Philip Michael Erb Sr. (Oct 01, 1944 - Aug 26, 2009)

It is with tremendous regret that I must write that Philip Michael Erb Sr. passed away sometime this morning, August 26th, 2009 following complications from his stroke 2 weeks prior.

Around 2:30am he had some seizure activity on EEG and shortly thereafter had a major spike in his body temperature. Around this time his EEG signals began to flatten out and his brain stem reflexes began to become compromised. It is believed that the highly labile blood pressure he has had for the past 2 weeks contributed to injuring the brain matter in both hemispheres leading to diffuse malignant edema. This swelling began to shut down cortical function, and eventually press on his brain stem leading to herniation and a rapid decline in Phil's health. By the time the family arrived around 6am his EEG showed only trace marks and his posturing and neurological exams were suggesting the worst. Within a few hours his prognosis became so poor and his EEG so faint that he was pronounced brain dead and final arrangements were made. These, as per Phil's wishes, included donation of organs so that the lives of others may be spared.

To anyone that knew Phil, or has been a friend to the family, I'm sure you can understand what a loss this is for us all. His ever-friendly and tirelessly giving personality won so many over, and his wit will be remembered down the ages. While shy, my father had an endearing charm that spoke of comfort, ease, mirth, and security. I'm sure each of you who knew my father can easily think of a well timed pun you can blame him for. But more than anything, to his family, my Dad was our rock. I'm sure my brother and sister will agree with my saying that whenever we needed advice or help with anything, Dad was there for us with well thought out suggestions. Whenever anything went wrong, Dad was there. And whenever something truly great has happened in my life, invariably a large part of the thanks belongs to him.

My father raised me to love technology, to love understanding how things work, but more than anything, he raised me to love learning. It sometimes feels like Dad taught me everything I know, but I realize it's more that he encouraged me to learn everything I have with his support and adoration. Between him and Mom, I do not feel I could be blessed with any better parents, and I will remember and remain grateful to him always. I would only ask that those of you who knew him continue to treasure him in your hearts so that his legacy might live on and flourish.

A memorial service will be held, and when the specifics have been determined I will post them here. Thank you everyone for your support and love in this trying time. Our world has lost one of its treasures, and I'm sure you will all not only join me in grieving for him, but also in remembering and emulating his kindness and humor.

The memorial service will be at 3pm on October 3rd, 2009 at Mills Riverside Park in Jericho, VT. The service will be a potluck, so if you can bring any food that would be appreciated.

Tuesday Afternoon 8/25

I got to meet with Dr. Wayman this afternoon, and to spend a little time with Dad before that. The big news actually has nothing to do with his MRI, but rather my encounter with Dad. He woke when I spoke to him, and then reached out and physically took my hand in a coordinated movement. I waited a couple minutes and then asked him if he'd squeeze my hand, and he gave me a good grasp with the hand. While he's squeezed other family members hands in the past few days, I've been of the opinion that it was a reflexive response, but I was careful to be sure I'd not trigger a grip response while holding his hand. This was very encouraging, and he generally seemed a little more with it today.

Also, I got a chance to view dad's MRI. On one hand, its very scary, as I know what all the structures are, and what's supposed to be there that has been obliterated by the stroke... but it's also encouraging because it doesn't show major changes in areas you wouldn't expect them. For examble, his left hemisphere looks pretty good, and his brainstem is in very good shape. There's a very good chance that Dad could recover a lot of function, so we're still very hopeful.

Also, the 24 Hour EEG is a great thing; if they can identify any seizure activity they can add more anti-epileptic drugs to his regimen and hopefully prevent the seizures. Consequently, this is a situation we can actively combat to help his recovery, where most other options that may be keeping him asleep we have no control over.

Tuesday 8/25/09

I've not yet had a chance to see Dad since getting out of work yesterday (and then the nurses tried to take me out as they were prepping Dad to go for his MRI - well not really, but it was a bit of humor in an otherwise humorless situation).

Although Dad was moved to a new room, he is still in a corner room with a nice view, and now on the floor he should have been on all along. So that is not a bad thing.

The results of Dad's MRI do not show anything alarming - though we hope to learn more after Larson meets with Dad's doctor this afternoon at 1:30. Otherwise the latest is that they have moved his procedure for placing the stomach tube until Thursday.

And today they will run a 24 hour EEG to get a much more complete picture of what is going on with Dad BEFORE they do the tracheostomy tomorrow. Dad is also on another breathing trial like before, where they reduce the amount of assistance the ventilator gives him to breath, forcing his lungs to do more of the work. This is a good thing as it keeps those muscles from getting too lazy, and demonstrates that Dad may be getting closer to no longer needing the ventilator (though there is no guessing as to when that will be). The other day he did so well on the trial that instead of the two hours they pushed him to four - and he did great. So Sunday/Monday they were going for a 12 hour trial, which must have done well for them to do yet another one today.

Mom says that Dad is resting comfortably, and seemed a tiny bit more responsive - but we are talking baby steps here - which is all well and good since they are steps forward rather than back. And you all know Dad - Gold Medalist in Olympic Napping for the past eight Olympics - ever since they made it an Olympic sport. And I am working under the assumption that Dad is simply in training for the upcoming winter Olympics - he has to be in top form to keep his title and the gold!!

I plan on going to see him straight after work (as I do everyday, since I am lucky enough to work across the street from the hospital and live only blocks away - and the kitties are willing to wait [impatiently at best] to get fed for a bit longer than usual). If there is more to share I will post an update or share it with someone near a computer to post for me.

Once again thank you all so much for your incredible support. It really has helped all of us keep our heads and hearts above water - you are all amazing and we love you.

Monday AM 8/24

Dad has been fully transferred to the MICU and now has a bed on McClure 409. This is kind of unfortunate as his last room was on a corner and had a great view, but it will be good to have him on the same floor as the doctors who are in charge of his care. I'm hoping this will allow more contact with his physicians.

Update 12:20pm: I just spoke with one of the medical students following dad's case closely. He will be having an MRI done this afternoon, and is also having a workup done for a Pheochromocytoma. The theory is that dad may have had this tumor which is releasing massive spikes of adrenaline leading to the lability of his blood pressure. Speaking of his bloodpressure, he is back on Esmolol and his BP is now about 150/60, but last night his systolic pressure exceeded 200 for a short while. Early this morning it was down around 120/50.

Dad's condition still remains critical and he's unresponsive, but I've seen a couple new things today. For one, he picked up and drew his left arm to his chest. While I'm not sure what this means (good or bad), it still strikes me as encouraging to see him move it. He has been asleep for the bulk of the time I have been here, but his neurologic responses are perhaps a bit better regarding withdrawal from pain.

Update 2:20pm: Dad is having a PICC line placed. Not a big deal really, but one more little procedure for him.

Sunday Afternoon 8/23

Just got home after spending a little time with Dad. Unfortunately, I didn't see any of his doctors, so don't have any real information to update with. He did have a CT yesterday, and general consensus of people who saw him this morning is that he was a bit more responsive. My brother and I saw him for a little over an hour, but he appeared to be sleeping the whole time. At one point he did squeeze my brother's hand following a request, but we're not sure if it was a concious response or not.

Saturday Evening

Meredith spent all day with Dad today. Some good things have happened today, but things are still not overwhelmingly good. The good news is that they did a breathing trial with dad where they took him partially off the vent for 2 hours, and he did so well that they extended it to 4 hours. Also, Mom says that he really squeezed her hand hard today, which he hasn't done for a few days. He still won't respond to commands, but he does appear to be looking around a little more perhaps.

Also, his left side is more tense and rigid than before, mostly from lack of use. They have told us that we need to move his arm and leg for him throughout the day to help with that.

The neurologists have ordered another CT scan for tonight, but we're not sure exactly why they want to do that. The MRI is still pending, and may get cancelled entirely as they're quite difficult to do with patients like Dad.

Finally, Dad continues to choke on his intubation periodically, so we're eager for him to have the tracheotomy next week. It should help him relax more comfortably. Also, today we were given some very yummy food by kind friends, which is an awesome improvement over take out!

Saturday Morning

Pauline and I went and saw Dad last night. He was pretty well unconcious, though he did wake when I came in and spoke to him (he did not speak to me, sorry for the confusion). He of course then started to gag and cough on the intubation tube, which looks beyond miserable. I can't wait for Wednesday, when he should be getting the tube surgically placed in his trachea. He will also have his feeding tube surgically placed so that he doesn't feel like he's choking on stuff all the time. This will be a wonderful change as he will not require sedation to tolerate the assisted breathing anymore. Dad seems to focus and respond to changes around him, but as of now doesn't respond to direct comands like to blink his eyes or squeeze your hand.

From what I understand Dad had a fairly normal night last night, resting peacefully. His blood pressure remains under better control which is a nice change (around 120-130/80-90). I'm also told the nurses have discontinued his arterial line as they didn't trust the pressures it was reading. Thank you all for your kind thoughts and wishes, we all hope he wakes up soon.