1/10/06
Rob was transferred by helicopter to the Surgical service at UMD on 1/7/06. He was taken to surgery nearly immediately to open and drain infectious materials from absesses and tissues in and around his neck, and right shoulder/arm. The area removed from his chest surgically was approximately 8X8 inches and 4 inches deep.

The agent causing the disease was identified as one of the Group A Strep bacteria, some of which can cause some very nasty problems (necrotizing fasciitis, for one) if not addressed completely and rapidly. There are some indications that Rob continues to have active infection: appearance of his upper arm (extremely red, blistering, tearing, peeling skin), fever, elevated ( and increasing) white blood cell count. He is scheduled for a CT scan in the wee hours of 1/11 to determine whether further surgery is required.

On Tues 1/10, four absessed teeth were extracted in an oral surgery procedure that included treatment of his gums to eliminate any infected materials.

His condition remains critical but mostly stable. He is extremely ill and the outcome is far from certain. We do know that recovery is expected to take a very, very long time and may require repeated surgical procedures to drain or remove tissues.

Positive signs noted since the first surgical intervention include the reduction in inflammation and redness in his chest, solid renal function and manageable heart rate. He does have a funky heart rhythm that is being managed and will have to be addressed further; its nowhere near the top of the priority list. He is currently quite sedated as he is having mechanical ventillation support until the care teams are certain he's beyond the need for acute surgical intervention.

I'll try to keep this site updated frequently. We appreciate all of the concern and offers of support. We're going to take all of you up on them, count on it!

11-Jan-06 07:50 AM from Kathy
Good morning: after the first night of sleep that even came close to restfulness (thank you, Ambien), I called the unit to talk to his nurse who reports there has been no change except he's had his CT scan. I'll have some feedback around noon. Until then I'm going to try to take it a little easy, get some household business wrapped up, drink some of my own coffee and spend some time with the girls.

As soon as I hear about the CT scan and any treatment plans, I'll send an update.

It was great to hear from so many this morning and I know Rob will be pleased, too. Thanks.

11-Jan-06 12:07 PM from Kathy
I just spoke with the nurse caring for Rob today; the CT scan of his chest was not remarkable which is consistent with the improvement I can see over the last several days. I'm a bit frustrated because my concern continues to be about his arm and they didn't take any images of the arm. During AM rounds they talked about taking more CT images of his abdomen so I've made sure that the nurse gets the message to both the surgical and critical care teams that I don't believe his arm looks any better since he was transferred out of Shady Grove. Dr. Kathy is convinced that his arm requires surgical debridement. I keep reminding myself that these physicians actually ARE more qualified than I am and exceptional, even. But its my job to make sure they pay attention to everything that catches my eye because I've got more invested in his recovery than anyone.

The upside of not going to the OR this morning is that I can spend a few more hours at home before I go to see him. It will be a long day as I will pick my Mom up from BWI around 8:30. It will be good to have another adult in the house, a Mother's concern for ME, and give my exceptional nanny (and critical family member) a much needed break.

So many have done so much that it is humbling. We don't really see an end in sight, unfortunately, so please don't feel left out if you haven't been called upon. You will be.

Ciao---next update from the lovely UMMC---its the most pleasant hospital I've ever been in. And I've been in too many.

11-Jan-06 04:58 PM from Kathy
En route to the hospital I had a call from the senior physician on the surgical team (who have been the established lead on the case). He is a most remarkable physician and surgeon and also a very personable fellow with a great comforting demeanor. He was calling to let me know that he thinks Rob is beyond the need for urgent surgical care and that his infected tissues and surgical wound will continue to heal well. He was not concerned about his arm, attributing the swelling, redness to several things other than absesses, etc. I am very confident in his skills so this is welcome news.

Upon arrival, I could see that BoyWonder was doing better---if most of you could see him you probably would think he was almost dead---but the visual indicators of his infection are much improved. The senior physician on the critical care team, which I would imagine is now taking the lead on his case, let us know that he had seen Rob in the OR on admission (had actually intubated Rob without sedation because of his risky status at the time) and that he was very familiar with the case even though we've not met previously. He thinks Rob is better, that they've got the infection about 90% whipped. He offered that of course Group A Streps are bad bugs and although this particular species appears to be bad, producing purulence, etc, that there are no signs of necrosis. Again, I find this to be good news. And I have confidence in his opinion.

Rob continues to have significant fever, elevating white count (which could be related to the steroids he had to have to prevent anaphylaxis during the last CT), fluid in his pleural space, atrial fibrillation and really bizarre renal output.

As I've learned, in settings like this, a number of very serious things can be precipitated by the primary interventions and the state of the infection at presentation so I think we are still holding our breaths but today we are actually allowing ourselves to hope for our husband, father, son, friend and colleague to come back and be his self.

The girls are doing OK, really. Only Otis, Jackie (the dogs) and Lindsay really seem to have any issues and they mostly have to do with my lap being unavailable.

Back up to the unit with a great big coffee for me.


11-Jan-06 11:54 PM from Kathy
This afternoon/evening's visit with Rob was great; the infection in his arm truly is better and that is such a relief to me. The critical care team plans to gradually wean him from the ventilator and increase his level of consciousness. I think in just a couple of days he'll be able to talk to us. I'm a little concerned about what he may say....

At any rate, I was so overwhelmed when he surfaced long enough to smile at the sound of me calling his name and then smiled once more when I was so clearly pleased. I haven't allowed myself to hope for much and I've been very frightened. While I wouldn't describe my state as hopeful, I am beginning to feel like we have a good shot at bringing Rob home in reasonable health.

What a relief.

I have a family conference scheduled with the team leaders from the nursing, critical care and surgical teams tomorrow. I'm hoping to improve coordination of information, establish a routine for handling the family's concerns and understand explicitly the overall care plan and roles of consultants. Otherwise the only thing on the agenda tomorrow is to watch him improve and knit a little bit. And rest. I'm exhausted.

Thanks everyone for messages, for food, for moral support. Rob is going to be overwhelmed by all of this.
Ciao---
khm

12-Jan-06 08:31 AM from Kathy
The morning report by phone is that Rob had a good night; no changes noted and that he is more alert. He continues to have a fever and is making good use of a cooling blanket.

We're heading up to see him soon and I'll have more info.

12-Jan-06 01:46 PM from Kathy
Rob looks GREAT to me today. His arm continues to improve as does his chest. He was a little less alert when we arrived owing to the sedation for the transesophageal echo (which was normal). All signs are good, the physicians are now quite candid that they think he's getting better--pointing out that the infection is merely controlled, not eliminated, and barring any complications he should have a full recovery---albeit long and arduous.

They've begun now to try to strike a balance between consciousness and pain control so that he can be taken off the ventillator. I can't wait for him to be awake and to talk to me. We could all see he was happy for us to arrive and he recognized myself, both mothers and my buddy Dave.

I told him I was going to get something to clean and moisten his mouth and he clenched his teeth. Now THAT'S Rob!

The family conference went well and we've established a routine for daily comprehensive updates from a physician on the critical care team. I've had a good lunch, even so in all I'd have to say this is shaping up to be a very good day.

Thanks everyone for your great support, distraction and contributions.

12-Jan-06 09:05 PM from Kathy
Well, today makes the eighth day of Rob's illness and I'm afraid its beginning to exact a huge toll on me. Much of the progress I had made in my own recovery is waning: I'm sore, tired and have no stamina. I'm emotionally exhausted as well with so much up and down, fear and concern. I can't remember much beyond Rob's clinical information.

Today we had a little bad news with drug-related (?) pancreatitis setting in. Additionally, an attempt was made to cardio-convert his atrial fibrillation (you know, "CLEAR!" and ZAP!). Unfortunately it wasn't successful and he's still in fibrillation. A cardiologist will now be joining his team.

The late report from the unit in my last call of the night, however, includes the removal of the ventillator tube. Rob is able to breathe on his own and TALK. His nurse reports that he's been doing that: loudly and with annoyance. He wants OUT of the hospital and apparently I'm supposed to come take him to his hotel. If he doesn't calm down, he'll have to be sedated again. So he's down to one IV line to deliver his pain and cardiac meds as well as fluids and an NG tube for feeding but they're hoping to get that out before morning as well.

Poor Nurse. I'm going to bed.

13-Jan-06 09:41 PM from Kathy
Today was an eventful and happy day. When I arrived, I found Rob conscious and able to talk. He has periods of being very confused but he was very eager to know whether the Redskins and/or the Patriots had won last weekends games. Of course he did ask about our daughters first but I think he was just being polite.

He had been out of bed, sitting in a chair briefly but had a little cardiac crisis which was managed reasonably well and he's back to his preceding status. The activity was probably a bit much for him. I can see that he's overeager to get things back to normal.

The physicians are pursuing his pancreatitis and when the sonographer came in and reported that he was going to look at Rob's abdomen, Rob turned to me and said, "he has peculiar interests..." After so many days of watching and worrying, the return to not only consciousness but his wry wit was just about the best thing I could have asked for.

More signs Rob is better: he asked me to smuggle in some juice for him (he's still NPO); when I declined and later left the room, he asked my mother to quickly bring him some water (she swears she did not); he asked for the television clicker, the day's Washington Post and the current ESPN magazine.

And best of all, I shared some recent photographs of our family with him and when presented a photo of my Mom and Dad, he said, "Who's the old dude with your mom?"

I finally feel relieved. We have lots of issues to manage still but I definitely feel we're on our way out of the woods.

14-Jan-06 06:39 PM from Kathy
Signs of Rob's infection are steadily improving: decreasing white blood count, no fever for the last 24 hours and his chest and arm look nearly normal. Its hard to imagine the magnitude of the improvement.

His heart rhythm is getting a bit less manageable and they're going to have to get on that. Still no word on the pancreatitis but they're manipulating his meds to see if his pancreatic enzymes improve. The ultrasound was unremarkable. They've added Unisyn to his vancomycin but I don't think they plan to use that for very long. Also, they learned today that his sputum culture was positive for resistant Acinetobacter but he really doesn't seem as ill as someone would be with active infection so they're operating under the assumption that he has merely been colonized----so its back to contact precautions and vigilance.

He sat up in a chair for a couple of hours today and that was VERY difficult for him and he was glad to get back in bed but insisted on getting some vicodin before even attempting it. We washed his hair and cleaned him up a bit and he's looking much more himself.

His thinking is a bit more organized today which is good and bad. He's more aware of what happened, how very sick he was and those thoughts scare him a good bit. He's not always sure exactly where he is but I'm not always sure he isn't fooling with me. He does frequently ask me to confirm that he remembers my cell phone number correctly and sometimes worries that I'm still in the hospital myself and that I won't know where he is. And finally, with increased awareness he's saying fewer of the really hilarious things he said yesterday.

There's talk of moving him to a step-down unit in the next couple of days. He'll still need cardiac monitoring and evaluation and to build his strength before he can be on a regular floor. Barring any setbacks, it looks like he could be nearer to home, if not home, in 2 - 3 more weeks.

The adrenalin that has propelled me through all of this seems to have waned and I'm more tired than ever. Once he's off the SICU he'll actually need more of the family's attention and presence so I need to get it together here.

We all remain very grateful for all of the many kinds of assistance extended to our family. Thanks so much.

15-Jan-06 10:36 PM from Kathy
Well, Rob was moved out of the SICU to a step-down unit today. He's on cardiac monitoring and has an IV line, but otherwise, he's free of devices and tubing. He has virtually no strength at all which is a big change for him and he's going to require much physical therapy.

He's still getting tons of antibiotics, pain and cardiac meds but he's clear to eat and drink again (Coca-Cola stock will likely be increasing...) and many of the meds are being given by mouth.

He's come a long way. I actually believe now that he'll eventually come home. I'm so relieved.

In the meantime, the girls are really showing the strain of the last couple of weeks and I feel very torn between being with Rob and being with them.

More tomorrow...

17-Jan-06 10:33 AM from Kathy
Sorry for the long delay in posting; with Rob out of the ICU I've been able to stay in the hospital with him and the pc lab here in the hospital has been closed.

There's not a lot of news. He is getting a lot of attention from the occupational and physical therapy people and is making good progress. His surgical wounds are healing nicely; I got a good look at the chest incision today during the dressing change and the notion that I might have to be involved with that when he goes home is....well, unimaginable. I only PLAY a doctor on some occassions because I can't handle wounds. At all.

Rob is increasingly coming to terms with the seriousness of what has happened to him and that is sometimes overwhelming. We're hoping for some help with that today. He is from time to time confused, still. Its something we have to pay careful attention to because he's capable of pulling off pretty straight-faced leg-pulling; I'm never sure what his intention is and he needs to stop that.

There's concern over isolation of some staph from a couple of sites, including sputum. For the clinical folks out there, its coagulase negative and the sensitivities from two sites conflicted with one another---he certainly doesn't seem terribly ill at this time so that's a good sign but his WBCs actually increased a bit yesterday to around 18K. The cultures are being repeated.

We continue to be concerned and watch very closely. He's being transitioned from amiodarone/aspirin therapy for his cardiac issues to coumadin so that will take some manipulation. They feel he's pretty well rate-controlled so they're going to leave the issue alone. I don't like having him on coumadin. But its better than the alternative.

Rob hopes to dictate his own post for later today so stay tuned. He is VERY grateful for all of your concern and for assisting our family.

17-Jan-06 11:31 AM from Rob, as dictated to Kathy
Hi Everyone! It's actually Rob this time. Sorry not to have posted sooner but.... been KINDA busy. Let me say a huge Thank YOU to all of you for your wonderfully warm thoughts and deeds on our behalf. I haven't actually seen the webpage yet but Kathy's been relaying the information to me.

Kathy is still definitely the best source for updates anyway since I have been unconscious for so much of it! I remember some details, such as the helicopter trip from Shady Grove to University of Maryland Medical Center, but then again, I was convinced for several days that UMMS had transferred me to be kept at a private raw bar/hospital docked on the New Orleans waterfront! Coupled with my partly serious conviction last night that there was a large, well-known cartoon character sitting on the edge of my bed (ed. note: no, it wasn't his wife), you get the picture of not only my memory but some of the cognitive challenges I'm facing (don't you dare say "dementia"!).

As I think Kathy has mentioned, I'm now out of ICU and actually got out of bed yesterday, albeit with a walker and a horde of occupational and respiratory therapists. So while I think the bug is on its way to being licked, there remains a host of physical and cognitive challenges to meet.

I wish I could invite you all to come visit but there's a strict no visitor policy and I haven't even seen Haley, Anna or Lindsay yet. Writing (ed. note: dictating is more like it) this much has been exhausting so I'll sign off for now. Hope to post again later. Again, thanks so much for all you are doing to help us get through this.

18-Jan-06 08:27 AM from Kathy
Good morning! There's the beginning of rumblings at the hospital this morning about discharging him soon. We both are eager to have him home and working his way to good health but we're quite alarmed given his current physical strength and occupational capacity. Nonetheless this is a great sign about his infection and sugical wound.

He had his first "good" night last night with some rest and relatively little anxiety despite the fact that my mom was the overnight guest... no more cartoon sightings in his room (we kept the television away from those channels).

I think we'll be lobbying today for a brief inpatient stay at a Rehab facility to make sure he's really up to being away from the assistance of hospital beds, chairs and floor plans without stairs.

More later....

18-Jan-06 04:30 PM from Kathy
Well, its been two weeks of intense worry and lots of driving and no sleep and coordinating care for my children. Clinically Rob was ready to come home, so here he is. He is sound asleep in our own bed, fully clothed because he was too worn out to even allow anyone to help him into some jammies.

His physical status is better than yesterday, for sure, but we are all very concerned about our ability to assist him with any needs he is yet unable to meet on his own. My wonderful father is on his way up from Florida tonight to assist with the kinds of help that might require more physical strength than I can muster. So we'll have three RN's in the house with the following expertise: Emergency (Dad), Critical Care (Rob's Mom) and damn near everything else, including Home Health (my Mom). And then there's me. I think my clinical role right now is going to be making sure he has everything he wants to eat and drink, that he gets his meds on time and coordinate the REALLY hectic outpatient follow up visit schedule.

For now, he's on augmentin for the infection, coumadin to prevent clotting given his atrial fibrillation, percocet for pain and something or other to keep him calm. We'll have a home health nurse for a very limited time coming to the house for wound care---I know they expect me to take that over and I'm sure I'll be able to but it is sincerely one of the few things in life that COMPLETELY freaks me out. I can barely deal with scraped knees. We'll also have occupational and physical therapy here in the home until he is significantly stronger.

Once things calm down....and it feels like that could take a very long time, I have to get back to my own doctor because I feel every bit as badly as I did at about 3 weeks post-op. But with Rob home and the hordes of nurses here maybe I can get a bit more rest, stay off my feet a little.

Gosh. I'm overwhelmed by everything. I'm glad to have the girls here to be reminded of how joyful this homecoming really is. Once they figure out this means they've been evicted from Mommy and Daddy's bedroom at night their outlook might change.

In the near term, I anticipate a continued need for the kinds of help folks have been giving, perhaps even more of the "play date" kinds of things in our neighborhood to give Rob quiet.

Whew. I can finally admit to you all that for most of these last two weeks I had very good reason to be afraid Rob wouldn't make it through all of this. At least now I know that once we get through these early days of his homecoming, we will all be able to relax and be happy.

19-Jan-06 03:10 PM from Kathy
Well, Rob's been home about 24 hours and nothing horrible has happened. He's a little anxious but obviously relieved to be home and near his adorable daughters, comforted by the arrival of my family and their assistance.

The home health nurse came at 8:30 this morning, unannounced----i could suggest that this was, perhaps, poor form. It was a long visit with history, etc. The dressing change is clearly very very difficult on Rob---probably about as hard as it is for me... well, maybe more so for him. She drew blood specimens for anti-coagulation testing and tomorrow we'll make the first of about 1 zillion office visits to establish the follow up plans for his heart, his infection, his mouth, etc.

I might not have mentioned previously that when Rob first became ill and I called our internal medicine physician from the ER, I was told that he had very recently made an abrupt medical retirement---so here we are beginning follow up for this bizarre and serious event with a physician we've never met. Oh well. At least we got the appointment.

We're beginning to feel like we can manage his recovery here after all. Nice relief.

Thinking of all of our friends, family and colleagues and feeling very grateful. More later.

20-Jan-06 08:04 PM from Kathy We've been home about 48 hours now, I guess. We're all adjusting to things fairly well. Rob needs lots of help, still and requires the full attention of a competent adult nearly continuously. That should change in short order, I would imagine, if everything goes as the case workers at the hospital assume they will.

But today sort of suggests otherwise. We were scheduled to visit his primary care physician to evaluate his anti-coagulation status. The home health nurse drew the specimen yesterday. And today, no one in the lab had heard of him, the home health agency secretary didn't know who Rob was and the nurse herself couldn't be reached. Finally we suggested that the physician simply take a new specimen today for the testing....and then actually getting the blood drawn took about 40 minutes of the phlebotomist trying to find a vein she liked and then FINALLY---my Dad, with all his ER nursing experience, finally offered to do the stick himself and voila! Success. Its not the kind of contribution Rob or I expected him to make when we asked him to come help but boy are we thankful for his broad skill set! It was excruciating to watch Rob be so uncomfortable in the exam room, waiting and waiting, knowing that he just needed to be at home.

We then attempted to purchase the solution which his wound dressing is supposed to be soaked in (chlorpactin). No one in the pharmacy has ever heard of it, no one in medical supply has ever heard of it...so. We don't seem to have on hand the supplies we need to take care of him. And all of this is after the visiting nurse yesterday told us we'd have to go purchase all of the tape, gauze, etc that she'd be using... isn't that odd? I assumed the agency would supply those things and bill our insurance---its not like we're talking peroxide and band-aids here; these are serious clinical supplies.

So---once again the reality of the challenge is different than we'd expected but giving us plenty to do in any event.

Rob is glad to be home. He's going to be OK. He hurts and he needs a lot of help. But its going to be OK. Its so nice to find him here when I wake in the morning.


24-Jan-06 09:57 AM from Kathy
Rob is improving every day; he still requires lots of support for many of his daily activities but its clear he's on the mend.

We have a huge appointment list to manage---physical therapy, wound care with the visiting nurse, follow up appointments with a handful of specialists. Getting out of the house is still something of a challenge for Rob.

2/3 of the nursing contingency have flown home; we'll miss them but we're feeling like we can manage with just one nurse for now. It was great to have so much clinical support right here.

26-Jan-06 11:49 AM from Kathy
Well, we're really getting killed with follow up appointments these days, both in our house and ones we have to go out for. Rob is actually needing more pain control because he's having to move about so much but we can clearly see his strength returning. But I'm beginning to feel like I would actually get more rest if I were able to go back to work.

This morning we spent at the pediatrician because our little Anna has a REALLY nasty infection on her big toe. We have no idea how it began but it is NASTY. So we had lab tests and lots of head scratching and we've come home with 10 days worth of augmentin (that's what Rob is taking) for her and strict orders for keeping it uncovered and 3x daily soaks---no school until the follow up visit. So we have another patient at home now. Next Thursday she also has a surgical consult with an ENT for her fairly severe adenoids/tonsil issue.

And just so we don't leave anyone out, Otis, the adorable 6 month old shih tzu is being neutered on Feb 6---As long as I'm here, we might as well get everything taken care of, right? If any of you are feeling under the weather and need a little help, just bring your favorite jammies and pillows over here. We'll take care of everyone.

Rob swears he's going to post soon. See you later

28-Jan-06 04:45 PM from Rob
Hi Everyone. I'm continuing to get better bit by bit. My big milestone is that I've now graduated from a walker to a cane for getting around the house, although I still need the walker for longer trips, such as to the doctor's office.

Speaking of the latter, on Monday I return to the University of Maryland Medical Center for follow-up with the surgical team. On one hand, I'm looking forward to it, as I should learn more about the timetable for my return to work. On the other hand, I'm not tolerating car trips well, and every speed bump and pothole in the mid-Atlantic seems to have been strategically placed between my house and Baltimore.

The home health nurse says that my incision site is shrinking, so that's good news, and I'm hopeful that the surgeons are likewise pleased with the progress. A little bit of boredom is starting to set in, but there is so much traffic from nurses, physical therapists, and occupational therapists that it seems there is always someone arriving on my doorstep trying to cause me pain. The physical therapy is now causing more pain than the dressing changes on my incision, so I suppose (?) that's a good sign.

As Kathy mentioned in her most recent post, our five-year-old Anna is now my co-patient. What she didn't mention is that apparently the pediatrician came very close to hospitalizing her so that she could get antibiotics intravenously, rather than the course of oral antibiotics they're now trying first. I just don't know how we could manage another hospitalization. I think that some of you may also not know that Kathy had abdominal surgery of her own in December, and so she was still recovering from her surgery when I became ill. She developed some (thankfully minor) complications at about the time I was released from the hospital.

So, the take-home message here is to take an umbrella if you come to visit us, so as to protect you from the dark cloud that seems to be hovering over us.

Many, many thanks for all of your extraordinary acts, prayers, and thoughts on our behalf. I'll try to post on Monday or Tuesday to let you know what I've learned from the Baltimore folks.

-Rob

01-Feb-06 12:10 PM from Rob Hi. I had posted an update following Monday's appointments with the ENT surgical team and the oral surgeon, but it seems to have disappeared, so I'll try to recap. Both were pleased with my progress. The only hitch was when the ENT surgeon described my case to one of the medical students there and used the term "on death's doorstep". Kathy and I (especially Kathy) had heard similar things before, but it still had kind of a chilling effect on both of us. At least after that I wasn't phased when one of the residents marvelled at how he used to be able to fit his entire hand into what is now a considerably smaller incision in my chest. Apparently, it used to take three rolls of gauze to fill the cavity, but it now takes less that half of a roll when the dressing is changed. I asked about a timetable for returning to work, but they put off that discussion until I return for an appointment next Monday. I sense, though, that it won't be more than a couple of weeks.

The PT and OT are going well, and I'm able to do a lot more for myself. The only hitch is with my right arm, which is right next ot the incision site. The OT is concerned that any further work on that arm (which is by far the weakest part of my body right now) could have the effect of stretching the incision so as to prevent it from closing. So my fear is that I might have to wait until the incision is completely healed until working more on the functionality of my right arm, and that will prevent me from driving, cutting my own food, and other stuff. Always something, huh?

Good news on the home front - the oral antibiotics cleared up the infection on Anna's toe, so she's back in school today. Also, my increased independence is at least partially allowing Kathy to catch up on her own convalescence!

-Rob

06-Feb-06 08:32 PM from Kathy
Another relentless series of days for the Mullen's. We awoke Sunday to Rob's Mom's request to go to the ER---having fallen and nearly passed out after showering she had injured her foot---sufficiently badly that with Rob's compromised strenght we were unable to get her out of the house. So 911 answered our call and Mary is now home, resting her ankle.

Today Rob and I went back to see the surgical team in Bmore. He continues to improve---there's no doubt his story is miraculous. Those ENT physicians and the Intensivists saved his life and he has really repaid their efforts by doing everything in his power to heal and grow stronger. We took Anna and Lindsay with us becuase Mary wasn't up to caring for them; it was interesting to note that Anna wasn't the least bit taken aback by seeing Rob's wound---something I still have at least some difficulty with.

So its a good thing Rob is getting better because I got really, really sick on the drive home and actually had to have Rob drive us from about the half way point. It looks like I'm feeling better now but I had the worst migraine I've hadin a while and for once I actually didn't have any of my Imitrex with me. It was a miserable trip and I spent the next eight hours or so in a dark, quiet room. I imagine it was hard for Rob to take care of the kids and I feel like a jerk.

Otis had his little surgery today and the post-op report was fine. He had to stay overnight and I miss him. Anna's Tonsillectomy/Adenoidectomy will likely happen next week despite my attempts to get it done sooner.

But we're moving from the crisis issues to the routine craziness and that's a great trend.

I'm always happy to see those doctors in Bmore and let them appreciate the outcome of their fine work. Stay tuned--I know these updates are becoming less frequent, less dramatic but we want you all to enjoy in our progress.

Thanks for all the food, the play dates, the salads and the wine!

21-Feb-06 11:51 AM from Rob Another successful visit to the surgeons yesterday, and I'm now cleared to return to work! So, I'll return to work on Wednesday, and gradually work my way back to full-time.

There are still some minor issues to deal with:

My incision wound seems to be colonized with a new bacterium that is resistant to the antibiotics I was taking for the original bug, so we're hopeful that a change in antibiotics will defeat the new bug.

I have some (hopefully temporary) nerve damage in one arm, apparently from all of the needle sticks and IVs from my hospitalization, so it constantly feels as if my upper arm is "asleep".

Then there's the whole heart issue. I think the plan is to try to blast me (probably not the correct clinical term) back into a normal rythym in about a month.

So, some minor annoyances, but the bottom line is that there are no more "if" questions about my full recovery, only "when" questions. That being the case, I think it's time to wrap up this site.

I can't do so without trying to offer my profound thanks to everyone who has helped me and my family get through these last two months. I'm intimidated in doing so, because I'm still in awe of the quality of the medical care and humbled by the kindness of so many people. I am going to try to thank as many of you as possible individually, but I certainly want to mention...

the truly extraordinary medical care I received from the physicians and nurses at Shady Grove Adventist Hospital and The University of Maryland Medical Center;

my mother and my mother- and father-in-law, all three of whom are retired nurses (how lucky am I there?) and who dropped everything to help us get through this;

our dear friends from across this area who took Kathy to the hospital and sat with her for all of those hours in waiting rooms;

my [work] family (and boy is that not a misnomer!) who have given me an incredible amount of support, not to mention a lot of terrific meals! Kathy's friends and colleagues [in her place of work] have similarly been great;

the wonderful Seniors group from my Mom's church and others from that and the adjacent parish as well as the numerous churches and individuals from across the country who were praying for us;

our great neighbors, who watched the girls when Kathy needed to be in Baltimore and who also showed off their cooking skills and generosity.

I'm so afraid of leaving someone out. Please know that it's not intentional.

As I said, this will be the last update to this site. We'll leave it up for a few days for folks checking in. A very heartfelt thanks to all of you.