The Beginning of a Nightmare: My Wife’s Stroke

Discovering My Wife Was in the Midst of a Stroke

My Wife and I are in love with one in other and our life together was that of two newlyweds that adore each other. I never thought my wife would have a major medical event, and figured, if either of us did, it would be me. I’ve planned financially for my Wife’s welfare should I have a heart attack, stroke, etc. I never saw my Wife’s stroke coming until on a Thursday night, after calling her from work late in the afternoon to see how she was doing, receiving no answer from her on her cell phone, I arrived home at approximately 5 pm to find my wife lying in our bed, face up, with a snoring, gurgling sound coming from her mouth, and a white powdery substance (I assumed was a pain reliever such as Advil, or Ibuprofen) running down either side of her mouth, her eyes open, glassy, and distant.

I knew something was wrong as I left work that day, driving as fast as possible and rushing home in heavy traffic. Once home, I entered our house through the garage into an eerie and quite house. Our dog, Holly, was no where to be found. I quickly went from the garage making my way to the master bedroom at the other end of the house, I found my wife in a state I have never seen before. Holly, our dog, was sitting beside the bed as if she thought her best friend was going to get up at any minute. I immediately called 911 to get help

The conversation with the 911 operator started with me giving my name, our address, and the nature of the emergency as I have been taught. The operator was direct, asking me to describe my Wife’s appearance, questioning me about possible drug overdose, choking, heart attack, or other signs of distress. He had me check my Wife’s airway for obstruction(s) (I knew she was still alive, or at least assumed so, when her eyes seemed to recognize me pushing me away with her hand as if she were annoyed by me actions). I told the operator that there was no way my Wife would purposely take an overdose or do harm to herself. Unaffected by my assurance, the operator had me look for all medications she was taking, which I did and reported. I also mentioned that we had a Dog in the house after I asked how far out the first respondents were. I was instructed to let the Holly out into the backyard, and unlock the front door for the ERT to enter the house.

How Shall We Log This Call?

The 911 ERTs did what I would consider standard operating procedure; blood pressure, try to get the patient to respond, etc. I kept wondering if I was losing the love of my life, and had no idea what was going on with her condition. I did not take offense to questions about her state of mind, if she took drugs, if she was depressed, etc. After what seemed like an eternity, I was told she was to be transported to the hospital. My Wife was whisked off to the ambulance while I was waiting for the remaining ERT team to exit the house. My last memory of the ERT experience was a comment between two of the team members, “How shall we log this call – stroke?”. The response was “yeah”.

Triage Room at the Presbyterian Hospital Emergency Room

The first stop was the Emergency room of the Downtown Presbyterian Hospital in Albuquerque, NM where we live. I drove like a mad man to get around traffic snarled by highway construction to get to the Hospital ER. I was greeted by one member of the ERT team and was led down a hall to just outside a room where the medical staff was fighting to diagnose and stabilize my Wife. At one point, the Doctor came outside the room to get my permission to intubate my Wife and inquire about a DNR (Do Not Resuscitate) on record. I informed the Doctor that we did have a DNR on record but gave my permission to resuscitate my Wife. At this point, I wanted to give my Wife every opportunity to recover. By the way, if you don’t have a will, medical directive, and medical power of attorney, you need to do so. Consider situations such as this (stroke, heart attack, etc.) and specify your wishes should you be faced with those conditions.

While waiting for news on my Wife’s condition, I called her kids, my Sister and Brother-in-law, and informed them of the situation. My Sister, Brother-in-law, and one close neighbor arrived to offer support. The events that unfolded were very hectic. Nurses entering and exiting the triage room were clearly fighting for my Wife’s life. The Doctor came out to asked more questions, inform me that my Wife had a dual brain bleed (left and right hemispheres), may have pneumonia, and returned to the Triage room to continue saving my Wife. Finally, the Doctor came out to allow us (my Sister, Brother-in-law, and I) into the room to see my Wife. My wife was intubated , unconscious, and frail. The Doctor informed me that there were no available Neurosurgeons or hospital beds available in Albuquerque, and that he was consulting with another Doctor (a neurosurgeon that was a friend of his in another state). while searching the surrounding area (Denver, Texas) for a hospital with a Neurosurgeon and bed. After 20 minutes or so, we were informed that my Wife would be transported to the University Medical Center at Texas Tech in Lubbock, Texas. Within 5 minutes of being informed about UMC, we were whisked away by ambulance to the airport and flow by the UNMH emergency air transport to Lubbock, TX.

The flight to Lubbock lasted about 1-1/2 hours. Once we landed, my Wife was taken to UMC. As I recall, it was 1:30 am in the morning. My Wife was then taken via ambulance to the UMC Neurosurgery section and given a room in the ICU.

Your Wife Experienced a Serious Medical Condition – Intracranial Hemorrhage of the Right and Left Hemispheres of Her Brain

When we arrived at the UMC ICU and my Wife had been initially examined (The CAT Scans and x-rays images were provided via DVD-ROM by Presbyterian Hospital ) I met with the attending Neurosurgeon PA about my Wife’s status. I was informed that there was nothing the Neurosurgeon could do with respect to operating as a brain bleed is not, necessarily, operable. My Wife, at that point apparently, would be attended to by the Neurology specialists. The ICU had two Doctors that alternated weeks and shift. Both Doctors (Dr. Latchmansing and Dr. Philips) were excellent. I have never seen and ICU (and I have seen a few with other family members) where the staff and attending Physicians were so accommodating and thorough. The nursing staff was also the best I have ever seen. I am fortunate that I work for a Company that cares about the employees but is also accommodating in emergency situations such as my Wife’s. I mention this because I have been at my Wife’s side every step of the way, sleeping in the ICU, the Hospital, and presently in Rehab; more on the Hospital and Rehab later. I have witnessed all of my Wife’s care, 24/7, shift-to-shift coordination (pass down efficiency and hospital protocols in particular) , the bedside manor each Nurse and Nurse Aide has, physical handling, and facility cleanliness. As an Engineer, and specifically an Engineer who is highly training in Systems, I was able to note how each facility carries out medical care and the mistakes that are so obvious that I don’t understand that someone in my Wife’s condition would possibly survive without an advocate vigilant enough to go to the CEO of a facility if conditions warrant. But I digress, more on this later. My Wife is the Love of my life, the woman of my dreams, so, the care she receives must be the best. On this account, I believe that the UMC ICU met what I would consider the best care my Wife could receive.

Living in the ICU

Prior to being flown to UMC in Lubbock, TX, I called all of My Wife’s immediate family; Sister, Brother-in-law, her Son and Daughter (All were either living out of town or on vacation). All wanted to come immediately to Lubbock because, as at this point, we had no idea if my Wife would survive major brain trauma, or, if she did survive, what the prognosis for quality of life would be. My Sister and Brother-in-law left a Cruise to be with us. My Wife’s kid’s flew into Albuquerque to stay, to meet with my Sister and Husband to gather what they could to bring to Lubbock (clothing, computers, etc.) as all I had was the clothing on my back and my wallet. My Wife literally had a hospital gown and that was all. Fortunately, we have a wonderful family (and neighbors – more on that later) and life in the ICU, although very difficult to sleep in, was tolerable. After all, it was about my Wife care and recovery, not my comfort. UMC Neurology ICU, as I understand, is new (build about 2 year ago?), has large rooms, and a char that folded out into a bed. It is not the most comfortable sleeping platform, but not horrible. The Nurses carry on their activities, and are very considerate of a family member staying in the room. Most every Nurse was spectacular, and I don’t want to forget any of them, but there are a few in particular that deserve honorable mentions Trey, Gayle, Chris, Nailah, Brittney as well as the Respiratory Technicians, Robert, Tim, and Megan (a “Traveler”) provided above and beyond care for my Wife. There were a few moments that left me wondering but not worth swelling on as my Wife was able to move on the the next level of care, “The Floor”.

The Floor

The “Floor” (A.K.A. “Production” by UMC Staff Members) is what I know as “the Hospital”). I was told that my Wife was too well to remain in the ICU and needed to be transferred to the “Floor”. I’m not sure of the ratio of Nurse to Patients in the ICU (I’d guess 4 or 5); the floor seems to be double or triple the ICU. I found that the ICU had a few “bad apples” where are the “Floor” wasn’t quite triple that of the ICU in bad apples. The bad apples come in several flavors; those that are new to Nursing, those that are burnt out, and those that are Nurses for a job. The best Nurses are old school, or have the gift of compassion with the intent to help people suffering. The ICU had 2 great old school nurses “Gayle” was my favorite, I think the other was “Susan”, a friend of Gayle. The other great Nurses I mentioned above. Here, on the floor, there were no nurses that stood out as spectacular but there were professional staffing with only one or two that I would, personally, seed out. Other than that, the UMC “Floor” was what I would consider among the best Hospitals I’ve been in. Again, I was with my wife 24/7, from the start. Another think I noticed is that the “Floor” is clearly not as well funded as the ICU. We had discontinuity between the way the ICU repertory team managed my Wife’s incubation than the “Floor”. I think it has to do with inconsistent protocols between the two areas, but was clearly inconsistent between the repertory team that served the floor. Specifically, the use of “wet”, heated oxygen, verses cold dry oxygen. When my Wife was transferred from the ICU to the “Floor”, there was no apparent coordination on the fact that my Wife had 33 C wet oxygen and the “Floor” repertory team wet straight for the cold, dry oxygen and my Wife struggled. She coughed more, and had much more intubation induced mucus. I would not get the repertory team to understand and finally had to call the ICU and ask for help. The ICU charge Nurse (I think it was Brittney” immediately came down, and resolved the issues. This is an example of why you must be vigilant as a patient’s advocate. When I get to the rehab discussion of my Wife’s care, I will have plenty to say about being vigilant!

After, roughly a week in the “UMC” floor, my “Wife” the attending Physician told us that she needed to get into rehab as soon as possible. When a patient is in bed for long periods (about 3 weeks at this point) the mussels of the body degrade due to lack of use and this can be permanent if not attended to (as I was told). So, the Social Worker, Linda, came to the room, and we had a discussion about the next steps.

Pick Your Rehabilitation Facility Carefully!

The Cortex M4 and the Cypress FM4-176L-S6E2CC-ETH Development Kit

I’ve been experimenting with the Cortex M-series of ARM Micro-controllers for many years. I the beginning, it was curiosity of the ARM architecture when compared with the (Microchip) PIC architecture that made think about my platform of choice. I started with Microchip’s PIC architecture years before, was impressed with the variety of devices in the PIC product line. Like many, I read about and tried digital signal processing on 8 and 16-bit devices with mixed results. Later with the introduction of the dsPIC, I  was inspired with a (finally) low-cost entry into digital signal processing. and moving to a 24-bit word length. At the time the dsPIC was introduced, TI and Analog Devices already offered very powerful 32-bit digital signal processor architectures with great development kits, but the combination of the development kit and software (compiler) required funds that I could not afford as a hobbyist. There were was a GNU compiler for the Analog Devices 21xx family, but it was not the best choice for my situation. So, at least with the dsPIC I could advance my digital signal processing knowledge, but, for the better part, constrained to low(er)-frequency applications (motors). So, the dsPIC was interesting, and I learned quite a bit, but,  meanwhile,  I continued seeking out a more general purpose architecture with an open sourced, or low-cost commercial, compiler, with 32-bits I could afford.

Enter the Stellaris product line based on the ARM Cortex M3 architecture. I purchased various development kits from Stellaris and  became proficient with the architecture choosing to program in mixed Assembly and the C language. The ARM Cortex M3 supported only Fixed point math, and as such, taught me quite a bit about when math meets metal.

Later, Stellaris was acquired by Texas Instruments and future of Stellaris was not clear to me. Furthermore, TI seemed to be trying to figure out what to do with the Stellaris product line and how it fit in with the MPS line of Micro-controllers. I decides to make a switch to Atmel’s SAM product line which was very well supported with development kits, a free IDE, Atmel Studio. I became acclimated with the Atmel ARM ecosystem and was about to develop an retrofit a Chinese made  SMD oven with a Atmel ARM with USB support (So I could transfer solder profiles to the oven), but then the Cortex M4 was released. I got side tracked with the Atmel SAM4 series of products with the Cortex M4, FPU, and MMU options (DSP/Linux on a Microcontroller?).  So, to make a long story short, I spent way too much time playing with the technology and not accomplishing anything of substance. Time, to reboot my priorities.

So, now I finally get to the present and the near term project I have decided to pursue; an audio filter for my Amateur Radio HF work.  Simple enough, not rigorous digital signal process theory (as compared to SDR), but should provide me with development experience in digital signal processing and embedded/PC software I love to write. So, time to consider the goal of the project, the requirements, development platform, and the software tools to get going. I am document the progress I make on this web page.

Where the Cypress FM4-176L-S6E2CC-ETH Development Kit comes in, the subject of this blog entry, is that, while researching digital signal processing theory, I came across a site at the University of Colorado at Boulder maintained by a Professor Mark Wickert. It started with reading Dr. Wickert’s book, Signals and Systems for Dummies. While reading Dr. Wickert’s book, and visiting the link to his web site within, I discovered a series of laboratories Dr. Wickert assigned to his students in another of Dr. Wickert’s courses (Real Time Signal Processing) where the Cypress FM4-176L-S6E2CC-ETH was being used for some of the lab assignments. I started working the same, or at least the material that was posted on Dr. Wickert’s site and found the Cypress development platform well suited to what I believe is general purpose enough, to develop my project on, as well as share with the Amateur Radio community. I discuss the projects, complete with links to where I found information on the web, along with rational for my decisions here.

73, NM5DC

SPICE

I’m going to start a new blog category called “SPICE”, and sub-category called “LTSPICE” to share some of my experiences with the computer program, SPICE, which is an acronym for Simulation Program with Integrated Circuit Emphasis. I use SPICE periodically as my tool of choice to model, simulate, and validation of circuits I am learning about, or designing. Circuits such as passive RLC filters, active filters using operational amplifiers, and filters using commercial off the shelf integrated circuits. There are plenty of sites with examples of using SPICE to simulate circuits. So, why am spending time on the subject? I feel that an Amateur Radio Operator that wants to learn more of the theory of analog circuitry should know how to use SPICE to learn and experiment with circuits. The “Hands on Radio” series in the ARRL publication QST that Ward Silver writes is an example of experimenting with circuits, and with some self-motivated learning, would be more useful with  SPICE.  Inc short, “Hands on Radio” is an excellent series and using SPICE with the series can be used to further one’s knowledge of practical with theoretical. In short, modeling a circuit to understand how the circuit functions in a virtual environment where you can vary all circuit parameters from the baseline design. Using SPICE to  insert standard components in a theoretical design that has non-standard components and see how the circuit responds to the new values; learn about how the circuit functions over frequency, temperature, voltage, etc. before you physically assemble the circuit. In short, the process of designing, modeling, simulating, and validating a design using SPICE will be the emphasis of this category. I plan to used the free program LTSPICE provided by Linear Technology (now Analog Devices) to demonstrate the techniques I will blog about. I will tell you how to obtain LTSPICE and show you how to design circuits from theory to implementation. This effort is not to copy or re-write “Hands On Circuits”. In fact, I don’t plan to repeat the find work Ward had done. I want to share my experiences with SPICE to those Amateur Radio Operations that are interested in this topic. I hope you will enjoy. My next entry will be a short history of SPICE.

73, NM5DC

The Xilinx Zynq Processor – A New Toy

One of my previous positions (Signetics/Philips Semiconductors) was as a Design Engineer working on a family of 8051 micro-controllers derivative. The 8051 architecture, originally conceived and developed by Intel Corporation back in the 1970/1980’s was licensed to Signetics/Philips. As part of my work on the 8051 family (ROM, EPROM,  and FLASH) derivatives, I was involved in understanding the PLA (Programmable Logic Array, or, hard-wired firmware of the 8051. At that time, HDL, VHDL, Verilog, and FPGAs did not exist.  As an aside, Signetics was also developing a family of programmable logic known as  PLDs (Programmable Logic Devices) co-developed in Silicon Valley and Orem, Utah.  It was the PLD family that was the precursor to the Philips “Cool Runner” devices, later sold to Xilinx.

OK, so back to FPGA’s and the Zynq. I’ve started experimenting with the Xilinx  Arm 9. I’m not sure I can afford a license to use the Xilinx’s Vivado software design tool suite with the DSP engine, and, if not, I may re-focus my amateur radio efforts on a non-FPGA micro-controller  such as the ARM CORTEX M4 due to it’s built in floating point processor. So, in the end the Zynq may end up being an education for later projects.  My next post on the Zynq will focus on the low-cost development boards design by Avnet found at zedboard.org. Specifically, the MicroZed and the MiniZed. The MicroZed comes in single or dual A9 processor core with the Xilinx programmable logic “fabric”.

73,
NM5DC

The Journey Begins

I’m an Electrical Engineer, and, a Software Engineer. Let me explain what I mean. In the beginning, I received my BSEE from New Mexico State University, began my professional career as an Electrical Engineer designing integrated circuits for Texas Instruments (remember the 74HCxx family?), and 35 years later, by way of a resume of positions, here I am . As you probably know, most Electrical Engineers “think” they can program. I’d venture to guess that if you graduated from any accredited University in the past 45 years with an Engineering degree (say,  since the mid-70’s; remember the 20th century?),  you probably learn to program in  assembly, FORTRAN, Pascal, C, C++, or Python, other computer language, right?  Hence, “Most” EE’s think they are Electrical and Software Engineers. I found out later in my career that, although I had learned many programming languages, you really aren’t a Software Engineer until you master the skills used in the field of Software Engineering and not simply how to program many programming languages regardless of how well you program. The skills of software modeling, configuration management,  software testing, are but a few of these skills. So, many EE’s graduated as skilled programmers (coders?) and later, become Software Engineers due to interest, a change in career, necessity or other reasons. That is my opinion base on my experience starting with my first position after graduation from NMSU.

Somewhere in the early 1980’s, as I recall, when I was attending NMSU, the field of Electrical Engineering morphed into Electrical and Computer Science Engineering (the name of the program at other institutions vary, but the idea is the same). With the introduction and advancement of the integrated circuit, and Digital Signal Processing, the two Electrical Engineering fields I was involved in at NMSU, analog and digital electronics,  started to morph together. I recall one of my favorite professors Ray J. Black (He was not a PhD and I am not being disrespectful for not using the suffix for Dr.), exclaimed that ‘these digital guys think that the analog electronics is becoming less important’. That’s a paraphrase, not a direct quote as that was 30-something years ago.  Professor Black was one of those individuals at NMSU that I remember fondly and credit for my understanding of analog circuits, especially communications. But, I digress….

Those of us that graduated in the 1980’s experienced the transition from Electrical Engineering to Electrical and Computer Engineering and either took courses or used a combination of self-training and on-the-job training to become proficient on both fields (Electrical Engineering and Software Engineering) with the advent of the integrated circuit, micro-processor, micro-computer, mainframe computer; computers in general. The world of engineering changed immensely. The days of the IBM punch card, the DECwriter terminal, VT100, whatever, became the personal computer with software programs that changed the way one theorized, designed, developed, tests, and produced the systems for the future. Today, the paradigm is shifting with tablets, and the Internet. The Internet introduced Web-based tools, enhanced information sharing, communications, and added social networking. This is a huge change of paradigm compared to what I started out with at NMSU. I am continually striving to keep up with the pace. So, to make a long story shorter, this is all to say, as I often tell others ,”My left-half brain is Electronics and my right-half brain is Software”.  This website/blog site is an example of my right-half brain venturing into the land of on-line publishing. I hope to publish experiments and observations I personally am involved in  that are specific to Amateur Radio. Hence, the journey begins.

73,
NM5DC