Sunday, September 23, 2007

Homeward Bound - August 15

Hello Friends and Family,

We seem to live a lifetime every 3-4 hours here. Feels like I wrote to
all of you ages ago.

We are well. Forgive me if you are not found of foul language, but
over the past 2 days, Mark and I have taken to fondly calling him "one
bad-ass mother fucker". He is! For a guy who's been in an operating
room 4 times in the past 7 days, he is amazingly vibrant. This
experience living together here at Medical Center of the Rockies is
one of double vision. I am too close to be able to see outside of the
moment to moment decision-making and yet at moments I step away and
witness clearly what an outstanding human being Mark is.

We are quiet in our room, Kate Wolf singing to us through my laptop
here, crossing our fingers that tomorrow we will fly to Boston and
that a trauma surgical team will be assembled and waiting for us to
perform surgery on Friday or Saturday.

After long days and nights of sorting through information about the
procedure, with the help of amazing friends who've called and emailed,
we realize that we want to have this surgery done in the same place
where Mark will have his follow up after care. We want to head back to
Boston if at all possible. Even with the best possible outcome with
this surgery, he will have intensive medical follow up over the next
year. We want that care to be done by the same people who do the
surgery. This morning when the director of the trauma unit came for
rounds, we said we'd like to go to Boston rather than go into surgery
here tomorrow. The trauma team here supports our decision and have
been in high gear all day helping us make arrangements. They are just
amazing. They have made the calls to MGH to set up a team of
specialists to do the surgery. They have helped make travel plans.
They are making arrangements so that the travel will be medically
safe. While we are not SURE that this is all going to happen, we hope
to hear in the morning that indeed the head surgeon here was able to
get us in to an OR at MGH. It is scary to give over control of so many
arrangements and yet there is no way we could do this on our own. We
are grateful for this help. When Mark and I are rich and famous, we've
decided we'll give our big bucks to this hospital. Princeton has
plenty of donors.....


A team of talented doctors awaiting us at MGH with determination to
execute their very best work on Mark's leg.

And everything else you've all been writing many
wonderful images are floating out there! So wonderful to hear how many
of you now have that river-yoga picture on your desktop!

I will attempt to share what we know about the upcoming surgery. The
plastic surgeon and the orthopedist here has been very direct with us
and have said that we are stretching the limits of what is possible.
Yet they also express confidence in this upcoming procedure. Mark's
injury is severe. He had an open fracture of both the tibia and fibula
(the two bones in the lower leg) as well as an ankle bone. He also
lost much of the skin on his lower leg and some of the muscle. He also
lost a major vein. So the surgery is called a "free flap" in which a
muscle from a different part of the body is wrapped around the wound.
A reason for needing a piece of tissue rather than just a simple skin
graft is that the leg (as is) will not get adequete blood supply to
the extremity. The grafted tissue serves as a new blood supply. The
surgery is truly a craft as the doctor sews together, under a
micorscope, tiny blood vessels from the transplanted muscle into the
wounded area. Then skin is grafted on top of it. The complications
that have spun Mark and I around and around and around include the
fact that (1) the wound is so large that the doctor says the muscle he
will use for the "flap" (Mark's latissumus dorsi--the muscle you use
when you pull yourself up on a pullup bar) is barely large enough to
cover the wound. This is scary for Mark--to think of loss of strength
and function in his back as well as this leg/foot issue.... (2) And
the tissue and skin on Mark's heel is not guarenteed to survive,
making the wound even larger and thus perhaps not "coverable"--and a
tissue/skin graft on the heel is a very difficult graft to do. And
this issue about the heel--we actually may not know whether or not the
heel is viable for weeks or even a month after the surgery. So Mark
and I have some peace with the possibility that even after all of this
surgery, Mark might still lose his foot. Yes, long days and nights
here acknowledging all of the possibilities. The doctor has told us
that for many patients (people who smoke, people with vascular
disease, obese people) they would simply amputate now. But Mark is one
bad-ass mother fucker :). He is strong and healthy and has been
incredibly resilient through each of the previous surgeries,
continuing to impress the surgeons with how well he is pulling himself
together. So we are acknowlegding the possible loss, setting it aside,
and moving forward in the belief that Mark is the one to make this
surgery work. Yes! Gonna keep on movin' foward.

Some good news!......Today when Mark went in to the OR to have the
wound cleaned for our possible travel day tomorrow, it was the first
time the docs had looked at his leg since Sunday. When I talked to the
doc post-surgery, he said the tissue looked even better than he
would've expected--healthy, healing, not infected. And he said there
is NO DEAD TISSUE ON THE HEEL. Yes! He cautioned that the heel is
still a question mark, but it is still viable. Yes!

Today I got to be in the pre-operating room with Mark before this
wound cleaning I just described. The prep nurses are required to write
on the limb that is going to be operated on so as to have zero
confusion in the OR about what they are doing in there (god, wouldn't
you hate to be the guy who had a knee re-construction on the wrong
leg??!). I don't know if this is what they always write, but I watched
the nurse write a big "YES" on Mark's right leg. This pleased me
immensely! Helped me wait the 2 hours before hearing that the leg
looks good! Yes!

If we cannot get to Boston, if they cannot set up the surgery there
within a few days, we're back to difficult decisions. So if you pray,
get to it, sisters and brothers!

Mark and I feel like we are at the center of a joyous vigil (is there
such a thing?) that is worldwide. Strange that life offers us joy in
situations like these! We have heard from people literally all around
the world who are reaching out to us and meditating on visions of Mark
healthy, healing, whole, and of Mark and I coming through this
stronger than ever.

If we travel tomorrow, it will be late afternoon. We are trying to get
a direct commercial flight Denver to Boston. Mark and I are preparing
ourselves for the challenge of flying with this kind of injury. The
doctors have ordered special equipment that we'll need for draining
the wound while in transit. And Mark will get a lot of medication to
make this all possible. We're ready!

With the blessings that you have sent us, we are ready. Mark and I are
connected deeply through this craziness. We are each other's healers,
trading off being strong, being scared. We are enjoying legitimate
dependency on each other. Wouldn't have wished for this one, but here
we are.

I'll leave you with two things. First a quote from a kind and amazing
friend Dawnellen and then I'm pasting in Mark's account of his
evacuation. Thought you might appreciate his words making their way
into this thread. Sounds like Mark was an active and crucial part of
his own successful evacuation. And it sounds like the team that got
him off the rock--both the civilians who so generously stepped in and
the park ranger Search and Rescue team--were true "rock stars".

Goodnight. Hope to see some of you in Boston tomorrow.....

From Dawnellen:

"Don't miss out on a blessing because it
isn't packaged the way you expect."

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