Surgery Day.

Visited by OT/PT who evaluated Joe's condition to get a baseline before release. They noted his guarded gait as he walked. Assessed his radial range and measured his proprioception — kinesthetic memory. Conclusion: safe to ambulate. Walker with handrails at wrist crease.

Joe also walked up and down a flight of stairs with their assistance. All motor functions appear intact.

The neurosurgeon who performed Joe's procedure informed the family that post-op therapy does not need to be inpatient — it can be done at home. A significant change of course. Plans had been in motion for extended-stay quarters for mom and dad. That chapter just closed. He's going home.

Out of the four facilities the case manager presented, the family chose Vanderbilt Physical Medicine and Rehabilitation at Stallworth. It's on the Vanderbilt campus — familiar ground, known staff, and walkable from where family will be staying in case the car situation gets complicated.

Sometimes the right call is the one that just makes logistical sense.

Case manager stopped by with a concrete plan: four inpatient rehab facilities in the Nashville area, each offering 7–10 days of physical and occupational therapy. Joe's team will need to choose one.

Mom and dad are working through what comes next — logistics, timing, who's where. That conversation is happening now.

The pain hasn't gone anywhere. But it's becoming more manageable — and that counts.

Spirits are high. The goal is still out there: move, run, do the things. That day is coming.

Nurse cleaned the incision site this morning. The ice pack was removed — there was some redness, not on the incision itself, but in the surrounding area. Unexpected, but being monitored.

The neurology team came through early. Expecting to hear back around 10 AM with a plan for a potential 10-day inpatient OT/PT stay. That meeting is coming.

Both parents will be here for it — along with breakfast, which is maybe the more anticipated arrival.

Using the restroom is becoming easier. But standing up still brings dizziness — and something harder to name. An unmoored feeling. Like the body hasn't fully caught up to where it is yet.

Got a case of the hiccups. His nurse came in and pressed two fingers on either side of his chest, just below the neck — right at the top, not on the throat. The hiccups stopped.

She was hitting the nerves in a way that just cut them off. Worth knowing.

MRI came back clean. No tethered cord — the spinal cord is floating freely, exactly as it should be.

The only notable finding was mild early degenerative disc change at L5/S1, minor and not a concern right now. One less unknown.

All IV drip medications stopped. New oral meds administered to find what's needed to keep the sharp stabbing pain out of the 9–10 range.

MRI scheduled for 3:00 PM today to assess the lower spinal cord. The team is checking whether the cord is tethered — meaning abnormally attached to surrounding tissue — when it should be free-floating. If confirmed, it could help explain additional symptoms beyond the Chiari.

Visit from the neurosurgery department — pain assessment, incision inspection. Decision made to remove all drip medications and transition to oral pain meds and muscle relaxers.

Blood drawn for lab work.

Discussions included the non-stop flow of helicopter landings and takeoffs last night. Vanderbilt Medical Center has a trauma center that serves the needs of many from afar.

The outpouring of concern, love, and support from friends, family, and neighbors has been incredible. It is good to be able to share good news of Joe's progress.

The pain team stopped the Lidocaine and will titrate the other meds to replace the Lidocaine and Ketamine.

The neurosurgical team has ordered an MRI to rule out a tethered spinal cord — a condition where the spinal cord becomes abnormally attached to surrounding tissue instead of floating freely as it should.

The hypothesis on the table: a tethered cord can pull the spinal cord downward, which may contribute to — or worsen — the downward displacement of the cerebellar tonsils that caused the Chiari in the first place. If the cord is tethered, it could help explain symptoms Joe has been dealing with that the decompression alone may not resolve.

This is not a confirmed finding. The MRI will tell them what they're actually dealing with.

Headwrap came off this afternoon. Doctors say removing it should take some pressure off and help with the pain. The view from the back of his head? Staples, incision line, the whole nine. Frankenstein's got nothing on him.

Pain Team physicians assessed Joe and determined he needs to stay on the full current protocol — Ketamine, Lidocaine, Oxycodone, and Gabapentin — to keep the pain manageable. No changes to the regimen.

Goal going forward: get up and walk four times a day.

PT and OT came back on Day 2 and got Joe out of bed — walked the floor, then put him in a chair for a bit. First time on his feet since surgery.

Discharge planning is underway. Primary plan is returning to his mom and dad's house. A short-term rehab stay will depend on what therapy recommends.

Pain sitting at an 8 or 9 as the morning started, concentrated in the back of the neck. Joe asked for Oxy at 7 as it was picking up. He still can't rotate his head at all — he's been asking staff to stand directly in front of him when they talk. He wants to look people in the face. That matters to him.

Bladder still not cooperating on its own. Second straight catheterization of the night at 6 AM. The first one earlier in the stay had some difficulty — this one went smoothly. Matt made that clear. Small mercies matter at 6 in the morning.

Joe said he was able to sleep throughout the night — a meaningful improvement. He came into the morning more alert and responsive than the day before. The consistent painkiller regimen played a big role in letting him actually rest.

The team wants an MRI of the lumbar spine to check for a tethered cord, which could explain the syrinx. Joe declined — specifically because his pain is not controlled right now. Not a blanket refusal. His position: manage the pain first, then have the imaging conversation.

He asked Grace to bring Dr. Potter in. If a tethered cord is found, Joe needs to understand the actual plan — including whether another surgery is on the table — before consenting to anything further. That conversation has to happen first.

Grace ran the standard neurological assessment: grip strength, hand pulls, eye tracking, orientation questions. Joe correctly identified his name, location — 6th floor, Vanderbilt — and the year. He noted he keeps wanting to say 2025. Relatable in the fog. Oriented times three.

Blood sugar came in at 136. Not alarming, but worth tracking given the post-surgical stress response. Oxygen dropped when he tried to get up yesterday, so he's staying in bed until PT and OT arrive to evaluate him today. There's talk of a 10-day inpatient stay — that's a lot to process from a hospital bed.

Matt came off a solid night shift. There was roughly a 20-minute gap in coverage — charge nurse held the floor while Grace was in transit. The unit had some chaos overnight with another patient, but the staff handled it without it touching Joe's care.

Matt is back tonight for another shift. Joe is genuinely glad about that. They've built some rapport, and continuity matters when you can't turn your head and you're asking people to stand in front of you to hold a conversation.

The IV pump alarmed overnight due to an occlusion in the lidocaine infusion line. Nursing assessed and corrected the issue. A bag of IV fluids was available to start, but Joe already has two IV lines in place. Since the lidocaine was ordered for 24 hours and is nearing completion, the team opted not to place a third line.

The ketamine infusion remains active and is ordered for 48 hours.

Nursing shift change brings in a new care team for the next 12-hour shift. Neurological assessment completed — similar to what's done to check for stroke symptoms. All is good.

Fresh batch of cold cubes for the third time today. The small things matter in recovery.

After settling into the new room, Joe's new care team meets with the ICU nurse to exchange notes. Nurses inspected the bandaging on the back of his head — a.k.a. the zipper.

Dad calls Joe by his new nickname: Zipper Head.

The zipper. Proof he made it through.

Transport from the Neuro ICU to the Neuro Step-Down Unit completed. Out of the ICU — that's forward progress. New nurse had a great shirt on.

New nurse, new unit, same mission.

Attempt to urinate fell short. In-and-out catheter method used to drain the bladder. Standard post-op — the body's still waking up from six hours under.

As of 12:45 PM, the Ketamine drip was doing its job well enough to bring the pain down from a 10 to an 8. Not comfortable — but movement in the right direction.

After several attempts to empty his bladder on his own, the team used a catheter at 11:50 AM. Urinary retention is a known side effect of the opioids and anesthesia used in major surgeries like this. Routine intervention — the team handled it.

Both the physical and occupational therapy teams came by at 11:05 AM and recommended 10 days of in-patient care. They tried to do a physical evaluation — getting him up and out of bed — but he was either too weak or too relaxed from the Ketamine to manage it. They came back the next day to try again.

The case manager stopped by at 10:30 AM and recommended in-patient physical and occupational therapy. The team was already thinking about what came after the ICU.

The ICU nurse started a Ketamine and Lidocaine drip at 10:05 AM. Both are used for complex post-surgical pain — this was a serious pain management protocol, not a light touch. They meant business.

The pain management team visited at 9:05 AM. Their care plan was sent to the surgeon for approval. It was in motion — they weren't waiting on it.

Dr. Lee came by for rounds at 8:15 AM. He confirmed the surgery was a success and acknowledged that Joe's pain needed to be better controlled. The hard part wasn't the surgery — it was managing what came after it.

Out of PACU and into the ICU. He made it through recovery. His family was with him.

Two and a half hours in. This was the duraplasty — the part that takes time on purpose. Each stitch placed under magnification. No updates right then wasn't a bad sign. It meant the team was doing exactly what they were supposed to do.

An update from Joe's mom: "Just received an update via text. Procedure is still underway. Patient is doing well."

All pre-op work was done. Joe was ready. Dr. Lee was finishing up another case — the moment he was free, Joe headed toward surgery. Hurry up and wait. He was right there.

IVAC came by at 10:56. Walked him through everything — agents, airway, how they'd bring him up afterward. Joe knew what all of it meant. He'd cared for patients in exactly this position. That day he was the patient. Nurses were prepping him.

IV in. Vitals running. The anesthesia team had been by. That was the last hour before everything changed. Family was still right there.

Checked in at 10:38. They asked him the same questions he'd already answered twice — that's by design, not incompetence. Family was still with him. They stayed until the OR doors.

He was there. 10:15 AM. The address he'd had in his head for weeks was now a building he was walking into. Family was with him. Two hours until they called him back.