Tuesday, May 31, 2011

PT Day 9, by David

My Little Darlin, PT 9

It is almost 1:00 am.  I am alone and this is when I start thinking the worst.  Remember, this was "done to" Jan!  It is still being investigated.   I have given a lot of thought regarding how this could happen to Jan or anybody in a similar situation.  Jan and Kim were on a  straight, flat stretch of wide open road.  It was slightly overcast.  They were heading east so if there was any sun coming through it was behind them which improves their already excellent visibility.  I know how good the visibility was since I had already ridden 50 miles that morning and I have ridden that same route many times. They were wearing bright colored clothing as usual.  I am told there was no oncoming traffic in the opposite lane.  It was impossible for them to not have been seen.   I have heard Jan was hit full force squarely from behind and carried with the car for a long distance.  I was told she rolled off the hood to the ground unconscious when it finally stopped.  The person that hit her I am told showed no remorse at the time and I am told, in an accusing way, asked why they were in the middle of the road.  Jan and Kim were in their appropriate lane.  There were many witnesses, I have not spoken to them all.  It is still under investigation.  I do look forward to the complete investigative report from the time of impact until Jan was taken away by ambulance.   I am told there are things that occurred that will be very upsetting.  I have not heard from the person that hit her since the accident.  I have no idea if they feel any remorse or not for this.  If I had done this to someone I would be suicidal.

  Jan is lying in a hospital bed helpless, fighting for her life and if she survives this I have no idea how much if any of my old Jan I will still have. The extremes (late after the 9 o'clock visit to before the 6 o'clock visit) of the day are the hardest.  It is when I am by myself and I think about Jan with me before this happened,  the instant when she was going through the trauma and her lying in the CCU bed now.  I think about just how bad this was last sunday and I still do not know how she survived it.  I occasionally imagine she did not survive but very quickly put that out of my mind.  This is all extremely painful but that thought is absolutely unbearable.   I am still scared.  She remains in critical condition but most of the steps she has taken since the event have been forwards. At the moment you see very little signs of trauma on her face.  Since they got the endotracheal tube out (has a tracheostomy now) lying there she looks like an angel sleeping peacefully.  The rest of her body is a different story.   I kiss her and tell her I love her often.  I tell her she has an awful lot of friends pulling for her to get better.  We have music playing from her ipod.  The drawings from her granddaughters are taped up in the room.  Another drawing sent to her by a little girl that she help pick out a bicycle is taped up.  All of the cards well wishers have sent in are on a cork board.  Sweet Parisa, that is Parisa with her on her current Facebook page photo, got her one of those (I don't know the correct name of it) picture frames that you download photos and it continuously scrolls through them.  There are photos of her four granddaughters, sons, us on trips, friends and many more.

This morning no set backs (TIGT).  She remains stable on sedatives, pain meds and paralytic.  She is on multiple antibiotics.  Her temperature remains reasonably controlled.  She still has an intracranial pressure(ICP) monitor.  Her ICP is good. Her central intravenous line was changed out yesterday.   The tracheostomy is doing well.  Her blood oxygen saturation is good and the oxygen concentration she is getting is down to 60% (TIGT).  They started slow tube feedings yesterday.  Hopefully this will jump start her GI tract (TIGT), this will be a better way to give her nutrition than intravenously.  Baby steps I keep telling myself but I desperately want to see big steps.  I keep hoping for that, it will come (I pray) but may be later rather than sooner.  It is going to be a long road but at least we do have a road.

Please do not forget about what happened to this beautiful vibrant woman, my Little Darlin.  It did not have to happen. 

Thank you all for your kindness, concern, prayers and for slowing down and moving over for anyone biking, running, walking, checking their mail, working, changing a tire etc,
Pass it on.


PT Day 8, by David

My Little Darlin, PT day 8

She remains in critical care on the ventilator heavily sedated.  She has antibiotics pouring in that should cover just about any bacterial infection she may have.  She was having fever yesterday.  An antifungal drug was added  just in case her fever was fungal in origin.  Intermittantly a cooling blanket was placed on her to keep the temp down.  One thought was that her temperature was up from the extra work she was doing by fighting against the ventilator.  I don't know, just a thought.  Yesterday Jan had a tracheostomy(trach) placed which is a tube into her windpipe through a small incision in her neck (TIGT).  The endotracheal tube which was the breathing tube through her mouth needed to come out.  Leave these in too long and it can case chronic problems after it is removed.  Getting this out of her mouth  and having the trach will be more comfortable for her and a better way to manage her airway in the long run.  The scar from the trach is a small thing.  Don't sweat the small things there are too many large things to sweat.

She was fighting the ventilator more and more yesterday afternoon so much so that it required increasing her oxygen concentration to 100%.  Long term this high a concentration can damage the lungs so you want to get that down.  The heavy doses of sedatives were not doing the job so she was placed on a paralytic.  There was some hesitation because of prolonged muscle weakness after taking her off this medication but risk vs benefit dictated that TIGT.(a physician will always take into account risk versus benefit.  Any procedure, medication or pretty much anything else a physician does to a patient has potential risks.  If the potential risk is greater than the benefit expected you do not do it.  If potential risk is less than the benefit then do it.  There are still risks no matter how simple, if it happens to you it is 100%,  a little insight on how I think from a physicians perspective).

She had a good night after being given the paralytic.  This morning she was not fighting the ventilator, she could not, she was medically paralyzed.  The sedation keeps this from making her uncomfortable.  Her temperature remained good.  Her white blood count was decreased this morning since yesterday.  The oxygen concentration (FiO2) being given to her was 80% down from 100%.  The oxygen concentration in her blood was very good so I suspect her pulmonologist will decrease her FiO2 further.  Hope so.  Shooting for below 60% FiO2 so that it does not start damaging the lungs and 40% to start weaning off the ventilator.  Got to get her lungs to heal form the trauma, pneumonia and mucous plugging for this to happen.  Small steps.

While writing this my good friend who is a radiologist here texted me that Jan's chest X-ray showed definite improvement since yesterday (TIGT)

I want to thank all of you for the support.  If you texted, emailed, placed a message on Facebook or left a message in any other way I have seen it . I try to answer them all.  Some times I am not sure if I did or not.  You may get more than one response from me or not get one at all.  I hope the not get one at all has not happened but I frequently will start typing (I type with one finger but I can use that finger on each hand) get distracted and am not sure if I sent the message or not.  Please keep them coming.  For my friends and family that have visited,  not to lessen the notes, thoughts and prayers, your visits whether short or long are very comforting.  One of our boys, Derek and Sean, is always with me.  Man they are good guys and I could not love my own son more.  I do not tell them this often enough.  One of my brothers, sisters of my father and step mother are usually here.  I have had many close friends here.  Our dear friends Mike and Kay came over from Waco, TX.  They knew how down I was the night before last, showed up late and stayed the night here in the waiting room with me.   I know I can call any one of my friends day or night.  I heard you Boomer.   I do not think anyone that has gone in to see My Little Darlin  came out without shedding tears.  It is hard to see that normally vibrant, beautiful, smiling woman lying there like she is.  Family and friends (TIGT).  Many who have only briefly met Jan or do not know her at all have relayed their concern and prayers.  Thank you all.

I still cry often, can not help it.  Can not predict when except in the morning when I wake up, at night just before I go to sleep (if I do and I did last night, TIGT) and every time I go in to see her helpless on the ventilator.

To all,  do not forget how Jan got here,  do what you can to keep this from happening to someone else.  Stay the course. Please!


PT Day 7, by David

My Little Darlin, PT day 7

Sunday, 1:25 am The past few hours have been some of the worst of my life, approaching last Sunday when I got the call " David, it's Kim, Jan has been hit by a car and it is bad".  That is what started the nightmare.  My heart has been bleeding ever since.  Over the past week some moments have been light, momentarily not having a prolonged sad thought about my beautiful Little Darlin lying in that CCU fighting for her life.  Those light moments never lasted long, how could they?  Although she had a good night last night I felt uneasy all day.  Could not explain it but the anxiety had my heart rate up and tears kept welling up in my eyes.  Went in at 6 this evening for a visit and immediately was aware things were off.  She had suddenly started breathing more than the ventilator was set for.  Her blood oxygen saturation was decreasing requiring an increase to 100% concentration of the oxygen being given to her.  My anxiety was increasing logarithmically.  The pulmonologist was there.  All week, in addition to the despair of what had happened to and what my precious baby darling was going through,  I had the constant fear of what  potential complications could develop while trying to get her through this.  The pulmonologist, Derek (Jan's oldest son, my stepson and also a radiologist) and I talked about what could be causing this.  We know by her CT done yesterday that the left lung is working very poorly due to pneumonia, filled with blood or both.  The right one also has some of this.  When someone is on the ventilator the bronchi can plug up and cause some of this. This was one consideration but that usually does not happen quickly.  What I have been fearing for days now is pulmonary thromboembolism (blood clot to the lungs).  If I recall correctly this kills 8% the first time it happens which could have been yesterday when she had a similar problem.  It goes up to 30% death rate the second time.    It is usually treated with blood thinners but she can not have this because of her risk of bleeding from the trauma.  If she could have blood thinners she would already be on it to prevent blood clot.  This potential problem has been a worry from day 1.  The pulmonologist bronchoscoped her in the room and found some bronchial plugging and washed it out but her oxygen saturation did not improve significantly.  We looked at her legs with an ultrasound to see if any clot were there. There was none. This is where they form, break away and flow to the lungs blocking blood flow through the lungs.  If the clot is big enough to block significant blood flow the patient dies immediately.  If not that big their heart rate goes up and oxygen concentration in the blood goes down.  Sound familiar?   The best test for this is a CT scan but this meant taking her back down to CT.  The treatment for someone who can not have blood thinner is called a vena cave filter.  It catches any clot flowing from the legs to the lungs.  She needed the filter no matter what.  It was put in her tonight and now she is as safe as can be from this potential problem.  One thing to not worry about and can get the filter out when she is better. From the time I walked into that room at 6 until the time I was told I could come back to see her after the filter was placed at 10:30 I sobbed.  I thought i was about to lose her.  I am still so scared of that and have been for a week. I do not know when that fear will lessen.  We still are not sure what caused her change but when I could see her and kiss her and know she had not left me I felt some relief.  I love her more than anything in this world and I am so afraid.  God I pray that you get her through this and back to me.  I also pray that this never again happens to anyone else.  The pain is virtually unbearable.

Sunday, 2:05 am  Let me tell you a little about My Little Darlin Jan.  She has a personality.  Oh does she.  She does not mind telling you what she thinks.  She has a heart as big as gold.  We were recently in Mumbi, India.  We encountered a little girl on the street who was a beggar.  Her hand had been amputated.  Saturday night before the day of her trauma, before we went to bed I found her standing outside crying.  She was thinking about that child  She was so upset because she had learned that the parents will amputate their childrens limb to improve their worth at begging.  She wanted to do something about it.  We currently have 4 dogs.  They are all strays and all sleep in the bed.  We have had as many as 6.  If she sees a stray she will bring it home if it will come to her.  If it will not come to her she comes home fretting.  Those dogs love her.  Wish she was in the bed with them right now.  Oh how I miss her. I am writing this on her computer.  She has it set up so that every time her browser is opened www.theanimalrescuesite.com/clickToGive comes up.   You click on it and the sponsors donate food for rescued dogs.  She is always trying to get others to do the same for the animals.  Her motto is "Life is For Doing Stuff" and she did.  We travel.  We have traveled a lot because of her.  She always said all I have to do is show up.  She was right, she took care of it all.  She has been caving in New Zealand, trekked mountain gorillas in Ughanda, cruise the Amazon and Nile Rivers. Done photographic safari in Africa.  Camped a week in Alaska.  Camped and white water rafted in Idaho along with many other adventures.  I do not know how many cruises we have been on.  There are not many places in this world we have not seen.  There are a whole lot more that I want to see with her though.  I will settle for open eyes and recognition right now.  God how I love her.  She loves Disney.  She has completed 6 marathons (26.2 mile run)  Most of these were with Leukemia and Lymphoma Team in Training,  raising money for this charity.   She is a dynamic self starter that will tackle any job.  She was one of the founders of a large anesthesia group and practiced in Jackson.  She retired from anesthesia.  After about two weeks she was bored so she became a residential real-estate investor.  She did this until we moved to Starkville about 5 years ago.  About 3 years ago we were at a mountain bike race in the area.  She did not ride bikes at the time.  Several of us were talking about how it would be good if somebody would open another bicycle shop in Starkville. She said ok lets do it.  No retail experience, does not ride a bike, no bike mechanic I say to her.  We / she opened Boardtown Bikes 4 months later.  Oh yea, she and I went to Barnettes Bicycle Mechanic School about 2 weeks after opening.  She is a certified bicycle mechanic.  Don't ask her to work on your bike though.  She can change a tube. Keep the wrench out of her hand.  She does talk the lingo.   Sure do want to see her smiling face back in the shop.  We did a few triathlons about 25 years ago.  She had not done one since but in the fall of 2009 she decided she wanted to do an Ironman Triathlon (2.4 mile swim, 112 mile bike, 26.2 mile run ).  We worked the medical tent that year which allowed us to get a spot for the Panama City Ironman in 2010.  I have mentioned that she completed a total of 130 miles of this.  She was disappointed in herself for not completing tithes the training ride last Sunday.  Oh God how I wish she had completed that ironman.

She was taken down to the CT department at 3:00 this morning for a CT head. No change(TIGT).  When I saw her this morning she was doing well relatively.  I can not explain the relief I felt when I walked in her room.  Her blood and intracranial pressures were good.  She was not breathing over the ventilator.  Most encouraging her blood oxygen saturation was greater than 90% and the oxygen concentration she was being given was 50% (TIGT).  Still do not know what happened to her last night but her risk of dying from a PTE has been drastically reduced (TIGT) .  I have to keep reminding myself (and be reminded by my friends and family) to be patient.  Did not sleep at all last night and I know I should but was feeling panic about my Little Darlin all night and could not.  I am better now, for the moment.  Got to spend a good 30 minutes with her during this mornings visit.  Loved on her as much as I could.  God I love that little women.  This is so hard.  I am so scared.

Please tell everyone you know about Jan, nobody or their family deserves to have this happen


PT Day 6, by David

My Little Darlin, PT day 6

12:00 am near the beginning of PT day 6.  I saw my beautiful wife for the last time today at 9:00pm.  I get to see her again in the morning at 6:00.  Tonight was better than last night because last night I was bothered so much by her not responding after having her sedation turned off.  I have found out since that that was not surprising for several reasons and that I should not be alarmed.  I don't sleep much these days.  I come back to this hotel each night hoping I will sleep but as soon as I turn off the lights my mind starts going over things.  I remember her face in the critical care unit, her eyes are closed and there is no expression.  I kiss her face wherever there is not any tape holding some type of device on or in her.  I tell her how much I love her.  ( and I love her so much it hurts bad) . I hold her hand, gently though because her fingers are broken.  There is still no expression, I wonder if I will get to see any emotion from her again.  I think about the beautiful happy smiling face in the photo on her Facebook page.   I shed tears for a few minutes and I still can not go to sleep.  I begin to think  about her on her bike pedaling west on highway 50, she hears the car approaching.  All of us who ride road bikes hear the cars approaching from behind.   I see in my mind the absolute brutal impact of that car hitting my Beautiful Little Darlin (like you would see in a movie only this is real) full force at 55 + mph.  I feel the absolute terror she had to have felt (if she is still conscious) as that car is slamming her 200yards down the road.  I cry some more and I get angry.  I may get a couple of hours of sleep but got to get up at 5:00am so I can see my baby at 6:00.  I am always cautiously optimistic since it has been 9 hours since I last saw her.  I hope she has had some improvement and pray she has not gotten worse.

6:00am.  They have just announced that families can go back and visit.  All except the morgan family who is delayed, my heart rate increases with anxiety as to why? Is there a problem I wonder? This delay happens occasionally and usually not a problem.  I am always on pins and needles though.  The delay was short.  Her nurse just wanted to be organized so when I came she could give me her full attention.  Jan had a good night(TIGT).  Yesterday she had some problems throughout the day with her blood pressure going up.  Not critically high but her intracranial pressure went up as well.  With her brain trauma increased pressures are not a good thing.  Suspect the increased pressures were related to pain and stimulation from being moved quite a bit.  You may recall that early yesterday she had a CT of her head.  Later in the morning she had a CT of the abdomen.  Both were OK by the way.  Patients have to be taken to CT,  CT can not come to them. With a critical patient this is a major ordeal.  Transportation is cumbersome with all of the support devices that have to be taken.  The patient( side note, for the 20 plus years I have been in medicine it has always been "the patient", now it is My Littlt Darlin, this is a whole new way for me to see things, I do not like it but it will make me a better physician in the future,  another potential good thing to get out of this otherwise horrible tragedy) Once in CT several people must physically lift her from her bed to the CT table and back again after the scan.  It is awkward to do this with a patient and the difficulty is compounded by all of the tubes and lines coming from My Little Darlin.  Any one of these tubular structures could easily but accidentally get pulled out.  Even with the sedation and narcotic infusion she senses significant pain from with the transportation and movement from her numerous fractures.  They did this twice.  That is likely why her pressures were up.  Her morphine and versed were increased significantly for this.  Her pressures came on down last night to very good levels and remained there(TIGT).   Her fever remained in check and her oxygen requirements remained in check(TIGT).  Overall no setbacks last night which is always a very good thing.

This still hurts me as much as it did starting last Sunday.  I hide my emotions pretty well.  That has changed.  Just about every time I go in to see her, still on the ventilator, not knowing when or if she will come off,  thinking about what she is going through and then looking at her photo with a smile on her face( I have several of these taped up on the wall in her room, do not want anyone to forget who she is and it helps the caregivers see her as a person not just a patient), I tear up.  Throughout the day these thoughts and others creep into my mind and I tear up.  If I am talking to someone about her I tear up.  All of my family, friends and well wishers have been great.  It is normal that the longer this goes on the less it will be on others not directly involved mind.  All of your support with visits, texts, and notes are greatly appreciated and welcomed.  I am in this for the long haul and I fully understand it is going to be a very long haul.  Over the next unknown how long duration as this event lessens on your mind (I know that is normal) please drop the occasional note, prayer or visit.  They are all welcomed.  I will continue to make Facebook posts so long as I am getting feedback which has been wonderful by the way.  Doing this helps me and as a good friend suggested it will some day be very meaningful to Jan to see how many people really care for her.  Also do not forget about what happened.  We need to be vigilant about safety of those biking, riding, working etc on the roads.  There have been some positives to come from this.  Thanks J B for the note.  J B has contacted an Oktibbeha County supervisor about signage on the roads regarding bicyclists and the 3 ft law.  Let this snowball keep rolling and get bigger please.


PT Day 5, by David

My Little Darlin update, PT day 5

Positives today include her Ct head done this morning shows normal improvement in the bleed she initially had (TIGT).   She continues to oxygenate well, her chest x-ray(CXR) is unchanged and no significant fever.  A negative is a drop in her blood count.  Not sure why,  stress from the trauma is suspected.  She is going to get a CT of her abdomen today to make sure it is not decreasing due to bleeding from an abdominal organ.  Since it was ok when this first happened it is low likelihood she is bleeding.
She remains on morphine and versed infusions for pain and sedation.  My anxiety level has jumped considerably because last night her versed was stopped for a good while but she never responded purposefully.  I am hoping and praying she does not have an underlying neurological injury that can not be detected by CT or physical exam.  I have kept this to myself until now but this has been my worst fear of all the many fears I have had.   I know I have to be patient but at the moment this fear of her not looking at me, smiling at me, talking to me ever again is overwhelming and I have pretty much been in tears since I left her last night.  This is hard, it hurts and without her …..

Please keep her in your thoughts and prayers.  Please give anyone you see on the road biking, walking, changing a tire, police officer/state trooper, anyone a wide berth.  Slowing down would be nice too.  They are totally unprotected.  Their life and their families are worthy these simple courtesies.  Car always wins in car vs person.  I still do not know how my Little Darlin survived this.  I do not know if I will ever have the Jan I have known for 30 years back the way she was.  At least I still have her.  Other families that have had similar tragedies can not say the same and my heart goes out to them.

PT Day 4, by David

My Little Darlin, PT day 4

We are four days out now and there are small changes of improvement.  She in now on only one medication that is used for blood pressure support but its' dose is at a level below what is used to support blood pressure.  At this dose it does provide support for the kidneys(TIGT).  Her kidney function remains good.  Her lung function continues to improve.  The oxygen concentration she is on is at 50%(TIGT).  She remains heavily sedated.  Can not evaluate her neurological status with the sedation she has but her intracranial pressure remains normal.  We still can not predict what potential neurological problems she may have long term.   She is in a hard collar for her neck.  Do not suspect significant cervical (neck) spine injury but the neurosurgeon will keep this on her until he can confirm that by a physical exam after she has been taken off the sedation.  She continues to be very edematous(swollen) which is not unexpected with the severe trauma she experienced. This will improve over time.

As I said above she is showing slow signs of improvement. This is going to be a long hard road and it is going to be slow.  Some day in the future this will be a distant memory, hopefully my Little Darlin will be back to her usual vibrant self.   I want everyone to have and not forget a mental picture of how she looks now lying in the critical care bed.   This can not be forgotten because somebodies life may depend on it.  Ask the Frerer family here in Tupelo who lost their 18 year old son and brother John Paul last year while riding his bicycle.

Jan is in a small critical care room. There are no windows. Their are innumerable monitors surrounding her producing an endless stream of vital information about various critical organ functions.  There is the ventilator.  Its' monitor filled with information that is a foreign language to most.  There are infusion pumps showing rates, volumes and concentration of more different bags of medication than most people take in a lifetime.   All of the monitors are some how attached to Jan, most in an invasive way.  She has a bolt screwed into her skull. This continuously measures her intracranial(brain) pressure. She has a pulse oximeter clip clipped to her nostril.  This measures the concentration of oxygen in her blood.  This is usually on a finger but her fingers are too swollen, bruised and bloody to give an accurate reading.  She has an endotracheal tube coming out of her mouth and taped securely to her face.  The end of this is in her trachea(windpipe).  There is a tube coming out of her nostril.  Its' tip is in her stomach.  She has a stiff plastic collar secured to her neck to keep her cervical spine stable.  There is a large multiple hole IV line that was inserted under her left clavicle(collar bone) into the subclavian vein.  Its' tip is in the right atrium chamber of her heart.  Through her right and left chest walls there are large tubes about a 1/2 inch in diameter.  These are between the lung and the inside lining of the chest wall.  These prevent the lungs from collapsing.  The lungs were likely punctured by her own ribs(the sharp edges where they were broken).  There is a small catheter in the artery of her right arm to constantly measure her blood pressure.  She has a catheter in her bladder to allow it to drain.  Just about everywhere you look on her the is a cut, bruise or abrasion. You can not see the innumerable bone fractures but they are there.

The bed is kept at a fairly steep head up angle.  This helps keep the intracrainal pressure down.  She has to be gently turned on a regular basis so that pressure sores don't develop.  Although she is sedated she will still grimace from pain when this is done.  Her whole body is swollen from the accumulation of body fluid throughout her soft tissues.  This is from the massive injuries she has had.  We have all had small traumatic injuries that have caused localized swelling.  This is occurring all over her body.  Her usually small fingers are double the normal size.  Thankfully her wedding band was cut off in the ER on arrival.  I have had it on my little finger since.  Her fingers are mottled blue from the bruising and broken bones.  The skin weeps fluid from the multiple cuts and abrasions worsened by all of the fluid that has accumulated in her soft tissues.  Even the sclera(lining of the white part of her eyes) was swollen early on but this is better now.

Every time I walk into the room I see this.  I quickly glance at the monitors.  This gives me peace of mind to see good numbers.  She lies there motionless except for the movement of her chest with each breath given to her by the ventilator.  Her eyes are closed.  I kiss her and tell her I love her but she still does not respond.  I gently stroke her face, her skin is stretched slightly from the swelling, she still does not respond.  I am still waiting patiently for a her to respond to me, she has not,  it is hard and it hurts to see her like this.  But by some miracle, after the horrendous impact she took, she is still here.

I am almost always up before Jan in the morning.  For as long as I can remember every morning before I leave the house I kiss Jan goodbye and tell her i Iove her.  It was the last thing I told her before this happened.  I never expected it to happen but I have been in medicine long enough to know bad things happen without warning all the time.  None of us know if we will be here tomorrow.  Let those you love know it often.

Monday, May 30, 2011

PT Day 3, by David

My Little Darlin update, PT day3

By far this is an emotional experience for me and I do think ignorance can be bliss but I do see the clinical side.  This is good in some ways but bad in others knowing what potential problems can occur with this kind of trauma.  Today she remains stable.  No change in her neurological status.  This is a good thing(TIGT).  She is still heavily sedated which is likely a good thing.  Her injuries would be extremely painful if she were aware.  Her blood pressure remains good and the medications to help with this are slowly being weaned.  (TIGT).  She did develop a collapsed lung on the right side early this morning. This was treated with a chest tube which promptly re-expanded the lung.  This was not necessarily a surprise given the degree of trauma she experienced.  She has some infiltrate in the left lung. This could be a contusion from the trauma, pneumonia or both. She is on antibiotics to cover this.  This is truly a test of patience but it is going to be a slow recovery.  Thank God she is still here to recover.

I feel very strongly about having as many people as possible know about this and similar occurrences.  This includes the young man(18years) from here in Tupelo who was killed on his bicycle last year.  Many others have told me since this happened of their encounters with automobiles while on their bike.  The auto always wins.  Those of us who bike and run must use public roads.  We have all had near misses doing both of these activities with people in automobiles, commonly by drivers not paying attention because of their cell phone or other distractions.  There are a rare few people who are just mean.  Jan and I got involved in biking, running, triathlon etc for the pure joy and satisfaction of being active and for the short and long term health benefits.  Jan was heavily involved with Team in Training to raise funds for the Leukemia and Lymphoma society for several years.  We (Jan, I am a token) opened Boardtown Bikes as a way to promote good health(It is not how we make our living).  Jan tried to do Florida Ironman Triathlon last year.  For those of you who do not know,  this consists of a 2.4 mile swim, 112 mile bike ride followed by a 26.2 mile run.  140.6 miles under your own power and you are given 17 hours to do it for it to be official.   She made 130 miles and has been beating herself up since for not finishing.  How many reading this have ever come anywhere close to going this distance on there own power?  She signed up the day after the race to do it again the following year.

Last Sunday she was on a training ride.  She and our friend Kim were 35 miles into a 50-60 mile planned ride when she was hit.  I have been on an emotional rollercoaster since.  The worst comes when I am alone and see in my mind the description Kim gave of the incident.  Imagine the person you are closest to, your husband, wife, child, parent.  The person that if they die you will too. Then imagine that person being hit straight on by a 2000 pound automobile going 55 plus MPH.  Imagine the impact and the 2 to 3 seconds following.  This is what I see now every time I stop any other mind occupying activity.  I never know while I am talking, texting or otherwise communicating to a friend or family member if or when I am going to have to stop and choke back the tears.  It also happens every time I go in to see my usually vibrant little darlin lying in the critical care bed on a ventilator broken in ways hard to imagine but happy I am not at her funeral.  At this moment I would elate at open eyes and recognition.

I do not want what happened to Jan to be in vain. Tell everyone you know about this.  Tell them to give anyone they see on the road a wide berth whether it is a biker, runner, worker or someone who simply has no other means of travel other than legs or bike.  If you do not run or bike or do some other physical activity then do it.  It will do you good and the more of us there are the more aware others are.  When you drive keep your mind on the road.  I equate cell phone usage while driving to drunk driving, now that people are getting significant prison time for this less people are doing it.

I want to thank everybody for their prayers, kindness, concern, texts, Facebook posts, emails, phone calls and visits. This is the hardest thing I have ever faced not to mention what Jan is going through.  I would wish that no one ever experience anything like this either as victim or family.  The support from family and friends makes this bearable.  It is so meaningful to know that there are so many good friends out there.  We would not get through this without you.

PT Day 2, by David

Update on my Little Darling Jan
by Jan Morgan on Tuesday, May 24, 2011 at 8:15am
Good morning, This is David. It can be difficult for me to write any of this because I intermittently get very emotional as I am at the moment. I am as we all are desperate for some good news. The good today is that the bleeding she had in her brain is stable and pressure in her brain remains good. The not so good is she is having fever now which is not surprising. I suspect lungs as source. She is on antibiotics that will hopefully keep this at bay. Her hg/hct(blood concentration) dropped last night and she is going to need another transfusion. Not sure why it decreased but she has no bleeding site. It may be dilution since she is requiring a lot of fluid to help her blood pressure. A lot of the fluid is seeping into her soft tissues causing swelling. This is not surprising with the trauma she has suffered. Thank you all for your concern and prayers. Jan and I need all we can get. I feel desperate, helpless and hurt like I have never hurt before. To see your beloved little darling like this and to know how senseless it was to have happened is almost too much to bear.