May, 1999

May 1 & 2, 1999 (from Jud Klooster *edited by lk)   

This will be the last of the typical reports from the Columbus area, since Cherylin will be moved tomorrow, to the Miami Valley Hospital rehab facility-- an event to which we have all looked forward since we moved her to Columbus on March 16. Principal reasons for our delight over this: (1) it represents a tangible threshold of her recovery track, and (2) it will make possible the daily visits of her husband and family. Small details of the last two days, as follows:

We are looking forward to the increased intensity of sessions with the therapists that has been described to us as a characteristic of the rehab facility to which she will move tomorrow. One can only be grateful for the progress thus far, as we eagerly await the new levels of her recovery in the next phase of her care. -- Arlene and Jud

May 3, 1999 (from Jud Klooster *edited by lk)

Cherylin left the Riverside "Select" Hospital at about 12:30 today; Angie told me tonight that they (Angie, Clara and Kelly) arrived at the Miami Valley Hospital at about 2:10 p.m., and were afraid they would be late as a "welcoming party".   But  the ambulette arrived about ten minutes later, so their arrival was well-timed.  Cherylin had been given some Phenergan just as she left the Riverside Hospital, so she was pretty groggy when she arrived at MV.  The therapists moved in to start their evaluation,  but soon discovered that she was not sufficiently responsive for them to get anywhere!  Perhaps tomorrow will bring a new opportunity to start the evaluation, and with it, the beginning of designing  a suitable therapy program for her. 

Editor' Note:  Today we switch from having the reports provided by Judson Klooster, Cherylin's father > to having reports provided by Angela Peach, Cherylin's oldest daughter.  The Kloosters are preparing to return to California after two months in Ohio.  Angela (Angie) has agreed to furnish the information for the web updates now that Cherylin has returned to Dayton. Angie works full time and will provide information as her time permits. 

May 3 & 4, 1999 (from Angela Peach *edited by lk)

Yesterday and today have been adjustment days.  Since I've only been home from college for 48 hours or so, I don't have a lot to compare my mom's behavior with.  I know the kinds of improvements she's been making based on what Papa (Jud) has said, and from the few times I was able to make the trek back home from school.  But I haven't been witnessing her progress on a day to day basis.  I would, however, say that these past two days have been slow ones. 

Monday her transfer from Columbus was aided by a medication to help combat her tendency to throw up which also tends to make her tired, and a bit out of it.  We (Grandma Clara, Kelly and I) were there when she was wheeled into her new (and temporarily private) room holding flowers and wearing welcoming smiles.  She was "awake" during the hubub of transfer, but as soon as her head hit her new pillow, she closed her eyes and that was about it for the rest of the day.  One of the rehab doctors (I'm not as good as Papa at remembering all their names) attempted to evaluate her, but found her pretty unresponsive to commands.  The drug and stress of the move is the best explanation for her lack of cooperation.  We ended up just telling him history and small bits of information about her.  The staff psychologist visited and gave us all meaningful looks.  We met her new nurses and tacked up a picture and settled in some of her things, and then called it a day.

Tuesday we arrived at the hospital to find her absent from her room.  Informed she had been taken on a therapy tour (which apparently consisted of OT, PT, and ST) we found her down the hall in the psychologist's office where Kelly and I were asked to join in.   He attempted to get mom to tell him which one of us was the older kid and aid his understanding of our whole familial situation but she was generally a bit overwhelmed.   She nodded her head appropriately at times, but that was about it as far as communication goes.  Kelly and I were given the task of wheeling her back to her room, and after all the tales of vomiting Papa has written about we were a little worried that we would cause an "episode," but we made it safely back to her room.   After all of the stimulation she seemed a bit tired, and once again, as soon as she was put back into bed she promptly shut her  eyes and fell asleep. 

Around 1 pm or so the speech pathologist (Anita) woke mom up.  She offered an exciting selection of apple sauce, vanilla ice cream, or the ever popular spoon full of water to mom as a way of measuring her swallowing ability.  She seemed reluctant at first to swallow the water as it was put in her mouth, but after some prompting, she ended up getting it down.  Anita seemed encouraged by the fact that she has a "strong" swallow.  The suprise of this excersise was that mom didn't seem to enjoy the ice cream. She made a comical face while it was in her mouth and when asked if it was good she shook her head, "no."  It was also decided that we were distracting her from her therapy so we made a quiet exit and the rest of her therapy continued without our presence.

All in all she seems to be adjusting to her Miami Valley surroundings and just taking everything in.  The therapists have said that it is normal for patients to take a few days to get accustomed to and build trust with new therapists and nurses before real work in therapy can begin.  Also, Anita seemed to think that mom was still under the influence of the drug she was given in transfer Monday.  That also explains some of her unresponsiveness.  It is, however, an extremely positive step having our mom back in Dayton.  The timing couldn't be better now that Kelly and I are home from school.   We look at this as a new phase in her recovery, and one more step towards getting better.

May 6, 1999 (phone update from Jud Klooster - by lk)

Dad called tonight with a brief update which was very good news -- the team at Miami Valley has evaluated Cherylin's status and has placed her at the beginning stages of Rancho Coma Level 5 .  They have developed a finely detailed rehab plan with very quantifiable progress points for evaluation of her progress from this point forward. 

May 5 & 6, 1999 (from Angela Peach)

Yesterday (Cinco de Mayo.  Yippee) found mom a lot more responsive (as far as I was concerned).  The two days preceeding it were a bit depressing as she showed hardly a sign of recognition... But Wednesday the anti-vomiting medicine seemed to be wearing off and she was showing some signs of life.  When we got to the rehab unit, they were just wheeling her back from therapy and so she sat with us at a table in the little rec area.  When you've seen someone only lying down for weeks and weeks, it's a little bit of an adjustment to see them sitting upright, not wearing a hospital gown.   We sat and talked with her (or to her) and I got the distinct impression that she was really understanding us.  Kelly joked with her about joining in on the big bingo fun that was going to be taking place that night in the rec area (signs all around told us of this event) and she just shook her head as if to say, "when have you known me to get excited about bingo.  Come on!"

Various therapies occured.  She has about 3 hours of therapy a day spaced out in half hour increments.  She sees the PT, OT and Speech person all more than once a day.  The Speech person (otherwise known as Anita) seemed encouraged by mom's swallowing and by her consumption of a good dose of applesauce, orange sherbert, and of course the ever popular "spoon full of water".  A favorite.

Kelly and I ended the day by going back to the hospital after dinner and sitting with mom.  We brought our college yearbook along and showed her various friends' faces and explained their significance (and also how she might remember them).  She held the book and appropriately turned the pages, although I have no idea what she saw or understood.  We stayed for about an hour and when we were getting ready to go and explaining to her that we'd come back the next day but we had to leave she pointed to Kelly's chair and then to Kelly.  Back and forth as if to say, "no.  You.   Sit there.  Don't leave."  And I'll admit that leaving that night, just walking out of her room, leaving her there alone while we went back to our home and our dad and everything familiar just about broke my heart.  It was honestly one of the hardest things I've ever done.  That may sound melodramatic, but physically removing my body from her room was very difficult.  I didn't want to leave her there by herself.

Today (Seis de Mayo, although that really has no significance) we had a meeting with Iris, the case manager for mom's stay in the rehab unit (and also an old friend from back when both she & mom worked in Kettering's rehab) and the insurance woman.  They explained the goals Miami Valley has for mom and what they expect (hope) she'll be able to do in 6-8 weeks time.  That's the amount of time they expect she'll be staying in the unit.  After that what happens all depends on how she does.  There was a moment of dread as Iris uttered the words, "well, we had thought Cherylin was a Rancho level 4, but. . . "  (and if you could have seen the sinking look that came over all our faces as we thought she was about to say, "but she's not... she has to go back   to Columbus...")  But instead she completed the sentence, "but she's actually a low level 5!"  So even better than everyone had hoped!!!  There were six sighs of relief as we heard those words.

The meeting was a good way for Grandma and Papa (Arlene & Jud) to plug in their knowledge of the last few weeks in Columbus and to feel reassured about the next few weeks at Miami Valley, as well as for Daddy, Kelly and I to become aquainted with what to expect.  We all felt the meeting was positive and affirmed in the conclusion that mom's in the right place, being taken care of people who know what they are doing. 

SO other than that... I don't have great and wondrous words to report.  No great utterences.  No suprising movements.  This is a slow, painfully slow process.   But she's on her way...  And that's all I've got for now.     --Angela Peach

May 10, 1999 (from Angela Peach, *edited by lk)

This weekend we celebrated mother's day with mom at the hospital.  Not an easy time or place to celebrate, but we made it as special as we could.  This was the grandparents' last weekend here and so we went over to the hospital quite often.  On Saturday afternoon we spent awhile there.  Mom had a few visits from friends, and they managed to get a small upturn of the mouth which could constitute for a smile.   Grandma Arlene was also pleased to report that she got a bit of a grin when she went into mom's room on Friday night.  When I heard that, I told mom the next time I saw her she had better be wearing a big, cheesy grin because I was beginning to feel like something about my visits was unpleasant for her.  So far she's not cooperating with me on that... 

Sunday we took the grandmas and the papa out to The Breakfast Club for brunch.   And then we headed over to the hospital to give mom some flowers and a present or two.  Kelly and I picked out a couple of shirts and pants we knew mom would approve of the world seeing her in from the Limited now that she's allowed to sport "street" clothes.  During our visit they had her sitting up in her wheel chair out in the sitting area.  She seemed happy to receive the gifts.  We were happy to spend our mother's day with our mommy.

Kelly and I then spent the rest of the afternoon doing a little planting.  Every year (at least for the past several) when asked what mom wanted for mother's day she'd just say, "take me out to eat and give me a little time to plant my flowers."   Well, we couldn't do anything about getting her out to eat, but we decided we'd honor her other request (sort of) and plant the beds in the front yard with impatiens.   It was our first go at doing the whole thing by ourselves, even though we've helped her in the past.  I must say it looked pretty good when we were done.  Daddy thought that she'd be pleased.  I think we'll take a picture of the beds and post them in her room.  She'll enjoy seeing their progress.

As for today... she apparently has a bit of an infection.  My dad said something about E-coli.  Since I didn't get the whole scoop on that one, I don't want to scare anyone.  He didn't seemed terribly concerned, so the Doctors must not have pressed any sort of extreme danger about it.  I just know that masks and gowns are to be donned whenever we enter the room now.

Well, that's all faithful reader.  I'll attempt to be more of a faithful correspondent.  I'm not quite the communicator my papa is.  The shoes I'm trying to fill are huge.  Until the next time,  Angela Peach

May 15, 1999 (From Angela Peach)

It's not always easy to shrink the days down into an interesting bite of information.   The days all look pretty much the same, and since all of the Peach family works during the day it isn't often that we get to see therapy in action to catch every single word, step etc.  By the time I get there around 7 pm (which is my usual visiting time) she's worn out from all the therapy and other visits and she seems to want rest.   Take today for example. (Saturday).  When we (Kelly and me and some of our friends) arrived this afternoon they had her sitting up at a table out in the "common" area while everyone else is eating and she looked completely wiped out.   I have no idea how long she'd been sitting up, but she was practically falling asleep sitting up.  SO we requested her transfer back into her room.  Once she was in her bed she promptly fell asleep.  My friend Cheryl told her it was nice to see her again and such and mom uttered a gutteral, "hi..."  Last night we went in and had a little worship with her.  We sang her songs and generally amused ourselves (she was probabley cringing...).  They started her on Ritalin (spelling??), the drug they give hyperactive youngsters to calm them down.  Why you ask?   She's barely out of her coma, why would we want to calm her down??  Well, apparently it has an opposite action in adults.  It stimulates her responses and makes her more alert.  We saw minor evidence of this on Thursday night.  Kelly and I were visiting her with our friend Andy, and he was trying hard to remember the date of my birthday.  He was sitting by her bed and said, "Okay... I know it's in July.  Come on Cherylin, help me think of it...  When is Angie's birthday??"  And she looked at him and made some noises with her mouth and was making motions with her finger as if trying to say, "I know I know I just can't tell you right now!!!"  THat may not sound like much, but there was obvious recognition of our conversation in her eyes.  Shortly after that the nurse came in and was fiddling with her G-tube and mom said, "Oh, man!  That hurts.   Ouch!!"  Very intelligibly.  That was perhaps the most "with it"  I've witnessed her being.  And it's not so much that she said a bunch... I guess it's more the nonverbal communication we were getting.  She seemed to be processing a lot more of what we were saying.  Her eyes shifted from person to person while we talked to her.  More head nodding and shaking. 

I guess she has her good days and her bad days.  It's just hard when I see her like she was Thursday night and then today she just doesn't really seem to know what's going on.  I expect so much.  I expect that once she makes a little progress the next day I'll come into her room and find her sitting up watching TV, or talking on the phone...  It's just a very very slow process.  And I am a chronically impatient person.  That's all for now... Angie

May 17, 1999 (from Bob Peach *edited by lk)

One tidbit from me: today for the first time I asked Cherylin to squeeze my hand if she loved me.  I got a very quick and strong squeeze in return.  My heart was singing all the rest of the day.  Sunday morning I read the the newspaper "with" her, seated in the "common" area of the rehab unit where there are about 8 round tables.  She was seated in her wheel chair and she seemed to look with interest at some of the pictures in the paper.  She showed the most interest to the comic section.  She held on to the far edge of one section of the paper with her left hand and then with my help folded it up and firmly placed it up on the round table in front of us.

May 18, 1999 (from Angela Peach)

The first thing the nurse said when we arrived and began gowning up (for her whole isolation routine) was "everyone says she's been much more responsive lately."   She felt she'd seen evidence of this in mom's helpfulness in the transfer process from bed to wheelchair and back again.  She did seem much more alert to me as we went in and announced our arrival. I noticed she was disconnected from her feeding apparatus and asked the nurse about that.  Apparently she's begun bolus feeding (by which they come every couple of hours and administer her food all at once instead of it streaming into her constantly).  This is, according to the nurse, a positive step towards a more normal diet.  She's been responding pretty well (last time they tried this she wasn't able to handle it.  She had excessive throwing up bouts).  WE even observed the process.

She does seem to be doing a bit better than in recent days.  What I don't understand, however, is why she nods yes and shakes no for some things and others she just stares at me.  I wonder why she can nod her head that she'd like some lotion on her hands and when I ask her if she knows how much I love her she doesn't do anything but look at me.  I crave some sign from her that she gets it.  That she sees in my eyes the immense and basic love we have for her, that the hours we spend with her are because we just want to be near her because we miss her so much where she should be, home.   That will be progress to me.  And I know, I should be excited about all the little things too.  And believe me, I am.  But I just want some reassurance that she understands and remembers us.  That's more important to me than a bolus feeding any day.  On that note,  I must retire. Over and out. Angie

May 22, 1999 (from Angela Peach)

It's the little things that make me happy.  I found myself trying to explain today at church to one of my friends how exciting it was that last night at the hospital when Kelly, Emily and I were there to sing to her and do her nails that she blew on her own nails!  I realized how dumb it sounded and how small a thing that is. . . but if you think about it. . . she had to understand what we were doing, had to process that blowing on it would actually help the drying process (or that it had to dry in the first place!), and then had to connect all that in  her brain and actually do it.  It was small, feeble, and didn't really aid the process... but she did it.  In a weird way it touched me.  She also picked out her own nail polish color and seemed to relish in the attention Emily gave her fingers (thoroughly cleaning under them, a good shaping, lotion message).  She looked at Emily when it was all over and gave her a face that seemed to say all at the same time, "Hey, thanks.  I realize how much you love me in this one small act, and I am overwhelmed."  Well, that's what I took it to mean (perhaps because that's what I was feeling at that moment!) She seemed pretty with it last night. . . although today she was out of it because she'd had a spell of nausea earlier today and had to receive the dreaded medicine that seems to wipe her out for hours, if not days!  When we arrived we asked if she was tired and she kind of nodded her head in an exasperated way.  We read to her a little and just sat with her.   I'm realizing more and more how I just want to be with her.  That's what's   really important to me.  When she's holding my hand and her fingers rub my hand, or when she touches my face or hair, or when she gives me a kiss on the cheek as we leave it makes me aware(sometimes suddenly) of how much I miss her.  I am starved for any little small thing that she can do to show me affection. My goal is still to make her laugh.  (A far off one, I understand).  For those of you who haven't seen her, her face is set in this sort of perpetual unpleasant frown.  Once in a great great while that will break and a bit of a smile will appear. (We're talking tiny corners uplifted).  But I keep thinking she's just bored, or annoyed or sad and all it would take is a little teasing or something and she'll have her old happy face back.  So we try.  We'll remind her of long running jokes we have with her, and poke her in the sides (she used to HATE that).  So far we've only gotten one little smile for one little joke.  But it makes me keep trying. Remember, it's the little things...   I'm out,  Angie

Editor Note:  As you will learn from the next posting, Iris Snyder, the Nursing Care Manager at Miami Valley Hospital has generously agreed to telephone Jud & Arlene Klooster each week after the weekly case conference where the whole team sits together to review their patients' progress.  They regard the team conference as one of the really significant parts of the program since it gives them the advantages of  "group think" about their clients rather than leaning on the sometimes uncertain impressions of any one person.  Dad (Jud) has agreed to provide me with his notes on these updates to post on here the web.

(5/26/99) From May 21, 1999 (from Jud Klooster)

Conversation with: Iris Snyder, MSA, RN, CRRN, CCM

Iris called at about 8:30 this morning, to bring us up to date on her observations of Cherylin's recovery.  She is the nursing care case manager at the Miami Valley Hospital; she has known Cherylin for many years, since they worked together (nearly ten years ago!) as therapists, for the Kettering Home Care facility,  Her report was reassuring, even though she could cite no dramatic changes in Cherylin's behavior, etc. Specifics she mentioned were:

>  Nausea: No recent nausea episodes have been observed.  She is being given Propulsid, which helps her empty her stomach more promptly; Iris believes this accounts for the nausea reduction.

>  Ritalin: Bob had told us that they've started Ritalin, but we weren't sure of the daily total; Iris confirmed the regimen.  She is given 15 mg. twice daily-- first dose at 8 a.m. and the second one at about 1 p.m.  None is given later in the day, because they wouldn't want the stimulating effect to compromise her sleep potential.   Imagine having to protect the sleep potential of a coma victim...!   They are pleased with the effect the Ritalin seems to have for Cherylin-- she is more alert to voices of the therapists on each side of her... her eyes move quickly toward the one who is speaking to her, head turns in response (to some extent) etc. If after a few days, they think the Ritalin in not producing enough stimulation, they may go to some other medication, such as Bromocriptine; but at this time, no change to this is contemplated.  

>  Casting of legs:     Her right leg has been put in a cast to reduce the "foot drop" shortening of her heel ligaments.  This   process is now in its second phase... the first cast was on for about a week, and now a second cast has been placed, wherein they gained about 12 degrees toward the goal of a normal ankle posture.   They do NOT split the cast, as was done previously in the MVH neuroscience unit, largely because of the difficulty in avoiding skin breakdown at the corners of the split.  At Columbus, she developed some nasty little skin ulcers in about three of these sites.  Further, the effectiveness of the cast in maintaining the incremental progress toward the ankle posture goal really is never as good after it is once removed and replaced, as it was when first placed and before the split.  Her left leg does not require casting, the use of a fabric splint seems to be adequately effective toward this goal.

>  Response to psychologist?  I inquired whether the psychologist is now able to get more useful responses to his inquiries than was the case when she first arrived on this unit.  Iris said that may be improving in the last day or so, but until recently, there was not enough response for him to make a useful psychologic evaluation.  They hope the Ritalin regimen may help to move her forward in this regard, as well as other specifics of response.

>  Isolation:  Cherylin has been in a communicable disease type of isolation for the last week or ten days, because laboratory tests have revealed (in her urine and stools) a Vancomycin-resistant strain of e. coli.  So all nurses, therapists and visitors are  gowned and gloved before entering her room.  When she is brought out of the room to the common area (a sort of community room, that looks a lot like a coffee shop, with its table & chair clusters, etc.) Cherylin is gowned and gloved. The purpose of this is to maintain a barrier, so the V-resistant bacteria do not spread to other patients and other units.  She is not at risk (she is afebrile, and shows no evidences of specific infection), but barrier techniques are very important, particularly with antibiotic-resistant bacteria.  As soon as Cherylin's lab reports show that she is clear of the bugs in question for two Wednesdays running, the barrier techniques will be discontinued. Responding to our question about "how did she get this bug?", Iris told us it is not uncommon for patients transferred in (to MVH) from other facilities, to bring resistant bacteria with them.  Otherwise, nobody really knows how she acquired this contamination. Of course,e. coli is very common in most anybody's stools; the thing that "jerks the chain" of the healthcare people is the threat of an antibiotic resistant bug.

>  General Perspective:  Iris considers Cherylin to be more alert to her environment, more responsive to the therapists, and to use  her eyes more intently, in watching and following the activities of those who help her.  She has made a few hoarse sounds, and some single-word responses to her therapists, but other symptoms of   progress (other than verbalizations efforts) are more impressive, in Iris' view.   For example, Cherylin now wears a web belt all the time she is in bed, because she has shown some propensity for trying to climb out of bed ("isn't that great?", I hear somebody saying...!).  While that's a sign of progress, they don't want her to climb out and then have a fall.  Another good sign is finding that Cherylin uses her hands and feet (a little bit) to push herself around in the wheelchair.  Although this is just a beginning effort, it portends a move to less dependent behavior.

May 28, 1999 (from Bob Peach)

During this past week Cherylin has been walking more and more.  Aided, of course, by her PT.  She progressed from going 8-10 steps across her room to 50 feet along the hallway to standing holding the railing out in the rehab patio and walking to the right holding the rail with her good left hand for about 15 feet to then side-stepping to the left and then turning and taking a few steps to the left holding the railing in her weak right hand. This all was over the course of several days of therapy.  Her PT was also pleased early in the week that she was able to sit up on the edge of the bed and with only minimal assistance and scoot laterally several feet along the bed in preparation for assuming a lying down position.Her OT has been having success in getting her to straighten her weaker right arm.  She tends to favor this arm and hand holding it in a contracted position up against her chest. A large air splint that inflates by mouth and engulfs her arm gently forcing it to a more nearly straight position has been a useful aid this week.  She was able to reach forward with her right arm inside the air splint and push a small bowl forward on the table in front of her. Her ST reports introducing some new foods off the kitchen trays in therapeutic swallowing sessions this week.   She has had some trouble throwing up her bolus stomach tube feedings, but not always and somewhat unpredictably.    They keep experimenting with different approaches to this to see if they can find an approach that regularly keeps the feeding in her stomach where it belongs. Cherylin has great people working with her.   They are a real gift from God.  I keep praying that God will be with them and Cherylin to be encouraged and to work hard.  I keep praying also, that God will restore this wonderful woman to all of us who love her and care deeply about her.   Please join me in this prayer.  Thanks for your support and love, family and friends. -- Bob Peach

Editor's Note:  Bob has prepared a list of "Frequently Asked Questions" about visiting Cherylin that we posted as a separate page on this web site - Check it out!