Public service announcement - Estate planning

I have taken too long to thank Dad for very practical help that he gave me to deal with his stroke and what followed: planning. Many years ago, he executed a durable power of attorney, naming me his attorney-in-fact. He also gave me a list of institutions where he had financial accounts, insurance policies, etc. These tools, especially the POA, have been immeasurably helpful. Of course it has been a challenge to drop into his affairs and get up to speed on the bills, accounts, and all, but if I hadn't known where to look and then had the legal authority to take action, it would have been so very much harder.

The other key tool has been his email account. I lucked into access to this one: I saw him entering his code to unlock his phone at the hospital, and I used the phone to get into the email.*

Which is to say, if you are an adult, please take the time to make some emergency plans. Find that person you can count on and make sure that they have the legal authority and key information to help you out if things go sideways in a hurry.

* In fairness to Dad, he also provided me a vast list of account passwords, including his email. Unfortunately, the code that he used to disguise the passwords, while perfectly transparent to him, has stumped me. So when you do give that information to a trusted someone, make sure that you aren't _too_ much cleverer than they are.

Life at the new house

I haven’t posted about Dad since his move to the residential care home. It’s not a very good excuse, but it is a case of no news being good news. He seems to be quite comfortable. The caregivers are very nice. He is eating well. He was receiving physical, speech, and occupational therapy for a few weeks; OT has now stopped. He has a few pictures from his house on the wall of his room: a couple of his mom’s paintings, one of his dad’s mechanical drawings, and a watercolor of unknown provenance that was at the house in Tulsa as long as I can remember. He asked for a TV in his room, but I’m not sure how much he actually watches it.

Until yesterday, I was able to visit Dad at the gazebo in the backyard. I was masked and staying six feet away, but now that has come to an end; all visits have been suspended indefinitely. It’s a bummer, but given the still growing number of covid cases in Dallas, it makes sense.

I’ll be writing Dad notes. I’m happy to drop off notes from others at the same time, or please feel free to write him directly. Thanks.

Belated moving day

On Tuesday, Dad made a fairly smooth transfer from the rehab hospital to the residential care home where he will be for the foreseeable future. As I think I described previously, there are seven other residents in the house, each with their own room. There is a nice living room with couches and comfy chairs, plus a couple of dining areas, a back porch, and a gazebo. There are two caregivers during the day and one overnight.

This describes several residential care homes in the area. The killer app for Dad's house is that it is actually in our neighborhood. It's a ten-minute walk away. I haven't wanted to mention this detail, for fear of jinxing it, but he's now been in the house for two days, so I think it's safe to go public. He can receive mail there; please contact me for the address if you would like to start sending things directly to him.

I was at the house a good while yesterday, helping to get him moved in. It was a long day for Dad, so I was glad to pop in this evening to see him relaxing after dinner. He looked very comfortable and happy. He'd had a shower and a shave. Well, most of a shave; he seems to be growing a mustache. We'll keep you posted.

Almost moving day

June 2 remains moving day for Dad. Kerry and I were able to have two hours of "family training" at the rehab hospital, which ended up being two hours in his room, first with PT/OT, then with his speech therapist. Getting to see Dad in person for that long was an unexpected surprise. He was using his left hand to eat, a remarkable change from when I'd last seen him, in mid-March, when we were excited over finger wiggles. His speech was easier, and there seemed to be less of the compulsive fidgeting I'd seen in Tulsa. On the other hand, we were told that there has been little progress with his left leg; mobility/independence, even within a home, will be limited. And we played a game of Uno, which prompted mixed feelings. While it was good to see him participate in the game, it highlighted, in a very personal and specific way, how his brain was damaged by the stroke. Dad and I would play cribbage while having a running, unrelated conversation. When the family played hearts, he was always the one counting cards. And now, he needed coaching to play a game of Uno. I am grateful for his rehabilitation to this point, and I trust that recovery will continue, but at the risk of stating the obvious, his condition is very different from three months ago.

I'm looking forward to Dad getting settled in a new home. I know it will take time for him to adjust to yet another new setting and new group of people, but I am optimistic that this will be pleasant and comfortable for him. Whatever you are inclined to offer for this next transition - prayers, lit candles, cereal box tops, hugs - I accept on Dad's behalf with gratitude.

Looking ahead

I've kept planning to provide an update once I've had a chance to talk with Dad, but after last week's flurry of phone activity, I hadn't been able to connect with him. I finally got through. It turns out the ringer had been silenced on his room phone.

It was not the most encouraging call. I'm hoping that he was just distracted by the TV news in the background, but he was very quiet, and what he did have to say was, in essence, "I want to leave," and, "Therapy isn't getting anywhere." Of course it's natural that he wants to leave and that he should have times when he is discouraged. Hopefully, though, this is just a down morning, not how he's been feeling for the last week.

But as far as leaving goes, that is scheduled for June 2. We are making the arrangements for him to move into a residential care home, a converted house with as many as seven other residents. Everybody has their own bedroom. There are two caregivers there during the day and one overnight. The food is all prepared there in the house, and all medical/therapy care is provided there. Speaking with Dad's therapists and case workers, as well as some friends with elderly parents, the clear consensus has been that a home, with a higher caregiver ratio, would be a better fit for him than a larger care facility. And I also think Dad will be more comfortable in a house. It won't be his house, but it is as close as we can get, at this point.

Pa Bell

Out of the blue, I got a call from Dad this morning, on the phone in his room. He's had a room phone in all of his facilities since the stroke, but this is the first time he's used one. We talked for 20-25 minutes. It was a slow conversation, but a long one, and notable that he did it on his own, without assistance.

I asked Dad about being able to answer the room phone; I think he said that he could, but I'm going to test that (and his cell phone), before announcing that he'd like to receive a lot of calls.

This morning a friend sent me some questions about Dad that you might also have. And as he might be calling you next, I thought I'd share some answers.

Q: How aware is your dad of what has happened; what his condition is?

A: Pretty aware. He certainly knows that he's had a stroke and how it's affected him. One disconnect is that he wants to "go home". If someone talks with him about specific tasks that he finds challenging (eg, getting around a room), he will acknowledge the challenges and that they would be obstacles to going home. But when they try to put it all together, he still wants to and thinks that he can go home. According to his last speech therapist, a reasoning breakdown like this is more likely to be a consequence of the damage to his right frontal lobe than inherent stubbornness. He also seems to forget that he is in Dallas. (Admittedly, there aren't a lot of visual cues - no life-sized JR Ewing cut-outs - inside his room.)

Q: How aware is he of the pandemic?
A: Not sure. I've mentioned it on the phone and in writing. I've not wanted to dwell on it, but a) I want him why no one has come to see him in almost two months, and b) it's kinda hard to talk about our lives without mentioning it. He has expressed no curiosity about it and has never brought it up on his own.

Q: Is he able to read/comprehend a lengthier note (a typed letter...and should it be in larger print if he is?)
A: Yes, he can understand longer letters. My notes to him have typically been 1 to 1-1/2 pages, and by all accounts he's read and understood them. Typed is probably better than hand-written, unless your handwriting is much better than mine. But I'm just using 12-point font, nothing wildly big. And way back in March, when he started reading The Hobbit, that was an old edition with little print, so I don't think the visual part of reading is a challenge.

Moving (again, and not for the last time)

Dad transferred today from skilled nursing to an in-patient rehab hospital. The plan of keeping him in skilled nursing until he started to "plateau" ended up lasting about a week. As the therapy team only meets weekly, that's about as short as it could have run. At in-patient therapy, as in Oklahoma, he'll receive physical, occupational, and speech therapy, at least an hour of each per day. I'm glad for him to continue to receive intensive therapy.

I've heard initial estimates of one to three weeks at this hospital, at which time he'll discharge to a long-term care facility or residential care home. This next move should be his last for quite some time. We're assembling a short list of candidates nearby and will do our best to get a sense of them by phone interview and video tour.

The plans they are a' changin'

Yesterday, Dad's therapy team decided, based on the progress he's been making in his current setting, to extend his stay until May 11 (one week). I was a little surprised by the extension, as they've been angling towards in-patient rehab starting May 4 for a couple of weeks now, but I'm comfortable with the decision. He does seem to have made noticeable progress in the last 7-10 days; extending in that environment makes sense to me. Apparently they'll take stock at their weekly meeting each Tuesday, and as long as he's still progressing, they'll probably keep extending.

Something sounds different

The title of this post is somewhat misleading. When I spoke with Dad this morning, he sounded different from what we've been hearing since the beginning of March, but much more like himself pre-stroke. His voice was less croaky, and he was able to get out a lot more words. He said that it was still hard work talking, but it seems like LS's suspicion (mentioned back on 7 April) was correct: his vocal cords were spasming shut. It's clearly taking some deliberate effort for Dad to relax the cords, as the croaky, halting speech went and came while we talked, and he allowed as he needed a break after 15 minutes, but still, it was a wonderful conversation. The whole family here got to hear a lot from him.

Standing

I received a video call from the physical therapy gym yesterday and saw Dad standing up. It was with some support, mind; he was holding on to something like a walker bolted to the floor. Nonetheless, it was much more than I had seen since the stroke. His therapist said that he had been standing for about five minutes. Speaking to Dad's longer-term progress on this front, as the left side strengthens, he is listing less in that direction, and can right himself - no pun intended - as he does. Transfers are getting easier as he can assist more. His control over his left arm is improving, as well. I think I mentioned previously that he had used both his hands together to open some mail; the therapist also reported that Dad is better able to release things once he gets hold of them with Lefty. (Aside: I had always thought of a stroke as damaging the ability to do certain things. But one thing I've learned is that, at least for Dad, the damage often manifests as the inability to stop doing certain things, even things we think of as voluntary. This has applied in both the physical and cognitive realms.)

The plan is still to write an order next Monday for him to go to in-patient rehab on May 4. The rehab facility will need to review his case, to see that he is making progress, to accept him. Given what I've seen over the last seven weeks and within the last ten days, I am optimistic that he'll be accepted.

Update

For whatever reason, I woke up this morning and realized that I hadn't shared any updates for a week. There are indeed updates to share.

Most of Dad's sutures came out a few days after his fall. Everything seems to be healing fine. Beyond the wound itself, he had some bruising on the forehead and around the eye.

His care team wasn't happy about him spending another two weeks confined to his room, so they tested him for SARS-CoV-2. It came back negative, so now he's got a little more freedom within the facility.

We're still on the outside, of course, but the staff arranged a time for us to meet at a distance. A great distance, in fact, as he's on the 8th floor. But nonetheless, last Saturday morning, Kerry, Owen, Katherine, and I were standing in the median of the road outside his building, waving up to him. He sat at the window, and with assistance, stood twice, waving. Of course this being this modern life, we were also Facetiming, so there were moments when we were standing in the median of the road outside his building, huddled around my phone to talk with him less than 100 yards away.

I think these sorts of connection mean a lot to Dad. I know they do to me. In that vein, thank you very much to those who have sent Dad cards and emails via me. Please send them as often as you like.

Dad's care team thinks that he would benefit from another round of in-patient rehab. He would receive at least 3 hours of therapy per day, as he did in Tulsa. This makes sense to me, given what I've heard about most stroke recovery happening in the initial months after the event. If all goes to plan, he would move to a new facility for in-patient rehab on May 4.

After the fall

I Facetimed with Dad today. It was another good conversation, not quite as good as the one last Friday, but pretty good for a guy who has a fresh bandage on his head. His therapist, LS, also shared that he has been intentionally using his left hand (eg, to open an envelope).

But, as every silver lining has a cloud, my fear was confirmed: Dad's little jaunt to the ER caused his 14-day covid quarantine to reset. Yesterday had been day 14, but it became day 1. In truth, this is a relatively small limitation, as all group activities (eg, dining) are suspended. Nonetheless, once he gets past 14 days (again), he'll be able to go to the gym for physical therapy and use the full suite of equipment there.

Never a dull moment

This morning, Dad took a tumble out of his wheelchair, reaching for his shoes. He landed on his noggin and needed to go to the hospital to get some stitches. That sounds bad, but apparently it wasn't so bad that he didn't finish his breakfast before going to the hospital. They also did a CT scan there to confirm that there was nothing more serious going on inside. There wasn't.

One week update

Dad has been in Dallas for a week. My updates have come from his speech therapist, LS, who has helped Dad to call/Facetime me, but also to talk with me, to learn about Dad and to let me know what she's seeing. In short, there is not much change in his condition. He did eat his breakfast entirely on his own this morning, without any prompting. LS speculates that he may have spasms in his vocal cords, slamming them shut when he tries to speak. This would account for his croaky voice, as well as the extreme effort it seems to require at times for him to start speaking.

I don't know about physical and occupational therapy. I should learn more during a call this Thursday.

All of the staff are wearing face masks all the time, so patients can only see their eyes. This is an extra challenge, with mouths entirely hidden and facial expressions limited to eyes and eyebrows. LS was asking me about Dad's interests, so that she would have more things to talk about with him. I really appreciate her reaching out.

Speaking of reaching out, while there are no visitors, and phone calls/Facetime are touch and go, Dad can definitely receive mail. It's probably best if you send things to me, and I'll bring them over; I don't know when his location in the facility might change, or how good their mail forwarding is. If you'd prefer to do it electronically, you can email me, and I'll print out and take things to him. For content or questions, I'm at rtdunbar-at-gmail-dot-com. Thanks in advance.

The move to Dallas

Dad moved to Dallas today. It went very smoothly. He had medical transport, riding in a reclining wheelchair in a van, while I followed behind. At 10:00 he was ready to roll, and by 2:05 he was here.

Dad quickly was whisked away to his room, and that was the last I saw of him. I passed the covid temperature check outside, so I was allowed into the lobby and admission offices, but that was all. Beyond the restrictions on visitors, as a new arrival, Dad will be limited to his room for the next 14 days. It's a stinker, but I understand the rationale.

After admit paperwork, I spoke with a physical therapist and the admitting nurse, introducing them to Dad. They were nice. Later I got a call from a case manager, and I phoned a nurse or tech on Dad's floor to plug in his heart loop monitor base station. So, good communication. What's more, his building is new, with a lobby decorated like a chic hotel. Don't know what else I can hope for in the first six hours.

Unrelated to the day's events, but delightful, I'll share a story from Cousin Kathy:

   ... from the 50s and 60s when my family and John's spent time on Cape Cod for many summers. There was lots of beach time and card games. The women in the crew were avid knitters and there were lots of knitting instructions to be found in the cottage. Your Father entertained us all by reading these instructions out loud verbatim. Who else could crack up his audience with renditions of:
   Cast on 37 sts
   Row 1: K1, *P1, K1; repeat from * to end
   Row 2: P1, *K1, P1; repeat from * to end
Lots of percussive Ks and Ps to the great delight of his audience.

Really funny and off-the-wall. I'd never heard that one.

Moving on Tuesday

Tuesday remains discharge/moving day. While I've been in Tulsa, Dad and I did get to wave to each other through the closed door at rehab. We Facetimed twice. The second time, he got to see cousin Debbie and Chopper, his dachshund, which he enjoyed. I also learned that he walked 34 feet in the harness seen in a blog post last week.

Fingers crossed for a smooth trip and transition from care in Oklahoma to Texas. At least we shouldn't have to worry about traffic on the drive. It's all silver linings...

Moving plan

Dad's discharge on 31 March has been confirmed. I'll head to Tulsa today, and next Tuesday, I'll caravan with medical transport van back to Dallas. He'll enter skilled nursing only a couple of miles from our house. There he will continue his current therapies, albeit at about half of the time per day that he's had during rehab. This will continue for an unknown amount of time - on the order of weeks, we expect - as long as he's "showing progress".

The weird part about this exercise for me is that, due to covid-19, I won't be able to see Dad in person until he discharges on Tuesday morning. And once he's admitted here in Dallas, I'll have to say goodbye again, not even able to see him into his room. I understand the reason for all this, and I'm confident that the facility here is good, but it's still a very strange feeling.

Up and at 'em

Here's Dad at PT, in "the harness":

I think "the harness" is helping him get back the feel of using his legs to walk. I also know that it is not "the ambulator", and may be more demanding than that contraption. 

Facetime time

I had a very good video chat with Dad early this afternoon. He spoke with me in those few minute as much as at any time since the stroke, and his "lag time" was noticeably shorter than when I left Tulsa and on the phone last Friday. It was very heartening.

He says that in PT he's now using an ambulator - I think I heard that - which helps him to "move his legs where they need to go". In my mind, it looks like this:

In reality, it's probably more - dare I say - pedestrian.

Here in Dallas, I had a long talk with someone from a second facility that Dad might transfer to. Once again, getting more information from people who've been through this process is a big help.

No news is all the news

I got to speak with Dad for a minute or two last Thursday. As no visitors are allowed, hopefully a call can become a regular part of speech therapy. It was short, mainly me talking to him, reminding him that we're thinking about him.

Dad is still scheduled to be discharged from the rehab hospital on March 31. We have confirmation that one skilled nursing facility near us in Dallas has a place for him at that time. Trying to find out about a couple other options, but knowing that at least one is available is comforting.

Visitor lockdown

I learned this morning that visitors to Dad's rehab hospital are now restricted to primary caregivers there for education or discharge. I certainly get it, but it will be harder to know how he's doing.

In any event, I'm heading back to Dallas this morning. We're looking for places there where Dad might live after discharge from rehab, but I doubt we'll be able to visit any place because of their covid-19 precautions. Don't know how those might affect transfers of new patients.

Happily, before lockdown, Kerry and the kids came to have a double birthday party for me and Dad in his room. They brought a cookie cake, a balloon, festive napkins - all color-coordinated - and song. (On another visit, the kids played their sonatina pieces for Dad on the piano in the cafeteria.) It was very thoughtful, and I think he enjoyed it. I know he enjoyed the cookie cake.

A joke

I found this in Dad's email from a couple of weeks ago. I'm sure he'd like to share it.

Aphasia, Apraxia, Initiation, Perseveration

I am hesitant to write too much about Dad's condition because of my own ignorance. I'm not a doctor; I don't even play one on TV. That said, I thought I'd share the mental impact of Dad's stroke.

The terms in the title have all been used in reference to Dad's current condition. There seems to be a degree of overlap or connection among them, so I won't try to precisely define them or map them to Dad. Here are things I see:

- He speaks very little. When he does, it is almost always related to the current conversation or situation. It also takes a long time for the words to come. If you don't wait at least five seconds for an answer, you're conversing too fast. (Exception: He's been quite quick the whole post-stroke time greeting and saying goodbye/thank you to people.) And lots of times, he simply doesn't answer questions.

- As far as we can tell, he hears and understands everything said to and around him

- Dad has control over his right arm and leg. However, they have been weakened by the stroke, and control of those limbs is challenging. He may know what he wants to do, but it can take a while for him to start the action. The flip side of this, as J explained to me, is that once he starts something, it can be hard for him to stop. For instance, he'll chase and chase the last little flecks of food around the plate, or start repeatedly clicking his bed controls or TV remote (even when the clicking doesn't do anything).

- Living is really hard after a stroke. Every activity takes a lot of mental energy, which has reduced his attention span. Half and hour of watching a movie, listening to a book, or eating is a long spell. And the cumulative effects of days of therapy are also tiring. Yesterday, I went with him to all of his sessions. I could see how hard he worked in each one. But at the end of each, and between sessions, he was simply dog-tired (at which times the persistent or repetitive behaviors become more pronounced).

Today is a day of rest for rehab. Kerry, the kids, and I will spend some time with Dad, but I'm hoping and expecting that this will be a quiet day for him to recharge.

Quiet Day

I don't have much to report. During Dad's therapy sessions, I was back at the house with Debbie, going through mail and bills and the like. Afterwards, Dad was about the same as yesterday. I'm planning to join him at his sessions tomorrow, and sometime thereafter, Kerry, Katherine, and Owen should be here. (Yay!)

Make 'em laugh

To jump right to the headline/punchline, my last bite of Taco Bueno street taco for dinner was full of pungent onions. I didn't want to spend the rest of the evening with a funky mouth, so I put a dollop of Dad's toothpaste on my finger and rubbed it around inside my mouth. He looked at me bemused - as if thinking, "Who raised this kid?" - with a legit grin on his face. Not even my best bit, but it clearly tickled his funny bone.

Dad's second full day of rehab went well. He actually got a bonus, second hour of PT, and got to give some treats to Finn the Trainee Therapy Dog. He had more energy this afternoon after therapy than he did yesterday.

I'd started reading The Hobbit aloud over the weekend. We had some time this evening, so I read another chapter. When I finished, Dad reached for the book and picked up reading, aloud, where I'd left off. He read more than a chapter that way. I'd seen him ace a couple of post-stroke reading evaluations, but those were only a handful of short sentences. Otherwise, he hadn't shown much interest in reading. He would kind of stare at the newspaper, but there was no sign that anything was registering or catching his interest. That changed when Bilbo, Gandalf, and the dwarves were crossing the Misty Mountains.

Last news for today: Dad has a target discharge date of March 31, corresponding to a three-week stay in rehab.

Rehab Day 1

Today, Dad's first full day in the rehab hospital, did not disappoint. The highlights for him were an hour each with physical therapy, occupational therapy, and speech therapy (the last being more about cognition, not the mechanics of speaking). These were intro assessment sessions for the therapists, learning about Dad's current condition, but they were intense. I won't attempt to list everything that they did; suffice it to say, he was worn out by the time he got to dinner.

As well, I got to speak with Dad's case manager, who provided a very helpful overview of the next 2-3 weeks. Early next week, Dad's rehab team will have a plan, including a target discharge date and goals for various skills and abilities he will have by then. Implicitly, this plan will also provide expectations for the level of care and type(s) of therapy Dad will need at his next facility. Structured guy that I am, having a plan, or even a plan for a plan, makes me feel better.

The rehab hospital is a lovely change from a traditional hospital. Nothing against a traditional hospital; their design has to accommodate many different needs, and of course many of these facilities have evolved over decades as needs have grown and changed. The rehab hospital is quite new, with spacious corridors that encourage moving around, a big therapy gym, and a nice courtyard where Dad was able to sit with Debbie and Marty this afternoon. And the food is better.

It turns out that Dad's speech therapist, J, is the older sister of one of my best friends from high school. I'd say, "It's a small world," but this is all happening within ten miles of where we grew up, so maybe not. Still , it's a funny coincidence.

The "brains are weird/amazing" moment of the day occurred during speech therapy, where Dad was given a circle drawn on paper and was supposed to add the clock numerals and draw the hands for ten past eleven. (Evidently this a classic therapy question, which is why many of you readers are nodding in recognition.) My left-handed Dad was holding a pencil in his right hand, not having made any mark on paper, to the best of my knowledge, at any time since his stroke. He sat stock still for quite some time. J saw him look at his left hand, and the fingers on his hand twitch; Dad knew that writing was a thing to do with the left hand, even if it wasn't cooperating. So J offered that he could just point to where the "12" goes on the clock. After another long wait, Dad moved the pencil to the top of the circle, and wrote "XII", "12" in Roman numerals. He then proceeded to label the rest of the clock in Roman numerals, including the horizontal bars at the top and bottom of each numeral. Finally, for good measure, he drew the clock hands in the right places. It was amazing and heartening to see all those pieces come together. I was also so grateful for J's insight and patience to give him the time to have that success.

New location

Today Dad made the move from the hospital to a rehab hospital. Before that, he did get the loop heart recorder implanted and a second bubble study, to confirm that there is no shortcut for blood between the right and left atria of his heart. Beyond that, though, there was a good deal of simply waiting before he actually was wheeled out, around 5pm.

It's good to make this move. Once the initial stroke has passed, the hospital is focused on preventing a second stroke and assessing the level of need for rehab. As we heard on day one that in-patient rehab would be appropriate, there wasn't a lot more to be done. Not to say we were neglected; neurology and therapy staff visited, assessed, and answered questions, but it started to feel like a bit of a holding pattern. Of course he wasn't ready for this stage of treatment on day one or two, but now that he is, just changing locations feels like progress. I'm looking forward to tomorrow, meeting the doctors and therapists, and learning about the weeks to come.

We're also looking forward to seeing Cousin Debbie, who's arriving in Tulsa late tonight.

Last night in the hospital

Tonight should be Dad's last night in the hospital. The plan is for him to get an implantable loop heart monitor in the morning, then move to an in-patient rehab facility.

The cause of Dad's stroke has not been clearly found. An atrial fibrillation is a leading candidate. The implant is less than two inches long, slipping under the skin and wirelessly communicating heart data for three years. The data should help to determine if there is something abnormal going on with his heart.

Dad's left hand started to wake up today. We could see him flexing the thumb and forefinger, and a couple of times, when rolled onto his right side, his hand latched on to the bed railing. These are little movements, admittedly, but being the first ones observed in more than 72 hours, those little movements are big deals.

Speech

Something I should have mentioned in Sunday's update: Dad's speech is getting much clearer. He's not really mumbling at all now. There's still a fairly good lag between the question and the response, but more words are coming when they do arrive.

Shaving update

Back at Dad's house, where I grew up, I found my electric razor from high school. It still works. Now Dad is (fairly) clean shaven, and I can hear "The Circle of Life" playing in the background.

Sitting on top of the world

Dad spent most of the day in a hospital recliner instead of a hospital bed. This may not seem like much of a difference. It didn't seem like much of a difference to me, until he moved into the chair, and I saw his energy level jump up, as if a switch had been flipped. I guess there's something about getting out of bed that tells the mind, "Wake up!" It was definitely more work, being in the chair. He took a couple of naps, and looks like he's ready for a good night's sleep.

His right hand was more stable today. Friday and Saturday, it had a pronounced shake, often at rest. Today, he was drinking from a cup with hardly a tremor. He'd also been doing a lot of aimless fidgeting with the right hand. That seemed to have abated some today. (Although even now he's holding his cell phone and tapping it a bit as he drifts off.)

Marty visited again today, and Mom spent several hours in the room with Dad. He expressed his frustration to her. It was only a few words and some tears, but it was the first clear, emotional communication from him. Of course it's sad to see the toll on him. But the silver lining is that it shows so much about his understanding of the situation. We can't whisk away the frustration, but at least we know better where he's coming from.

We learned that Dad's hair-combing game remains strong, and that he has a good foundation for tooth-brushing. We learned that my give-someone-else-a-shave-with-hospital-razors game is weak. So weak that, with less than a third of his face even touched, Dad grabbed a washcloth and started wiping off shaving cream. We'll try again tomorrow with an electric razor. In the meantime, no, you can't see pictures of the Mangy Two-Face look I gave him.

Papa John had a stroke

At some point this week, my dad had a stroke at home. We don't know exactly when it happened, but on Thursday, cousin Debbie texted because Dad hadn't replied to texts or phone messages for a couple of days. Not his MO. After he didn't respond to my text or call, I got in touch with his friend in town, Marty. Marty went by the house to find Dad sitting in his chair, but not responding to Marty or EMTs pounding on the window, shouting his name. Once they got in the house, Dad evidently greeted Marty right away, but he clearly needed to go to the ER.

His was an ischemic (clot) stroke in the right anterior cranial artery. If you're going to mitigate a stroke by dissolving or removing the clot, you have to act within a couple of hours. That window had passed for Dad. CT and MRI show a large, damaged section of his right frontal lobe: to my untrained eye, a strip about an inch wide in the front half and upper two-thirds of his brain.

Dad went to the ER around 6pm on Thursday. I got there around 11:30 that night. Despite the events of the day(s), he recognized and greeted me right away (as he's done with every visitor or caller since). Friday was a full day of tests and visits from internal medicine, neurology, physical therapy, occupational therapy, and speech pathology. He was moved from the emergency department to a stroke service in the hospital.

So the immediate impact of the stroke: Being on the right side of his brain, the left side of Dad's body has been most affected. His left arm has scarcely moved; one nurse and doctor have discerned some reflexive movements in the fingers, but they are very subtle. His left leg has shown only uncontrolled or reflexive movement. (It has a superb tickle reflex; more on that later.) There's a droop on the left side of his face, which is more pronounced when he's tired. And it seems that his brain may be "neglecting" the left of his field of vision. He appears to have normal sensation all over his body. He can control the right side of his body, but movements are slow, and he's quite weak. When the PT and OT jointly got him to a sitting position on Friday, there was no sign he could maintain it.

He seems to be fully aware of his surroundings. As indicated above, he greets whoever enters, and he's aced every question about his name, birthday, location, month, year, etc. His speech is mumbled, with a very flat affect, and there is a noticeable delay for him to respond. He's been cleared to eat since late Friday morning, and has polished off every hospital meal since (being fed, of course). He is most talkative towards the ends of meals or on the phone.

His spirits are the hardest thing to gauge. Though he is not talking much, his speech is full of his typical, dry quips. (Extremely dry, given his current voice.) He's made a few comments about being home "tomorrow", and called the plumber to try to schedule a repair at the house. It's hard to know how much this is undue optimism, cynicism about the ability of the medical staff to help him, or complete unawareness of his own condition. (On Friday, he claimed to be able to move his left arm, but that didn't come up today.) He tends to clam up when he is being asked to perform various tasks ("raise your arm", "follow my finger with your eyes"). Again, it's hard to say why. Fatigue, because these tasks are very challenging at this point? Frustration, because he can't do them? Confusion? Pissed-off resignation? I don't know.

This afternoon, I did see his first grin, and maybe even heard a chuckle, while I was clipping his nails. I went to his left foot, forgetting its aforementioned tickle reflex, and was dramatically startled when it flew up at me. It made me laugh, and when I looked at Dad's face, he was clearly amused, too. That was the highlight of my day.

After a very busy Friday, I've been told that we're just hanging out at the hospital this weekend. For a few days after a stroke, there is an elevated risk of a second stroke. Preventing that is the top priority. Dad has high blood pressure - he'd just started a medication to bring it down - which is the top risk factor for a stroke, but there has been no clear, "aha, here's where your stroke came from" found. On Monday, we'll start talking with the case manager about the next step. That's likely to be an in-patient rehab facility, a place with hospital-level care plus three hours of rehab, five days per week. In extremely notional terms, he might be moved to such a facility mid-week, for a 2-3 week stay.

I want to thank all of the family and friends who have visited or called Dad and who have sent love, prayers, and offers of help. (This goes for all those back in Dallas who are helping Kerry, Owen, and Katherine fill in the gaps while I'm in Tulsa. I don't know exactly who's doing what, but I know that you have our family's back.) It means so very, very much; I can't imagine what this process would look like without you.

I will do my best to provide news here, or at least more funny stories of Dad trying to kick me in the face.