intubation – Page 2 – Tale of Two Parents

Taking it one hour at a time

Published on October 12, 2016October 14, 2016 by mellowdee551 Comment

sunflowers1 July 24, 2015. The call that we dreaded from the hospital during the night hadn’t come. We didn’t know what to expect today, but we had to take it one hour at a time.

When Mom and I arrived at the hospital, we found that Dad was back on dialysis, for the fourth time this week. According to Andrea, his nurse, Dad was less responsive this morning, which was not what we wanted to hear. She added that, according to his morning lab work, he was still suffering from metabolic acidosis. She had been able to wean him off of one of the vasopressors, but his blood pressure dropped below 65 MAP during dialysis, and they had to restart the vasopressor. When I asked her about his WBC count, she told me that it was up to 18.9, a 300% increase in less than 48 hours.

Dr. White started his rotation today as the attending physician. We now had what seemed like a long relationship with this doctor, and he didn’t pull any punches with us. He told us that because of all the vasopressors that Dad was taking for his low blood pressure, his toes were being affected and he might lose a couple of them. The doctor strongly suspected that Dad’s circulation problems would begin to move up his extremities. Dad’s liver was also in shock, and the good doctor said that he was surprised that Dad had been able to withstand the dialysis. He also stated that Dad’s pupils were nonresponsive and he did not withdraw from pain, even when taken off sedation. He reiterated Dr. Sanchez’s prognosis from yesterday in that he did not expect Dad to survive this episode. At the end of this uplifting visit, Mom and I felt that we might need to make a decision tomorrow or Sunday.

Pastor Don stopped by around 1:45 P.M., and Mom and I had a very emotional visit with him. I just couldn’t believe that this was happening, and Don said that it was OK for me to be mad at God. I was mad, frustrated, and heartsick, but I don’t think that I reached the point of being mad at God. Among other things, Don asked us if we had considered hospice. I wasn’t sure whether hospice care was available at the hospital or some other location. At that point, I hadn’t considered anything, and I wasn’t ready to think about it.

Shortly after Don left us, I walked over to the north tower to visit with some of the CTICU nurses. I found a couple of our favorite nurses and provided them with a brief update on Dad’s status. When I returned to Dad’s room, I learned that Andrea had been able to wean Dad off of two of the five vasopressors, and his blood pressure seemed to be stable. This was the first good news since Dad’s return to Memorial, and I could feel myself exhale. I said a silent prayer that we could wean Dad off the remaining vasopressors before he lost any extremities.

Later in the day, Pastor Don stopped by again with his wife, Wynn. Mom had met her two nights earlier, but this was the first time that I had met her. I found her to be delightful and I was pleased to learn that she worked in the chaplain’s office at the hospital.

Vasopressors increase blood pressure by constricting the blood vessels. This constricting of blood vessels is particularly acute in the extremities and in situations like Dad’s, toes and fingers sacrifice blood flow for the benefit of the vital organs. Andrea tried to find Dad’s pulse in his feet with her hands, but couldn’t. She eventually was able to find a pulse in both feet with a Doppler ultrasound. The relief among those of us in the room was palpable when we heard the sound of blood flow.

Mom and I went home for dinner and returned to the hospital at 7:15 P.M. Charlie, the respiratory therapist, had just finished Dad’s trach and oral care and ventilator maintenance. Dad was still on three vasopressors. Mom and I met Donna, the night nurse, before leaving for the night. She told us that Dad had additional blood draw after dialysis and that his WBC count was now 22.7, up another 4 points from this morning. His WBC count hadn’t increased at this rate since his first aspiration episode in May.

I should have been encouraged that Dad had survived another day, but I was concerned about Dad’s worsening responsiveness. I couldn’t stand the thought of losing him without being able to communicate with him one last time. I had mentioned to Andrea that I wanted to talk with a respiratory therapist to see if there was a way in which we could communicate with him.

July 25, 2015. Mom and I arrived at Dad’s room at 7:15 A.M. We were pleased to see Andrea again, but nurses work only three days each week, so we knew this was our last day with her. Dad’s WBC count was now 19.2, down slightly from yesterday afternoon, his hemoglobin was down, and his acidosis condition had improved to the point that he was now slightly alkaline. Dad had been receiving a bicarbonate drip, which they now decided to stop. The vasopressors were still affecting the blood flow in Dad’s feet. We held our breath again as we watched Andrea struggle to find a pulse with the Doppler ultrasound.

Dad was sleeping a lot, and Andrea said that he was not responding to commands, but he opened his eyes for her. He opened his eyes for me, too, but I couldn’t get him to squeeze my hand.

Charris, one of the residents assigned to Dad, told us that when Dad arrived a couple of days ago, they performed a mini bronchoscopy on him to take some cultures from his lungs. They now knew that in addition to the aspiration pneumonia, he also had an infection (pseudomonas) in his lungs. Severe cases of pseudomonas generally occur in people who are already hospitalized with another illness or condition, or people who have a weak immune system. It seemed that everything that ailed Dad now was hospital acquired.

Dr. Pan, the nephrology resident, stopped by and told us that because Dad was not very acidosic and didn’t seem to have much extra fluid, they would not dialyze him today. He said that the nephrology team would assess Dad on a daily basis to determine whether to dialyze.

Dr. White stopped by during rounds at 8:00 A.M. He agreed that we’d seen a slight improvement in Dad since yesterday–probably due to the dialysis. He was able to feel the pulse in Dad’s feet with his hand, and he said that Dad’s feet looked better than they did yesterday. I knew that I shouldn’t have been so concerned about his toes when his life was at stake, but I was relieved that the pulse in Dad’s feet was getting stronger as they weaned him off of the vasopressors.

Now that Dad was back on the ventilator, he couldn’t talk. I got some wild idea yesterday that I had to give Dad a chance to communicate with us if he was going to die. Andrea said that she would contact the respiratory therapist to see if it would be possible to enable him to talk. The respiratory therapist contacted Svenja, the Trach Goddess of Scott & White. We hadn’t seen her since June, when she first changed Dad’s trach. When she heard about Dad’s condition and our desire to communicate with him, she agreed to give it a try. Unfortunately, all of her efforts failed to work, and we probably sapped some of Dad’s strength. The exercise woke him up for a couple of minutes, but he fell asleep almost immediately when Svenja reinflated his trach collar.

When Mom and I returned from a lunch break, we found that Dad was still asleep and impossible to rouse. Most of his vitals were still good, but Andrea told us that his platelet count had dropped, and he needed a platelet transfusion. We sat in the room with Dad for a few more hours and finally went home for dinner. It was difficult to stay in the room with him in his current condition, but it felt worse to leave him. Although his vitals were stable, his condition was still grave, and the failed attempt to communicate with him had wilted my already sagging spirits.

We returned to the hospital at 7:00 P.M., in time to meet Tyler, the night nurse. Mom and I liked him immediately, and he seemed intent on weaning Dad off of the vasopressors. While talking with the nurse, the respiratory therapist, also named Tyler, attended to Dad’s trach, the ventilator, and Dad’s oral care.

Before we left for the night, Tyler put some lotion and booties on Dad’s feet to help with his peeling and cold feet. Tyler told us that he would be working for four nights that week, and we really hoped that he would be assigned to Dad. When Mom and I left for home at 8:30 P.M., we felt a small sense of optimism that Dad would have a good night, and maybe we would too.

And the nightmare begins again

Published on September 27, 2016 by mellowdee553 Comments

sky Wednesday, July 22, 2015: 3:45 P.M. I had just left a meeting at work and listened to the voicemail that my mother left 40 minutes earlier. “Melody, it’s Mom. I’m at the hospital with Dad and he’s not doing too well. He had a bad coughing spell during dialysis and they’re trying to bring his blood pressure down, but he’s got the shakes and delusions and all kinds of stuff. Call me on my cell, because I’m not going to leave him. Talk to you later. Bye-bye.”

A tingly feeling crept up my neck and face, and I hoped that she was overreacting.

Earlier that day, Dad was wheeled to the dialysis room on the second floor of the CCH. His WBC count had been holding steady at 5.6, but his creatinine level was still elevated. His stubborn creatinine levels prompted his nephrologist to predict that Dad was likely to remain dialysis dependent, news that we didn’t want to hear. During his morning rounds, Dr. Anderson found Dad to be awake and alert and said that his vitals were good.

At 10:30 A.M. Dad starting coughing hard during dialysis and couldn’t seem to stop. His condition seemed to worsen immediately. Dialysis was stopped and Dad was returned to his room. Dad’s oxygen saturation levels bounced between 75% and 90%. He was coughing and suctioning large amounts thin, clear looking secretions. Michelle, Dad’s nurse, said that he was alert and had a productive cough, but it was obvious to her that Dad was in distress. The respiratory therapist was summoned to Dad’s room. She removed the red cap from Dad’s trach tube and placed him on BIPAP with 40% oxygen—a big medical and psychological step backward.

Rachel, the nurse practitioner was called to Dad’s room to evaluate his condition, and she thought that his cough appeared to be calming down. Shortly thereafter, the nurse notified Dr. Anderson that Dad’s heart rate had elevated to 150. In addition, his clear-looking secretions changed and now appeared to be Nepro. His tube feed had been stopped in dialysis when he started coughing, so they were now certain that he had aspirated his tube feed during his coughing jag. Nepro in the lungs pretty much triggers pneumonia immediately. This would be the second time that he had had pneumonia in less than three months.

On dialysis days, Mom usually arrived at the CCH around 11:30 A.M., about 10 minutes before she anticipated Dad’s return to his room. When she arrived today, she was startled to see that not only was Dad already there, the room was also teaming with activity. Michelle briefly apprised Mom about what had happened, but Mom didn’t get the impression that Dad’s condition was dire. She watched the nurses administer some meds, prop up Dad in bed, and leave the room. From what Mom could tell, it didn’t seem like the meds or the upright position did anything to improve his situation.

A short time later, Dr. Anderson told Mom that they would move Dad to a larger room next to the nurses’ station so that they could more closely monitor and attend to him. After they moved him, Mom sat in his room, watching the constant flow of nurses while they injected one medicine after another into his IV. Several times she was asked to leave his room, although she didn’t always know why.

After sitting in Dad’s room for a couple of hours, Mom called her friend Marilyn. Being the good friend that she is, Marilyn dropped everything and went to the CCH to sit with my mother. Shortly after Marilyn arrived, my mother called me and left the ominous message on my voicemail. When I returned her call at 3:45 P.M., she was very concerned, and although they had just moved Dad from BIPAP to full ventilation, she was still not convinced that I should drive to Temple before the weekend.

Marilyn and Mom sat together in Dad’s room for a couple of hours. During that time, Dad’s condition had not improved and Mom became worried. To her, it seemed like they kept trying medications but to no avail. As Marilyn and my mother talked, Marilyn asked Mom if she should call Pastor Don, but Mom didn’t know how to contact him. Marilyn was pretty active in another United Methodist Church. She didn’t have Don’s contact information, but she knew someone who did.

Pastor Don’s mobile phone rang just as he and his wife, Wynn, started eating dinner at a local restaurant. Don promised to stop by the CCH as soon as they finished dinner. Mom called me again at 5:30 P.M., and said that she wanted me to come to Temple that night. Stan had come home for dinner and was about to return to his office for the night. His birthday was becoming memorable, but not for the reasons we wanted. I had already packed a bag in anticipation of Mom’s call, but decided to wait a couple of hours before leaving. Anyone familiar with U.S. 290 would understand why I didn’t want to brave that highway until after 7:00 P.M. I said good-bye to Stan, and he said that he’d come up to Temple in a couple of days.

Between Mom’s call to me and when I left Houston, Pastor Don and Wynn arrived at the CCH. Mom and Don spent some time together in the small chapel at the CCH, and Mom said that Don was wonderful and encouraging. Finally, at 9:30 P.M., Mom, Marilyn, Don, and Wynn left the CCH.

My drive west on U.S. 290 was a little surreal. The sunset was a spectacular display of stunning shades of orange. I was torn between appreciating the beauty of nature and praying that my father wouldn’t die on my husband’s birthday. I arrived at the CCH around 10:00 P.M., and made my way to Dad’s room. When I arrived, he was fully ventilated and surrounded by ice and fans in an attempt to bring down his temperature. I was met by his night nurse, Christine. She had arrived at 7:00 P.M., and was stunned by his sudden change. She told me that he had been doing pretty well, and she really enjoyed joking around with him during her shift. He had never spoken about her to me, but he’s a big kidder and it seemed like they had developed a friendly banter.

I went to his bedside and held his hand, but he didn’t know that I was there. Christine asked me under what circumstances I would want to be called during the night. I told her to consider her own father and the circumstances under which she would want to receive a call, and then I left. I had called my mother when I arrived at the CCH and she was waiting for me to arrive at the house. We were both exhausted, yet keyed up on nervous energy. We talked for a while before going to bed.

At 3:30 A.M., the phone rang and it was Michael, a nurse from the CCH. He mumbled something about how they were adjusting Dad’s medication. I listened for a moment, said “OK,” and then hung up. After the call, I wasn’t really sure why he had called. It was unsettling and confusing. I wished that I had been more alert. I learned later that he had called to tell me that my father’s condition had worsened and that Dad required additional medication and that they were going to insert an arterial line so that they could monitor his blood gases. He had probably told me that in some jargon that I couldn’t understand—especially at 3:30 A.M. Scarier still was that this phone call was to obtain consent for the procedure. About an hour later, Dad’s blood pressure dropped to 65/39, his respiration was 35, his extremities were cold, and he still had a slight fever. With full ventilation, his oxygen saturation was only 90%.

At 5:30 A.M., the phone rang again. This time it was Dr. Anderson. He told me that my father wasn’t doing well, and among a list of problems, he was pretty sure that Dad had had a heart attack during the night. He then said that they could keep on doing what they had been doing, and my father would probably die in 1-2 hours, or they could send him over to Memorial. Dr. Anderson went on to say that considering my father’s age and “extremely poor prognosis,” he assumed that we would not want to take “aggressive measures.”

God help me; I took a deep breath, and in that moment I flashed back to several conversations I had had with Dad in which he listed conditions in which he would not want to live or treatments that he would not want to endure. I told the doctor that I would call him back in a couple of minutes. I then woke my mother with the news from Dr. Anderson. I was relieved when she said, “We have to do whatever we can to help Daddy.” I immediately called the CCH and told Dr. Anderson to send my father to Memorial. He hesitated for a moment and said OK, but it sounded more like a question than an affirmation.

At 6:15 A.M., my father was moved to a stretcher and transported back to Scott & White Memorial to MICU. Following Dr. Anderson’s call, the clock seemed like our biggest enemy.

A departure delayed

Published on August 16, 2016 by mellowdee551 Comment

Monday, June 22, 2015. It was day 48 at Scott & White Memorial (Memorial). When Mom and I arrived, Dad’s WBC count was 18,600, a 7,200 point spike from the previous day. Dad’s hemoglobin had dropped below 7.0 to 6.6, which meant that he needed another unit of blood. These lab results were alarming. In the last few days, doctor visits had become less frequent and occurred later in the day. Suddenly, the doctor who had recently been so difficult to find was now a constant presence. To me and Mom, the staff had seemed frantic to get Dad to a level that would permit them to transfer him to the Scott & White Continuing Care Hospital (CCH). Although today was supposed to be transfer day, it was obvious to everyone that his worsening condition would delay his transfer.

Dr. Velazco decided that he would perform another bronchoscopy with bronchoalveolar lavage (bronch) on Dad’s right lung to see if he had developed another strain of pneumonia. While we were waiting for the procedure to begin, Barbara, one of the hospital chaplains, spoke with us outside the room. During the past 47 days at the hospital, we had become friends with her, and she could tell when we were tense. At this point, even the housekeeping personnel could sense our stress level.

Although the doctor said that Dad’s lung had appeared normal, he mentioned that he saw thick yellow secretions, which wasn’t surprising to me, given his increased WBC count. Unfortunately, the secretions that he removed required 24 hours to grow in the lab. While we waited for the results, they started Dad on a broad-spectrum antibiotic. I could have sworn that this was the same thing that we heard the last time they performed a bronch, which miffed me a little. Although I’m sure that there are valid reasons why you’d change antibiotics, something about their approach wasn’t working. I was also a little annoyed that when I questioned the staff about my father’s changing vitals a couple of days earlier, I was informed that unlike me, “they” look at the whole person and not just the numbers. I’m not a medical professional, but it seemed that his whole person wasn’t doing too well at the moment.

Because it was Monday, Dad was scheduled for a four-hour dialysis session in addition to the bronch procedure. After dialysis started, Mom and I went home for lunch, and I worked for another hour before heading back to the hospital. Later that afternoon, two hematologists stopped by Dad’s room and said that they would be working with Dad’s team of doctors.

The respiratory therapists had been administering a deep respiratory treatment that smelled like sulfur. Happily for everyone, those treatments ended today. Dad’s central line had become a little sluggish, and the nurse had to inject something like a tPA to clear it.

Before Mom and I left for the day, Dr. Sai, Dad’s heart surgeon, stopped by for one of his obligatory 30-second visits to say hello, and to assure us that they were looking into Dad’s WBC count situation. Because he was Dad’s admitting physician, he was overseeing Dad’s case, but he wasn’t adding much to our comfort level or the level of confidence in the doctors.

June 23. I had to stay at home to attend some meetings via phone, so Mom left for the hospital at 8:00 A.M. without me. Today was another tough day, but some of Dad’s vitals showed some signs of improvement. His WBC count had dropped to 12,900. It was still high, but considerably lower than yesterday. Unfortunately, his hemoglobin level was still low, and he needed another unit of blood. Daytime Natalie was back, which generally reduced our anxiety levels. There was nothing quite as wonderful as having a great nurse assigned to your loved one.

Dr. Velazco was adamant that Dad get out of bed and into the chair. He insisted that movement and exercise were important for Dad’s recovery. Dad was very lethargic and sleepy, and Holly, the speech therapist, was not able to rouse him for therapy. It killed me when he couldn’t receive speech therapy. He simply had to be able to swallow again without aspirating.

The doctor mentioned again that Dad’s worsening anemia was preventing him from transferring to the CCH. The hematologists attributed Dad’s anemia to bone marrow suppression due to his infection and the antibiotics (which he took because of the infection).

The physical therapist visited Dad and assessed his progress. They had missed several sessions because of various procedures and dialysis. Dad was still pretty weak and on BiPAP, so they worked through some bed exercises.

Robert, one of the PAs, stopped by and told me that Dad was moving to the CCH on Thursday—two days from now. I’d believe it when I saw it.

Natalie, Kelli the charge nurse, and a male nurse finally moved Dad to a chair at 4:30 P.M. Between his attachments and his weakened condition, moving him from the bed to the chair was somewhat of an ordeal. He wasn’t in the chair long before his oxygen saturation dropped into the 80s. The respiratory therapist suctioned him, but his levels did not return to the upper 90s until she removed Dad’s speaking valve.

I left at 4:45 P.M. and did not return that day. Instead, I weeded my parents’ garden and picked tomatoes and cucumbers. Before my parents planted their garden, my father had mixed cotton seed into the soil. The way the garden exploded with vegetables and melons made me suspect that he had also planted radioactive seeds.

Mom returned to the hospital after dinner to check on Dad and say good night. When she arrived, he was back in bed, but his trach tube was open and his neck was covered with secretions. It took her a while to track down a nurse who would clean him up and replace his speaking valve. He was placed back on BiPAP support overnight.

June 24. Mom arrived at 8:00 A.M. and found that Dad was still on BiPAP. He was very drowsy, but he could be roused. It was Wednesday, which meant that Dad required dialysis, but they ordered an eight-hour session instead of a four-hour session, although they didn’t tell us why. Dad’s WBC count had dipped to 11,100. It wasn’t where it had been just a few days earlier, but we were seeing a definite improvement in his condition.

Dad was bronched again this morning. According to what the doctor said, they wanted to look for, and possibly remove, more secretions from his lungs. I had lost track of how often they had performed this procedure. This time they inspected found thick yellow mucus in the bottom of both lobes. Once again, we would wait at least 24 hours for the lab results. The lab results from two days ago showed that he had developed pseudomonas tracheobronchitis, which occurs in patients on ventilation.

Svenja, the Trach Goddess of Scott & White, returned to change out Dad’s trach tube. The type of trach tube he had now would require weekly changeouts for as long as he required one. Dad’s hemoglobin level was holding tight at 7.0, which was the minimum level the doctors would allow before ordering another unit of blood.

The wound care team stopped by and said that the chest wound from Dad’s two surgeries was healing “beautifully.” They removed the wound vac, which meant that Dad had one fewer tube and hunk of hardware to drag around and take to the CCH.

Mike, the physical therapist stopped by and had Dad perform leg exercises in the bed. By the time that Holly from Speech Therapy stopped by, Dad was sleeping and she couldn’t rouse him. I hated that he missed another swallow therapy session with her. It probably would be Dad’s last chance to see her before his transfer.

Laura, the case manager stopped by and confirmed to Mom that tomorrow at 11:00 A.M. Dad would be discharged from Memorial and transferred to the CCH.

It had been a very busy, almost frantic day of procedures and therapies to ensure that Dad could leave Memorial tomorrow for the CCH. We left the hospital with our fingers crossed.

Four good days in a row was beginning to seem like an impossible goal

Published on July 13, 2016 by mellowdee55Leave a comment

It’s June 5, 2015. Mom and I arrived at the hospital at 8:45 A.M. We’d had three good days and were hoping for the ever elusive fourth good day. Because it was Friday, we were greeted with a new set of doctors. Dr. Velazco returned as the pulmonologist and Dr. Issac was the nephrologist. We hadn’t been in the room long when I started feeling a little anxious about our four good days. In addition to Dad’s WBC count being up by 3000 points from the previous day, he sounded somewhat congested. He coughed throughout the day, but seemed unable to expel any of the secretions from his lungs.

The dreaded dialysis machine returned and removed approximately 2400ml of fluid during the eight-hour session. We had been told that the dialysis was a temporary procedure so that his kidneys could “rest,” but we wondered how much rest they needed. Holly tried to see Dad for swallow therapy, but he was asleep and could not be roused.

The respiratory therapist gave Dad a breathing treatment, which seemed to provide him with some small amount of relief. When Mom and I left at 4:00 P.M., Dad was still sleeping.

Stan’s late arrival into town caused us to run behind schedule, so we didn’t return to the hospital until 7:30 P.M., well after the shift change. His night nurse, Carolina, entered his room—her first time seeing him that evening.

Dad appeared weak and it seemed to me that he was struggling to breathe. Carolina spent a considerable amount of time suctioning him and getting him cleaned up for the night. He seemed a lot better when we left, but this didn’t really feel like a good day.

My good-day counter remained at 3.

respirator Because it was Saturday, I slept in until 6:45 A.M. I usually slept with my phone on the nightstand, but I had inadvertently left it in the family room the previous night. I retrieved the phone and noticed that I had missed a call from Scott & White at 5:14 A.M. In a panic, I called the hospital and Kelli, the charge nurse answered. She told me that at 3:00 A.M., they had had to intubate my father. Evidently, he went into hypercapneic respiratory failure. Fortunately it was an emergency situation, so they didn’t need to obtain consent from someone separated from her phone. They also reinserted an arterial line in his right arm. In addition to all this good news, his WBC count had elevated to 15,000, which meant that yesterday’s elevation really was the beginning of the end of our good-day stretch.

When we met with Dr. Velazco that morning, he said that he would perform a bronchoscopy so that he could see what was happening in Dad’s lungs. They would also collect secretion samples. Knowing more about the infection in his lungs would help them target the infection with the correct antibiotics.

Mom and I left the hospital during the bronchoscopy. Because Dad was fully ventilated, the process was somewhat simpler, with the possibility of fewer complications. The rains that had started a couple of weeks earlier had finally stopped, and the daily temperatures were beginning to rise. When we stopped by the house, Stan was braving the heat to mow the lawn.

When we returned to the hospital after lunch, Dr. Velazco told us that he had removed a lot of “chunky” secretions from Dad’s lungs. Dr. Velazco was from Peru, was soft spoken and spoke with an accent that my parents couldn’t understand, but I really liked him. He took time to explain my father’s situation and often skipped the $20 technical terms for the easy-to-understand 5-cent words. The removal of this “chunky” matter improved Dad’s oxygen saturation levels, which zoomed from the worrisome 80s to 100%.

Somewhere around 2:00 P.M., I received a text message from a phone number that I didn’t recognize. The message said that there was a birthday hug waiting for me in the ICU waiting room. The mystery texter turned out to be my long-time friend, Susie. She had been in Dallas (a three-hour drive from Temple), and thought that she’d stop by to say hello.

friends Susie’s appearance in the waiting room was just one example of the random acts of kindness that my mother and I received during my father’s ordeal. I still marvel at our good fortune to have been blessed with such wonderful selfless friends. The neighbors seemed to instinctively know when we needed a meal, some cookies, or a hug. My friend Rhoda gave up a week of her time in Wisconsin to help when Mom had her stoke, and in three days, my cousin Chris would be arriving from Phoenix to help out for a week.

Although I loved their support, I never stopped hoping that I wouldn’t need it much longer.

Today was Dad’s one-month anniversary in the hospital, and the good-day counter had been reset to 0.