Here's a summary. The detailed messages follow:
Surgical Summary - Friday, Oct. 13, 2006
Surgical check-in was at 5:15 a.m, Friday, Oct. 13th and she went she went back for surgery. Tumor removal was expected to take from 2 to 4 hours depending on how much tissue and bone would need to be removed. Reconstruction was expected to take 8 hours or more. The first report from the surgeon was positive. They were able to remove all of the tumor. To ensure complete removal they cut out a bit of good bone and tissue with the tumor and test the areas around the margins. All of the margins tested negative, meaning there was no spread of the cancer beyond what they took out. Unfortunately, they had to remove a good portion of the eye wall on the bottom side. A surgical nurse reported in every two hours and indicated that surgery was going well and Madison was doing fine. After nearly 12 hours, another report from surgery indicated the doctors had been working for several hours under a microscope to graft everything together as they work to rebuild Madison's face. They closed up the thigh where they removed tissue for the graft. After more work, Dr. Holsinger stopped by to check on Madison. He said that the plastic surgeon was finishing up. He seemed very pleased with how everything went. Madison will be under sedation throughout the weekend due to intubation tube (for breathing). He said we should prepare ourselves as there will be a lot of swelling. This swelling was of such concern that they were considering a tracheotomy tube. The good news is that he does not think it will be necessary. Finally, after 14 hours of surgery, 7:30 AM to 9:30 PM, they finished. God was certainly in all of this. Dr. Hannasono indicated that this was a very difficult surgery and that he was very pleased with the outcome. She was moved to ICU where she will remain for several days. For more information, see the updates below. They include the days following the surgery.
Messages sent during the day from Dennis and Renee
Message #1
Dear Family and Friends:
At 5:15 this morning we arrived at surgical check in. At approximately 7:20 she went back for surgery. The portion of the surgery involving the removal of the tumor and surrounding material will take from 2 to 4 hours depending on how much tissue and bone must be removed. Then the rebuilding will begin which will take 8 or more hours. The surgeon still felt very comfortable about the surgery and the prospect for a complete cure. They have indicated that they will provide updates at various points of the surgery. We do not expect the first update to occur until sometime after 10 or 11 central time which is 11 to 12 on the east coast. My last prayer before she went back was for God to allow the surgeon to see totally healthy lower eye wall. This would allow them to forgo any removal and reconstruction of the eye socket. Please focus on this in your prayers at this time.
PS All three of us are comfortable with how things are going and we all have that peace that passes all understanding. We have no fear!! In fact the only thing Madison is concerned about is the feeding tube. As they were wheeling her away she told the surgeon in a stern voice that she would not need the feeding tube for more that 2 days!! His reply, "I bet you wont, Madison."
Message #2
Dear Family and Friends:
We just received a report from the surgeon and it was positive. Dr. Chris Holsinger was successful in removing all of the tumor. When they take the tumor out it is like finding a bad spot in an apple. You don't want to scrape just the bad spot because you don't know how far into the good part of the apple it went. What you do is cut out good apple from around the bad spot and you do it n such a way that you do it on one swoop. This may seam a little silly but I thought it might be helpful in understanding that he did not take the tumor out in a big glob. In fact he never touched the tumor. Instead when he got close to the area he worked his way around the tumor while staying in good (non cancerous) tissue. As a way of testing to make sure they got all the bad stuff they then take a little more tissues from around the area which are called margins. This is the same concept of "margin of error". The good news is that all of the margins tested negative, meaning there was no spread of the cancer beyond what they took out.
The disappointing news was that he had to remove a good portion of that eye wall on the bottom side. The plastic surgeon has begun his part of rebuilding her face which will include rebuilding this lower portion of the eye socket. This is a very difficult task as the eye socket must be rebuilt nearly perfect in order for Madison to retain good vision. There is a strong possibility that this would not turn out perfect and she would end up with double vision or vision impairment. As a result she would need to undergo additional surgery(s) in the future. That brings me to our current prayer need. Please pray that the plastic surgeon, Dr. Hannasono, will be able to perfectly reconstruct her eye socket and that the grafts they are using from other pats of her body will "take" and have good blood flow.
Another part of this complex issue is that they removed the roof of her mouth on the left side and the plastic surgeon is working to rebuild that as well. The concern is that the titanium plate and the grafts must be shaped perfectly. If it is not it could impact her ability to swallow food, her speech and the way she sings! Please add to your prayer that the surgeon will perfectly shape the titanium plate and the grafts in her mouth.
Message #3
Dear Family & Friends:
Thank you for praying for us! Dennis and I are very much at peace, and although very tired, we have had a good day together. We have listened to Madison's CD on the computer, prayed, and talked. A surgical nurse reports to us every 2 hours to let us know that Madison is doing well and that the surgery is going smoothly. It is 3:00 Houston time and we are still expecting to wait through the early evening for the 2nd surgeon team to give us a report. The last part of the surgery will be done by Dr. Martin, a dental oncologist.
The day has gone by somewhat quickly. (This is an answer to prayer!) We have been blessed by emails from all over the US & Canada today. Each email is an enormous encouragement and reminder of God's grace and love for us and especially for Madison today. Thank you for letting us know that you love and care for our family.
We will update you as we know more......
Message #4
Dear Family and Friends:
It is nearly 12 hours into Madison's surgery and we just received another update. The Dr. has been working for several hours under a microscope to graft everything together as he works to rebuild Madison's face. They have closed up the thigh where they removed tissue for the graft. I can only assume that fatigue will soon become a factor if it already isn't one now. Please continue to pray for the perfection of the graft and reconstruction as well as the surgeons and staff in the OR that they will be renewed with supernatural energy that only He can give!
The next update will come about 8:00 tonight.
Message #5
Dear Family and Friends:
We just spoke with Dr. Holsinger. He was stopping back by to check on Madison. He said that the plastic surgeon was finishing up. He seemed very pleased with how everything went. Madison will be under sedation throughout the weekend due to intubation tube (for breathing). He said we should prepare ourselves as there will be a lot of swelling. This swelling was of such concern that they were considering a tracheotomy tube. The good news is that at this point he does not think it will be necessary. We will see Madison briefly and then return to our hotel room for the night. Madison is completely sedated and they will not even attempt to wake her until tomorrow. Even then it will be only brief times that they bring her out. Hopefully by Monday she will no longer require the intubation tube.
Thank you for your prayers today. We have had a perfect peace knowing that she was being lifted before God.
Message #6
Dear Family and Friends:
It is finished. After 14 hours of surgery 7:30 AM to 9:30 PM, they are done. Now it is up to Madison. God has certainly been in all of this today. From the surgery to the all those who have been interceding on her behalf.
Now God and only God must begin the healing. It is interesting to think that the surgeons, using the talent and skill that God has granted them, can only put things in position for healing. God must conduct the healing. Certainly makes sense since He and only He created her!
We spoke with the plastic surgeon, Dr. Hannasono, a few minutes ago, He told us that this was a very difficult surgery and that he was very pleased with the outcome. She has a feeding tube that will remain for about a week or so. No teeth on the left side.
Right now they are moving her to ICU where she will remain for several days. In about 20 minutes we will go and see her briefly and then return to the hotel. This will be somewhat difficult for Renee and I as we, almost without exception, have never left Madison alone in the hospital. She will be sedated for a couple of days so she won't know we are gone.
I only had about two hours of sleep last night so I am not sure any of this is making sense. Bottom line - everything is good. God's been better to us than we deserve.
We will send out another update sometime tomorrow afternoon.
Messages sent in the days immediately following surgery
Saturday's Update
Dear Family and Friends:
I sure am glad that the afternoon spreads out over a long period of time or else I would not have been true to my word of sending an UPDATE out this afternoon. It's 4:30 local time here in Houston and today has been a pretty laid back day. We finally got to the room last night around 11:00 and it took us about 3/10ths of a second to fall asleep. We woke up this morning around 10 and drug ourselves out of the bed. I probably could have stayed there all day if it weren't for our deep desire to check in on Madison!
She has all kinds of tubes and probes running in to her body. Renee broke down last night when we saw her for the first time since surgery. Madison really didn't look bad and I thought she looked fairly good considering all things. She had a little swelling and has stitches where they closed the incision. The incision starts at the middle of her upper lip and runs up to just under her nose. It then moves to the side and up the left side of her nose to just under her left eye. At that point it crosses under her eye to the outer edge of her eye and stops. Needless to say it is disturbing to see her laying there essentially unresponsive with stitches across her face.
Madison had a good night last night; resting well throughout. When we saw her today the swelling was much greater, but not as much as some of the previous surgeries she has had in the past. Today we saw the incision on her leg where the bone graft was taken. It is on her right thigh and is in the shape of a giant "S". It extends from her knee all the way up to her hip. I told Renee that the "S" stood for "Super Girl" cause that is what she is.
The plan right now is to keep her completely out until Monday when they will wake her up after removing the breathing tube. The kid definitely has a long recovery ahead of her. I am confident, however, that she will meet this challenge as she has done every other challenge put before her this last 4 plus years. It will be with a positive spirit and a "get'er done" attitude.
We have received a lot of emails over the course of the last couple of days. Each one of them offering words of encouragement which we appreciated. One of those emails had a statement in it that really got me to thinking. It read, "I cannot doubt for one second that this ugly period in your family's life is not just about over for once and for all." I completely understand what he was saying and appreciated every word he wrote. The haunting words that got me to thinking was "this ugly period in your family's life". While this period has indeed been challenging I don't think we will ever be able to look back at it as an ugly time in our life. A lot of people may say that, but I just don't think we will.
Over the course of this last 4 years we have had challenges that no one should have to endure. Yet, all through this time we have seen God do incredible works. We have done things that we would never have done; seen things that we would have never seen; and experienced a world we would have never known. God has performed miracles right before our eyes. He has taught us to trust like never before. He has brought us new friends we would have never known, and He has allowed us to better understand what it means to be a part of the family of God.
So yes, we are hoping that this particular journey is about over. It has been a long one and we are tired, however, it has been anything but ugly. We have seen the light of the Lord, experienced His grace, mercy, and healing. We are not the same as were were and we are better prepared for the next journey He will take us on. Therefore, I will close with this -- thank you God for this "ugly" period of time.
Sunday's Update:
Dear Family and Friends:
Today is our 2nd day in the ICU waiting room. We are only about 20 feet from Madison's room and we are able to check on her periodically throughout the day. The surgeons check on her 1-2 times daily and are very pleased with what they see. Although she is more swollen today than yesterday, they are happy with her progress. She will be intubated until Monday around 9 AM. Although she has been heavily sedated, she opened her eye (the left one is swollen shut) and looked several times. She has communicated to the nurses and doctors by blinking her eye, using sign language, and giving the "OK" thumbs up!
Renee and I went to a late dinner last night and then came back to Madison's room to say goodnight. When we walked in, her nurse said Madison had been trying to communicate, but she wasn't sure what she wanted. This all amazes them. First, that she is communicating and "waking up" and second that she is not trying to pull out her breathing tube when she does open her eye. They said she is a very smart girl and she listens to everything they say! I was giving her her blessing; something I have done with all my kids since they were little. She reached for and held our hands and then took my hand and spelled out the letters....P-E-N. We got her a pen and paper and she wrote, "I CANNOT FEEL ANYTHING EXCEPT MY RIGHT EYE". Of course this took her a long time and she wrote very weak, but we were impressed that she jotted a complete thought. We explained to her that her other eye was there, just swollen, and that she was feeling funny because she was under a lot of medicine to make her sleep. She also communicated for her eye to be wiped as well as some blood that was running from her mouth. She communicated with hand gestures only. The next thing we tried was a communicating device they have in the room. It looks like a toddler typewriter keyboard with alphabet buttons and a space bar and then some picture buttons. Madison took the board, but was too weak to push on them. After a few minutes we figured out she was trying to type, "I LOVE YOU". This melted our hearts! I cleared the board and typed out, "I LOVE YOU TOO"! Although her face is swollen, I could tell she tried to smile because her ear wiggled a bit! We left shortly after that so she would rest.
This morning when we came in they had sedated her even more because she had been moving her head too much and draining blood from her nose. Although she is sleeping today we saw a note that she had written to the nurse this morning that said, "CAN I HAVE JELL-O?" This really broke our hearts because we know she must be hungry. She has had no food since Thursday evening. Until they bring her out from under sedation they are only able to give her water though the feeding tube. Even after that it will be a while before she is allowed to have even Jell-O.
When you walk into the room it is overwhelming to see all the tubes! She has 2 IV's, her IV port in her chest is accessed. She has a feeding tube in her nose, and a trumpet tube in her left nostril to keep it from swelling. A tube down her throat to maintain her airway. She has 2 drainage tubes-1 implanted under the skin on the left side of her neck and one in the incision in her right leg. She also has a catheter and then the tubes for her receiving blood, electrolytes, and antibiotics. We just stay focused that this is all temporary and required for her to get better.
The best way you can help Madison right now is to pray. We are not sure how she will react to: the incision on her face; or the missing teeth on the left side; the incredible pain she will have to endure during recovery; or to the huge incision on her right leg which is in the shape of an "S" . It starts above her knee and goes up toward her hip. In all it is probably 15 to 20 inches long. We know she will hate the feeding tube and catheter because she already told us she would if they put them in. Please pray that God will give her strength and wisdom beyond her years. She is beautiful to us, no matter what her face looks like, because she is BEAUTIFUL all over and a very brave young lady!
One final request. Renee and I were talking yesterday and marveling at all the people who are praying for Madison. Literally we know that people all around the globe are interceding on her behalf. What we are asking is for you to communicate that you are praying by sending Madison a post card. If you read this email PLEASE send Madison a postcard. You can simply write, "We are praying in (city, state, country)" If you cant get a post card just send her a brief letter or card. We are going to get a big map and place a mark on the map of every place she receives a card from. Please do not send it to the hospital instead send it to the Statesboro address below. That way if it gets delayed in the mail or you do not read this email for a couple of weeks after it is sent it will eventually get to us.
We will do our best to keep you updated on Madison as we go through the coming days.
Dennis Merrifield