Chapter 13 --- Alternate Ending

By 8:30, Josh was beginning to pace Elizabeth's room. He and Donna had been there since seven, and she'd been asleep for almost twelve full hours. Three times, he had gone out to the nurse's station, and each time, they told him it was fine, that she needed rest. He didn't get it; she'd slept for five days straight, now she needed rest?

She finally woke up around nine, confused and scared, which only increased Josh's worry. He calmly and patiently explained to her that she'd had a stroke and that she was in the hospital. Once she was reminded of it, she remembered and relaxed. A nurse came in and helped her clean up a little, and Dr. Bomboy arrived at 10:00 with the physical therapist.

"Elizabeth, this is Barbara, she's the physical therapist you'll be working with while you're in the hospital."

"Hello," she said with a scratchy voice, nodding slightly at the woman.

"And this is her son and daughter-in-law, Josh and Donna Lyman," said Dr. Bomboy.

"Mr. and Mrs. Lyman, hello," said the woman, shaking their hands. Josh glanced at his mother, who managed to smirk at him a little at the mention of Donna as his wife. He couldn't help but smiling back at her.

"Please, Josh and Donna," Donna said to the woman.

"She just woke up yesterday from five days in a coma. Are you both sure this isn't too soon?" asked Josh.

"We won't know for sure until we try, but the sooner we start therapy, the better," said Dr. Bomboy.

Barbara turned to Elizabeth. "We're going to take it easy today. You and I are going to get to know each other a bit, and then we're going to spend some time checking your responses, your movement on both sides of the body, your balance and your coordination levels. Do you understand what I'm saying?"

"Yes," she whispered.

Barbara smiled at her. "Good. Do you think it would be ok if it were just the two of us, or would you feel better if your son and daughter came with us?"

Elizabeth looked at Josh and then back at Barbara. "I'm fine."

"Good. Mr. and Mrs… sorry. Josh, Donna… we're going to be an hour to an hour and a half. When we're done, the occupational therapist will work with her and then the four of us, as well as Dr. Bomboy, will need to talk. By then, we'll have a much better idea of what Elizabeth needs and we can start to form a plan of attack." She looked back at Elizabeth. "Sound good to you?" Elizabeth nodded at her.

"We have some questions," Josh said.

"Of course you do. Put together a list. We'll be in a better position to answer them when we're done for today," she said smiling.

"We have a list," said Donna, handing the woman a neatly folded piece of paper.

Josh looked at Donna in shock. "We wrote the list down?" he asked.

She shrugged. "Of course we did." He smiled at her and kissed her on the cheek.

Barbara looked over the list, and then folded it and put it in her pocket. "Great. These are good questions. Now, if you'll excuse us, we're going to get her ready to go, and it's… it might not be easy to watch us put her in a wheel chair for the first time."

Josh's eyes got huge and he immediately reached for his mother's hand. "I don't want her hurt," he said sternly.

"We're not going to hurt her, but it's not going to be comfortable. It takes some time to get used to people helping you do the day-to-day things. We'll develop a system that works well for us, but we don't have that system yet," Barbara said. "But you should all know, over the next several months, she is going to be in pain. Therapy isn't easy, but it is necessary."

Josh started to say something, but Donna's hand on his arm stopped him. "We're familiar with therapy," she said to Barbara. "We'll be back here in an hour or so." She took Josh by the arm and led him out of the room.

zzzzzzzzzzzzzzzzz

An hour and fifteen minutes later, they were showered, packed and waiting in Elizabeth's room when Barbara wheeled her back in. Elizabeth looked the way she had when they left, not too much worse for wear. Josh leaned over and kissed her cheek, squeezing her hand. "How'd it go?" he asked his mother, not looking at Barbara. She might have said pain was part of therapy, but he was not ready to see his mom hurting, and for some unexplained reason, he felt like it was he and his mom versus the therapist.

"Not bad," she said quietly. He held her water cup for her, and she tried to drink a little. Most of it went down her hospital gown again.

"Will you work on this?" he asked, finally looking at Barbara.

"The dysphagia? No, the occupational therapist will work on things like that." She looked over at Elizabeth. "You'll be working with Angela. You'll like her; she's very young and very sweet." Elizabeth nodded at her.

"Who's very young and very sweet?" a woman asked in a thick southern accent, walking in the room.

"You are," said Barbara standing up. "Angela, this is Josh and Donna Lyman, and this is Elizabeth."

"Hi Elizabeth," Angela said with a huge smile on her face, holding out her right hand. Elizabeth smiled and shook her hand.

"You're…" Josh looked at her, eyes bugged out and mouth hanging open. She looked like she was about twenty years old, and suddenly, he didn't care for either of her therapists. "You're a therapist?" he screeched.

"Josh," whispered Donna sharply, nudging him in the side. "Hi Angela. I'm Donna, it's a pleasure to meet you."

"You too," said the young woman, smiling. "And yes, Josh. I am a therapist. I'm not quite as young as I look."

He looked at her and tucked his head a little. "Yeah, sorry," he said shaking her hand.

"So, how did PT go," she asked. "Are you tuckered out?" Elizabeth shook her head. "Good, then if it's ok with you, we'll get started." Elizabeth nodded, already feeling completely at ease with the young woman.

"Alright then," she replied. Then she looked at the other three people. "Get out," she said, good-naturedly. Elizabeth laughed a little.

Josh stared at the woman in disbelief for a minute. "You're ok Mom?" She nodded at him and he kissed her cheek one more time before leaving with Barbara and Donna.

zzzzzzzzzzzzzzzzzz

Two hours later, Josh and Donna sat on a couch in a conference room a few doors down from Elizabeth's. The room was small; the couch, a coffee table with a telephone, and three chairs were the only things in it. As they waited for Angela, Barbara and Dr. Bomboy to come in, Donna wondered how many other people had waited for similar news in this room.

"This is an important meeting," Josh said to no one in particular.

"You ok?" Donna asked, as she had done several times over the last two hours.

He looked over at her. "I just don't know about these people, Donna."

"What people?" she asked confused.

"These therapists. One's young enough to go to the prom and the other is looking forward to hurting my mom."

"Looking forward?" she asked him like he was an exaggerating child.

"That's what she said," he said, standing up and pacing the room.

"That is not what she said."

"Yes it is. She said 'it's going to hurt and you better suck it up and who gives a damn if she's 72 years old, we're going to torture her and there's not a damn thing you can do about it.'" His voice rose in volume as he spoke.

"That is most certainly not what she said."

He stopped pacing and looked at her. "It's what she meant."

She stood up and calmly spoke to him. "It's not what she meant, and you know it."

"No I don't Donna. We don't know these people. We don't even know if they're really therapists. They could be contract killers."

"Contract killers? Josh, these are the therapists Dr. Bomboy wants her working with."

"Yeah. Dr. Bomboy. Dr. Bomboy who did nothing for five days except poke her head in the door twice a day and said 'yep, she's still in a coma.'"

She tried not to laugh, but it was pretty funny watching him unravel like this. "Ok, you're officially losing it."

"You're supposed to be on my side here!"

"Listen to yourself. Contract killers? You sound like a lunatic."

"They want to hurt my mother," he yelled.

She put her hand on his shoulder. "No they don't. They want to help your mother and you feel helpless, so you're attacking the only people you can."

"I don't want to see her hurt."

"And we didn't want to see you hurt, but therapy hurts and that's the way it is," she calmly replied.

He stopped and looked at her, and then quietly said, "I couldn't even watch them put her in a wheelchair."

"It was probably embarrassing for her Josh. She's not used to other people doing things for her, she's wearing a paper-thin gown that doesn't close in the back, and she can't move half of her body. Barbara probably thought she'd be more at ease if she didn't have you staring at her when she's like that. It had to be awkward getting her in that chair."

He tilted his head to one side. "I hadn't thought of it that way."

"Well, you did when you were in the hospital. You freaked out thinking your mom was going to see you."

"I wasn't allowed to wear boxers for a week," he said. "I didn't want her to see…. Oh."

"Yes."

He was quiet for a minute. "What about the young one?"

"She's funny."

"She's young. She probably just got out of college."

"Then she's up on the latest techniques."

"But… but…"

"Josh, don't be that guy," she said, shaking he head.

"What guy?"

"That guy who complains about everything and yells at the doctors and thinks he knows best, and basically makes everyone's life a living hell."

"I'm not… I'm being that guy?"

She smiled and pulled him close, kissing him lightly on the nose. "You're bordering on it."

He frowned. "I'm acting like an ass?"

"No, you're acting like a son who's worried about his mom."

He studied her for a minute before asking, "You think they're ok?"

"The therapists?" He nodded. "I've only met them once, but they seem competent and Elizabeth seems to like them. Let's just give them a chance, ok?" she asked.

He reluctantly agreed. "Ok, we'll give them a chance, and I won't be the guy."

She smiled at him. "That's all I ask."

zzzzzzzzzzzzzzzzzzz

"Thanks for waiting," said Dr. Bomboy as she, Barbara and Angela came in a few minutes later.

"That's not a problem," Donna said with a smile.

"Have a seat, please." Donna and Josh sat on the couch and the other three took seats in the only chairs in the small room.

"Where do we start?" asked Josh.

"We need to discuss your mother's mental state, her physical condition, her therapy options, and her long term prognosis. Eventually, we'll include her in these discussions, but she's not really aware enough to make any decisions regarding her care at this point. You hold her medical power of attorney, so ultimately, you'll need to make any decisions." He nodded at her.

"Let's start with her physical conditions," said Barbara. "She has absolutely no movement in her left side. During therapy today, she was unable to move her hand, arm or leg, even slightly." Hearing this, Josh put his head down for several seconds, and then looked at Barbara again. Donna took his hand in hers and squeezed lightly to let him know she was there.

When Josh looked at her again, Barbara continued. "She has also lost muscle control on the left side of her face, which I'm sure you've noticed."

"Yes," Josh said quietly.

Angela looked him and smiled slightly. "Your mother also has dysphagia, which meansshe's having trouble swallowing. Therefore, she can't eat. Her right arm is weak, and since her left arm in currently incapacitated, she really can't take care of herself at all."

Josh rubbed his hand over his face and through his hair, sighing deeply. "Ok, what else?" he asked calmly.

Dr. Bomboy took over at this point. "There's still swelling in the brain. We'll do an MRI tomorrow to check the progress on that. She's also still recovering from the carotid endarterectomy she had on Thursday, although she's doing very well in that regard. She's also starting to talk some and she seems to be comprehending fine, and mentally, that's a great sign. "

"As for as her mental health," said Barbara, looking at Josh and Donna. "She has significant short term memory loss."

"Significant?" asked Donna. "It hasn't seemed that bad to us."

"You'll notice it more as she begins to talk more," replied Dr. Bomboy. "She's mostly listening at this point."

"Several times during therapy today, I'd ask her to do something and she would. Then, I'd ask her to do it again, and she wouldn't remember what she was doing," Barbara continued.

"I found the same thing," said Angela.

"Is that permanent?" asked Josh.

"Probably," said Dr. Bomboy. "And as she moves and speaks more, you'll notice other behavioral changes in her as well."

"Now," said Barbara. "Let's discuss therapy options." Josh took a deep breath and nodded. "There's a wonderful new technique called Constraint-Induced Movement Therapy. It greatly helps with movement. However, your mother has to have some movement in her arm prior to beginning CI therapy, so for now, we go with traditional therapy to restore some movement on her left side."

"She hasn't even mentioned not being able to move. Isn't that odd?" asked Donna.

"To you, it seems odd. If you woke up this morning unable to move part of your body, you'd be freaking out, right?" asked Angela.

"Yes."

"Well, this is different. It's not like if she had a broken spine. In that case, the brain would be telling the limbs to move and she wouldn't be able to move them. In this case, Elizabeth's brain no longer thinks that part of the body should be moving, and therefore, she doesn't see anything odd about it."

"You can no longer assume that her brain works the way your does," said Dr. Bomboy. "It simply doesn't. It works, but not the same way." Donna nodded at her.

Josh turned to Barbara. "Once there's some movement in her arm and leg, we can do the new therapy?"

"If there is some movement, Mr. Lyman. Her stroke was severe, was it not?" Dr. Bomboy looked at her and nodded. "I can't guarantee that she'll ever have movement on her left side again. We're going to give it our best shot, though. In the meantime, we're going to work on strengthening her right side, so she can do some of her daily activities. We're also going to get her as mobile as possible in a wheel chair."

He put his face in his hands and asked, "What about the swallowing?"

Angela spoke to him. "The dysphagia will be the main focus of my work with your mother at first. We won't be able to kick it altogether, but we will be able to control it. The goal, of course, is that your mother will be able to eat regular foods. I'd expect her to be swallowing better in a few days. Hopefully by mid-weak, she'll be swallowing well enough to be able to eat soup, Jell-O, things like that. She and I will also be working on the little everyday things like brushing her teeth and answering the phone."

"I recommend a speech therapist too," said Dr. Bomboy. "Her speech isn't that bad, and I think a month or so with a therapist will make a world of difference."

"That's fine," said Josh. "Whatever's best for her."

She nodded. "Good. I'll make the arrangements today."

"What about her long-term prognosis?" asked Donna. "You said we'd discuss that."

"Yes. I expect the brain swelling to go down completely, and I expect her to fully recover from the carotid endarterectomy. I also expect her to be able to recover her speech almost fully," said Dr. Bomboy. Josh squeezed Donna's hand and smiled.

"That's the good news, Josh," said Barbara. "At this point, I'm not convinced she'll ever walk again." He took a deep breath and fought a tear that threatened to fall. "I do think we'll be able to get some movement in her arm, and if so, the CI therapy will help immensely to improve that movement. I know it sounds bad, but if she can move both of her arms and hands, it will go a long way towards her independence, even if she doesn't walk again. And I don't want you to think I'm giving up on that; I'm just trying to be realistic."

Donna looked at Barbara. "And what about independence?"

"Will she be able to live alone, you mean." Donna nodded. "The three of us have discussed it, and no, at least not in the foreseeable future. I'm sorry to be so blunt, but that's our assessment."

"The two of you have only met with her once," said Josh, motioning towards Barbara and Angela. "How can you be sure?"

"We can't be. But going off of experience, that's our guess at this point."

Dr. Bomboy cut in. "That conclusion is not only based on her paralysis, Mr. Lyman. It's based heavily on her memory. She could go into the kitchen and turn on the stove, then answer the phone and completely forgetthe stove is on. She could forgetshe hasn't eaten, that she's already taken her medication, that she's lit a candle, that she shouldn't light a candle, that she has to take small bites or she'll choke."

The room was quiet for several seconds while Josh and Donna absorbed everything they'd been told. "So, at best, we're looking at a nursing home," he said quietly.

"At best, I think you're looking at assisted living," said Angela. "There are great places, Josh. Small apartments attached to nursing homes, with a bedroom, a small living room, a kitchenette. These places have on campus dining rooms, hairdressers, convenience stores, activities… They have nurses who check-in with you throughout the day but still allow you to have some independence. Then, if and when you need to, you progress to the nursing home. I think that's your best case scenario, but I don't think she'll be ready for that for months."

"And in the meantime?"

"She'll be in the hospital for a few weeks to a month and then she'll be moved to a full care facility that will continue her therapy," said Dr. Bomboy.

"When can we transfer her to Washington DC?"

Dr. Bomboy smiled. "We noticed that question on your list. It'll depend on the swelling in the brain, but I'd say as soon as a week, maybe two. We can help you arrange for the transfer when she's well enough to be moved as well as help arrange for a hospital in Washington with a full time therapy unit."

"Barbara and I will research care facilities and therapists there, and make some recommendations," said Angela.

"Thank you," said Donna.

"It's not a problem. We all want what's best for her, and I think being closer to the two of you is exactly that."

"What do we do for now?" asked Josh.

"Well," said Dr. Bomboy. "Right now she's getting a bath. She'll spend the rest of the day sleeping on and off, I'm sure. Tomorrow morning we'll be doing the MRI, and then she'll have physical therapy for…" she looked at Barbara.

"Two hours a day, everyday."

"Two hours a day of occupational therapy as well," said Angela.

Dr. Bomboy nodded and smiled. "And I'll have a speech therapist come by tomorrow afternoon, I'd plan on an hour a day for that. She's going to be busy."