Wednesday, May 31, 2006

In Lieu of Flowers

In lieu of flowers, we ask that donations be made to one of two Memorial Funds:

1. Dr. Kaufman has been a supporter of Environmental Defense (formerly Environmental Defense Fund) for many years.
Environmental Defense has established
The Yoram Kaufman Memorial Fund on Climate
.
Donations should be sent via check, made out to Environmental Defense and sent to:
The Yoram Kaufman Memorial Fund
Environmental Defense
257 Park Avenue South
New York, NY 10010

Attn: Bill Chameides

2. Dr. Kaufman was a member of the Union of Concerned Scientists for over ten years and appreciated their work on climate change. Contributions in his memory will be designated for UCS work on global warming.

Contributions may be made in several ways:
Union of Concerned Scientists
2 Brattle Square
Cambridge, MA 02238-9105

ATTN: Susan
  • By phone: 1-800-666-8276, ext. 8053
Please indicate that the gift is in memory of Yoram Kaufman.

Funeral Information

Please join Yoram's family and friends for a short grave-side burial ceremony at 10am on Sunday, June 4th. Please plan to arrive by 9:45am.

Judean Memorial Gardens
16225 Batchellors Forest Rd.
Olney, MD 20832

Click here for Directions

Memorial Information

Please join the Kaufman family, and Yoram's NASA family, for a memorial gathering to be held on Sunday, June 4, from 1-4 p.m. EDT in the Building 8 Auditorium of NASA's Goddard Space Flight Center in Greenbelt, MD.

Please note that the purpose of our gathering is to celebrate Yoram's remarkable life. As you know, Yoram brought exuberance and passion to everything he did, in both his personal life and his scientific research. He touched and inspired us all in ways that were uniquely his. In remembrance of him, we are asking you to join with us on Sunday for a time in which, together, we can recall and rejoice over the wonderful times we shared with Yoram.

There is no particular dress code required for the memorial. Dad would have wanted everyone to wear whatever they are comfortable in.

All adults guests are asked to **please be sure to bring a photo identification (either a valid passport of drivers license).** All guests are required to enter through the GSFC Main Gate, off of Greenbelt Road (Route 193). Click here for driving directions.

Dad has Passed

Time of death 6:05pm.

No organ donation

While it seemed Dad could give the gift of life with his liver, pancreas, and kidneys - in addition to tissue donation - it was determined that his body is not eligible for donation because he had a small melanoma about a year ago.

I have to imaging that someone who desperately needs an organ transplant to survive would gladly accept the miniscule risk of some residual melanoma cells if it gave them several more years of life. However, any form of cancer disqualifies organ donors.

So, we have now instructed his supervising physician to remove all remaining life support. Dad's heart will likely stop shortly.

From Brent Holben

Jean, Nadav, Daphne, Yoram's extended family, friends and colleagues,

A chapter is closed. Yoram, our friend and colleague, his ever flowing ideas have stopped. His impact on our fields is enormous, from atmospheric correction, to BRDF, to in flight calibration, to NDVI, to aerosol characterization, models, assimilation, MODIS, new satellite concepts, radiative forcing, climate change--he even named AERONET. He loved to experiment. With a little data and his intuitive genius he bridged gaps for the rest of us to follow.

Our friend and colleague will be mourned and missed but his inspiration and humanity remains with us.

Yoram-you turned out the lights a bit early but we can all see better through the darkness because of you. We're so fortunate. Thanks guy!

love to you all,

brent

Wednesday, May 31, 2006 11:53:13 AM

For those wishing to speak at Dad's Memorial

Those who wish to speak at the Memorial Celebration of Dad's Life on Sunday should please contact Dave Herring. We have asked Dave to coordinate the schedule of speakers.

His contact information:

Dave Herring
dherring@climate.gsfc.nasa.gov
(301) 614-6219

Memorial Celebration of Dad's Life

A Memorial Celebration of Dad's life will be held on Sunday, June 4th at 1pm at NASA-Goddard Space Flight Center. We will announce further details about the exact location as they become available.

We welcome all guests.

No dress code required. Dad would have wanted everyone to wear whatever they are comfortable in. We will be there to appreciate Dad.

To those who wish to speak at the memorial: Please stay tuned for details as we begin to build the program.

Thank you,
Nadav

Services

We will post that information on the blog. Jean

Please stay tuned

While Dad's body may still be alive, we know - sadly - how this story ends. So, tomorrow, we will begin to make arrangements.

I will post more information as we begin to make plans.

one further contribution

My father, the most brilliant, loving, funny, special man on earth is gone. His body is still alive, but there is no sign of brain activity at even the most basic levels necessary for surival.

The Nematol (drug used to induce com) has been removed so that brain function (or lack thereof) can be assessed objectively without any compromising medication. Once his body clears the Nematol, the medical team will remove his ventilator and check for signs of apnea (the body's last attempt to breath on it's own - but also an indicator of at least some very basic brain function). Then, they will measure the blood flow to his brain by tracking it with a radioactive isotope. Results from both of these tests are necessary to legally confirm brain death.

We have given the medical staff direction not to resuscitate dad in the event his heart stops before brain death is confirmed.

We also very much hope that Dad's body will hold on long enough that he can make one further contribution to this world by giving his organs to other patients who can still survive.

Tuesday, May 30, 2006

goodbye

All signs point to brain death, but confirmation will not come for another 24+ hours.

Those of us here have said goodbye.

Nadav

nadavkaufman@yahoo.com

Pupils dialated & fixed.

Pupils dialated & fixed. No gag or caugh. Abba is dying. Pray
- Nadav Kaufman Sent from 9085782573@vtext.com

CPP 80 ICP 10 -

CPP 80 ICP 10 - Nadav 9085782573@vtext.com

CPP < 60 for over

CPP < 60 for over 90min. Worried about dad. :(
- Nadav Kaufman Sent from 9085782573@vtext.com

Lungs still bad. Too unstable

Lungs still bad. Too unstable 4 tracheotomy or CAT Scan.
- Nadav Kaufman Sent from 9085782573@vtext.com

tuesday the 30th: 9:20

While Nadav is running around and taking care of everything and everyone, I (Daphne) am doing the morning update.

We got our morning call from Abba's nurse. The lungs are still the focus now. They're not in good shape. This is a normal complication that comes from being in bed on ventilation for as long as he's been. So, as I think Nadav explained in yesterday's blog, they're trying not to compensate by pumping more air because that stresses his brain, but instead to increase the proportion of oxygen. They want to be pumping at a level of 45-50 percent: right now it's at 80 percent.

Otherwise his other two numbers are OK. HIs ICP was between the mid-teens and 40 through the night and was at 24 this morning.His CPP was 76.

Just I also want to mention how wonderful friends and family are to us. There are three overlapping spheres: there is my parents circle of friends known as "the usual suspects"; there are the legions of friends from NASA and the scientific community; there are friends from my mother's former workplace; and our neighbors who have thanked us for giving them tasks. They take great care of us, and they love my parents so much. Our family has been wonderful- calling from Israel constantly, with local ones visiting as well. We're especially grateful that Abba's brother and his wife, Alex and Rina, have joined us.

Well, off to the hospital and hoping for a good day. But we're prepared (and hoping) for a long period with many ups and downs.

- Daphne

Monday, May 29, 2006

Monday, May 29th 8:30pm - Pressure back under control

Dad's ICP is back under 20. :)

His latest lab results showed a further reduction in his sodium level (good), and an improvement in the serum osmolarity (Serum Osmolarity is a measure of how hydrated or dessicated his cells are). The improved osmolarity made it possible to give him another dose of Manitol. Manitol is a diuretic, so it helps reduce pressure in the brain. The danger is that is also drains fluid from other tissues - hence the relationship with serum osmolarity.

The Manitol brought Dad's ICP back into a safer range. Also, he is gradually being pushed deeper into a coma to minimize his brain activity.

The medical team is now closely observing him and considering options to deal with the fluid in his lungs. Left untreated, it forces them to keep up the pressure in the ventilator so his pulseOx stays high. Additionally, the fluid serves as a breeding ground for bacteria and can lead to pnumonia. He is on two antibiotics as a preventive measure against the pneumonia and other possible infections through his various wounds, etc. (remember there is still an open egress to his brain through one of the skull fractures).

One possible next step to treat the fluid would be to perform a treachotomy to enable better access to his airway. This could help them suction out the fluid.


Also - one amendment to the previous post: In addition to moving his leg and coughing when he was coming out of the coma this afternoon, his pupils were reactive (a good sign).

Dad is fighting for his life, and - complications not withstanding - we think he's winning.

Monday 5/29 7pm - Some Complications

We were warned from the beginning that extended stays in Intensive/Critical care usually involve complications. For example, being intubated for many days puts the patient at risk of Pnumonia (not the case with Dad).

Today, Dad's numbers continued to be very good as Angela was pulling him out the coma. She's taking great care of him. As he was coming out of the medically-induced coma, he moved one leg and caughed (good signs). The trouble began shortly thereafter.

Fluid has begun to build in Dad's lungs and PulseOx (oxygen in his blood) began to drop. The fluid is building because he is unable to caugh it out. To get the pulseOx back up, Angela had to increase the pressure coming into his lungs from the ventilator. This, in turn, icreased his ICP. As of about 6:30pm, ICP was hovering just under 30, and CPP had fallen to 70 and then the high 60s. As long as CPP is above 60, his brain is getting enough blood to provide oxygen and glucose, but we were much happier when it was close to 100 earlier this evening.

Angela is gradually pulling Dad back into a coma to calm his brain, and to reduce it's metabolic needs.

Again - we expected complications. But, this is still a very scary time. We should hear an update in the next hour, and I'll post as soon as I can get back to a PC.

Mon. 5/29 @ 4pm - Holding Steady

Dad's medical team continues to pull back on his medications. His sodium level continues to improve, and they are bringing him out of the medically-induced coma. Predictably, as his brain activity is increasing, his ICP has risen some, to about 10, but it is still well within a safe range. His CPP is in the high 90's (60 min; above 70 is good). We are all holding our breath over the next 24 hours in hopes that he will stay stable. If his numbers are still stable by tomorrow morning, the medical team will begin performing Neurologic exams to determine the location and extent of brain damage. They likely won't be able to provide a precise prognosis, but they should be able to give us a rough idea of what Dad will be facing in the next few months. As his coma continues to lighten, his nurse is closely watching all of his numbers and making all the appropriate adjustments.

Speaking of his nurse... I once again want to stress that Dad is getting excellent medical care. His current nurse, Angela, has excellent, in-depth, clinical knowledge and a firm, yet calming bedside manner. She is both brilliant and caring, and Dad is lucky to have her caring for him. The same goes for the other medical staff that have cared for him before Angela.

Mark Anderson, the Neurosurgery PA who was on site caring for Dad up until this morning, is an absolute gem. He is extraordinarily knowledgeable and experienced, and constantly focused on the care of his patients. His way of explaining Dad's situation - as it evolved throughout the weekend - was fact-based and realistic, yet soothing. Mark is a very special person, and I consider Dad extremely fortunate to have had Mark so involved in his care. Even though Mark's 48 hour shift has ended, he continues to follow Dad's situation and is helping us all through this difficult time. (For his day-job, Mark is in Medical School working on his M.D. - I expect he will make a stellar Physician).

Backing off more of the Medication

Backing off more of the medication. GOOD! It means more tools are avail. again if #s get worse.

Sent from 9085782573@vtext.com

Mon 5/29 12:45pm

ICP 5 or lower. CPP 97. Need a bigger waiting room :)

morning update- good news

This is now Daphne with the morning update on my abba's ("dad" in Hebrew) condition. The numbers are looking good and this was a critical time. HIs ICP is hovering below ten and was actually at 5 when we got the call. His CCP has been above 80 all night and they've been able to almost totally remove the adrenaline drip.

Ilan helped me think of something very important yesterday: pessimistic projections based on statistics do not take into account the most important variable, which is something known to everyone who knows my abba but not to his doctors. That is how much that man loves his life, his family, his science, his friends, and especially my mother. And how calm and strong he is. He will be OK.

Sunday, May 28, 2006

Very Good Care

We'd like everyone to know that we are confident that Dad is getting top-notch medical care. Prince Georges Hospital Center has a very active Trauma Center, and deals with Traumatic Brain Injuries daily.

There are many highly-trained "eyes and ears" watching Dad and caring for him:
  • Dad is assigned a Critical Care Nurse on a 1-on-1 basis at all times.
  • Mark Anderson, a Physician's Assistant in Neurosurgery was on site and very closely involved in his care (hands-on) day and night Saturday and Sunday.
  • Dad's neurological care is supervised by Neurosurgeon Dr. Joel Falik. This Physician is responsible for Dad's neurologic health.
  • Dad's overall care is supervised by a specialized physician called an "Intensivist". The intensivist focuses not only on the neurologic health, but on the health of all of Dad's other organs.
  • My father in law, Dr. Patrick Lawrence, is a very experienced interventional cardiologist, and is involved in Dad's care. He has also helped interpret the medical terms so we better understand Dad's situation.
  • Thanks to Dad's colleague, Franco, Dr. Alessandro Olivi has joined Dad's medical team. Dr. Olivi is Director of Neurosurgery at Johns Hopkins Bayview Medical Center. Dad always said to get 2nd opinions from Johns Hopkins. :)

Some Background - Updated June 1st

Note: The account below has been corrected with additional information that has come to light from accounts of the accident site, from colleagues who were with Dad shortly before his last bike ride, and from my visit to the site of the accident.

To fill everyone in on some background on the events of Friday afternoon (May 26th):

  • Dad was struck by a black SUV while bicycling on Soil Conservation Road.
  • Dad was found unconscious on the road.
  • Emergency services arrived on the scene quickly, and he was taken by helicopter to Prince Georges Hospital Center just outside Greenbelt, MD. Dad's colleagues, Ilan and Vanderlei, estimate that he was in the ER within 20 minutes of the accident.
  • He was unconscious upon arrival. At this point, he was rated a 6 on the Glascow Coma Scale (GCS).
  • 1-2 hours after arriving, Dad regained consciousness. He responded to directions from the medical staff. His GCS was upgraded to "8-10" - which is almost as high as someone can get when they are intubated. Mom held his hand and he squeezed her hand. She thanked him and told him she loved him. He squeezed again.
  • That night, a special "bolt" was installed in his head to measure his Intracanial Pressure (ICP). Whereas normal ICP is about 5 mmHg, he peaked around 45.
  • For the continuation of this time-line, please go to the bottom of the Blog.

Sunday 5/28, 10pm

Nurse just called with an update from the Critical Care Unit. His ICP is down to 6 (Terrific!!), and CPP is 80 (also great!!). With these numbers, the medical team will start to reduce the medication that is keeping his blood pressure high (it is being administered to maintain CPP).

Also, he was given another blood transfusion.

Comments are Welcome

To all of our wonderful family and friends:

Please feel free to respond to any posting in this Blog by clicking on the "Comments" link at the bottom of one of the postings. If you prefer that we keep your comments private, please write "PRIVATE" at the end of your comments.

I will review and publish non-private comments daily.


Our warmest thanks for the tremendous ourpouring of support and concern from so many wonderfuly people. We are deeply touched, and look forward to sharing this with Dad so he understands how much he is loved.

- Nadav and Family

Sunday 5/28, 9pm

Dad's situation is holding steady, with even some improvement.

His ICP is about 10 (under 20 is good), with CPP in between 80 and 90 (60 min; over 70 is good). The medical staff have been able to cut back the barbituates by half (these were used to induce a coma to calm his brain and minimze the swelling). His sodium level is slowly falling (this is good).

He was infused with Fresh Frozen Plasma to help his clotting.

His most recent CAT scan, from 9am today, indicated new/increased edema (swelling) in the left cerebellar region, in addition to the existing edema in the both the right and left frontal lobes. There are also hemmoragenous contusions in his right temporo-parietal region. To view brain maps to make sense of all this medical jargon, go to http://www.biausa.org/Pages/brain_maps.html
Or click here to view a Glossary of Neurosurgical Terms

The next 24 hours will be critical. If his numbers stay the same or improve during that time, his progosis will be much better.

Sunday, May 28 - 4pm

It has now been 48 hours since Dad's accident.

The Ventricular Catheter installed last night has done a good job of keeping his ICP down. However, his Neurosurgeon explained to us that his condition is still "grave". He has seen patients pull through from this state in the past, but the odds are against him.

The CAT scan this morning revealed significant damage to the frontal lobe, bilaterally. This is the area of the brain that enables Dad to think, feel, react, etc. There are also signs of damage to the back of the brain. While the resolution on the CAT scan isn't good enough to see it, the Neurologist thinks there is a strong chance that Dad has Diffuse Axonal Injury. It is an injury caused by accelleration/decelleration of the brain (the brain sloshing back and forth inside the skull). This injury causes a shearing of the axonal connections of the brain.

The Diabetes Insipidus also continues to be a problem. His body is excreting too much water, and not excreting enough sodium. So, Dad's sodium levels are too high. This is caused by the pressure being exerted on the pituitary gland, which is responsible for releasing antidiuretic hormone (ADH), also called vasopressin.

Another complication now is that Dad's clotting mechanisms are not functioning properly. The medical staff has not yet identified whether this is due to the large amount of clotting capability that was consumed by the many soft tissue injuries, or for some other reason. If it is simly that the clotting capability was consumed, then a couple more units of blood should help. If not, then any surgery would be out of the question due to risk of bleeding.

I mention surgery because - if Dad's ICP were to begin climbing uncontrollably again - the only remaining option would be surgical removal of the right and left, frontal, portions of his skull. Removing these bones would allow more room for the brain to swell without further damaging itself. However, there is little evidence to date that this very invasive procedure reduces mortality or morbidity. Furthermore, if Dad were to survive such a surgery, he would likely be left with very severe cognitive deficits (much like someone who has survived a severe stroke).

The next 24 hours will be critical. If the swelling plateaus, if his ICP is stable and low (below 20 is good/normal is about 5), if the Cranial Profusion Pressure (CPP) [the net of his ICP and blood pressure - meaning how well his body is getting blood to the brain] stays good (60 minimum, 70+ is better), and if the complications don't get worse, then Dad could still recover. The extent of permanent brain damage will not be known for several days yet.

Nonetheless, we are hopeful. I bought a monthly parking pass for the garage at the hospital.

Image of the Week - by Yoram Kaufman

The Image of the Week on the Climate and Radiation Branch at NASA GSFC was submitted by Yoram to be posted beginning today.
Climate and Radiation Branch web site - http://climate.gsfc.nasa.gov/

Sunday May 28th 8:30am

Yoram is stable. His numbers are good. He will get a cat scan at 9:00 am.
Jean

Sunday 5/28, 3am

While the medically-induced coma helped did help for a few hours, ICP rose again early this morning. Another CAT scan (his fourth) revealed increased swelling in the temporal lobe. His Neuro-surgeon installed a Ventricular Catheter to releive the pressure. This is a catheter into the brain to drain brain fluid. This therapy has brought his ICP down below 20 again.

He has also developed some problems with Diabetes insipidus, meaning that his kidneys are not retaining enough water. So, too much water is excreted in urine and the sodium levels rise in the blood. His medical team is responding by actively pumping more fluids into him.

Saturday, May 27, 2006

Saturday, May 27th 9:30pm

Yoram has been in a medically-induced coma to reduce the pressure inside his skull for about two hours now and is responding well to this therapy. His Intra-Cranial Pressure (ICP) is down to 11 (under 20 is good). Earlier this evening, the ICP was in the mid-30s, so we we're all very pleased to see it down so low!

PG County Hospital Info

Prince George's Hospital Center (H)
3001 Hospital Drive
Cheverly, MD 20785
(301) 618-2000

From GSFC:

Go south on BW parkway
Hospital is on the left around exit at Rt 202 (Landover Road).
Follow "H" signs.

Visiting hours at the Critical Care Unit:
  • 11am - 12noon
  • 2pm to 3pm
  • 5:30pm - 6:30pm
Note that only family is being allowed in to see Yoram. However, everyone is very welcome in the waiting room outside the CCU at all times. Yoram's family will be there intermittently from 11am to 7pm daily.