Face-to-Face with Dr. Diem - Leader of Paul's ICU Team

Regular followers of Paul’s blog will remember Charles’ description of how Dr Diem had the thankless task of explaining the extent of Paul’s very serious injuries after he had admitted him to the ICU back in February. Towards the end of March Paul was transferred to the neurological ward at Rankweil, where his progress has been accelerating, particularly during the last month - so Dr Diem has been completely out of the picture. Paul has been back in Feldkirch in the neurosurgical ward for the last fortnight so they can investigate his cerebral spinal fluid (CSF) leakage, so it was a dramatic moment when Penny spotted Dr Diem in the corridor and he popped in to see how Paul had progressed.

Like Dr Diem, I had not seen Paul since March (10th in my case), and I was full of trepidation that the reports of the changes could really be so profound. Last time I saw Paul he was lying, face expressionless, connected up to all the ICU monitoring paraphernalia and fed through a tube into his stomach. He could open one eye and it was very difficult to know what was going on in his mind, or whether he would ever walk again.

On Monday, when I entered the room he has shared with Steven (a lovely man of 35 who speaks good schoolboy English, recovering from an operation to remove a benign brain tumour) I saw immediately what dramatic improvements Paul has made …there he was sitting up in bed watching the French Open tennis, and greeting me with a smile. Wow!

Of course first impressions are important, but they can be simplistic, and I soon found that he is by no means his old self yet. Much more time will be needed, but the omens are very encouraging.

The exciting physical signs are that he can now get himself out of bed unaided, he can walk the few feet to the bathroom, do what he needs to do there, and return to bed. He is swallowing better, and he eats what looks to be well-prepared normal hospital food at the table in the window (although he isn’t always complimentary about more traditional Austrian dishes!). If you examine his head, you can see the left side has had a most severe biff: it is well dented and the left cheekbone, eye and socket pushed back – drops need to be inserted in the eye every hour and at night he has an elastoplast eye glass covering to keep it moist. The scar running from his left temple to the top of his head has healed really well, and when the hair grows back will be almost invisible, although probably uncomfortable if brushed.
As you can imagine, 15 weeks in a bed has left him very weak and he’s lost a lot of weight – he says that his 6 pack has been removed! Muscles have atrophied, and he tires quickly; two hours of one-to-one contact is enough. At the moment he is quite quiet and subdued, but will normally respond to direct questions and is able to makes his views known, but does not always engage with you, particularly in the morning. At the moment he doesn’t ask about people outside his hospital world, although he can tell you what is happening to the price of gold and copper!

His memory is also returning, particularly of the long term. I showed him a slide show on my laptop of our joint trip from Poole to Mull last year, which he said brought it all back – particularly video of dolphins swimming by the boat. Together we went through his diary and he wrote (fairly dodgy handwriting still!) in the dates of his visitors which I figured out from the blog: he has no recollection of anything between skiing in Lech the day before the accident until ‘waking up’ in Rankweil at the end of April, so was pleased to discover that so many people had come out here. His short term memory is less reliable and occasionally he confuses things, and comes out with some slightly ‘random’ statements – all apparently par for the course in brain injury.

He spends his time reading the paper (the FT is available daily in the town), watching CNN and Eurosport. He loves the many letters and cards from his friends – ‘post delivery’ is a bit like at prep school, the high point of the day. Penny brought out a DVD player and he loved Jamie’s video of Mull – the White House at bluebell time, featuring Jamie, Pen & Rory, Rualeyn and Carl.

The great concern for the neuro-surgical team at the moment is to try to get to grips with the continuing minor leakage of CSF. This has been the subject of investigation during the last fortnight and there is still ambiguity about the source and hence the best solution. This has led to a number of changes of plan, which has been very frustrating for them, for Paul, and particularly for Penny who has been put through a mincing machine of emotions. CSF leakage is worrying because it increases the danger of infection of the fluid the brain floats in, leading to meningitis.

Feldkirch life continues and people are preparing for the Festival later in June. The market place bubbles with life and Penny is becoming known – she was hailed in the street on two separate occasions by people she had come into contact with. The Alpenrose provides her with a safe haven and the staff treat her with affection. During this visit to the hospital I noticed that it is not only the NHS that is stretched: long queues in the outpatients in the morning, patients in beds parked in the corridors overnight due to overcrowding, nursing staff and doctors busy and feeling under stress. Paul’s room is spotlessly clean, and the food looks appetizing. And it makes a huge difference if someone else is there to stimulate communication as to what is going on and lift spirits.

So what was Dr Diem’s reaction to seeing Paul for the first time for two and a half months? He smiled with delight to shake hands with him as Paul sat in a wheel chair, but when Paul stood up and walked a few paces across the room he was visibly moved at Paul’s achievement. He turned to Penny and said “I can hardly believe it – you certainly made the right decision to keep him here”. For Paul this was the first time he had met the man who led the care with the medical team which has saved his life.

Moments of elation like this counteract the bleak days when things conspire to go wrong. Paul, with Penny’s support, is achieving great things, but patience will be needed in plenty to see it through.

Mike Palmer 4th June 2009