More falls, more letdowns

     

    

                               Mary on Christmas Day, 2009

     Mary struggled mightily after her first rehab stay. She’d returned to the hospital badly dehydrated, malnourished and with a raging infection. She was weak, listless, uncommunicative and agitated – worse than before. And more frightening, she seemed to have lost her ability to swallow.

    The infection would do other things, too. Somewhere along the line, as it raced through her body, pushing her already damaged brain into overdrive trying to cope, she lost the ability to feed herself.

     It hadn’t been pretty, there’d been food over everyone within 10 feet of her, but she could feed herself. And we had been so thankful for this one, small thing. It gave her a confidence boost, and it showed us she could possibly do so much more.

     Mary slept – and slept when she returned from her first attempt at rehab. And while she tried to heal and come back from whatever dark place she’d gone to once again, we worried.

      What now? She’ll go back to rehab when she regains her strength, we were told by the hospital case manager and the nurse practitioner.

      Unbelievable. Yet what other options did she – or we – have? The prognosis given by Mary’s neurosurgeon (and only given to us three years after the event, when we put in a written formal request for answers we’d been unable to get out of medical staff) was that the first year is crucial for recovery. Not much happens after that time period.

     So it's one reason patients are rushed out as soon as possible to rehab centres so they can receive an optimum amount of occupational, physio and speech therapies.

    How I wish we’d known that. Could we have tried harder? Been more vigilant when she was in rehab? We’d hired PSWs to help, we were there every day. I really don’t know – short of moving in with her and sleeping on the floor – what more we could have done to prevent that infection.

    In the meantime, the hospital case worker and social worker were pushing other ideas; complex care (read end of a future), a nursing home (read end of life). We were aghast.

     Heck, we’d seen violent convicts brought back to health to be rehabbed and returned to jail; we’d seen alcoholic street people healed, sent to rehab only to go back to shelters and the street. 
     If the health system could invest in these people, why not Mary? We’d ask that question many, many times as she was ultimately refused OHIP-covered therapies two years into this odyssey.  

       Nov. 24, 2009. We were 230 days into this tragedy. Mary and I were, once again, riding in a patient transfer vehicle, Mary strapped to a gurney, for the short ride back to the rehab facility. We’d all got our mental armour on. We’re going to watch, speak up, speak out and make sure the infection doesn’t happen again.

      Mary’s weight is good, 123 lbs. We were so, so hopeful. She was admitted, taken upstairs and quickly went from looking fairly content to absolutely desperate when she reaches the same room she was in the month before. It’s still dark, still gloomy and bare with the single dim light just inside the door. She looked at me, corners of her mouth downturned, a frown on her face. I tried to tell her it’s okay, that this is where they will get her back on her feet, that she’d done so well with the therapists when she was here last. “It’s not forever,” I whispered. She grimaced.

      But she remembered the place and the staff and she seemed depressed; within two days she had stopped eating. Once again, she was dehydrated and weak. Despite our best attempts, consulting with staff, making sure they are paying attention to her, helping her eat, she was put back into an ambulance and returned to the hospital after just eight days.

    We were devastated. Mary’s nurse practitioner told us the gastric tube would have to be re-inserted, that she couldn't eat well enough to sustain herself. Fine.  Just do it.  Whatever it takes. And at this point, it’s taking more than we ever believed.

      By Christmas, with Isabella looking like the most adorable elf that ever existed, as we forced ourselves to put up a crappy, thin artificial tree I picked up at a hardware store, Mary was considerably better. She was more Mary-like, had a small gleam in her eye and seemed healthier. That was good, but we still couldn’t muster enough energy for festivities. The usual wreaths stayed locked away; the red candles weren’t displayed, there was no holly, ivy or joy.

        Paul, Isabella, Paul's mom Pat, and Mary

             Mary, Bob and Isabella

     My sister-in-law hosted Christmas and we took Mary, thin but chirpy looking. If you can swan into a room in a wheelchair, that’s what Mary does – even being pushed by someone else. She always had a presence and still does; she has a way of looking at you, assessing, waiting before speaking, and she does that still. She’ll sit very quietly her in chair and just look when introduced to someone. When she thinks they might be okay, she’ll reach out an arm to grab their hand. We recognize her “how do you do,” but you have to be practiced to catch it.

     Christmas Day: We were determined to mush up her food and get her to eat. She did. And she enjoyed it. Her cousin asked her what she wanted to drink. It took several attempts and various queries but we managed to figure out she’d croaked, “white wine!” She had two glasses.

    Looking back, we now realize this was the best Mary would ever be (so far) – barring a future miracle. She looked bright, she took in everything around her, enjoyed the family, her baby and Christmas. 

    Perhaps the new year would be better? Did we dare to hope?

    We didn’t even flinch when they suggested a third try at rehab.

   Day 287.  Jan. 20, 2010: Once again, Mary and I are back in the ambulance trundling along snowy winter streets. “Third time lucky?” I asked her. She glared back glumly. She knew where she was going and she wasn't happy. It’s not forever, I tell her again. It’s just to get her back on her feet. And then maybe she can go home.

      She wanted to go home. She tell us over and over, spell it out on a special alphabet board we'd devised for her.

      I think the rehab staff were determined to make it work this time. They tried to implement a washroom schedule (it didn’t work as no one stuck to it); they tried to get Mary to feed herself again. And they did take it slow. Her therapies were spaced so she could rest in between sessions.

       Still, there was that old problem rearing its ugly head. She wasn’t regularly toileted so she sat in wet diapers. She pushed herself up and down the hall trying to find her room, banging into things because she couldn’t see well enough. One day she tipped her wheelchair back and frightened the staff. 
   Well, they noticed something!

    I got an angry phone call from some bureaucrat who sat in a dingy office down the hall. It was as though I’d been the one to push the chair back and scare the nurses.
     I just couldn’t figure it out. The patients at rehab are there because they are wounded and hurt. They are there to be fixed. But that isn’t the attitude conveyed. It’s like the patients are nuisances.

   The upshot of the angry call: they were going to put Mary in another wheelchair that tilted back so she sat back on the tail of her spine and she couldn’t ever do that again!

    Yes, that’s fine. We want her safe, after all.

     Mary became distraught. She hated the chair because it was uncomfortable. And then it started. Again. She was weak, couldn't eat, would fall asleep. She was almost comatose – and worse, thanks to that ill-fitting wheelchair – she was in excruciating pain with a huge round sore on the tail of her spine.

        She had a fever, she seemed delirious. But instead of sending her back to hospital right away, they put her on antibiotics and tried to wait it out. Bad decision.

       Feb. 9. We were absolutely frantic. I was certain Mary was dying. A doctor from another floor at the rehab centre came to see her, (the floor doctor was away), and wondered if it was her liver.

     “Her liver?” I asked incredulously. “Her freaking liver? What are you talking about?”

      An ambulance was called and we headed back to the hospital. Mary was catheterized immediately in the ER and I watched blood clots flow into the bag. She had a raging urinary tract infection as well as the painful bedsore. (It was, thankfully, the one and only bedsore she ever had.) A doctor came in and examined her some more, lifting the dressing on the gastric tube in her stomach. It was oozing, red and infected.
     “Oh dear,” he said, and left.

     I put my head down on Mary’s arm. It was too, too much.

    “Oh great,” I said to Paul, “they couldn’t even keep that clean!”

      Mary is readmitted to a medical floor. Her old nurse practitioner comes by and is shocked by her appearance. “She appears,” he told me, “to be almost septic.”

      Mary was then moved back to the floor she practically called home since April 8, 2009. She stayed there until Sept. 5, 2012.

     If we thought things couldn’t get more desperate, we were so, so wrong.
     Mary did recover from the infections, but it took weeks. She fought to regain the abilities she had prior to the infections, but it seemed the damage had been done. She still couldn’t feed herself. And that hasn’t come back. She couldn’t speak well enough to be understood, yet if we surprised her with a piece of news or gossip, she'd pipe up and ask as many questions as possible.
      To this day, this come-and-go ability to speak leaves us baffled. 
    

      Mary awaits treatment after a fall in physio

    On March 2, just three and a half weeks after returning from rehab, Mary was in the small gym on the floor having physio with the therapist and the assistant. Now I really like these people. They were wonderful with Mary. They got her on her feet initially and they worked her and worked her.

     But we got a call after one particular physio session to be told that each of the therapists had turned their heads briefly while Mary was not strapped in and she had fallen headfirst onto the floor. 
     We rushed down to the hospital. It was early afternoon and Mary was a mess. Her lip was swollen, her lower face cut and bruised. We were told someone would be by to put in stitches. So we waited with her, back in her room, mopping up the blood and keeping her calm.

       And we waited and waited, until after 9 p.m. Then Paul completely lost his patience. He headed to the nursing station and I followed. I was thinking one hothead was quite enough in the family and just as I went forward to intervene he slammed his (very large) hands on the counter, scaring the hell out of everyone, and yelled that it had been “enough. Enough.” He yelled a lot more, but I won’t get into that. He’s awesome when he’s angry – all the more so because he doesn’t lose it very often.

       A young resident arrived within 20 minutes. Mary’s stitches were put in. She was properly cleaned up, given painkillers and settled for the night. It only took more than seven hours to be seen – and that’s IN a hospital.

      The physiotherapists were aghast and apologized profusely. Falls are taken fairly seriously in hospitals – and a fall is how Mary’s initial tragedy began.

       April 4, Easter Sunday. We were 361 days into this journey and the first-year anniversary date is looming.

        It was such a lovely spring day we were able to sit outside briefly at my brother-in-law’s home while he barbecued a crown roast. This impressed me to no end. I can hardly BBQ a shrimp.

      We watched his golden doodle play about, we talked with the extended family, enjoyed the thin sun and the rebirth of the warmer season. Mary didn't attend this dinner as there were too many tricky stairs to negotiate with a wheelchair – and we didn't want her falling again.

     It was probably the first time in months that we felt – well, not great, but perhaps hopeful we could find a solution. We were, at that point, exhausted beyond belief. Worn out. Tired.

      We had decided to sell our retirement home in St. Andrews, N.B., the 200-year-old historic Cape Cod into which we’d poured so much of our time, money and energies doing renovations. It was a stunning home, but we just couldn’t get down there enough to justify keeping it. Having a sick family member was proving to be very expensive.

     I loved that house. It was “home” the minute I walked through the door. I put my heart and soul into making it ours.

      So that decision rocked us. (It would take two years to sell, however, and we took one hell of a loss.)

      And then, since we were hiring people to do most of the work at our Toronto home, cleaning it, doing the gardens, etc., while we camped out at the hospital, we decided to sell it, too.

      We were complete and utter messes, making bad decisions, acting irrationally; we were starting to get sick ourselves, we were at a total impasse with our lives, neither coming nor going, unable to move on, unable to live our own lives, unable to make a decent decision. Everything we did, everywhere we went was governed by what had happened to Mary.  

     But on that Easter Sunday, we thought that maybe, just maybe, we could dare to hope. It was such a lovely day.

       Driving home after dinner, around 10 p.m., my cell phone rang. It was a doctor whose name I didn’t catch saying that he’d just put stitches in Mary’s head after she fell off the bed and caught it on a metal piece. The stitches are at the back of her head, he told me, but nowhere near the pump for her shunt. She had been put back to bed and she was fine, he said.
     (Oh yeah. I’d heard that before.)

     Mary, at that time, was in a four-bed room. They have one PSW who tends to the patients, as I’ve mentioned previously. But when one person is tended to and the curtains are closed, all kinds of things go on with the other three. This was when Mary tried to do her swan dive.

      Never rush to hope. You’ll be disappointed.

      That crack on the back of her head and those few stitches? By this time, nothing shocked us.  It was just yet another mishap at this supposedly world-class Toronto hospital. We looked at each other. "The fourth fall?" I asked Paul as he gripped the wheel in anger. He nodded.
     Dear God, what more could go wrong?

     Lots, we were to discover.

     See, that little mishap led to a blood clot. And that blood clot was only discovered May 19 after an emergency craniotomy.

    Now this is the thing we’ll never understand. As a hospital, you have a pregnant patient who ends up brain-injured while under your care: She falls out of bed post-surgery onto the floor while no one is watching her.

    So, she is CT'd and put back to bed where she’s vomiting – ‘cause she’s pregnant, after all, and has been really, really ill with a blocked shunt – and then she vomits and aspirates because, still, no one is watching her ...

     And then this poor woman, through no choice of her own, ends up having to come back to this hospital with this bloody brain injury because she just can’t get through rehab. So she falls a few more times –  cuts, bruises, stitches.

      But that’s not enough.
     This hospital – and others, too, I bet – uses a lot of agency personal support workers to fill the gaps. So this one night, May 19, 2010, there was a young fellow who had not only not worked very much at this hospital, he’d just arrived in the country and was all new and shiny to the job. (A staffer confided this information to us, as well as the fact this man had been warned to watch Mary and not leave her alone.)

   He took her to the washroom in the middle of the night. Mary would never go to the washroom with a strange guy. Even with a brain injury she would know this wasn’t right. And worse? The young man DID leave her alone – and unbuckled on a commode chair – and went off searching for a diaper.

     Mary crashed to the floor, hitting her head. We were not informed right away about this fall. Well, let’s face it. This is the fifth fall ... the fifth huge injury.  But who’s counting?
     Well, not the hospital, obviously.

     Paul notices the next day Mary’s not quite herself. We wait 20 hours for the results of a CT done several hours after this fall. (And this is IN the hospital!)

     We got the news after midnight, May 20, after calling the nursing station several times during the evening for the results. The bad news was given to us by one of the nicest nurses on the floor, a very sympathetic woman.

     Mary has a brain bleed – the result of that fall from the commode chair. She’ll need more surgery, likely in the morning.

     “I’m so sorry. I’m so sorry,” said the nurse.

Next week: Two craniotomies in 36 hours

     

     

        

 

Rehab lets Mary down

   

                                    Mary,  London 2007

      You cling to hope in so, so many ways, even when it all seems to be said and done.

       Except that it’s never really done. You just go through various stages and phases of the next damn crisis and you learn to carry on and live with it even as you’re trying to solve the original problem, wondering what you can do next to make things better.

    If there’s one thing we’ve learned: there will be another crisis and you will have to solve it and the solution may not be what you wanted.

      The worst thing about watching Mary go through those early months of her brain injury was watching the changes it wrought. She became thinner because she couldn’t eat properly. But that was to be expected. What we didn’t expect were the peculiar faces she’d make, the drooling, the spastic movements, the very un-Mary-like behaviour that came over her. Friends and co-workers found it difficult to see, so they stopped coming to visit – or did so very rarely.

      I can’t think of anything more difficult than knowing a vibrant, young person, full of life, with a huge personality and ambition being reduced to someone sitting in a wheelchair, devoid of the very things that defined them. They’re there, but they aren’t there.

      Gone was the sharp, edgy humour, the rapid-fire retorts, the woolly tales of work, the opinions, the words, movements, gestures that made Mary so special and endearing. The driving force, the bustling entity that was Mary was reduced to a vulnerable, confused person in a wheelchair. I hardly knew her.

    

     And I have to confess, to this very day, I have the greatest difficulty in realizing the person sitting in that wheelchair, fighting to communicate, is the same person I watched grow up, the lovely daughter we raised. It seems impossible.

       Mary just became a very, very different person as a result of this brain injury and no one really expected that. It just happened. One day she’s able to talk to you, to communicate, the next day all vestiges of what she was, all she’s done and accomplished is reduced to constantly stained T-shirts, the fact she wears a diaper – although she’s never been incontinent – and the fact you can’t seem to understand what she’s trying to tell you. 

     And she tried to tell us lots those first few months.

    Mary’s first encounter at a rehab facility – where they made it clear they didn’t want her – was a horrifying experience. There were a lot of things going on in the background during this time period. The food, or gastric tube, caused mayhem, Mary was still fairly agitated (it would take months for this to ease), she began to eat pureed foods – and we sought legal advice.

      We had full plates; but the main portion was Mary, getting her better however we could. It’s a daunting task that is still – after more than four years – foremost on our minds as we go to sleep, and the first thing we think of as we wake up.

   

      A patient leaves hospital in one of the many transport ambulances used to ferry them about. I’ve been in and out of a few of these vehicles and I have to say the people who work for these companies are terrific, upbeat and positive – even if the job really isn’t.

      Mary arrived at this particular facility on a cold October day. Her arrival on the floor where she was assigned was met with some turmoil between staff members; there was a great deal of nastiness between two individuals over the placement and need for a pole to help steady her getting out of bed, and a lot of kerfuffle about the bed alarms that would sound if Mary tried to get up. It was a bit of a sideshow. I couldn’t believe staff would behave this way in front of a patient’s family – and the neutral ambulance drivers.

      It was just a taste of what was to come.

     Over the next few days, however, we met all the therapists who’d work with her and they more than made up for the floor staff. Therapists at rehab facilities are dedicated and professional, innovative and willing to employ all kinds of methods to help get someone back on their feet. They were wonderful – the only thing wonderful about the whole rehab experience.

     What wasn’t so great was the floor staff – except for two nurses, who proved to be helpful and kind – and the fact they kind of let patients do what they wanted, even if they weren’t really capable of doing anything much.

     Mary, keen to come back and struggling with being in a wheelchair, would push herself up and down the hall, banging into things. The staff hated this. She needed 24-hour care. We stumped up a whole bunch of money to cover most of this, and the facility stumped up the other half, but with a great deal of animosity. We hired personal support workers from an agency used by the hospital and they had, luckily, already met Mary.

     We knew by this time that she was legally blind, her optic nerve a pale version of its former healthy self. She had what the neuro-ophthalmologist called “cortical blindness,” a condition where half of Mary’s sight was gone in each eye; in other words, Mary was wheeling herself around and unable to see out of the left side of each eye; what she saw, in fact, was described by the specialist as dark blinds drawn down over half of each eye.

     I arrived on the floor one day – they had to keep changing the codes as patients kept escaping (there’s a universal theme here in all facilities, I think) – and I had a hard time keeping up with the latest code. This day I’d come through the back door and up the stairs to the end of a dark hall.

    I could hear a nurse berating someone and it was Mary. The nurse was shouting that Mary had to stop going into other people’s rooms. Mary couldn’t really see and she’d shuffle her chair along until she saw something that looked familiar.

      I was aghast and shouted at the nurse that Mary was all but blind and how dare she, etc. (The old harridan thing came over me, yet again.) Mary was trying to find her room and unable to because of her impaired vision. It was heart-breaking.

     The nurse was only slightly chastened. I frankly don’t know what it would take.

     And Mary seemed completely and utterly exhausted: I don’t think I’d ever seen anyone so tired, even as we met other exhausted and wounded people. There is something about a brain injury that defies logic. You just don’t know how the person will react to therapies, how well they will recover, or even if they can recover.

    Other patients assured us – and Mary – that it would take a week or so, that she would get used to the pace of the therapies, that she could rest in between and regain her strength. Still, it was a major concern.

                     Mary and her friend,  Johanna, in London

     Often, behaviour in rehab is altered dramatically. We met a number of people there who had been roommates of Mary’s at one time or another. It was comforting to see them so well, so recovered from various trauma and head injuries due to aneurysms, strokes, accidents.

   One successfully recovered patient who stands out in my mind was a prison inmate who’d been attacked. In hospital, he had to be handcuffed to the bed and lay there screaming obscenities, lashing out at the nurses and generally being a nuisance. (We demanded Mary be moved after he called out that he wanted to do certain things to her … well, you can guess. Sex was the last thing on Mary’s mind.)

      Burly prison guards or police officers would sit at desks outside the hospital room and come in and say really tough things like, ‘Get back into that bed,” or “Cut that out,” but it was the poor nurses who bore the brunt of their mistreatment.

     Another patient who had suffered terrible aggression following an accident acted out horribly, screaming and shouting, pulling out her tubes, escaping and being obnoxious to all around her. If it hadn’t been so bloody sad, it would have been downright entertaining.

     We encountered both these people at the rehab centre: we hardly recognized them. They were subdued, on the mend, co-operative and friendly. When I asked how they were doing, that I’d met them at the hospital, they all said, sorry, they didn’t remember being in the hospital, yes they were fine and getting better.

      What a blessing, we concluded, that most of them couldn’t remember the hospital stay or the things they did and said. And wasn’t it amazing what time and rehab can do to the injured brain?

      So, despite Mary being agitated and trying to get up out of the wheelchair and walk by herself and get about, we were very hopeful. 

     While she baffled the speech therapist, who just couldn’t get her to talk, she did well at physiotherapy and other cognitive therapies. I recall with the greatest delight, the day I arrived on the therapy floor and watched Mary, a cane held behind her back, walking along the hall, a person supporting her at the back, one in front of her in case she fell.

     And Mary did talk, when she was startled or surprised: “It’s too bad we just couldn’t keep her surprised,” the speech therapist joked one day. It was the oddest thing he’d come across and he was at a loss.

     She was seen by a physiatrist, a specialist who treats brain-injured patients. This doctor knows a lot about anoxic brain injury and Mary still visits regularly for meds tune-ups.

    They adjusted Mary’s medications at the rehab centre and she was put on a drug used for Alzheimer’s patients to help memory and cognitive abilities. Mary had been taken off the Scopolamine patch at the hospital (a drug used to treat drooling but which can and often impairs cognitive abilities), but this had to be put back on.

      Still, although the advances were small, they were there. And it was a good thing.  It was the best she’d ever be – to date.

      Then over a period of three days, Mary started to become really fatigued, fought to eat, stay awake and aware. We’d had a problem from the very beginning with obtaining fluids for Mary at this rehab facility. She couldn’t drink water (it’s deadly for brain-injured patients who choke easily), and the only fluid they provided came in the form of puddings or a thickened juice. There didn’t seem to be enough of these small containers they considered ‘fluids’ and Mary always seemed to be dry and dehydrated. We trekked to another hospital and bought boxes of thickened water and brought it in for her, begging staff to help her drink it.

     The feeding situation was not good: She’d had the g-tube removed prior to going to rehab (they don’t like to deal with such things) and so it was imperative that she got optimum calories and fluids. We think this was very much hit and miss.

   

    In fact, one evening, an aunt of Mary’s, who’d been visiting, was so utterly enraged I thought she’d explode. She’d just witnessed a nurse watching TV in the dining area and shovelling food into an elderly man’s mouth. This nurse didn’t say a word to the patient, didn’t interact with him at all.

     This alarmed us and we tried to be around at mealtimes.

     Mary had been able to feed herself up to this point, a tricky procedure, but she could do it. Special grips were put on the spoons and she’d happily eat everything given her. She especially loved the thickened cranberry juice and drank it with such gusto it flew everywhere.

     We arrived one day to find her surrounded by the thick gooey stuff and thought she’d been bleeding.

     But there were other problems with staff. While the PSWs we hired would get her to the washroom, often she was left to sit in a wet diaper during the day between therapy sessions.

      A washroom schedule was suggested but never really implemented.

      Now Mary was never, ever incontinent. These diapers were always for the convenience of hospital and rehab staff. It made it so much easier for them. It’s only since last December that we finally got the dreaded diapers put aside, although they’re still used at night. 

     I often think, when I look at her, the old Mary would have been outraged at the indignity of all that has happened to her … She was a social worker, after all, and knew quite well what could happen when brain injuries were involved.

     Being left in a wet diaper is not only uncomfortable, it’s dangerous for a person who is in a weakened state and brain injured. It set the scene for another crisis, another scary scenario: Mary picked up a urinary tract infection that altered her forever.

    We came in one day to find her nearly unconscious, her head down on her wheelchair tray, almost unresponsive. We started to panic. The staff seemed unconcerned, so we made them call a doctor. She was prescribed antibiotics, but it was too late.

    To this day, I am utterly disgusted at the cavalier attitude of rehab nurses. It was like my daughter wasn’t important enough for them to watch out for her well-being.

     The infection – in fact any infection in a brain-injured person – was disastrous. We all feel lousy and take to our beds when we get sinus, chest, or other infections and need penicillin or antibiotics. But for a patient with a brain injury, something occurs chemically in the brain and they take a downward spiral within a few hours, from being maybe okay, to being dangerously ill. (This information came from the physiatrist.)

     She just couldn’t come back. An ambulance was called and back she went to the hospital where this whole ordeal began. It had taken a mere 10 days for her to go from promising, to seriously ill.

     We were devastated as we sat with her as she went through the readmission process in ER. She was so terribly sick, had to be catherized again and put back on the floor she left. 

     Nurses who’d previously cared for Mary were appalled at the sight of her. She’d left in great shape – well, all things considered – and she came back thin, sweaty, pale and unaware of her surroundings.

      They were as shocked as we were.

      So Mary had to start over again – begin that long haul back to awareness and well-being. It took weeks and weeks.

      We all wondered what would happen now. Perhaps she was just too damaged for rehab? What we would do? Where would she go?

     It was made abundantly clear to us by hospital staff that Mary would be made better, made stronger and – yes, return to rehab. We had mixed feelings about this plan but there was no alternative. So we waited as she got over the infection, were horrified at the damage it had done and hoped, once again, for the best as the reapplication to rehab process began.

  

    

             We often brought Mary home from hospital for visits

         The best has never really happened for Mary, although her vision has improved somewhat.

    And there are signs she is making small advances. This week, (on Aug. 20), Mary attended her weekly outpatient therapy program at another rehab facility (fabulous staff at this one). Patients were asked to take turns reading aloud paragraphs in a statement about self-esteem.

    A first: Mary was asked to read two paragraphs out loud. Caught off guard, she did just that, stumbling on some words due to her dodgy vision.

   The others cheered.

    So maybe progress come in small triumphs, not huge leaps.

    That's fine. We’re patient people.

Next week: Regaining her strength for more rehab