Another hot day in Khon Kaen.... and passing the time.

It's another hot day here in Khon Kaen...  A quick look at a weather site, and I see it shows a moderate 93 degrees F., but with a "comfort level" of 105.  A walk down to the Family Mart just confirmed it; the walk was not comfortable.  

Family Mart is one of the competitors of Seven-11.  Or is that 7-Eleven?  Seven-11 has proved to be so successful in Thailand that it's about like Starbuck's Coffee in the U.S.  Only more so.  I'd guess there are a hundred or so here in Khon Kaen.  It's hard to go a few blocks without seeing one, two or even three of them.  It's a haven from the heat, where you can get what you need and  not at premium prices.  So with it's success, it has proliferated.  With that proliferation have come the competitors.  Tesco-Lotus, a superstore with business roots in France has sprouted up many Tesco-Lotus Minis, often just next door or across the street from 7-Elevens.  Another is Family Mart, which has been a bit more subtle in its choice of locations, moving into neighborhoods which are more under-served.

What these stores offer are the basics-- things people need and buy frequently.  Drinks, snacks, some quick hot foods (micro-wave-ables), body care and baby care products, magazines, a few books, umbrellas, MP3 headphones, cigarettes, beer, whiskey, condoms-- all the stuff that people normally buy on a day to day basis.  The formula also includes a predictable floor plan-- oh, and a Coke and ice machine, hot water urn and coffee and hot drink mixes, instand soups and noodles, and so forth.  Not too much, but enough to have a very successful shop. 

But under-service for convenience stores is not really of an issue here.  Sprouting up a little mom and dad  business is as easy as putting a fridge in your front room and putting some sodas, energy drinks and beers in it, having a shelf of "kanom" (snack foods) and anything else that might round out the inventory.  This kind of store is virtually everywhere, making it pretty impossible to die of thirst or starve here as long as one has ten baht in the pocket.

It must be the air conditioning that makes the upscale convenient stores so successful.  Which, finally finding I have a point in mind here, confirms the fact that it is really hot!  In case you didn't believe that before.

It's interesting how we need to confirm things.  I remember in philosophy class, how "experience shows it to be so, and reason proves it."  As if the walk to the store weren't enough to confirm that it is hot.  Gotta go to the internet to prove it.

I've noticed how other experiences have been compared to more virtual experiences as point of reference.  I once walked past a flock of wild turkeys, perched on a building, that first one by one and then in mass flew over my head.  I thought-- "Wow, that was just like in Star Wars or something. Exciting!"  Funny that I refer to a movie to compare with a live, vivid and really first hand experience.

I remember in my my younger years, having a more lively and proactive participationwith experience.  I'd been living in the country, and it was common entertainment for me, with no television even, to go walking at night.  I tried to use the flashlight only when necessary, and preferred to stumble along the moonlit (or not) trails in the dark, relying on memory or instincts to discern the trail from the bush as much as possible.  My most self-celebrated walk was a New Year's Eve walk home on a moonless night, taking the "high trail" which was the least traveled and most difficult to distinguish in the dark.  I was on my hand and knees a fair part of the way that night, feeling for the smoothness of the trail where it meandered through the slightly rougher bordering landscape. In those days I felt truly alive. 

Now, it's a walk to Family Mart or 7-Eleven / Seven-11 to get a cup of gaffe yen that gives me that aliveness.  Ha!  I find that writing is good food for thought, and so I'll have to think about this some.  It's the question we ask ourselves often in NVC (nonviolent communications) groups:  What's alive in me now? 

Well, as they say..... keep tuned. 

Back home with Patty

Patty, crashed in the comfort of home.  She really deserves a "sitting up" picture now, too, as she's been doing that so beautifully now that she has more energy.

This post is a bit old now, but I'll pick it up where I left off writing on April 13th..... 

After a day of showing she could "hold her own" in the blood oxygen saturation department, it looked good for Patty to depart the hospital.  On March 27th we'd brought her to Srinagarind Hospital, with about a week in Intensive Care  and the time since that in the moderate care ward.  Before that, Patty had experienced nearly a three month stretch of hospital stays, with perhaps just a week break at home during that time.  Most of the time she spent at Khon Kaen Hospital, with two stints in ICU there, and the rest of her time there in the pediatric "mix" ward.  So getting a green light for her to go home was a big "Whew!"  Were we all glad to get her back home! 

The level of anxiety for Lak and I had too often been too intense for comfort.  During Patty's first stays in ICU, we saw several children succumb to their illnesses.  It was pretty sobering, especially given that with only ten beds in the two rooms of ICU where we saw what was going on, this was not a really low percentage mortality rate--not low enough to feel that Patty was clear profound danger. 

I learned that the blood oxygen saturation percentage was a very important figure, and seemed to be a very visible indication of the condition of each patient in ICU, with the vital signs monitor showing that, pulse rate, and other signs, in big, easy to read figures.  Seeing that figure drop, in several instances, lead to an empty bed upon our arrival the next morning. Thus, that very visible figure on the vital signs monitor became very loaded with potential for me, and it was never out of sight, out of mind for very long. 

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There is where my writing stalled, getting into the more grim side of what can happen when a kid is in ICU.  I decided to perhaps come back to that writing in more detail at a later date.  For now, we are on an upswing.  Patty has been at home for about ten days now.  Ironically, life has been all the more demanding now that she is out of the hospital.  Here at home my appreciation for the nurses, and all that they do, comes into clearer focus, as we've needed to be doing many of the things that they routinely have taken care of  for Patty. 


Patty is still dealing with respiratory issues, as they don't easily or completely clear up following such an illness.  So it's been a demanding time at home, though certainly lacking the intensity of her being in ICU or the regular hospital ward.  Phlegm continues to hang in there tenaciously, and we've been trying to deal with that issue in various ways-- with diet, with medicine, and with mechanical means of just clearing it out for her.

I called a shot, for a change, last week, and bought a good phlegm suction machine for a couple hundred dollars (6,000 baht).  It's been making the job of clearing her airways a lot easier than using the rubber bulb device that Lak had been using.  Lak had thought that was fine, but having the suction machine is like having gone from hand washing to having a washing machine.  (Perhaps Lak could be liberated from doing Patty's laundry washing by hand, too!  But some things are hard to change.)  


The day before yesterday was a marathon for us at the Srinagarind Hospital clinic, with three doctors appointments in the same day: one with a neuro clinic, one with an endocrine clinic, and one with the rehabilitation and physical therapy clinic.  The night before had been full of wake-up calls for milk feedings and suctioning sessions, and in order to try to get there early, I'd gotten up before four a.m. in order to do my morning market run earlier than usual.  The temperature was soaring, with the so-called "comfort level" well over a hundred degrees.  Somehow we all made it through the day of mostly sitting and waiting, and now have some reduced medicine dosages (good!) and a few simple exercises for Patty (exciting!).  I went to Big-C to buy an exercise ball today, for her to do her balance exercises, and we'll soon have our front room turned into a gymnasium.  :-)  

Oh, and here are a few recent pictures: 

Slide show: Patty back at home.  


Well, that's my blogging for the moment.  Please stay tuned!  (subscribe! and don't miss a post!) 

Breathing Easier

I'm breathing easier this evening.  And it's because, of course, Patty is breathing easier too. 


The transition from the ventilator to breathing on her own was not completely seamless; she did show some signs of having some throat discomfort today, as if she were trying to cough something up that was choking her.  We thought it was phlegm at first, but the nurses tried to suction that out, and told us there wasn't much phlegm to suction, so phlegm wasn't the problem.  By a couple hours later her coughing had diminished a lot, and she didn't seem to be having much difficulty.


So, signs were good when we left this evening after our visit:  less phlegm; good oxygen levels in her blood, even better blood pressure than she's had for the past several days; heart rate more stable, too.  And I thought the energy behind her coughing seemed stronger than she'd been able to muster the energy for before.  


In between this noon's visit and this evening's, I spent about two and a half hours getting a refund of about $20 for some parts that I'd purchased at a Honda dealership near the hospital.  It turned out to be the biggest challenge of the day for me.  


When I'd purchased the parts, I didn't know quite what I needed, so I showed them the engine and had them talk on the phone to the mechanic as well.  When I wanted to pay with a credit card, I was told that if I paid that way I wouldn't be able to exchange the purchase or get a refund back later using a card, so needed to get cash to complete the transaction.  So, a ten or fifteen minute rip was needed to the nearest ATM.  When I paid, I thought the cashier assured me that I'd be able to get a refund.  


Well, so much for thinking I understand what people are saying here.  In short, there wasn't really a "short of it".  But I did get the money back, probably more as a result of being obstinate than being patient.  But there was some patience involved, and when all was said and done I told the manager that if I bought a new car, I'd buy it there.  Well, I might have overstated that, but I left with a feeling of goodhearted-ness (jai dee).  

A challenge that lies ahead.

The plan is for Patty's breathing tube to come out tomorrow, and she'll be breathing without the assistance of the ventilator machine.  Her breathing has been better, and the machine doing less in assisting her, and it's a transition she's ready for in many respects.  The one thing I am nervous about is this-- the last time this was attempted, her swollen throat prevented her from breathing adequately, so she had to go back on the machine.   Thus my anxiety.

Well, despite the anxiety, I remind myself that if there are problems, she is in the best place I can think of to be having them.

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Meeting the big doctor, and more shopping.

"Big the doctor" (sic--- that's the correct Thai word order, so that's how Lak says it in English) showed up to introduce himself two days ago (already) and answer any questions about Patty.  He is very smart and knows his stuff.  And that is, he knows HIS stuff.   I'll quote the late Zen priest, Suzuki Roshi:  "In the beginners mind, there are many possibilities.  In the experts, there are few." 

He explained that in a few days Patty would need to try breathing on her own again.  That will be a big test for her, given that last time her swollen throat hindered her breathing.  So, if that's a problem again, more investigation, and there are things they can do to deal with it if necessary.

I asked if perhaps getting the phlegm more cleared from her airways first would be helpful.  I also used the (narrow) opening that the moment barely offered to suggest the use of herbs, or something other than the mono-diet of milk.  But, in this expert's mind,  "there are few" possibilities.  Perhaps herbs can be used when she is able to eat many more kinds of food, was his opening.

Oh, well.

 Srinagarind Hospital, where Patty began staying on March 26th.

Patty does continue to breathe more strongly, despite the "selate yut" (profuse phlegm). And her oxygen level is staying high, blood pressure and heart rate seem to be holding much better after several days of medicine for that.  She is awake and likes to move her arms and legs around-- has energy!

Last night after our evening visit with Patty, we went to Central Plaza (see the first video in the "Action Channel Video" column of this blog for an exterior night view) to do some shopping for Patty.  This is a big and fairly new shopping maul that is an example of the modern side of Thailand.  It's a stark contrast to the morning market, where we go to get food for Lak's papaya salad shop.  It's modern as modern is, and is replete with shops offering all the modern trappings of our consumer society.  Weekends,  one may see Suzuki students performing violin recitals, while BMW sales and Ultraman photo-ops are happening near Starbuck's in the large main-floor mall.   It's a hub-bub of sound and activity, and do underscore sound--Thailand has not heard a peep of acoustic design.  It's too loud here for anyone to have heard!

We went to Robinson's department store and bought another pillow and bed comforter set for Patty.  I thought it was excessive, but I hadn't considered that the other one DOES need to be laundered every so often.  And, it's a pleasure to buy nice things for our little princess!  So, again thanks to the generosity of friends, Patty has another cool bed-set.

After shopping, we went to one of the half-dozen large Japanese restaurants and ate more than I was bargaining for.  The sashimi was good!  The miso soup was something I'd been missing, being a long-time miso soup devotee.  The nori-maki was "so-so"-- an  expression that the Thais have picked up on for use in the restaurant.  To finish things off I braved a hit of wasabe, and thought my brain might hit the ceiling as the energy went up my nose big-time. 

Maybe that's one reason why I'm up writing now at three o'clock in the morning.  But, gonna go give sleep another try now.  

for now... adios

Friday morning, and Patty's been doing better....

Patty has been doing better on a couple of fronts.  Notably, her breathing has been improving and her blood oxygen saturation has been quite steadily in the upper 90s to 100 percent.  That's an encouraging change.  The ventilator is assisting minimally, and a lot of her breathing is spontaneous, rather than initiated by the ventilator.  She's back to drinking (through a feeding tube) a couple of ounces of milk at four-hour intervals, six time a day.  That's encouraging.

She did have an ECHO (don't even know if I am spelling that right, and don't have time to check it at the moment) yesterday afternoon (or was it the day before?), but we haven't heard the results yet.  She's been getting a couple medications to increase her heart rate and blood pressure.  I think those being low may be a side effect of the antibiotics.  (I need to research Dopamine more, to learn more about that.  Dopamine and Dopadumine (sp?) are the meds being given to raise the heart rate and blood pressure.

This morning she was very chirpy and active, wanting to kick her feet around, with eyes wide awake.  That's nice to see, when she's been sedated so often.  Although, one reason she is often sedated is to keep her from being so active, and possibly pulling the breathing tube out of her mouth and throat.

Still a lot of phlegm, and I am looking for an opening with the doctor(s) to explore the possibility of getting more than milk into her diet, and possibly some herbs.

It's a little laid back at this moment, a little cooler today, figurattively and literally.  I don't know why my wife has her guard down a bit for a change.  But, I'll go with it.  I am hoping that spending time at the computer writing will soon be a more acceptable way to spend time than watching TV.  But in the meantime, I steal time here!  Okay!  Gotta go! 

Emotional roller coaster

Things seem to be going well, and I enjoy a lull of complacency.  Then a new piece of information arrives, and back comes the dread of what might happen.  It's the roller coaster ride of hope and fear, watching my emotions swing up and down like the graphic on the monitor for Patty's breathing, swinging up and down from green into red and back into green again with each cycle of breath. 

Two days ago, news of Patty's swollen trachea and her being put back on the ventilator swung my emotional state deep into the red zone.  Suddenly there is a new tone that accompanies my  awareness in such a state.  Then, the next day, looking better, and finally transferring to the new hospital, that index swings up into the green zone.  My humor comes back.  I can walk upright again, not shoved forward by despondency.

My tendency to be literal ("literal Luteral") wants to write this all down, chronologically, getting the pertinent details in close focus.  Trying to generalize just doesn't seem to do it.  But I have to settle for something in between the two.

By yesterday, in fact the day before, Patty was snug in a big, modern hospital bed in a more modern facility:  Srinagarind Hospital.  It's the place Lak has been wanting to get Patty into for well over a month-- ever since her first round in ICU at Khon Kaen Hospital.  Yesterday we bought, and brought to her, a cool mobile that plays music while plastic penguins rotate around the axis, with a central penguin.  Also a very lovely comforter with a rabbit, with hands, feet and ears that flop out from the fabric, and a matching set of pillows--"big baby" size.  She looks like a little princess nestled in her bed with new amenities-- gifts from a couple of wonderful, caring friends, who've been following the story of Patty from the near the beginning. 

Patty's bed is very similar to this; maybe hers looks more comfy, now with a pretty pink and yellow rabbit comforter, a penguin mobile dangling from above, and numerous pillows.  

The equipment there is impressive.  The nurses seem to be very on top of things, and knew a lot about her within a few hours-- more than we'd known.  I've thought, this appearance might easily give us a false sense of security.  Perhaps this thought was informed by having listened to a talk about security a couple days ago (on my iPod), given by Ajahn Sumedho, a senior Buddhist monk who is from America and has spent much time as a monk in Thailand.

Now, two days later, we have perhaps been lulled into that complacent place again.  But just now, while eating breakfast, a medical student called to ask us to come early for our noon visit, at which time we have an appointment to talk to a doctor about Patty.  The nurse told Lak that they need to do some procedure (my words) with Patty, and want to talk with us about it at eleven.  So, here comes the anxiety again, along with the question of what this may be about. 

Now later, after that appointment:  It turns out there are two Pornthips in PICU, and they'd called our number about the other one.  The call was a false alarm.  The talk I did have with a doctor was not alarming.   But there is one thing they need to investigate more, and that's Patty's slow heart rate and low blood pressure, for which they are giving her Dopamine now.

A cardiologist will give Patty the ECHO that I thought she'd already had.  (Another mis-communication.)  Then we may know more about that.

In the meantime.... home for lunch, a long nap, and planning to back to visit late this afternoon.  

Catch 22

Sometimes you need to do "C" before you can do "B" and subsequently move on to doing "C".  This is called a "Catch 22". 

Patty was on the breathing machine again for just a couple of days before the doctors thought she was ready to breathe on her own again.  So, I believe it was the night before last that they took out the breathing tube again.  

The last previous attempt was stopped short when it was apparent that breathing without the mechanical assistance was requiring too much effort on her part.  Her trachea and vocal cords had become swollen, as can often happen with an extended use of the breathing tube in a patient's throat.  This had made it more difficult to breathe, and she had become fatigued trying.  Also there were some digestive difficulties. 

The complicating issue seems to be phegm, and lots of it, that is congesting her breathing passages.  I asked what means their approach had to get rid of it, and was told that the bronchiodilator medicine and the use of suction to physically remove the phlegm were their means.  I noted that evidently the medicine was not enough, as the phlegm has not lessened.  It was a case of "lost in translation" again: they said it was enough, because she was getting the maximum dosage.  I said, well, apparently that isn't enough. We could probably have repeated this exchange many times, but sometimes I know when to stop trying to make a point.

With the help of a Chinese doctor friend in California, I've made an herbal formula that addresses her issues very specifically.  That's one of the advantages of Chinese medicine: formulas can be  tailored very specifically to individual cases.  The formula should be very helpful in clearing the phlegm, and as well as addressing a couple related things.  The doctors have been sympathetic and have allowed it to be administered.  However, given the digestive difficulties that have not been resolved, they are reluctant to do that now. And the number of times I've been able to give it have been few and far between.

I guess it's more complex than I'm putting it.   There is a possibility, because of the phlegm, that anything intended to go into her stomach will go into her air passages, particularly if the quantity is more than about 10 ml.

So, here it is, the Catch 22:   I have a formula that is very good for getting rid of phlegm.  But we need to wait until there is less phlegm to use it. 

Lak seems to have good faith in the Western medical approach that they are using.  I have less.  I know it can and does do amazing things.  But I know it has limitations, and I'm aware of some ways that Chinese medicine, in particular Chinese diagnosis and Chinese herbalism, fills some important gaps in what Western medicine can do.  But, before we can do B, we need to accomplish C. 

Anyway, it's frustrating. 

I am starting to write what's happening with our daughter, Patty, here on Blogger, and hope that those who want to follow her progress can subscribe.  If you do, you'll get email notices of new posts, and it will save me remembering all the friends who I want to keep posted. 

Yesterday was an upswing for her, as her breathing had improved to the point that the doctors felt it was time to remove the tube that had been supplying her oxygen-rich air from a rather high-tech "ventilator" machine.  The amount of assistance from the machine had been gradually decreased over the preceding few days, and she was showing more signs of being capable of breathing on her own.  So, yesterday she began doing all the work of breathing again.  We could see it was not easy for her, though this same process had happened several weeks earlier, and the re-entry to breathing did seem somewhat easier this time.

But when we came to the hospital this morning to visit her, we learned that she'd become fatigued, because of a swollen trachea.  So the tube had been re-inserted into her mouth down into her trachea, and she is now getting assistance from the ventilator again. 

It was disappointing to see this.  But, she obviously was not ready yet for the transition off the machine.  She still has a lot of mucous secretion in her lungs, and that makes breathing all the more difficult. 

I was able to begin giving a Chinese herbal formula for pneumonia yesterday.  I have confidence in this as an adjunctive therapy to the antibiotic approach, and hope it can be continued.  With the herbs, perhaps the mucous, which has been so tenacious, can be cleared more, before taking her off the machine again. 

So..... here is praying for the best for our much loved little girl! 

May she, and all children, all grown people, all beings everywhere, be happy, peaceful, and free from suffering.