I really need to get out and get stuff done, so I’ll post a more (this sounds SOOOOO ridiculous) ummmm . . . detailed analysis (ahem) of the presser when I’m back. Meanwhile, a synthesis. 4 main conclusions for me, for now:
- Michael is in VERY good hands. It doesn’t matter a hoot that this or that famous neurosurgeon and/or neurointensivist would or wouldn’t do this or that element of Michael’s treatment, the point is that these guys are smart, they’re talking to each other and to the family, and they seem technically up to the job. Oh and by the way, the decision to evacuate the second, intracerebral, hematoma seems to me, a non neurointensivist, to make sense. But more on this later.
- It sounds retrospectively that MichaeL’s ICP was worrisomely and persistently high yesterday, despite the right sided bone flap not having been closed. This was a standard and totally normal decision Sunday in the OR. The ICP problem was so worrisome that they considered a dip to be a “respite” allowing them to scoot to the scan. Now remember, I’m piecing this together from the words used, so everything I say is therefore subject to interpretation. But we’ve all had patients like this and agonised over going to the scan, coz until just before (the respite they’re talking about) every time we TOUCHED them their ICP shot up. So the decision was made to gain some room, and drain what sounds like superficial left-sided hematoma. These are usually left alone, and it had previously (and reasonably) been decided NOT to touch this one. But given the ICP problem, and that overall the brain was less “angry”, it was decided to evacuate it, especially as this meant leaving the left sided bone flap off.
- This leads me to insist on just how sick Michael was yesterday. These guys were sweating bullets, doing everything known to man to help, and they deserve a lot of credit. But this was SERIOUSLY life threatening minute to minute yesterday.
- Lastly, I think we can A) reset all the countdown clocks we started yesterday (time to reduce sedation, time to wean from vent, etc). And B) insist on just how severely Michael is injured. Be patient. This is gonna take a long time.