This is going to be a long post:
It’s Sunday. I could only steal about 30 minutes with Travis before having to head out to Murfreesboro. He had just been bathed and had his hair washed, so he was smelling and looking good. Jesse had been by earlier today and couldn’t stay long. Kerry had stopped in and stayed an extra 30 minutes because Travis became upset hearing of his departure. When I left today, he was notably upset. I couldn’t give him a hug because of the way his lines and trach were in the way, so he was agreeable with a kiss on the cheek. Such a sweet kiss, but it set him off. He may have been confused as to why his friends came and stayed for such short visits, or he may have just been agitated.
There’s a recovery scale for coma and brain injury patients, and they enter these different stages in order during recovery. I’ll go over them now, and you’ll see how he fits into it. If any of you saw him during his 5 month coma post-accident, you most likely saw him as a Level I on the Ranco Los Amigos scale. Level I brain injury/coma patients have no response. That’s it, they don’t respond to light, touch, sound, or movement. At Level II, Travis would begin to show a generalized response. He would just begin to respond to the above stimuli, but slowly and inconsistently. Level III: Localized response. Travis would be awake on and off during the day, he would make more movements and begin reacting more to outer stimuli, such as turning to sound or reacting aversive to pain. He starts recognizing family and friends and follow simple, one command, directions. At Level IV, Travis would be confused and agitated. Now, this is the level doctors think Travis is in now. I disagree thinking he is going between IV and V (confused-non agitated). He’s agitated for good reason, not just to be agitated. Saying goodbye is hard for anyone to do, let alone someone who has to stay in a hospital who didn’t even get to see friends for months, of course he’s wondering “Are they coming back..?” and starts to throw a fit. Not to mention that tube sticking out his throat, I’d be pretty mad, too. I’ll explain the difference between Level IV and V, and you can see how Travis is further up on the scale at V. Level IV: Travis would appear to be very confused and frightened. He wouldn’t understand what was going on around him and how he feels, which may lead to him overreacting to what’s going on around him: thrashing around, hitting, or screaming. These spells happen every so often with him, not all of the time. He wouldn’t be able to pay attention for more than a few seconds and have difficulty following directions. He would recognize friends and family some of the time, and he would have to be restrained so he doesn’t hurt himself. Travis hits some but not all of these. He’s more with it than he seems to get credit for, and when he’s feeling well, he’s extremely content, stays with us in conversation, and follows directions very well. Here’s level V, which he falls more under unless he’s having a fit over his trach or feeling uncomfortable, so I’ll use it in the present tense. At Level V, Travis is able to pay attention for a few minutes. He shows signs of confusion and difficulty making sense of things outside of himself, such as the date or why he’s in the hospital. If completing physical tasks, he would need step-by-step directions (i.e. brushing his teeth) He becomes restless when overloaded or when there’s too many people around. Compare that to being really stressed out, too many people in your face and too much going on around you, which you’re not all that sure of to begin with anyways.
So you can see, Travis kind of hovers between Levels IV and V. It’s hard to really assess what he truly knows due to his lack of/poor vision and nonverbal communication. He’s able to answer yes and no, and pick between two things using his arms. He just requires time to process. He can differentiate between left and right. He’s really strong, too. I worry about doing any strengthening therapy on him since he put ice on a nurse’s shoulder one night…hmm… I’ll stick to stretching and range of motion for now.
I’m getting attached to him. Every day is something new, and it’s always an improvement. He’s changing my life. He makes you want to live and do things. I don’t want to waste anymore time. I wonder if I was in his position if I would be happy with what I had done with my life, I couldn’t answer that with a yes. There’s so much more I want to do both in my life and my career, and I’m making those changes now. You only get to live life once, and it’s so cliche, but it’s so true. You can make mistakes, but you don’t have to live in those mistakes. It’s how you react to them and make a change the directs the course of your life, not those mistakes alone. Sorry to get so deep, but that’s how I feel, and I think that’s how everyone who knows him and has interacted with him, even if just this past week, feel.
Select Rehab will be in tomorrow to evaluate him to see about him coming to their facility. Cross your fingers, it’s right next to Baptist, and one facility of about 2 in the Nashville area that will take someone on a trach and ventilator.