Friday May 27, 2010 at 0958

The nurses comment today sums up a bunch of what is happening right now - this is not a level road. Lots of ups and downs.
Today is surgery day again.
We talked with the ortho surgeons and the hand and arm surgeons yesterday and I found myself almost pleading with the hand surgeon. I know it's a bit selfish of me but I really am trying to put myself behind David's eyes. The blast to David's hand took out a major portion of the tissue between his pinkie finger and his wrist - the bone for that same finger was also broken in several places. With all the conversation and my desperately trying to talk the surgeon into another direction, it is pretty much determined that the finger must be removed as it is only being held on by a few small pieces of tissue. The idea is to take all of the bones out of the finger and use the skin from that finger to fold back against the hand and close the wound. We're told that, unless you look very very close, you don't even notice because the knuckle is also removed.
The surgeon said that the finger could be saved but about 5" to 6" of the ulnar nerve in the arm was severed and destroyed. They can graft in a canal to give the nerve a path to generate itself but the likelihood is extremely low and even if it does generate itself, David will have little or no sensation and use of that finger.
Now to the arm and the thumb and wrist area. The plan is to make incisions on David's abdomen in two places and create a skin fold. The arm will be sewn into that skin fold and left for approximately 3 weeks. The same procedure will be done for the meaty part of the thumb and the wrist just above the thumb. After the 3 weeks or so, they will surgically separate the arm and the abdomen and do skin graphs on his abdomen and his arm and hand.
It is felt that he will have fairly good use of the remaining fingers and thumb but it will probably never be pain free.
The surgery today will also include cleaning his leg wounds and possibly removing the tube from his chest. Today they will be applying a specially designed mesh to the end of the right leg that will enable them to graph skin to the end of his leg in preparation for his prosthetic. The left leg was damaged much worse and is not yet ready for that procedure - at least that is my understanding.
David's kidneys are still a concern. The magic number they are looking for is below a 1.2 and his current number is 7. They are still considering this as an acute renal (kidney) failure - that is a good thing. There is still a great deal of optimism suggesting they believe his kidney will still be rebounding and functioning perfectly normal in the future. He went through another 3 hours of dialysis this morning and received another 2 litres of blood.
They put a big bad of special dye through his system last night in an effort to detect whether or not he had some major infections in this system and the CAT scan was, wonderfully, negative. His fever is doing much better today after the 103 yesterday.
The psychology of this is going to be an uphill climb. This morning we were told that, at some time in the future, they set up mirrors so these warriors can see that they have no legs. It is very hard for the mind to realize that they are gone. Yesterday he asked for his uniform and his boots. Catherine had him reach down and feel the end of his left leg and explained to him, again, that he had lost his legs. He said "I know, but my feet are still there!" I know my great friend Brian Cook lost the end of his pointing finger many many many many many (he's really old) years ago and he still can feel the sensation of a full length finger. They are giving David special medications that deal with the "phantom" pain.
Yesterday, 3-Star General James R Amos, who is the Assistant Commandant of the United States Marine Corp, came in and visited with David. What a great person he appeared to be. He held David's hand as I or Lynnette would hold his hand. He stroked his hair and I or Lynnette would stroke his hair. General Amos sincerely had a love and concern for David. It was truly a beautiful scene and I'm not sure if he'll every know how much that moment meant.
David was quite concerned that he hadn't received a clean shave and was not in full uniform when the General came in.
Next Thursday David will receive his Purple Heart from General James T. Conway, Commandant of the United States Marine Corp. We'll make sure he has a clean shave that day. David is very proud of his mustache but is very willing to shave it for that occasion. David has been eligible, to the best of my knowledge, for two other Purple Hearts but refused to allow the application to be place because "I'm not going to give the enemy a merit badge for getting to me!" When I was told about next Thursday, I told David I would not allow him to turn this one down.

The following comments come from Catherine.
David had a very long day and I hope he can get better rest tomorrow night. He spoke about how something was a tragedy and we discussed his legs earlier. He was complaining of phantom pains in his feet and the nurse told him his legs were gone. He looked at her with shock in his eyes and she told him she would go see if there was something she could give him for the pain. Thereafter, David said she scared the heck out of him and I asked why and he said because he thought he lost his legs and I discussed with him how he had in fact lost his legs and it was taking his brain a little longer to understand that. He argued with me about it and I think he will be able to understand all this a little better once he comes down off the pain killers.
After the 3 star General visited David, he was adament about getting a fresh haircut, a clean shave, and a clean pressed marine uniform for when he would be accepting his purple heart. He instructed me specifically on the sizes of uniform and boots I should go purchase at the Marine Corps store and got very upset that I was not going immediately because, as he told me, he did not think I was taking it seriously and he was "a little offended and insulted." I went for a walk and when I came back he said he wanted to watch movies. Lauren, his nurse, is going to obtain a television for his room. He is very comfortable with Lauren, and in my opinion, she is incredibly good with taking care of him and addressing all his concerns adequately. I was very happy to see that.
I am hoping the television will help with all his hallucinations. After you both left for the night Lauren gave David a shot to help with the hallucinations and said she would speak with the doctors about finding something more suited to address his fears properly. David asked me where we were and told me he saw bad guys but shortly after this he calmed down a little. He is speaking to himself quite a bit and later told me to get down because of the guy behind me (there was no one there.) I told him there were no bad guys here and he said "they" were conducting psychological evaluations on him to see how he would react and it was okay because he loved video games and now he was in one all the time. He later stuck his tongue out at me, and was able to joke about video games so at least he is finding some humor.
Overall David had a really long day today and I think he started off his day really tired because of the dialysis and judging on the CAT scan he is having at 3am, followed by his session of dialysis to rid his body of the liquids placed into his system for the CAT scan, and his surgery scheduled thereafter, he will probably be exhausted by tomorrow night.
He has been all over the place in his thoughts but always retains the ability to make jokes and laugh, which is really beautiful to see given the magnitude of the trauma he has so far endured with little to no complaints. His spirit is so strong and he is a beautiful person that will serve as an inspiration and symbol of strength and courage to everyone fortunate enough to cross his path or hear of his story,
He expressed having a lot of nausea tonight. He also threw up today (3 times) and after speaking with Lauren she seemed to think there might be some infection in his stomach. I'm very worried about this but hopefully after tonight the doctors will know whether there is an infection, and if so, how to go about treating it immediately.
Notwithstanding all his hallucinations, he was a little more aware when he was 'present' so to speak. He asked me "what was up with [me]" and how I was doing. I told him I was well and like everyone else, hoped he would get better really soon. He smiled and rubbed my hair and told me he would. He then proceeded to instruct me on how to go on a "special op" with him, get in the helicopter, and drive while he took care of other things. He had several very detailed instructions for me regarding which "paths" to take and all the while didn't forget to stick his tongue out at me whenever I'd start laughing.
Lauren gave him some medicine to help with the nausea and this put him right to sleep, he was mumbling to himself a little, but for the most part snoring so all in all I think he'll get a little bit of sleep tonight.

Gordon again.
As hard as all this is, it is also very beautiful to see him rebound after each and every jolt of pain or dilusion. This morning he talked with Mary Jayne, with Michael, and with Ryan Whicknick. As he talked with them I would watch his face and see him flinch at another pain that hit him, but, at no time, did his voice reflect the discomfort he was feeling. He asked me if I had seen really weard things and visited really strange places when my eyes were closed - this was referring to the time when I was having so many problems with the morphine after my surgery 10 years ago. I could honestly feel exactly what he was talking about and I vividly remember it being a very awful time as I am sure it is with him.
This is a very long blog but, I believe, it gives you a really good feel of the awful yet beautiful feelings we are having.