For the next several days there was a series of indications that David was becoming more aware of his surroundings. Every morning we would show him the calendar and called out loud the month, day and year.
One morning he reached for Jorge's hand and then reached for mine. He squeezed them and brought each hand over his shoulder. We watched in amazement and cried of joy. He listened attentively to Jorge conversing or singing to him, he focused watching TV or grabbed his grandmother Mama Aby’s hands and smiled. The way he looked at me was different. I could see him. We wondered if he recognized who we were. We asked him to blink his eyes once for yes and twice for no. At times it felt we were really communicating with David and this breakthrough encouraged us to continue playing music, showing him pictures of family and friends; we talked about his business, his job and of places he had been. Having learned that memory almost always is impaired by a brain injury we incorporated activities to build up his memory.
By the fourth week, David was able to stay awake a total of 10 hours. Several events were quickly being introduced such as a feeding tube, which was surgically placed into his stomach through the abdominal wall. “Brain injury frequently affects the skilled coordination of the nerves and 26 different muscles in the neck and esophagus that are used during the normal swallowing process” (www.calder.med.miami.edu). We were becoming more and more aware of so many aspects of our lives we took for granted – lifting a finger, blinking our eyes, swallowing, breathing, coughing and how much our brain controls just about everything we do.
Marla, the speech therapist, ordered to change the tracheotomy tube to a smaller one appropriate for a patient being considered as a candidate to eat and speak which meant a step up for David. Up to this point he had only been given lemon flavored glycerin swab sticks to increase his mouth sensory awareness and moisten his lips. He became a big fan of these lemon swabs to the point that we had to watch him of not biting them out of the sticks to try to swallow them as he did one time to a CNA intern who almost had a heart attack struggling to get the swab out of David’s mouth.
It is also common for traumatic brain injury survivors to have one or more of their senses altered after the injury. Appetite can be affected as well. David had lost over 40 pounds in 4 weeks. We were certain he missed eating. David always enjoyed a good meal. He had his favorite spots for fried calamari, a good piece of steak, empanada or a typical Miami coffee “colada”.
On Tuesday, June 7th our daughter Ana Carolina came to the hospital with fun news. As roommates, David and her would visit “The Sandwich King” cafeteria for their breakfast and coffee colada before they each would go to work or school and on Saturdays for their famous “parrillada” or cookout grills. David would order a sandwich he invented and would encourage other patrons to try it, which always obtained so many praises on how delicious it was. The owners and the attendants had developed a real camaraderie with David throughout the years and the sandwich became their special connection. After learning of David’s accident, the cafeteria owners, Lily and Gustavo decided to add a new item to their menu and the “David Arroyo Sandwich” was born. It became a favorite of family and friends and word has it that it also turn out to be a best seller.
It becomes apparent that God placed an enormous amount of time on the details which makes us breath, laugh, see, smell, listen, feel. It is no accident the way all our senses are interwoven in perfect unison to accomplish the right task. Details are very important and can portray one’s character, interests and state of mind. If we pay close attention to the details in our lives and that of others, we can discover a deeper understanding of one’s’ soul. Whether we purposely intend it or not, details are outward signs that unfold truths about us.
Because of David’s immobility, he acquired a pressure ulcer on his lower back. Ulcers or bedsores develop quickly on people who are bedridden or have limited movement. The medical staff was focused on its healing and was constantly checking on him, turning him from side to side and re-positioning him every 2 hours. He rested on a pressure-reducing mattress and wore compression boots wrapped around his legs which would inflate and deflate every so often to stimulate and promote circulation.
Still in isolation, so many of David’s friends, co-workers and acquaintances came to visit but were unable to see him, yet shared with us a story or a prayer.
Eddy was on a daily mission. He would practice and have David show him 2 fingers, thumbs up, grab a ball, move his legs, stick his tongue out or blink his eyes. David’s response was very slow and significantly delayed. It was obvious he was having trouble thinking what he was supposed to do. Regardless, Eddy was resilient and kept drilling the fact that he had to be able to consistently respond quickly to these commands in order for the doctors to approve the acute rehab that would follow as so many other patients were doing.
We continued to learn new terms. The Glasgow Coma Scale is a neurological scale which identifies the conscious state of a person in three areas: eye, verbal and motor response. The lowest possible sum is 3 which would be a person on a deep coma and 15 is the highest sum which is for the fully awake person. The Rancho Scale, which is an assessment tool or scale based on observing the patient’s response to stimuli, helped explain the stages of progress. The scale from Level 1 of (No Response: Total Assistance) to Level 10 of (Purposeful, Appropriate: Modified Independent) provided us an outline of what behaviors to expect and explained possible psychological and emotional conditions in which David would go through during his rehabilitation process. These assessments would be considered to determine David’s path of recovery.
We incorporated classical music, Break dancing videos, TV programs and various activities to stimulate his brain. Our focus was the hospital’s acute rehab which had the reputation of one of the best in the Nation. That became for us the absolute right path to recovery and our anticipation grew stronger every day.
New routines were in place: doctors’ 6:00 a.m. rounds, bed baths, shaving, respiratory therapies, legs and arms exercises. Special heated caps which generated steam were placed on David’s head to clean his hair. For as long as I remember, David methodically scheduled his haircut every 2 weeks. After 4 weeks, Jorge took courage and gave him a hair cut which we called the St. Francis cut and made the promise that we would never let him do it again. I became proficient and less nervous at shaving and we continued to pray and wait in faith.
In the meantime, I thought often on how my father was doing back home and how much I missed talking and laughing with him. Shortly after my father moved with us, Jorge, dad and I would drive to downtown Winter Park after work to enjoy a fun conversation over wine and cheese at the beautiful picturesque sidewalks of Park Avenue. The three of us looked forward to our “date” every Friday. Even though at this time he couldn’t go to Winter Park, my sisters spoiled him cooking his favorite dinners, watching his favorite movies, specially “Independence Day” which he named “La Constitucion”, eating Bar-B-Que at Bubbalou’s or ice cream at Cornerstone. He enjoyed having his son and daughters around him and grandchildren visit him. He was also on a path to recovery. Due to poor leg circulation, he started receiving physical therapy at home. Once in a while he would tell my sisters that he was planning on dressing up, renting a car, walking out of the house and going to Winter Park. He would do anything for a fine cup of wine!
Routines help us to develop discipline and many times some necessary structure in our full lives. Routines can also help us to create special moments and even begin significant traditions. Every moment, feeling, challenge, every circumstance we are faced with and every person we come into contact is an opportunity for growth. Sometimes in the routines of our lives, we miss those opportunities because we start acting automatically. When we listen and pay attention, we learn.
(Sirach 6: 32-33)
My son, David Arroyo and I, Ana Curras, collaborate together. This is our story. Our story because we are connected. We all are. When you hurt, I hurt, when you succeed, I succeed, when you have joy, I do too. It's in our design as human beings. Our story is intended to give hope, joy, encouragement and light. We pray to be inspired by our Creator, guided by Jesus Christ, moved by the Holy Spirit and accompanied by our Mother Mary.
NOTE: Bible verses referred to in each post are linked to open to the verses for your convenience.