The Short Version (can you imagine the long?!)

Hi all, it's Jason. I'll do my best to summarize the kaleidoscope of the last few days briefly.

Thursday and Friday have been as tough as any days we've had yet. So I try to remember what Atticus Finch tells his son, Jem, in To Kill a Mockingbird: "Courage is not a man with a gun in his hand. It's knowing you're licked before you begin but you begin anyway and you see it through no matter what." Thanks to the most recent news, this is where Sam and we are--trying to remain courageous.

So here's the scoop...though there is a lot of debate regarding Sam's current status--his hemodynamics, the seriousness of his stroke, the severity of the vegetation (now vegetations!) in his heart--one thing is certain: Sam doesn't care a lick about what doctors say; he just keeps on keeping on. He has courage (perhaps born from ignorance of the severity of his condition). The least Kristin and I can do is try to match it. And I believe before we are done, we will need every ounce of it.

Here's the scoop...Sam had a significant neurological event, yet the stroke and resulting seizures are not entirely unexpected. We knew bits could break off of his tricuspid valve vegetation and go to other parts of the body. Also, as a nurse corrected me the other night, having a stroke is not like being pregnant; there are several degrees of severity. Evidently, the severity is largely a function of the size of the embolus, in this case the clot that lodged in the brain causing the stroke. Sam's appears to be small. And while no stroke is good, Sam's prognosis in this regard is still relatively positive. Because it was a small stroke, because his brain is still developing, and because medications appear to be controlling the seizures at this point, there is a good chance his brain will continue to develop with little negative effect. No harm, no foul as it were. We may never even see pronounced, long-term effects. In fact, after three days of frequent seizures, Sam was in many ways back to his normal self today. Check out the pictures at the bottom!

On the more...challenging side, there is still a lot of mystery (and some disagreement!) regarding the source of the embolus. Echocardiogram now reveals another vegetation on the former aortic valve. There was also growth on the tip of the PICC line, which has since been removed. These new growths are most concerning. If they weren't there when we started antibiotic treatments, that means they are drug resistant or a different strain that has likely spread elsewhere, making him bacteremic. If that is the case, that would change the nature of his struggle significantly for the worse. It would mean that antibiotics may have little, if any effect, and surgical options would have a high risk of mortality. However, his first blood cultures have returned negative (which is good). If the next few are the same, then perhaps this other vegetation was present originally and simply was not appreciated. If so, that would be encouraging; it would mean the status quo continues and we observe Sam carefully, treat his stroke, and move on towards the second surgery, the Glenn, as before, hoping we can address these vegetations surgically when the Glenn is performed. And though there are a hundred other variables, and this summary does not begin to reveal the complexity of all this, this is the best I can offer in a brief note. We are gathering our courage and preparing for the results of the next several days' tests.

Here's hoping Wolfman ends up on the right side of the odds for once! In the meantime, here are some pictures of Sam this afternoon. He's up to his usual vivacity, and I, for one, love him all the more for his ability to keep smiling while all this nastiness is going. It is his most endearing trait, and I will do my best to learn from him how to remain courageous.

So...without further delay, here are some new Wolfie pictures. Let's call it "The Smile Series"...







Not a smile picture, but I couldn't resist. And don't worry...no Wolfie's were harmed during the taking of this photograph! The bear is not actually kicking him in the face; he's just holding the binky in place while Sam tries to go to sleep. Good night everyone, and here's hoping the morning (and especially the next few blood tests!) turn up good news.