Steffan is much more interactive today than I’ve seen him since he was admitted to the ICU.  He’s cracking the intermittent smile, and rolling his eyes in response to my jokes.  He is able to throw one of the stress balls that make up the arsenal of squishy toys now in his room (including one that has left a messy trail of glitter in its wake), and he even agreed to an arm wrestling match (correcting me when I didn’t initially give him the proper grip).   And while his left side still seems to be weaker and less active than his right, hands and feet on both sides are moving.  He’s introduced a little shoulder shimmy into his repertoire, which came in handy for some dancing we were doing this morning thanks to DJ Brandon.  He also kissed Brandon’s hand, and asked him for a couple of wet ones (kisses, not antimicrobial wipes).

The doc in charge of getting rid of Steffan’s infections was impressed by his condition this morning.  But he continues to have occasional fevers, and so the doc has recommended a slightly higher dose of one of his antibiotics to make sure that they get rid of these things once and for all.  They may also replace his external ventricular drain (EVD) this afternoon just to make sure that stays bacteria-free.  There is some talk of eventually replacing the EVD with a VP shunt – a permanent subcutaneous catheter that allows the excess cerebrospinal fluid (CSF) to drain to the abdominal cavity.  The irony is that they won’t do a shunt until there is no sign of further infection, but the EVD is the primary culprit for how bacteria are getting in.

Because of the tracheostomy, Steffan’s exhalations typically go through a tube below his vocal chords.   But a device called a Passy-Muir valve can be placed on the tracheostomy tube, allowing him to speak and even to eat food.  As Hannah reported, the speech pathologists and respiratory technicians have begun to supervise his use of one of these valves, but it will be a gradual process as he learns to breathe normally and to swallow.   The valve looks very similar to the valve on the top of a kazoo, so I guess we weren’t too far off!

The other thing the doctors would like Steffan to do more of is sleep.  It can be very difficult for patients to get a night’s rest in the ICU when there are multiple beeping machines all over the place, and nurses are checking in on you at least hourly.  Not only is sleep an essential part of his recovery, but a lack of adequate sleep can lead to “hospital delirium”, affecting his cognitive functions while awake.  His ICU doc said that she would change some of his night meds to try and help that happen.