July 19, 2017 10:20 pm

Happy birthday? Josh was surprised to find out that today is his birthday. When I asked him how old he is today, he said, “I don’t know.” I said, “25! You are 25 years old today!” He looked shocked. I said, “Do you feel old?” He replied, “I didn’t until now.” THAT is a GREAT answer!

Because Josh is still in such a fragile state, they have assigned him one-on-one care. That means that he is to have a BA (Behavioral Attendant - the rest of the world calls them CNAs) with him at all times. So even through the night, a person is hired to watch him sleep. Apparently, last night’s nurse didn’t watch so closely because he pulled his IV out. They had to reinsert it during the night.

Josh’s birthday started at 6:45 this morning when he was taken to Swedish Medical Center for x-rays. They x-rayed his PEG tube to see how deep the infection is. Then he was wheeled into the ultrasound room. While they were doing his ultrasound, he told his BA, “This is stupid.” I’ve never been so happy to hear a report of Josh’s bad attitude.

I had a discussion with the speech therapist. Her report was that Josh has PTA (post-traumatic amnesia). It’s this PTA that is causing his short-term memory loss. This is why when I tell him it’s his birthday and he’s 25 years old then the nurse says, “Is today your birthday?” he will answer, “No.” PTA typically resolves itself over time. This is the same report the neuropsychologist gave me yesterday.

Speaking of the neuropsychologist (Dr. Schraa – much shorter than typing neuropsychologist each time), he came to Josh’s room to have a discussion with him, but Josh kept falling asleep in his wheelchair. When he got Josh to wake up a little bit, he asked Josh, “How are you doing?” Josh wouldn’t answer, so Schraa handed him a piece of paper and asked him to write how he is doing. With pen and clipboard in hand, Josh roused from his sleep. He wrote, “I am life avrything is gret..” (I am like/alive, everything is great.) Schraa asked him a couple of more questions, and he wrote similar answers … which means they didn’t relate to the questions at all. Then Schraa asked Josh, “Do you know where you’re at? What city are you in?” Josh wrote, “Everything is in oregon!.” At lease there is some correlation between the question and the answer. Schraa asked, “What kinds of things do you like to do?” Josh wrote, “Ereything is name oregon!”

It wasn’t working, so Schraa handed Josh a piece of paper with a clock on it and asked Josh to copy the clock. He did! His circle wasn’t very round, but he put all the numbers on the clock and even made the hour hand shorter than the minute hand. Schraa was very pleased. He said that Josh’s drawing is MUCH better than many of his patients. Very commonly, they draw only half the clock. Many don’t include the numbers. And very few make one hand on the clock shorter than the other.  That was the end of Schraa, so he left and Josh fell asleep.

After just over an hour of sleep, the curtains were opened and Josh woke up. They brought him lunch: salmon with lobster sauce, mashed potatoes, mixed vegetable medley, applesauce, cranberry juice, and ice cream. I tried the salmon, mashed taters, and vegetables, and they were all surprisingly delicious! The salmon and mashed potatoes weren’t just good, they were VERY good.

During lunch I was talking with the BA. We were talking about Josh’s birthday being today and I told her that Josh is great and well loved. I said, “One day we had over fourteen hundred people look at his blog!” Before she could answer, Josh said, “Fourteen hundred people? That’s a lot!” This is the first time he has shown a real comprehension of numbers.

After lunch, PT took him to the gym. She had him walk in a circle. He did well, considering. Then she spent the rest of the time customizing his wheelchair to fit him.

We went back to the room and I asked Josh, “Do you want to FaceTime Eden? I know she’d love to talk to you today since it’s your birthday.” He nodded his head. The BT asked, “Who’s Eden?” He said, “She’s my sister.” Another first. Until today, Josh hasn’t known who Eden is and he hasn’t recognized her picture. I dialed her number but he fell asleep before the first ring finished.

After this, Josh saw the:

• nutritionist (She gave us menus for the next 10 days and we circled the items on the menu we thought he’d like for each meal.)
• gastro-intestinal doctor (He said that Josh’s x-rays showed that the infection is just on the surface, so they will continue antibiotics and when Josh is able to swallow food consistently without choking, they will remove the PEG tube, even if it’s before the required six weeks. Here is a picture of the PEG tube today:)

• his physician (He said that Josh’s ultrasound revealed a DVT (blood clot) in his right arm. They will treat that with continued Lovenox shots and add Coumadin to his medications for the next three months. He said that the blood clot was likely caused by repeated arm trauma with so many needles being inserted into his arm since the accident.)
• PT ... again. (It was a bad experience for him, but to protect his privacy I will refrain from including details.)
• OT (We weren't there, so we don't know what happened.)
• two pulmonary doctors (Last night he slept only 4 hours. They track that with a band on his wrist that is like a watch. That might have something to do with Josh’s nose, which was broken in 7 different places in the accident. He can’t breathe through it. They are making an appointment with an ENT to resolve this issue, which will likely require surgery. But they might be able to fix the nose when they fix his vocal chords, which still aren’t working. But until then, they want to put Josh on 1 liter of oxygen overnight and see if that helps him sleep better.)
• infectious disease doctor (She had no definitive information yet since is the first time she’s seen Josh, but she said that she wants to continue monitoring the PEG tube insertion site.)

The saddest part of the day, for me, was when we left Joshua tonight. He was snuggled up in his posey bed (a tent over the bed so he can't fall out) with his sunken head because his brain swelling is going down and he has no skull.

Josh was already asleep and as we were leaving his room, Paul turned back and said, "Goodnight, son. Happy birthday." We both know this wasn't a great birthday for him, so we stood outside his door and shed a few tears.

On a lighter note, I’ll briefly explain a little about our apartment. First, we have free ice cream 24 hours/day where we live!  For those who remember that I hold the Guinness World Record for number of ice cream cones eaten in three days; you can be sure that I'll gain 20 pounds before we leave this place.

Second, there are no recessed lights, the carpets are clean but significantly stained, the shower has the lowest water pressure I’ve ever experienced, and the shower temperature fluctuates drastically. It’s like we are old people attending BYU and living in dorms, but without the social life.