To those gentle folk who ask about my health: a week and half in Bangalore has been spent seeing doctors and having doppler tests. On one of the days it seemed like I could be going into having two operations, but thankfully, one is not necessary (the arm with a large scar on my deltoid, upper arm) and other could be postponed for a partially functioning valve or just cured through prayers and medication! I am certainly having more of a rest and recovery time here, but it has been interesting to discover after 4 months of my accident how my debilitated left arm causes me more pain and discomfort than ever before. My legs can heal or they will remain my Achille's heel!! A few more prayers for a complete recovery would be forever appreciated, though I fear I shouldn't ask for more after all I was given...

-Kiron

Just to correct a few: I am not back to normal, still have much recovery but certainly on the road to it and hopefully will stay on track that will take me to normality, but then one has to ask do you really want to go back to normality... did I live such a normal life. Gracefully: life, relationships, the world and things will be lived anew and better.

Kiron was moved to upgraded from the critical care to the regular care room.  Kiron is now in bed 16 in the same floor and section of the Moroncelli building. She has also had the last piece of tubing disconnected from her - she is now free to move around the room!  She has been taking herself - aided by friends or the nurse - to the bathroom - an enormous relief and milestone for Kiron. 

Kiron was also visited by the taxi driver who ran into her today. It so happened when there were no other visitors around.  I will expand on the meeting in a detailed update to be posted later but I will summarize it by saying it went well and was beneficial for both. 

 Aug 8, 2013 Update

From the Facebook post of Joanne Ford: Kiron is back! 2 nights ago she was able to ask me 1 question. Last night she was speaking a lot more. Tonight she's not drawing breath and swapping easily between Italian and English! And the best news is she's moved out of ICU & into bed 9 in medicina critica 3rd floor - look for signs to medicina interna. NB. New visiting hours. There's no stopping her now! — with Kiron Ratham.

She asked me to take the photo and knew I was going to post it. It's the first time she's seen herself since the accident. Who else would look that good without hair and makeup?! All she needs is a smile.

From Arun: On her 2 week anniversary, Kiron is out of ICU. She has more energy and is awake for long stretches and fully conversant.

As has been the case for all the time Kiron has been at the hospital, Melanie and Sarah Gildea, her sentinels and very present guardian angels, were there to see Kiron off at ICU and be there when she entered her new digs.

Apart from difficulty getting to grips with the period around the accident, some mild dyslexia and a few quirky ideas, Kiron seems to have her full memory and mental faculties. I expect she will ace physical therapy – she is raring to get out of hospital and back to her apartment.

Aug 7, 2013 Update

Another good day. Kiron had tracheal and feeding tubes removed. Both, especially the tracheal tube, were very trying for Kiron. The siphoning of the tracheal tube was pretty gruesome to watch so you can imagine it being very hard for Kiron. It is almost like watching someone being choked since she cannot breathe during the procedure. It also created a risk for infection as well as potential breathing complications.

Today Kiron’s meals were all food taken through her mouth. Sarah brought in a variety of foods including white and black rice, boiled broccoli, salmon, pork and watermelon. The hospital provided rice mixed with tomato sauce with small pieces of chicken.

Kiron is inching towards accepting her situation and surroundings and has asked about her accident without prompting. The doctor says it is important for Kiron to because to understand and accept what she has been through and where she is now. She seems to have full recall about live before the accident and has had long conversations with visitors.

Couple of FB comments from friends:

Claudia Rossi: "Did you come by car?" in Italian. Before the accident, she often asked me this because I sometimes complained whenever I had to lend my car to my parents... She's incredible!

Andrew Moran: Someone keep a watch on Kiron to make sure she doesn't escape the hospital! I can't help but think of the episode of "Fawlty Towers" when Basil slipped out of the hospital to greet the German tourists.

Aug 6, 2013 Update.
Kiron is talking.  And she wants to go home – NOW!  The doctors have changed the valve on her tracheal breathing tube and she is able to speak.  She tells every one of her visitors that she would like to be taken home, and she sees no reason for being in the hospital!  Kiron obviously does not have a full sense of the situation and there seems to be gaps in her reasoning and her recall of some names possibly even her own.  On the other hand , she has far less of a problem with name recollection with Italians.  I think that blood has taken over. 

The other area with no gaps is her determination.  She cannot understand why her father and brother will not comply and take home this very instant.  Those lungs are rapidly getting to full capacity.

She also ate a few teaspoons of rice and vegetables today.

Additionally, as Loredana Contrino has highlighted in her Facebook post, Kiron shares ICU with several other seriously ill patients including a 33 year old Nigerian priest who, due to a series of mis-diagnosis, is fighting for his life and far away from his family.  We request they be included your prayers and thoughts.

Arun

Having trouble with Kiron's website so updates have mot been made at kiron.us/update for the last few days.

Aug 5, 2013 update.

This will be a brief update just so I can get this out. Kiron has been the best she ever has since the accident. Better hand coordination and the least discomfort yet. She is off the ventilator and the doctors have said she can start drinking water and eating. Kiron turned down ice cream because of her lactose sensitivity and requested a meal from the rice diet she was on prior to the accident - rice, vegetable, olive oil and a few herbs. She is back and she is hard-core! Melanie and Sarah gave her some water and then swung into action. Soon, they had procured some boiled spinach and boiled rice (brother screwed up and unfortunately left the hospital with the spinach). Kiron had her first solid food since the accident – 8 spoons of rice.

At the daily consultation that takes place around 3 pm, the doctor (another very impressive healer) clarified some of actions taken the previous day – an anxious day covered below. The blood transfusion was ordered to raise both, Kiron’s iron as well as her hemoglobin levels. She lost some blood the previous day when some of the stitches were replaced. It is generally a good idea to keep iron and hemoglobin levels at normal to high levels to help the brain heal. Her fever was also being suppressed because the brain does and heals better when it is at normal body temperature. We were also assured that there was no damage from the episode of low pressure the previous day and the high pressure she seems to have when people are visiting her.

Today she seemed very comfortable and a lot less anxious. She had been give a clean-up, and in the evening her face looked almost unblemished with much of the scabs, bruising and dryness seeming to have almost disappeared. That blood seems to have been a good vintage.

With all the blood Kiron has received, first, several pints on the day of the accident and then the 2 bags yesterday, Kiron can be declared a full-blooded Italian. Might explain why she seems to use her hands more when she attempts to talk and is better understood when she mouths in Italian. Thank goodness for blood donations, and this may be a way for many who have offered, to help – consider making a blood donation.

Aug 4, 2013 update:

Today there was a setback but things were almost back on track by the end of the day. I twist in the tracheal tube in caused Kiron to have breathing problems enough for the ICU staff to use a breathing pump (an American football shaped rubber ball with a mask to put over a patient’s nose and mouth that was manually pumped to force air into Kiron’s lungs). After a bedside x-ray revealed the twisted tube and a procedure started to replace the tracheal tube with a different assembly with a stiffer tube that will not twist in the future. The downside is that the new tube and assembly will be more uncomfortable for Kiron. The new assemble also allows for other attachments that will allow Kiron to speak once it is safe for her to do so.

Kiron also suffered a serious drop in blood pressure to the 60/40 range, I believe as a consequence of the tracheal tube twist. She also continues to have a fever and has been started on a course of antibiotics while a blood sample is being tested to identify the infection. Kiron came out of sedation around 7 pm. At the 3pm daily consultation with the ICU physician (who happened to be the head of the head trauma unit and the progesterone study that Kiron is part of), he assured us that Kiron was back on track. While such setbacks were not desirable, it was quite normal for such incidents to crop up in ICUs given the nature of the setting and the condition of patients.

In the evening, another cause for concern. Claudia Castellani called Kiron’s brother and father to let them know that while she was there she overheard the a doctor briefing his replacement doctor for the night shift say that Kiron was going to receive 2 bags of blood. The reason seemed to be because her Iron was low. When they got to the hospital, Richard Moynihan and Victoria Somogyi were visiting with Kiron. They said that Kiron was awake and fine, and she was communicating with them. Kiron was already receiving blood and thanks to Victoria and Richard’s fluent Italian, we were able to talk to the nursing staff that this was “routine” and Kiron was doing fine.

- Arun

Further progress today. Kiron was more communicative. With the tracheal breathing tube in place, she is physically unable to speak. Using a combination of mouthing words – English and Italian, head nods, eye blinks , “20 questions,” and ICU charades, she communicated. Kiron even attempted to write her requests with pen and paper after we failed at figuring out the words she was mouthing. Melaine brought an etch-a-sketch tablet having anticipated Kiron would want to communicate. After several and varied attempts by the assembled visitors we did figure out the following:

She wanted us to do something about the pain in her leg from an old back issue – 9 days in a soft iCU bed for someone used to sleeping on a board of wood, was going to result in some serious sciatica pains. The doctors added some pain meds to her current medication cocktail. When we inquired if the pain meds could possibly affect her recovery, the doctor scoffed saying after the powerful pain and sedative regime she had only recently stopped, the paracetemol he was recommending was like a drink of water for her.

• She wanted to go to the toilet - no self respecting ICU allows that!
• She wanted the feeding tube that goes through her nose – it’s a package deal in ICU, the tracheal breathing tube and feeding tube are a combo deal not available separately.
• She wanted her foot massaged – several visitors obliged including some reflexology from Ricardo, and foot and leg massages from Sarah, Claudia, Joanne and others.
• She wanted a priest to come over and give her communion. Father Sebastian, the hospital chaplain (who will soon be appointed to a Catholic parish in the Coimbatore area in S. India) responded to the call.

Given all her attempts at getting her demands met, one part of the full Kiron is back. Her brother is wondering if we really need to remove the tracheal breathing tube!

Kiron continues to make a steady recovery. Small bumps included a fever in the afternoon that was gone by the evening, and the need to use the ventilator at night (she breathes on her own during the day).

She seems to have improved in her responses on the right side of her body. She smiles with both sides of her mouth, she eyes are open equally wide and she seems to have the same strength in her arms.

The doctors are almost ready to upgrade Kiron to the Critical Care Unit where they will be able to start her physical therapy.

We also found out that Kiron’s accident did make it on to couple of the local papers the day after the accident. She was embellished with a husband and two kids back in the States … or is there a secret side of Kiron that has just come to light! She is about to make the move from the police blotter to the scandal sheets – Stay Tuned!

- Arun
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Andrew returns to Dallas tomorrow.  This will be his last at-the scene update.  He had postponed his departures to help Kiron and her family, especially her father. He has been Kiron's "brother from a different mother."   Kiron's family is immeasurably thankful and deeply moved by Andrew's steadfast help and companionship.

Andrew's Aug 2, 2013 Update:

The news from Monday's consultations is a mixed bag, a little disappointing at the end but a reminder of what we already knew, that we have to be patient. Earlier in the afternoon, while Kiron's dad was in the room with her, through the window Elissa Picasso (no relation to the artist but a friend of Kiron who has been a big help, driving to Ostia today to get Kiron's bag from a police station) and I were shocked to see Kiron's head moving. Elissa got the nurse, who then called Dr. Nardi, who I believe is the head of the ICU. He had been there the day Kiron was brought in, and was once again especially clear. He corrected a misunderstanding from Sunday's consultation: the hematoma is still there; I'm thinking that the previous doctor had meant to say that the hematoma was going down and this had come out wrong or been misinterpreted. But he said that Kiron's condition had progressed "as we had hoped," and the doctors had decided to diminish slowly the amount of the sedatives she was receiving in order to bring her slowly out of the coma. That was why we were seeing movement from her. As we had previously heard, it is only after she comes out of coma that the doctors can evaluate her injuries. He also explained why she was getting progesterone, that initial small studies had shown its value in the treatment of traumatic brain injuries and that no negative effects have been recorded. The official consultation, later in the afternoon, reminded us, however, that any recovery is not going to happen quickly. After the reduced sedation, a nurse translating for a doctor told us, Kiron's "trepannic pressure" (which I took to mean cranial pressure, the amount of fluid in her skull) increased, and so they decided that the safe thing was to resume full sedation. This is disappointing but not disastrous news. We briefly got our hopes up that maybe she could be brought out of the coma quickly, but she simply needs more time for healing.

Andrew Moran



The consultation yesterday went along the lines of the day before, but there was a doctor around who speaks English (and who is also a friend of Kishor, one of Kiron's friends) and so there was a little more information. He said that they may keep Kiron in a medically-induced coma for a longer period, for maybe as long as two weeks, but if I understood rightly, that's a positive thing, that they don't believe they need to pursue a more aggressive but risky approach. He said that the hematoma is "thin," obviously better than a large one.

Hi  - This is Kiron’s brother, Arun 

For those who have not heard, Kiron was in an accident on Thursday, July 25, while riding her bike in Rome.  She was struck by a taxi and her head hit a windshield.  She is in the Intensive Care Unit at San Camillo hospital, in a coma, and is being sedated to maintain the coma so that the bleeding and bruising in her brain has the best chance to heal.   I will go into more details about the accident and subsequent events later in this note but I wanted to give the latest update to those who have already heard about the accident.  I apologize for not getting news out earlier which I should have done. 

I am still in Dallas and relying on updates primarily provided by Andrew Moran, Joanne Ford, and my Dad who left for Rome on Thursday a few hours after being told of the accident.  Updates are also being posted on the Facebook pages of Ann Schneible, Chris Wells and Athanasius McVay

 After the latest meeting with the attending doctor, Dr Femini (?), Kiron is in stable but still critical condition.  At this point, given that best current protocol for head trauma is deep sedation (induced coma), progesterone shots (helps reduced damage and quicken recovery), relieving pressure in the skull with a drain, monitoring her vitals including electrolytes and pressure in her skull, Kiron is receiving the best possible care.  Many Rome residents have said, San Camillo is the best hospital for head trauma treatment in the Rome area.

Here is what my Dad emailed me after his time at the hospital today, Saturday, July 27:

Was in the hospital most of the day and saw kiron in the same condition and consulting doctor repeated the same thing that we have to wait for a week or two if she can progress from her very critical condition. One of kirons friends kishore whom you took around dallas last jan knows another surgeon in the same hospital and he got him to discuss with the ICU and neurology and pretty much concurred with their views. I hope to see Nardi on monday in the consultation session which starts at 3pm every day.  

Dr. Nardi is the head of Neurolgy Dept at San Camillo and is the first neurologist to attend to Kiron.  He was the person we spoke to about Kiron after Dominco at the US Embassy called to tell us that Kiron had been in an accident and was in a coma.  He was wonderful, the best person we could have spoken to after getting a call no one wishes they ever receive.   He had a caring manner, was empathetic, deliberate, with an obvious wealth of experience and knowledge, and communicated with the archetypal bedside manner that was frank, informed and balanced. 

Many Rome residents have said that Kiron is in the best hospital for head trauma and we certainly felt that she had the best doctor taking care of her.  It is rare for a doctor to give you his cell phone number and say, call him any time with any questions.  When Andrew Moran and Dr Greg Roper, the first of her friends we managed to contact (thanks to Karen at the UD English Dept in Dallas) and who immediately jumped in a car to head to the hospital, Dr. Nardi, who was on his way home, turned around  to go back to hospital to wait for them.  Yes, we have received much needed comfort and uplift from the caring and kind help she has received by staff and friends who have been unreserved in their expressions and actions of help, love and prayers.

Friday was the crux day.  Within 24 hours she had received 4 brain scans and none of them showed any increasing bleeding in the brain.  So, there was no need for brain surgery.  Here is what Andrew Moran wrote after the meeting the doctor:

I think that I heard that Joanne said that she'd contacted you after the consultation this afternoon, but in short there is no change in Kiron's condition, which the doctor characterized as "good news." She is under sedation, which I took to mean a medically-induced coma, and this apparently will continue for a few days as it is a way to avoid further trauma. I think the swelling in her face is going down, a little thing, but it's nice to see her on the mend in one way already. Maybe the key thing that came out of the consultation, after the news that Kiron's newest brain scans showed no further swelling, is that the doctor stressed that now is a time of waiting; there likely will be no real news for a few days. In the meantime her friends are having masses said for her throughout the world, I think maybe six countries at last count.

Here is what Kiron’s Dad said:

 All kirons friends were there at the hospital.

Had a long chat with Dr ferini and he says the next few days or a week are

critical to see how kiron comes through. She is on ventilator and has been

shaved and several injuries are seen on the head and arm. It is so sad and

fearful to see her immobile in this condition. The Dr presumably is cautious and does not want to commit to her prospects but andrew said his manner looked positive.

Joanne Ford, a friend of Kiron’s that I was able to contact through Facebook, also went over to the hospital with another one of Kirons’ friend, Veronica.  Joanne messaged updates on Kiron’s condition that evening and the following day when meeting with the doctor.  Her FB messages:

The swelling on her face and head seems to have gone down a lot since last night

Hi. We've just spoken to the doc. No change - which he sees as positive

The bruising in her brain isn't any bigger which is what he was hoping

We're going to be waiting a few days

Some of her messages from Thursday evening:

Hi. They let us wait until the 3rd scan came back. They said no change since the earlier ones. They gave me a small list of bathroom amenities to pick up for her and bring tomorrow. I will be there about 1.30pm and the doctor will give us an update at about 3pm. I'm sure your father will take over the communications when he arrives but feel free to message or call me.

She has some swelling and scrapes on her head and face but she doesn't look as bad as i feared. They shaved her head. Eventually I'll take some scarves for her. I could go in and talk to her and tell her we were there.

off to bed now. Work in a few hours. Andrew is meeting your father at the airport in the morning and I'll be there in the afternoon. We will look after him.

By Thursday evening, word had gotten out that Kiron was in San Camillo and about 8 of her friends had shown up including a priest who gave her the Anointing of the Sick sacrament.

Dr Roper, UD Dallas and the Rome campus have offered its resources to help in whatever way they can.  Joanne Ford, Andrew Moran and many friends have organized and help to make sure Koron’s Dad was picked up at the airport, taken to his hotel and accompanied to the hospital as well as assisting with other details.  Kiron’s friends have organized to make sure a host of other details are attended to such as securing paperwork, getting Kiron’s personal effects retrieved from the Police in Ostia where the accident took place.  Others in the US have helped in getting information out and offers of help have poured in.  Of course, literally hundreds of Kiron’s friends and relative are offering prayers, and in many countries including Brazil by some attending World Youth Day.

To those just finding out about the accident here are details:

Kiron was on her bicycle when she was hit by taxi. Her head hit the windscreen of the taxi (or perhaps another car nearby).  Many have asked but I don’t have information as to whether she was wearing a helmet at the time.  She also suffered some injuries to her wrist and elbow.   She also lost some  blood from  injuries and had heavy bruising and swelling to her face and head.  Just after the accident, Kiron was talking but very agitated.  A determination was made that she had brain injury and rather than go to an emergency room near the accident scene,  she be sent to San Camillo, the best place for the treating of head trauma injuries.  At some point, she quickly went into a coma at a speed that surprised the medical personnel attending her.  Not sure if this was at the accident scene, in the ambulance or at the hospital.  At San Camillo they tried to wake her up but she was incoherent and not able to recognize her surroundings.  So, she was sedated and a hole made in her skull to relieve the pressure build up.  They also performed the first brain scan that showed bleeding in her brain. 

The third scan, performed late that night, showed that the areas of bruising and bleeding had not increased.   Andrew, Joanne and several friends stayed late at the hospital to wait for the results of the 3^rd scan and reported it back to me in Dallas.

The 4^th scan was performed on Friday afternoon.  Kiron’s father had arrived in Rome and was able to attend the 3 pm meeting with the attending doctor.  Since her brain scans showed that her brain condition was stable (though still critical) no additional brain scans would be ordered and Kiron would be kept in coma for the next several days to let her heal.  She has been on progesterone shots and a drain and pressure-monitoring stent was put in her skull a few hours after being admitted,

For the next several days Kiron will be kept in a coma.  In addition, if things are progressing well, there should be little to report on.  I imagine after a week of being in a coma they will do a brain scan or use some other markers to decide if she should be woken up or left in coma for a while longer. 

The doctors have been keen to stress that even though Kiron’s brain injury does not seem to have increased in the first 24 hours, she is still in critical condition and there may be a turn for the worse.  But, she is being closely monitored and we all know Kiron to be determined and strong willed person.  She also has the large and worldwide group of ardent friends and relatives who are praying and willing her to make a full recovery to the Kiron we all know and love.