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The Morning After

Friends, Family, Colleagues, Members of the Partners Organization

Our family would like you to be aware that last night, Friday evening we came to the end of what we could do regarding Sherin. She has gone to be with her savior. We will miss her very very much, as will you all. As time passes we will write more. Thank you for all of your concern and prayer support regarding Sherin. Surely God has heard us.

Psalm 116:15 Precious in the sight of the Lord is the death of his saints.

Introduction

Written on Monday, March 16, 2009 by Tom Ordens, a traveling colleague of Sherin, who was with Sherin at the time of the accident, and who graciously postponed on his return to the US after the accident.

Monday March 16, 2009

Sherin fell from approximately 4 feet while descending the stairs at the house next door of the WNP Office. Sherin struck her head on the concrete floor causing a cut to the back of her head. Paramedics were called at approximately 2:30pm.   Sherin was awake but dazed, she responded to my voice when I asked her to squeeze my hand. Paramedics arrive quickly and placed Sherin on a back board and immobilized her for transport. The ambulance took her to Lenin Fonseca Hospital.

By the time Moises, Ken and I arrived, Sherin had not been seen by anyone. She was in the hospital admitting area for 1/2 hour. The paramedics, who still at the hospital, suggested we put her back in the ambulance and take her to the Metropolitano Hospital Vivian Pellas.  The ambulance arrived at Vivian Pellas at about 3:50 p.m. Sherin was seen immediately by Dr. Enrique Vega.  They did an emergency room evaluation and then took Sherin to radiology and did either an MRI or CAT scan, I am not sure which. Dr. Vega came back at 5:30 p.m. and reviewed all of the images with us. He explained that Sherin had a small fracture on the back of her head and a large hematoma in the left frontal lobe. There was also a small subdural ipselateral hematoma on the left side.  This was the more serious issue at that time. Dr. Vega said that they would wait 1 hour and observed her condition. No surgery was planned at this time.

At about 7:30 p.m. Dr. Vega indicated that there was swelling around Sherin’s right eye and that they would be performing surgery to reduce the swelling. At that point they began to prep Sherin for surgery. While on the phone with Bob Bowen, Sr., I signed surgery consent and anesthesiology upgrade consent due to the depth of the surgery. Dr.René Morales arrived at about 11:00pm and was admitted to the operating area. He returned and told us the surgery was going well and would be finished in a while.

Dr. Vega came out to talk to us at around 12:10 a.m. He indicated that they removed a portion of the skull bone to relieve the pressure on the brain. The bone piece was placed in Sherin’s abdomen. We left the hospital at about 1am and went to the hotel.  Dr. Vega said that ICU would call us if there was a changed in Sherin’s condition. We didn’t receive a call.

Tuesday, March 17, 2009

We arrived back at the hospital at about 9:00 a.m. At about 9:05 a.m., we spoke by phone with Dr. Vega who indicated that he would be in to see Sherin at 9:30 a.m.

At 9:15 am we were allowed to see Sherin for a brief time. Mirna and I then talked with Dr. Ernesto Parajon, the anesthesiologist for Sherin’s surgery; he indicated that Sherin was in critical condition. She is connected to a ventilator and he’s been giving her medication to keep her stable. She is in an induced coma. Dr. Parajon spoke about an Interparakemotoso (not sure what that is).

During the surgery they drained between 50 -60 mml of liquid from her brain. Dr. Parajon told us about the Glasgow scale which goes from 3 to 15 with 15 being the best, Sherin is currently at a 4. Sherin’s vital signs are good and all bodily systems are functioning properly. At 10:05 a.m. we met with Dr. Vega.  He indicated that Sherin’s condition was very critical.

Sherin’s blood pressure is very high; there is a compression on the brain stem and a contusion on the brain stem.

She continues on the ventilator.  There is massive swelling in the brain and multiple small hematoma in the brain and on the brain stem.

Dr. Vega indicated about 20% success rate with Sherin’s condition.

We will return to the hospital at 4:30 for the 5p.m. visitation time.

[Bryan] Sherin’s Airlift to Milwaukee, Wisconsin

At the time of this entry (Friday 3:00am), many of you may have an incomplete account of the events that have transpired since March 16, the day of Sherin’s accident in Managua, Nicaragua. At this point I think it is best to provide an overall general picture and to focus on what is happening in the present.  A more complete picture of events past can come at a later time.

Sherin’s accident occurred while she was viewing some property adjacent to the current office location of the WI-Nicaraguan Partners (Managua).  It was a simple fall from a staircase in which she struck her head directly on concrete. This resulted in very serious trauma to her head, brain and brain stem region. The impact was manifested by an external wound requiring stitches and a short time later, swelling within the skull. She was taken to the best hospital in both Managua and Nicaragua as a whole.  The evening of the day of the accident, surgery was conducted to relieve swelling and to remove fluid.  My understanding is that her condition degraded for multiple reasons which are beyond my ability to explain.

Sherin had been in Nicaragua leading an Eco-Tour group with a secondary purpose to conduct additional business after the tour members returned to WI.  Bob, Sherin’s husband had been part of the tour activity and had also returned to WI with the larger group.  Two members of the group, Tom Ordens and Ken Wiske, had remained in Nicaragua and were with Sherin at the time of the accident.  Tom and Ken are to be commended for their role in handling extremely difficult decisions following the incident and for their gracious willingness to remain in Nicaragua as long as was needed to support Sherin.

Bob was notified of the accident and flew as quickly as possible back to Managua, accompanied by daughter Beth, on Tuesday.  Other children Amy and Bobby also flew on Wednesday from Florida and Minnesota respectively as the situation looked very grave with regard to Sherin’s survival. Bryan (the one writing was booked and scheduled to fly as well on Thursday. As the events of Wednesday night unfolded Bob and children began to pursue the option of airlifting Sherin back to the states. While the staff at Vivian Pellas hospital had done all possible within their means, the family was convinced that bringing Sherin back to the US was the best medical option at hand given the seriousness of the injury.

Brad & Joanne Martin from Whitehall, WI with the help of Beth and Amy in Manauga, orchestrated the dispatch of the Lear medi-vac aircraft from Ft. Lauderdale. The US Embassy and many others smoothed the aircraft entry into Nicaragua airspace, landing and transfer to Vivian Pallas. It was great to see the EMT flight crew collaborate with hospital staff in prepping Sherin for the airlift. After a high speed, traffic dodging trip to the Nicaragua Military ramp the medi-vac jet headed for Houston at 24,000 ft. After a very short fuel stop in Houston it was on to Milwaukee where a waiting ambulance rushed her to St. Lukes for a 11:00 pm arrival. I, Bryan, was at the hospital when the ambulance arrived. I cannot explain my feelings as the back of the ambulance opened and I saw my mother lying on the stretcher with Dad faithfully at her side. He was the picture of both compassion and composure yet worn with the evidence of the 3 day vigil and airlift.

We accompanied mom to the ICU neurology unit on the 1st floor of St. Luke’s Hospital in Milwaukee.  It was a fast paced, sobering walk as they brought mom into the ICU. At that point the ICU team took over the admissions process and tests that would provide a baseline for the medical staff evaluation. It was expected that by 9:00 am Friday morning an initial consultation with the Doctors would share the prognosis for what we might expect.

Beth and Dad have been sleeping for a few hours approaching 6:00am. Amy is presently driving up from Chicago where she arrived late Thursday night. Bobby is still in Managua and hopefully will fly out on Friday (don’t know the details).

At this point I need to end.  More will be posted as information comes available.  Thank you for the constant prayer on behalf of Sherin and family.  We also pray for all of you, who have concern in this matter.  The Lord God, creator and giver of life can be fully trusted in these events; even the smallest concerns of our daily lives.

God’s blessing be with you all,

Bryan Bowen (son of Sherin and Bob)

[Bryan] St Luke’s Hospital

Friday March 20, morning and early afternoon

Friday early morning was a time of handing off a heavy burden to the staff of St Luke’s. My father and sister Beth were absolutely exhausted. After two or three hours of debriefing as a family of three-when we just talked about our experience of the last three days, Dad and Beth  slept for a block of three or four hours.  This is probably the first time since this saga began. The fact that they could sleep is a testament to the fact that they have let go some of the emotional burden.

For mom this period from 1:00am to 7:00am was a time of attempting to establish metabolic equilibrium. She came in with a body temperature of 91 deg. F. We were told later by staff that this was the lowest body temperature they have ever seen. By 7:00am they were able to bring her vital signs and blood chemistry into a relative normal range. Activity in mom’s room calmed a bit prior to 7:00am and allowed me my first time alone with her. My heart was broken and the tears were profuse. The thoughts, feelings and memories were a torrent.  I am sure many of you feel this way.  It was a time of making peace over opportunities never taken, and a recognition that we must all choose the path in life we are meant to walk… and how well have we done?  The answer is that we would be lost without the grace of God.

At 7:30am the attending physician came by while I was still the only family in the room. He gave me a very straight appraisal based on the data provided by the Nicaraguan Hospital and what had been observed thus far at St Luke’s.  Several forms of key external stimuli resulted in no response and the digital scans of the head revealed severe trauma from which the Dr. suggested there was little to no chance of normal recovery. This was deafening news. Dr. McCoullah indicated that two additional tests could be run that would provide clarity of brain activity or lack thereof.

The first  test, a nuclear blood flow test, would determine if there was any blood flow to mom’s brain.  In the course of preparing for the test mom became extremely unstable metabolically and the test was cancelled for fear that she would end in cardiac arrest. This was a dramatic 30 minutes where we literally experienced the possibility of losing mom and a dialogue was forced to determine if family would allow for extreme cardiac response measures to keep her alive. It was agreed that we would honor mom’s intent in her living will and let her go into God’s hand if it came to that. This was a turning point where we had to reckon with what we could not control.

There would be one more period of extended grace for us as family: Mom’s vitals became stable once again through an increased dosage of intravenous treatments. We were shook to the core and resigned to fact that we might ultimately lose mom.  We read scripture, (John chpts 16 and 17) to mom and each other. We were fearful that mom might not last until Amy and Bobby might arrive. We were greatly relieved when Amy arrived around 11:00am and she was so grateful to see her mother again.

Dad in the midst of tears and controlled emotion suggested we step away as a family and find some food and space in order to sort out the situation.

Mom was somewhat stable going into the afternoon, only through the administration of sustaining medication.  Given mom’s stability it was determined that the nuclear blood flow test would be attempted a second time.

While mom was having this test, Glenn Smith and daughters Torie and McKenzie arrived at the hospital.  Eventually we gathered in one of the waiting rooms for a very meaningful time of prayer where we laid down the burden we could not carry and relinquished mom to the Lord’s will.  This was a difficult but freeing moment.   Is this not what we all must come to?

I Peter 5: 6-7, 10

Humble yourself therefore under the God’s mighty hand, that he might lift you up in due time.  Cast all you anxiety on him for He cares for you.   And the God of all grace, who called you to eternal glory in Christ, after you have suffered a little while will himself restore you  and make you strong.