Feldkirch, 9-11 March 2009

I arrived here three days ago not knowing what to expect - just wanting to be here for Penny and Paul at a time of great shock and uncertainty and - as the blog reveals - so many of you out there. It's been a huge privlege for me; harrowing, yet at times, particularly yesterday, very moving.

Yesterday afternoon - for the first time since the accident - Paul responded to Penny, which in a way was recognisable. A small, but magic moment. Let's hope there will be more of these to come. It's going to be a long and difficult journey.

Let me start with my first impressions coming face to face with Paul. He is recognisable. The impact was taken on the left hand side of his face, which has been brilliantly rebuilt during the first few days in the critical care unit. There is no visible scarring on his face. Naturally, due to the trauma to the left side of his head, the swelling is going to take time to reduce. The team of doctors are now waiting for the clues of connection and contact - there are a few, but this is where time and patience from everyone is key.

On Monday night the surgeons inserted a small tube to drain fluid from the brain - this in the skull just above his right forehead. He will remain in ICU while this drain is in place. This is all due to the trauma of his head/brain injury.

Paul really has had a most severe accident. Following his very swift helicopter transfer to Feldkirch hospital, the ICU team has done an amazing job to prevent the build up of cranial pressure in the brain during the vital first few hours and days after the impact. No one could have done a better job, and he is being cared for on a one to one basis - they have now got him to the point where he can begin the long journey to the next stage. At the moment no one is able to say where that will be; with severe brain injuries of this type, each case is individual and there are no predictors.

The good news is that he is breathing normally. The drug induced coma and sedation is over, his cranial pressure is normal, and he has pain relieving drugs to relieve any discomfort and distress. He is being fed through a tube into his stomach which is a lot more comfortable for him. He is wired up for all the normal electronic functions we expect in ICU. All vital signs are currently normal.

The best analogy for his condition seems to be that he is like a new born baby - unable to control his body or communicate with the outside world. The trauma his brain has received has broken all kinds of connections. The dedicated team at the ICU has tried to ensure that the "hardware" has survivied so that the neurons still stand a chance to reconnect and recover - it is only time now that will allow the "software" to try to make sense of things again; the motor functions, the memory, the logic and the emotions. All of this is likely to take many long months - and even then the results in all these areas are uncertain. Clinical uncertainy is a fact of life for a long time, which is frustrating and frightening for all of us who love Paul and Penny, Charlotte and William.

How is Penny coping in the face of all this distress and uncertainty? From my observation.... amazingly well.

She is a military commander, operating from her forward HQ in the hotel Alpenrose, here in Feldkirch. Surrounded by two mobiles and her laptop her days are very busy; after breakfast we spend an hour on emails, two and half hours each morning at the ICU talking to Paul and the staff with whom she has built a great relationship of affection, trust and information. Back to HQ for lunch and more communications, then back to the ICU to 7:30pm before dinner at HQ and then bed. Of course she couldn't do any of these things without the skilled and willing help of so many people - the support I have seen has been wonderful from so many family members, friends and business contacts of Paul's and the people of Feldkirch. Inspirational in so many ways. And, like any commander, she has to plan the next move. After so much uncertainty about Paul's survival, living one day at a time, the focus will slowly switch to the longer term.

Now...., back to this little bit of magic I mentioned at the start. I have tried to paint you a picture of a seriously ill man who is alive, stable but really not himself. This is the situation as I see it. But on Tuesday evening something significant happened that suggests that there might - just might - be a smidgen of hope.

When we arrived on Tuesday morning, Paul had been put in a kind of slung arm chair so he was able to sit up. An important step in his recover journey; this he seemed to find very tiring. Helga, his nurse, gave him his first drink from a cup - another small step. When we returned in the afternoon he was asleep and Helga awoke him. Penny and I nattered away for an hour or so, not talking to him directly, and then Penny spent time massaging his feet on Helga's instructions. This was a great success - blood pressure went down, pulse dropped slightly and eyes closed. After she had finished, Penny planted a little kiss on his lips - and then it happened - with the close proximity of her face, he responded by pursing his lips. This is really the first time I saw him respond to visual external stimulus. Not once, but several times. We were both so excited, Penny went and grabbed the team to witness it!

It's on these small steps that we build to the next with a little more hope.

Mike Palmer, 11 March 2009