Sunday, May 22, 2011

Update from David

Aloha to our Ohana,
After returning from Bakersfield a couple of weeks ago, my plan until the next scheduled visit in June was to remain in Hawai'i and catch up on office work and home duties.  Of course, our best-laid plans don't always mesh with those of our Lord and sure enough after about ten days back, a message arrived from the Center for Neuro Skills.  They were having issues with renewing the approval for Theresa's continued stay so the possibility of a coverage gap existed.  In order to cover all bases, it would be best for me to return to Bakersfield in case Theresa had to be discharged.  So for the second time in less than three weeks, I made flight arrangements for yet another Trans-Pacific crossing; again not knowing how long I would need to stay but trusting in God that this was part of His plan.
Thankfully with the passing of Easter, the airfare has dropped back to the $800 range compared to at least $1200 beforehand; plus there are plenty of seats to choose from.  Not an hour after the flight was booked, Theresa called to give me her nightly update.  In addition to her walking, arm movements and cognition progress, Theresa was fixated on the primary care physician labelling her as diabetic from a single fasting blood glucose test of 119 mg/dl (101 to 140 is considered pre-diabetic) and then putting her on Metformin, a drug to control blood sugar levels.  Theresa told the nurse the proper way to diagnose diabetes is with the hemoglobin A1C test and anyone that relied solely on the blood sugar test was practicing medicine from the last millenium.  Because Metformin has several uncomfortable side effects including diarrhea, nausea, gas, weakness, indigestion, and headache, Theresa would not consider putting her patients on it without a positive set of tests.  That said, because Theresa is playing the role of patient this time, she will reluctantly take the Metformin but has warned the staff to prepare for sudden and urgent bathroom sorties.
Theresa's mood brightened considerably when I let her know of my upcoming trip back.  She said it was actually perfect timing because CNS was holding a Lu'au themed picnic that Friday afternoon, partly in honor of the three patients currently there from Hawai'i.  So if I could pack her paʻu or hula skirt and also bring a lei, she would be properly dressed for the occasion; and it wouldn't hurt to pick up some local treats to share with the CNS staff and patients.  Time was a luxury I didn't have that evening as I rushed home to repack (keeping a packed carry-on bag ready to go has become a habit these past six months.)  In anticipation of the next trip, I had started to collect some treats to bring so mac nut kisses and wasabi-flavored tortilla chips would have to suffice this time.  Besides, with the bulky paʻu my carry-on was already stuffed beyond its design limits.  Again, Pastor Al and Lynda were kind enough to provide the ride and comforting faith on the way to the airport and for that I am truly thankful to our Lord.
The flight to SFO was relatively smooth and for the first time since starting these ocean hops in January, I had the blessing of a row of three seats to myself.  The horizontal position is definitely more conducive to sleeping however in times like this, I do envy Theresa's ability to lay across a row of three and not have her feet dangle into the aisle.  Still, laying down and curling up has its advantages, not the least of which is to block the glare from the overhead monitor.  It may be the fantasy of some but this night, Jennifer Aniston would not be keeping me awake.  Getting a couple of hours more rest on the layover before the shuttle flight to Bakersfield, I arrived at the CNS Clinic and ran into Wade, a compatriot from Theresa's time at Craig Hospital.  In his unique way, he said there must be a mistake because he saw Theresa roaming the clinic hallways using a 4-prong cane and in search of her wheelchair.  Turns out her first session of the morning was PT and the therapist took away her wheelchair and gave her the cane to get around with for the remainder of the day.
When I finally caught up with Theresa in cognitive rehab (CR), we were so happy to see each other that it distracted her from completing her sorting box task accurately.  She was working on multitasking by listening to a nature story while answering questions, sorting out objects and then switching tasks every few minutes.  Between tasks, Theresa recalled with relish the toppings and sides on her evening outing to Juicy Burger that included chipotle ketchup, assorted veggies and sweet potato fries.  As I listened and marveled at Theresa sitting on a regular chair and not her wheelchair, there was something else different about her.  She was wearing pajamas and in fact, so were most of the staff and patients.  Turns out Thursday was PJ day and thankfully, the attire of choice leaned towards Cotton Ginny rather than Victoria's Secret.
Theresa's next class was occupational therapy(OT) which she stood up and walked to slowly and surely without any struggle.  It was a pleasure to watch as she prepared an omelet from scratch, scrambling eggs, chopping up peppers, onions, etc. and even walking to the cupboard and reaching up for spices.  For safety from oil splatter, the therapist assisted with the flipping but it came out so poorly that I'm sure Theresa could have done a cleaner job.  That afternoon, Theresa walked so well with the cane to the rest of her sessions that the PT assigned the cane as homework.  To celebrate this milestone, we went to dinner at a local Chinese restaurant with the rehab aide along just in case.  I don't have the words to describe my joy watching Theresa get in and out of the car without needing a sliding board, and then doing the same to sit in the restaurant booth next to me instead of at the end in a wheelchair.  All I can do is thank our Lord for his gift of grace and healing powers.
Friday was Lu'au Day at CNS and sure enough, most everyone was decked out in aloha wear, plastic leis and grass skirts and even coconut shell tops.  Theresa looked lovely in her paʻu and blue fringe lei and in addition to the Hawaiian wear, she also sported some kinesiology tape on her elbow and knees; too bad I forgot to take a photo of its colorful and intricate pattern.  This tape has been used in Asia for decades to relax overused muscles and facilitate underused muscles and for Theresa, it has certainly reduced the soreness from all of the walking, stairclimbing, pedaling and reaching.  Kinesiotape was seen most prominently on the shoulder of Kerry Walsh, the U.S. beach volleyball player at the Beijing Olympics.  Not to be left out, I also joined in with my standard office attire aloha shirt topped with a kukui nut lei.  One of the patients, Gary, seemed fascinated by the style so we switched leis on a whim.  Later that morning, he gave me a salmon-motif bracelet he had made from a piece of ceramic found on the beach.  It's said a good negotiation is when both sides go away happy and that was certainly the case here.
The good karma continued later that day during the conference call with the health insurer.  It seems the reason they were reluctant to extend further coverage for Theresa's stay was because an initial discharge planning report had not yet been prepared.  Apparently, it is standard procedure to begin planning for a patient's discharge from the moment of their admission so everyone involved has a timeline to follow.  Because CNS had not presented this report yet, the health insurer had no idea how long Theresa might stay here other than the initial estimate of 3-6 months.  And with Theresa exceeding most benchmarks of healing after seven weeks, it's becoming more certain that her length of stay will be in the lower range of that timespan.  So with an agreement to extend coverage for a few more weeks in place, Theresa can continue with her intensive rehab therapy and look forward to returning to Hawai'i by late June if not sooner.
Following the morning therapy sessions, the staff and patients transferred to the site of the lu'au picnic, the nearby Yokuts Park located alongside the Kern River.  Yokuts (also called the Mariposa Indians) is the name of the indigenous population that inhabited the Central Valley and they numbered as high as 70,000 before the arrival of the European settlers.  Today, there are fewer than 2000 Yokuts and they mostly live on reservations in the outlying areas.  The lu'au festivities were well organized and the catered food was delicious with kalua pork, teriyaki chicken, sweetbread, homemade pineapple ice cream and an orange/cranberry salad (OK, maybe not so much that last one.)  Theresa and I enjoyed the meal together although she did miss her favorite lu'au dishes, Poké and poi.  One of the afternoon activities was mini golf and despite Theresa's soreness in her taped up legs, she still managed to play three holes before retiring.  Given all of the exertion of the past week, Theresa has done so well and made such progress along her healing journey.  Despite all we've gone through, she continues to keep a positive attitude as do I and we know in our hearts it would not be possible without the support of our Ohana and our Lord, Jesus Christ.

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