, intubated and may or not not know that we are around him. The problem is a base case of pneomina, which became a blood infection as well. While in critcal condition, he stabalized during the week and while he is not getting much better he has not gotten much worse.

We are reaching out to his circle of family, friends and professional associates to keep you up to date on his progress. We are hopeful of a recovery, and know that Dad will need the support and help of the people who have been part of his life over the last few years.

Please pass this posting on to others, send us new addresses at my emial (mnemerson@snet.net) or contact us through the comments field here to share your thoughts, advice and news.

For Andrea and David.