Tuesday, September 30

Good progress for Tommy the last couple of days, especially with Shannon in walking and continuing to master transfers. Speech pathologist Ralph has been working more intensively with Tommy during meals in an effort to help him master the pacing of food and drink intake...i.e., a small bite followed by a small sip; not three giant bites followed by four giant gulps. The speech therapists are concerned about aspiration--i.e., a particle of food or drink going down the wrong pipe into the lungs, which can lead to pneumonia.

Sunday, September 28

Another fun weekend. Tommy got a lot of rest on Saturday; for dinner, he and I joined Rosemary and her daughter, Sue (a veterinary surgical nurse, so you can be sure the table talk was interesting). Afterward, with Rosemary's fluffy pomeranian, Foxy Lady, leading the way, we all hiked down through the long-term-resident wing to the facility's roofed patio. There, we found Bill and Allan, who we often see out there. The patio conversation again revolved around Sue's stories of life in the pet-operating room; Tommy didn't say much but listened as intently as the rest of us. Over the weekend, Tommy talked on the phone with a half-dozen family members and friends, which always perks him up.

Friday, September 26

Because the blog site, for some reason, wouldn't let me in for several days, I was unable to make entries. I finally got in this evening. I don't know how these sites work, but I wonder if it sometimes gets overloaded with users. So--to the subject of the old man. Tommy has been progressing this week on all fronts except the eating/swallowing function. As far as strength and mobility, he can now pull himself up to a standing position with the help of grab bars, but he still needs work on pivoting, using a walker and walking with an assist. The therapy department folks believe that Tommy can and should master these things before coming home, so they have just moved his discharge date to Oct. 31.

Tuesday, September 23

The plans are going into place for Tommy's homecoming. His tentative discharge date remains Oct. 4, although the therapy department may extend it a week or two more. But, barring a setback, it will be October. In therapy, Tommy continues to work hard for Shannon, Heather and the others. Last week, Red taught Tommy how to use the sliding board. (Red left Ren rehab at the end of last week. We were really sorry to see her go. She was lively, fun and very good at what she did. She helped Tommy a lot.) Tommy is comfy in the Rehab wing; he's getting great care from the nursing staff and he likes to sit with Rosemary, Willie Mae and Al. Tommy has been eating unusually well this past week, compliments of Gaie, who has made fish chowder, pot roast and quiche for him.
At home, the ramp and new shower are ready, and Gaie and I are figuring out where the sidebars will go. I've ordered a pedaling machine for Tommy to use. I'm in the midst of learning exactly what is required to set up the next stage of Medicare-covered supplies and services once Tommy gets home, including home health care and therapy. Gaie, who teaches nursing at Eastern Michigan University, has been my go-to girl for a lot of that, all the way through.
We heard from Marty Wolfe this week (thanks, Mike, for letting him know about Tommy), and Tommy and Marty are going to talk tonight. Old buddy Frank Carr stopped by twice this weekend, during his recent trip to South Bethany, and Tommy was thrilled to see him walk in the room. "Hi Frank!" he called in a strong voice (the first time I have heard that voice since before the stroke). For those of you who would like to talk with the old man, a good way to do this is for you to call on our home phone (302-539-8079) and let me know. Then, I'll place a call for him to you, just before dinnertime, during the next day or two. Hmmm. Next week would be a great time for Tommy to catch up with his old pals... hint hint.

Sunday, September 21

Sundays at Ren rehab are pleasant. All the patients who were bushed by the end of the week have taken Saturday to catch up, so by Sunday everybody is pretty mellow. Today was even better because it was a perfect sunny autumn day. Lots of family and friends visited the wing, and by now we all know each other. Amid the hubbub of kids working puzzles and one patient's four-generation family contingent, Rosemary took the cake. She sat in her wheelchair with her five-pound Pomeranian, Foxy, in her lap. Meanwhile, Rosemary's daughter, who was pushing her wheelchair, was walking a miniature dachschund named Noodle, whose leash was attached with a carabiner to the loop of her jeans. It was a sight to behold. Rosemary is one of Tommy's new buddies around the place; two of his old buddies, with whom he always ate breakfast, were discharged last week. For dinner, Tommy got a special meal prepared by Gaie, who is visiting from Michigan--quiche with a spaghetti-squash crust. He savored every bite.

Friday, September 19

All's well the last couple of days. No setbacks. With help from physical therapist Red, Tommy now knows how to transfer from wheelchair to bed using a wooden sliding board. He continues to walk very well with Shannon. Our friend Gaie, who just arrived for a visit, went with me today to see Tommy, and when he saw her, he said, "You look like a flower." During dinner, we were joined by speech pathologist Ralph, who said Tommy's eating and swallowing have improved over last week. Two good days.

Wednesday, September 17

Today, Tommy walked very well with Shannon at his side; his balance continues to improve. However, he's still not getting the pivots and transfers down, so Red told me that they are going to bring a "sliding board" into the mix. A sliding board can serve as a backup for those times when standing-and-pivoting transfers are too risky. A strong, thin board (the ones I've seen are heavy plastic), it can be inserted partway under the rump of the person and extend to the target sitting spot--it provides a continuous, sliding surface from point A to point B. So, for example, if the person is sitting in a wheelchair, you can line the wheelchair up next to the bed, remove the wheelchair's armrest, insert the sliding board across to the bed, and then (with help from the sitting person) slide that person across the bridged gap, at a slight diagonal angle, without doing any lifting. At least, I think this is how it works....I'll be learning more about it in rehab.

Tuesday, September 16

Several of you have asked me questions about yesterday's post--specifically, why has his discharge been delayed if he's advancing so well with walking. Yes, it's true that Tommy's progress with walking has been encouraging; but remember, he has had a lot of sessions, even dating back to his time at Milford Rehab during the month of July, when he was walking along the parallel bars. So, he's been working up to being able to walk for a long time. But there are other skills where he needs a lot more practice. For example, he needs to learn to pivot--that's when he stands up in front of, say, a bed, and he needs
to sit down in a wheelchair that's sitting alongside the bed. Before he can sit down again, he needs to "pivot"; i.e., he needs to move his feet in a simple turning pattern--with assistance from one person--so that his back is no longer facing the bed, but is instead facing the wheelchair. As with other seemingly simple tasks that Tommy has had to relearn, such as swallowing or standing up, it's more complicated than one would think. Think of riding a bike or driving a car; it seems seamless to us now, but when we were first learning, the number of individual things to remember and integrate was daunting. Also, Tommy needs to learn how to reach back behind him to find the armrest of the chair or the side of the bed before he commits himself to sitting down. And, of course, he needs to become more dependable at being able to stand up at all--that is, sometimes he stands up without weight-bearing help from the person assisting, but sometimes he doesn't--and on those occasions when he doesn't stand by himself, it can take a toll on the back of the person assisting him. (I was chatting with one of Tommy's nurses, who told me that the backs of most nursing aides are "shot" by age 40 because of so many years of lifting.) These are all basic necessities before Tommy can come home, where, for much of the time, only one person (that would be me) will be available to assist him.

Monday, September 15

This morning I learned from the social worker at Ren rehab that Tommy's discharge date has been moved from Sept. 20 to Oct. 4. Tommy has been progressing well in terms of walking and general regaining of strength, but he needs improvement in other areas, including transfers and swallowing. Tommy also needs to voice his wants and needs, a task that is complicated by the fact that he has periods of confusion (I suspect that the reason he clams up at times is because that's what's going on). Occasionally, for example, Tommy says things to me that reveal that at that moment he thinks that he lives in DC, or that he still runs the boatyard, or even that he is working at the car dealership in Georgetown (where he worked before he began to repair boats). It's interesting that, when I realize he's confused in this way, I get him back to "now" by asking him if he has dogs; and when he says yes, by asking what their names are. He always remembers Penny and Sandy.

Saturday, September 13

Today was Janis' last day here, so we splurged on a crabcake dinner. Tommy's newest buddy at Ren rehab, Rosemary, joined us at the table. She is a blast and we had a great time. During the meal, speech pathologist Ralph also checked in with Tommy from time to time to make sure that he was swallowing okay. He's been having a problem this week with dry food getting caught on its way down, so we need to make sure that he takes a sip of his beverage between every bite or so.

Friday, September 12

Today Tommy led a parade. Tommy was at the center--walking the entire circular route of Ren center's interior hallway, resting only once. The total distance was roughly halfway around our house. With no walker! Marching with him were therapy-assistant Pearl at his right and therapist Shannon on his left. No marching band, but Janis--bringing up the rear with the wheelchair--sang out steady praise as he stepped along briskly. No majorette, but I walked backwards ahead of the cluster, taking pictures with the camera. Along the route, staffers and patients congratulated him. "Way to go, Tom!" called his pal Bill, who has also progressed from walker to free walking. "Look at you!" said Meredith, Ren's social worker, as she passed by.
In the evening, Janis and I joined Irv at the VFW bar (with its splendid view of the sunset over Indian River) for some perfect comfort food--pork and sauerkraut with a side of mashed potatoes. A great day.

Thursday, September 11

Today was nonstop therapy for Tommy. He was a little tired because one of his buddies, Craig, was discharged last night to his home, and the nursing staff threw a little party for him. Usually, Tommy is in bed by around 7, but by the time they'd had their cake and milk, it was a good hour later. Speaking of discharges, during the afternoon I met with Pam, the finance person at Ren rehab--now that Tommy's own discharge is approaching, I must get a firm handle on the next chapter of Medicare hell. I could immediately see that this will be another "interesting" challenge when she began a sentence, "We can't skill a person if..." "Excuse me," I interrupted, "Did you say skill a person?" "Yes," she said; "Am I confusing you?" "Uh," I said. "I've never actually heard skill used as a verb..." She was patient with my many questions. I have learned that, among others, there are the Romance languages, the Indo-Tibetan languages, and the Healthcare languages.

Wednesday, September 10

This morning--for the first time, and with Shannon and Pearl at his sides--Tommy walked a few steps without his walker. It happened in the therapy department's outside courtyard.
We were in the courtyard because, a few minutes earlier when Tommy was walking the hallway with his walker, with Shannon at his side and me following with the wheelchair, he pointed through the window to the courtyard. Shannon asked, "Do you want to go out there?" and Tommy nodded yes. This was a very good moment, because Tommy was asking for something he wanted rather than being passive. The therapists have explained to me that part of Tommy's recovery is making his needs and wishes known, and I have been impressed by the way that Tim and Barb, and now Shannon and Red, have all responded to Tommy, on those rare occasions when he asks for something, by immediately doing all they can to give him what he has asked for. The same is true of the nursing staff. But I digress.
Once we got Tommy wheeled out into the courtyard, Shannon brought a small beach ball outside for Tommy to throw to me. The game was that I would stand like a statue and if the ball hit me, I would give Tommy a kiss. Then, with assists from Shannon and Pearl, Tommy stood up and, with them holding him at his sides, he continued the game, tentatively aiming and dropping the ball in my direction. After a few minutes of this, as Tommy got his sea legs, Shannon said he thought Tommy was ready to take a few steps. Indeed, he was; he walked about ten steps to collect his kiss. We were all excited by it. Later, Janis and I joined Tommy for dinner; we brought him crab cakes from Pizza Palace; but alas, Pizza Palace seasons the crab cakes much as they do their excellent pizzas, which is to say the crab cakes were too spicy. Looks like it's time for another carry-out pilgrimage down to my poker group's favorite beach eatery--the Crabcake Factory in north O.C.

Tuesday, September 9

A good day all around. Tommy's physical-therapy schedule is now firmed up--he'll have Shannon on Mondays, Wednesdays and Fridays, and Loretta (whose nickname is Red, for her long red hair) on Tuesdays and Thursdays. This morning Red gave Tommy a good workout, and a speech-therapist joined him and Janis for lunch. Tommy is still on a "mechanical soft" diet; i.e., the food is midway between solid and pureed. This weird food category is most noticeable with meat; a "mech-soft" pork chop, for example, looks kind of like a pile of chopped-up rubber bands. But until Tommy can limit the size of his bites, the speech therapist will keep him on this regimen. Today, she also directed that Tommy not be given straws; this is because he continues to sip too much too fast (rather than taking one sip at a time), which leads to coughing fits. Our dinner was quite fine--I brought steamed shrimp and Pat, the wife of Tommy's roommate Mike, brought a big box of Popeye's chicken. After dinner, Tommy had a long phone chat with his son Steve. So things are back on track after yesterday's turmoil.

Monday, September 8

Just after lunch, we had a scare when the nurses at Ren rehab thought that Tommy might be having a heart attack. His symptoms included pains in his chest and arm, not to mention his "deer-in-the-headlights" look and muteness once he was surrounded by a flurry of staffers hooking him up to an oxygen tank, putting nitroglycerin under his tongue, and other stuff. So off they sent him to Beebe Hospital in an ambulance (with me riding in front and Janis following in her car). Thank goodness, after Tommy had an EKG, heart-enzyme workup, chest X ray and other procedures, the doctor there determined that his heart was fine and that the symptoms may have resulted from Tommy leaning too much on his walker during morning therapy. We were all back at Ren rehab by dark, and after some hot vegetable soup with fresh parmesan-tossed corn I'd brought him from home, he was his old self. It'll be "therapy-lite" for a couple of days, but after that the old man should be as good as new.

Sunday, September 7

Tommy had a very good weekend, with both Janis and me waiting on him, and with lots of laughs with our friends at the rehab center. In general, Tommy's strength continues to return. I found out on Friday the good news that he will have Shannon as his physical therapist (Shannon was a part-time therapist at Milford Rehab, and Tommy had a couple of good sessions with him there). Also, tomorrow his occupational therapist Barb returns from her vacation. So, all systems are go.

Friday, September 5

After dinner this evening, Tommy had a speech-therapy session with a nice fellow named Ralph, who hadn't met Tommy before. It was very entertaining to witness. "Ok, Tom," Ralph said; "I'm going to start a phrase, and you finish it. How are...?" "You," said Tommy. "Very good," said Ralph. This went on a while until Ralph said, "Oops, I dropped the ..." "Boat," said Tommy. "Boat?" said Ralph. "Yes, I dropped the boat." "Uh, okay," Ralph said dubiously as he made a checkmark on his worksheet. "Most people would say the phone or the ball, but a boat...okay." Further into the session, Ralph said, "Now Tom, I'll start a sentence and you finish it." After a few of these, Ralph said, "I like to drive a ..." "Travelift," said Tommy. "A what?" said Ralph. "A Travelift," said Tommy. "That's what I was driving when I dropped the boat."

Thursday, September 4

Today things seem to be getting back on track. Heather, who is filling in for Barb this week for Tommy's OT sessions, reported that this morning Tommy was far more talkative than he's been before, and that he made her laugh. "I asked him if he was growing a beard," she told me when I arrived at Ren rehab; "and he said yes. So I asked, 'Do you want to shave it off?' And he said, 'No--I don't want to ruin my image'"! She did help him to trim his beard, however, which he did quite well. In the afternoon Elaine and Alan arrived, once again bearing a big box of tomatoes and green peppers from their garden, and they joined Tommy at dinner.

Wednesday, September 3

Today was Tommy's last physical-therapy session with Tim, who appears in several of the photographs above. Tim has been such a great help to Tommy, and we wished him best of luck in his pursuit of a career in real estate in Rehoboth Beach. We gave him a small gift in appreciation, which Tommy handed to him, almost shyly. "You have all the tools to get well," Tim told Tommy; "and you've been working hard. Keep it up and you'll just keep getting better." We'll know in the next couple of days who his new physical therapist will be. Meanwhile, his occupational therapist, Barb, has been on vacation this week; and while the other OT staffers have been working with Tommy, we'll be glad to see Barb back again on Monday--Barb also has been very good with Tommy, and it's that continuity issue again. This whole week, actually, has been difficult for both Tommy and me. The long Labor Day weekend followed by changes with Tim and Barb have set Tommy back a bit with therapy and also with the bladder-control program. It's been a slog for me, too; on the home front, the shower renovation (as with any work on this house) has led to more complications and so is still ongoing; and I also got very worrisome news about one of my beloved cousins. There will be weeks like this, and this has been one of them. We do look forward to a visit tomorrow from Tommy's sister and brother-in-law, Elaine and Alan; and this Saturday our dear friend Janis arrives for a weeklong visit. So things are looking up.

Monday, September 1

It's Labor Day, so Tommy got a vacation from therapy. Instead, this afternoon, we watched Planet of the Apes with several other patients and their families on the rehab center's large-screen tv. Tommy worked hard all week and earned this day of rest. Yesterday, in his OT session, he propelled his wheelchair (with his arms and one leg) with much improved agility, and for quite a distance.