Tuesday we arrived in Boston on time and uneventfully (thanks to Dr. Simkins, Ativan and Tylenol 3) and had a "chair car" to Brigham (thanks to Vally). After being admitted, he had all the usual tests (blood, chest xray, ekg, etc...) and since he was allowed to eat, we decided he must not be going directly to surgery.

Tuesday evening, Dr. Black came by and asked to see the films. ....

I can't seem to get the energy to give you a detailed history. The upshot of all the travel and effort was that on Wednesday afternoon, Dan had a 4th craniotomy to access the infection. There was apparent infection under the scalp and in the bone, so they did not replace the bone section. They inserted a titanium metal mesh. Although to me this sounds awful, Dr. Black later assured us both that it will be much stronger than bone, and Dan will not be vulnerable there. Dan, in fact, said he was fine with it because he was concerned the bone was weak after all these surgeries.

During the surgery he had 3 seizures, one that was significant enough that they had to hold his head while the rest of his body convulsed, so his head would not come out of the head frame (clamps). Also, apparently everyone was so shocked that he would have seizures under anesthesia, Dan had to tell them to get ativan. Dr. Black says "Do we have any Ativan?" "It's in the refrigerator" "Well go get it..."
Dan interpreted that to be that the nurse left the room, and later Dr. Black said it was on the cart, she just had to go draw it up.

The final blow of the surgical procedure was that during the closing, when he asked for more pain relief they did not give it to him right away. Later Dr. Black was disturbed by this and said he would speak to the resident who did the closing.
Dan and I talked about how important it is to have the closing go well. When a person does that type of surgery, while awake, the closing is the part they "walk away with"... the part they remember.

I spent several hours with Dan in ICU afterwards. When he first got there he kept saying, "I really don't like surprises..." He told me the story I related above, we paged Dr. Black and had the conversation above, and then Dan felt a little better. Overall, he said the experience was somewhere between his 1999 traumatic surgery and his December '02 very successful surgery, in terms of emotional energy and experience.

They started him immediately on antibiotics, and will culture the samples from the scalp, skull, inside the cavity and the borders of the cavity. There was some "white ragged tissue" that they took out that was "questionable" and so it was biopsied and sent to pathology. So, how long he will stay and what they will do next is dependent upon what the cultures and path bring.

One more thing about Dan's condition is that each seizure brings more weakness. Overtime, he gets some of it back, but so far, he has not regained anything like the strength he had on Saturday before all this started. When I left last night his face was weak, and he had difficulty speaking, his arm was almost completely weak and he said he had no idea of the condition of his leg.

So, that's where we are as of Thursday am. I apologize for the rambling nature of this letter. I suppose it is reflective of my current state: floundering. It hurts my heart to send Dan off with the trust that he will be cared for... and to have him returned with so much pain and confusion. I can't tell you how many times I have had to send my children off into the hands of G-d and our loving community with apprehension and prayers for their well being. I love and appreciate you all so much. And, I am, and I believe Dan is, so tired of all this.

Ok, enough for now.
With much love and prayers for peace,
Abi and Dan