New Year

Jim is now entering the third phase of his recovery. Yesterday morning his feeding tube was taken out as well as the IV line in his hand. The only surgical devices that he is still wearing is a neck brace for his neck injury. Losing the tubes has been a big step forward for Jim as they have been a continual source of irritation, and he has often tried to pull them out. Now he is focusing all his frustration on the neck brace, though this really only happens when he starts to get tired.

The third phase of Jim's treatment will involve rehabilitation to learn to walk and use his right hand again, as well as retraining his short-term memory and socialization. He is regaining a lot of movement on his right side but it is not clear how complete the recovery will be. We are told that large-scale movements like walking and moving his right arm will come fairly easily, but that delicate right-hand finger skills might take more time. The "motor strip" that controls the right side body movements is on the left side of the brain, a region that was bruised in Jim's injury. The fact that Jim is left handed has helped him a lot here, as this means he can still write easily. Moreover, in left handers, the capacity for language lies in the right brain hemisphere. This escaped injury and so Jim can speak without difficulty. The ability to communicate will help in rehabilitation.

The longer term aspects of Jim's rehabilitation involve restoring his ability to form memories. His memories of events prior to his accident and plots of television shows or novels is very good. This afternoon we listened as he gave us a complete plot synopsis of the television series "Breaking Bad". However Jim currently has very little short-term memory recall. For example, he comes up with some bizarre explanations for his plight. He has difficulty recalling our previous visits, and often thinks that we are seeing him for the first time in months. We are confident that his short-term memory capacity will return with rehabilitation, but have no idea of how long this will take.

The other aspect of phase three is becoming socialized again. In his current state, Jim is without inhibition, a feature of people with brain injuries at this stage. The mechanisms for sensing and correcting inappropriate behaviour are malfunctioning. Jim's conversation is a stream of his own consciousness which is very revealing and endearing, but can be too honest. He needs to learn to be reticent again.

So phase three involves restoring all this and more. It is a long and arduous process. Jim will be assessed on January 5th for transfer into a rehabilitation clinic where phase three will begin in earnest, probably at the end of the coming week.

Jim is eager to see his friends, but he tires easily. He is now out of the ward with restricted entry to two people at a time, and so he would be overwhelmed if too many visitors show up at once or for too long. As a default, Brigie and I would like to keep visitors to close family for a few more days.