Monday, January 17, 2022

Heading Home

The plan is to head home today.  Really!  

We thought maybe on Saturday, and were pretty certain for Sunday.  Nope.  But today?  Today it's going to happen!

We were all set for yesterday but about 8 in the morning he had a random, significant desat requiring an early breathing treatment.  And he was still asleep.  Now, if it had happened at 8 pm, we would have just shrugged our shoulders and gone with it.  But 8 in the morning is different.  

Most people who need extra support need more while sleeping.  As the body relaxes, it doesn't breathe as well.  But with pulmonary hypertension, it's the opposite.  As the day progresses, the lungs get tighter, more resistant.  It's harder to make that gas exchange.  So we gain ground while sleeping and mornings are his best times.  That didn't bode well for the day.

However, it didn't go that way.  He recovered and maintained.  And slept and slept and slept.  So about 3:30, we asked the doctor for some more labs.  We were worried that we were missing something.  Throughout this whole stay, his heart rate has been 20-30 beats per minute higher than normal, and he was just sleeping SO MUCH!  

But everything came back really good!  So my thought is, he finally wasn't uncomfortable or in pain (stupid ear infection) and his body was finally able to rest!  He did wake up pretty well about 9:30 last night and got ready for an all night party, but took pity on Mom when I turned off the light and was actually pretty quiet most of the time.

So once we get our papers, we'll bust out of here.  It's going to take time.  We call it "hospital time." That's okay.  It's a holiday Monday, and tonight we'll sleep in our own beds.

"There’s nothing half so pleasant as coming home again."
Margaret Elizabeth Sangster

Friday, January 14, 2022

Here We Go Again


On our way in the ambulance.
Thanks, Lone Peak Fire!!
Soooo, here we are, again.  

In truth, it's actually been quite a while.  We spent a day in the ER in September, a few days in the hospital last April, and then the ugly stay back in September of 2020.  That's all (that I'm remembering) for pretty much the past two years.  I've enjoyed not being here.  

So what happened?  I'm not really sure.  No one else is, either.

He was sick over Christmas time.  But the great part is that with the new trach that we put in the beginning of October, we had lots of wiggle room.  Over time, we went from tolerating sats above 77% and oxygen needs of 6-10 liters every day to sats in the mid 80's and oxygen flow of 3-6 liters.  That gave us enough breathing space (like what I did there?) to be able to increase his oxygen to compensate for not feeling well.  Long and short of it is we stayed home, and it wasn't even that hard.

But this week has been a bit rougher.  Not bad, per se, but "something" going on.  By about 6 pm on Thursday, I figured we were coming to the end of what I was going to be able to do at home.  But still,  I kept telling him that it wasn't a good thing to miss the first day of class in a new semester.  I needed him to give me until Friday afternoon and then we could go in.  Um, I guess I forgot who really is in charge.

If you're triggered by medical issues, stop reading here and just know he's doing okay and we'll make it.  Yeah, our evening was that ugly.

We tried bagging, extra breathing treatments, and then changed out the trach.  Often it's helped.  It DID. NOT. GO. WELL!!!  At all!  

After the awful trach change.
It wasn't an "emergency" change.  I got the back-up trach, not the one we have hanging and ready to go in an emergency.  I prepped it.  Michael bagged him while I did this.  Even with bagging, sats weren't "amazing."  Pulled the old one out, put the new one in.  Easy peasy.  Except it didn't work.  Like, he wasn't breathing.  Sats plummeted.  Quickly hit 60% while bagging on 10 liters.  In the meantime, I grabbed the stethoscope and listened to all four lung quadrants.  Nothing!  Asymmetrical tugging and retracting.  Audible crying as he struggled to breathe.  

Yanked the trach, threw the old one back in.  Bagged more, and he started to come up but still struggled.  And there was NOTHING in either trach.  No reason for what happened.  But when we'd stop bagging, he didn't maintain, which meant that I couldn't bring him on my own.  

So we called in the cavalry, you know, the ones in the big red truck.  Actually, by the time we got to the hospital, he was looking pretty good, but then we were still bagging him.  

So once we got here?  X-ray was read as viral pneumonia, but the docs and I all agreed that it pretty much looked like Aaron, cloudy with a chance of junk (although we're still not pulling any junk out).  Viral panel came back negative for everything.  Labs did show higher markers for infection, and he possibly has an ear infection, but we're really not seeing anything else.  By the time morning came, he was back where he belonged at home.  We've got a couple newer docs who don't really know him, and they were ready to push to the floor.  I suggested we needed to wait for that one until we saw what he did today.  They wanted to move him to the regular ventilator instead of the ICU one.  Okay, but keep the ICU one in the room as insurance.  

Hangin' in the ER waiting for a bed.

So now he's on the regular vent, but has also maxed out a few times on his oxygen.  They've been in and out a few times this afternoon.  We've done more breathing treatments.  He's gotten Tylenol because his heart rate is still quite elevated, although no fever.  Long and short, we're not sure what's going on.  It could be the ear infection.   If the antibiotics work, he may feel much better tomorrow.  It could also be another virus.   I mean, they test for about 30 or so, but there are hundreds.  It's not Covid.  It's not Rhino.  It's not the flu (any of the flu varieties).

But he's playing.  He's not as interactive and energetic as he usually is.  He's not well.  But I'm also not worried about where this one is going.  He's whacking at his toys on his Mardi Gras beads strung across the bed.  We'll make it work.  

We got to our room about 4 am and I had class at 8 am.  Thankfully, that one was online.  Nothing like missing the first day of class to make a good impression on your professors.  Fortunately, they're understanding and are willing to work with me.  But I'm exhausted.  I'll try to keep things updated, although most updates may be on his Facebook page.  Anyway, please keep us in your prayers.  

"Be strong because things will get better. It may be stormy now, but it never rains forever."
- Unknown.

Sunday, December 12, 2021

Smarty Pants or Smart Aleck?

Sooo my kid.  Yeah...

Last week was the wax museum at school.  For the third year in a row, Aaron has chosen to represent a strong female character.  I'm kinda proud, and kinda hoping it's because of the strong women in his life.  I keep trying to live up to what he needs.

First year he chose Amelia Earhart, second was Helen Keller.  This year was Eleanor Roosevelt.  

Now, every child at his school is severely handicapped.  It's the prime requirement for enrollment there.  Federal law requires a child be educated in the least restrictive environment (LRE) possible, and this is pretty much as restricted as possible without being confined to home/hospital education.  In short, none of these kids are at "grade level" so to speak.  (In spite of the fact that I got an invitation to test my sixth grader for the ALL program, Advanced Learning Lab, the honors program in the district.  Whatever.)

But at the same time, they are learning and being taught and challenged.  So Aaron was asked to write
"Eleanor Roosevelt" on his computer for the report.  Here's what he did!  I couldn't believe it.  My severely handicapped child, the one that would only progress to a six to nine month level, if that, identified the first two letters in Eleanor and the first letter of Roosevelt.  It's kinda on par with a kindergarten or maybe first grade level.  A little beyond the average six to nine month old.  

Now for the second part.  He IS in sixth grade.  And sixth graders are notorious for not always wanting to work.  On Wednesday they were trying to get him to finish up his report.  He didn't have enough information.  

"Do you want to put this in?"


"Do you want to look at this?"


"Do you want to try this?"


"Are you going to say no to everything today?"


Oh, boy...  There's obviously more going on in that brain than people give him credit for.  I've always said one of the things that makes Aaron a little easier to parent than my typical kids is that he always does his work.  I may have to rethink that one...
His reaction immediately
after his vaccine. I think
he was relieved it was so
much easier than an IV!

Anyway, in other news, Aaron has now had both Covid shots, for which I am incredibly grateful!  I was a little concerned with possible side effects from the second so we scheduled it for a Friday afternoon so I could watch him over the weekend.  He was a bit more tired and needed a tiny bit more support than usual, but overall, if I hadn't been looking for something, I'm not sure I would have even noticed.  

This weekend he does seem to be starting to fight something.  He's needing quite a bit more support, although still within what we can provide at home.  He's more tired, a bit more junky, and his temp is a bit higher although not technically a fever.  (100.4 is the fever threshold.)  We're having a talk right now about how good he's been all semester, but just because it's coming to an end doesn't mean he has to take a "vacation" trip up north.  We'll have to watch and see, but I'm hopeful that we'll weather this at home.  Still soooooo grateful that we have the new trachs and they're helping him breathe so much better.  

Be a student of life and a lifelong student. 
~Terri Guillemets

Sunday, November 28, 2021

I Am Enough

 It's been a long time.  Two months.  How did I go two months without writing? 

Actually, I think I know how I did it.  I have been writing, a lot!!  But it's been for classes and not on here.  As a side note I mentioned that on the 16th, I was done with what I needed to do for one class until after Thanksgiving.  Michael said he wished he had a class like that.  I then informed him I'd written four papers in 36 hours for that class, and he retorted that he didn't want a class like that.

But anyway, here I am. 

It took four weeks to get Aaron's new trachs in.  Fortunately, the special needs world looks out for its own.  A mom got in touch with me and asked what size and length we were looking for and sent me one within a few days.  Can I say, I did NOT expect what came next.

Aaron has not been doing great.  He's been declining.  It's slow, but it's real.  We keep hearing "disease progression."  We kept seeing disease progression.  Higher oxygen needs, lower saturations.  And then, with the new trach, things changed.  We started seeing higher sats, lower oxygen.  The opposite of what's been happening for months and even years!  His digestive system was working better.  He was happier, more alert!  Could it be that what he needed was a longer trach for oxygenation?  Kinda looks that way!

The last several days have been a bit harder.  I think he's fighting off something, but he's still doing pretty well.  We're still below 8 liters, instead of pushing 10 plus.  His sats are generally in the low to mid 80's instead of high 70's.  I said he hadn't been doing as well, right?  We're now tolerating oxygen saturations down to 77.  Yeah, 77%.  Kinda rough to wrap your mind around, so I generally don't.  

In the meantime, we've had Halloween, cutest Dracula ever, and he got a new wheelchair.  This is kinda awesome, and intimidating, too.  I mean, I learned to drive way too many years ago to put it down here, but it was like learning all over again.  This chair is a power chair, and also has the ability to raise and lower so he can be up at eye level, instead of everyone looking down at him.   It also turns in place, which is a bit hard to get used to.  He has his own controller, but so far, he doesn't get a whole lot of access to it.  He can do it outside, or at school in the gym or hallway, but you know, in the interest of not putting holes in walls and running over people, we kinda control it the rest of the time.  

He also got his first Covid vaccine.  I cannot say how grateful I am for this!!  He gets his second one this next Friday.  It is such a blessing to be able to help protect him this way.  He still won't be going out much until at least spring.  The viral season is already exploding.  The last count I heard from Primary's was between 245 and 249 patients.  It's only a 260 bed hospital and that includes units like NICU, the ER, and behavioral health.  It's busting at the seams.  Right now, it's sorta okay because they can do something called load leveling, where they send patients to other hospitals as well.  Kids that are older or less complex that don't need quite the level of specialized pediatric care.  But guess what happens if the other hospitals get too full?  

Anyone remember a few weeks ago when Idaho enacted crisis care standards?  Know what that means?  For us, that means Aaron does not get admitted.  He gets turned away.  Kinda see why I'm so vigilant about masking and vaccines and such?  'Cause you know what, you just don't know exactly how it's going to affect you.  You don't know if it's going to land you in one of those oh so sought after hospital beds.  And you don't know what it's like watching someone turn those nasty colors as they fight to breathe.  I do.  It's ugly.  And that's why I'm so insistent that everyone around Aaron take precautions.  And why he doesn't go to church, and we're very careful who we see in close quarters.  It's just not worth the risk.  

But anyway, off the soap box.  

I've been pretty blah lately.  I've struggled just to feel.  Sometimes that protects me, and sometimes it just hurts.  We lost two more trisomy kiddos last week.  Older kids, one that I know personally, in real life.  It's a gut punch. 

But I thought, once I get Christmas things out, that'll do it.  Nope.  When I get Andrew's package put together?  Not really (but I am excited about his reactions).  I've tried to be easy on myself.  We didn't do quite as much with the decorations this year.  But still...

And then tonight I got my old Christmas songbook out.  

Yeah, that's what I've been missing.  For the second year, we haven't had our community choir that I always sing in.  For me, Christmas music began with rehearsals in October.  We sang on Sunday nights and the songs would play in my mind all week.  It came to a climax the second Sunday in December, and that's when Christmas really started.  

But as I sat at the piano, I started feeling again.  And it was poignant, and soul-filling.  I went through the songs I grew up playing:  "Chestnuts Roasting on an Open Fire," "Silver and Gold," "I'll be Home for Christmas," and so on.  Playing them, singing some, hitting sour notes because it's been waaaaaay too long.  And then I came to "The Little Drummer Boy."  

I don't know, that's always been a favorite of mine.  Sad little boy with nothing to offer, home gone, just his drum surrounded by all sorts of magnificent gifts.  But he plays it, plays his best for the Christ child.  And the Baby smiles at him.  What he has to offer is enough.  

What I have to offer is enough, too.  What I can do, what I can't do, what I want to do, it is enough for Him.  I don't have to do everything, be everything, know everything.  It is enough.

In class, we're often reminded of the importance of self-care.  I think I've been neglecting that aspect of mine for too long.  I need my piano, my music, the grounding.  I'm glad I found it again tonight.  I'm glad I found myself again.  I am enough.  

Then he smiled at me
Pa rum pum pum pum
Me and my drum

Tuesday, September 28, 2021

Warning: Rambling Therapy-type Post

Okay, it's time for a "therapy" type post again.  You've been warned.

One of my (self-assigned) assignments for a class was to pick a word to focus on, reflect on, and use to re-center myself.  I'm supposed to use it to help frame both professional and personal regulation.  When I asked the family hive mind, the one all the kids who responded chose was "resilience".  Various others had some other ideas, but that's the one that spoke to me, perhaps because my kids, without consulting each other, said so. 

So resilience it is.  And I like it.  One described it as ocean waves that keep coming in, and sometimes they send you for a tumble, but you get back up.  When I asked what resilience looked like, another said pansies (you know, the flower I associate with Aaron, the one on the blog).  

But maybe it's a bit like praying for patience.  I learned LOOOONG ago to never do that.  See, God doesn't give you patience.  He gives you opportunities to practice and develop patience.  

And I'm left wondering if resilience is something similar.  

Can you tell I'm having a bit of a rough time?  (And I'm avoiding homework??) 

So here we go, and like I said, you've been warned.  

Aaron is still struggling, although he might have finally gotten rid of the ear infection that sent us to the hospital in the middle of the night in an ambulance on August 11.  But it took three different courses of oral (okay, g-tube) antibiotics and a fourth round of three antibiotic injections, each 24 hours apart.  

And yesterday he decided once again that breathing was totally optional.  As in even with the bag, his nurse was struggling to get him out of the 60's.  Someone tell this kid if he's going to be a rebellious tween, he needs to pick something else?  So I raced out of a (mandatory) meeting and picked them up at school.  (It didn't help that last week as I passed the school, there was an ambulance and fire truck there with lights on and doors open.). Anyway, we got home and did a trach change that went pretty normally.  There was some "junk" in the trach, but not completely blocked.  So who knows? 

And then the fun began.  Big blood clot.  I'll spare you the picture I took but about the size of two peas stuck together.  And then more bleeding, frank, fresh bleeding.  And later, another.  And another.  All told, by the time I got up this morning, he'd had about eight clots that he'd coughed up with fresh bleeding behind each one.  After the first two last night, I decided he wasn't going to school today.  The trouble with bleeding is a two-edged sword.  Suctioning, especially going just beyond the trach, can make it worse, but not suctioning can lead to clotting inside the tube, cutting off all breathing.  See the problem?

This morning when it continued, we had to head in.  So we spent the entire day in the emergency room.  They ran a ton of labs, took an x-ray, and called the ENT who brought in a fun camera to look down his trachea.  Long and short, they found lots more blood and clots, mostly up by the end of the trach tube.  The thought is that it is curving enough that it's rubbing on the front of the trachea and causing the problem.  Unfortunately, the solution is probably a longer trach, which doesn't just hang out on hospital shelves.  It's a specialty trach, and I really didn't like the other options we had there.  We did come up with a workable plan until a new one can be acquired, but then given the amount of blood (and the fact that just as they came in, he did block his trach leading to us doing an emergency change), they wanted to keep him for observation.  

Nope, not happening.  I was very much against it unless there was something they could do there that we can't do at home, and there's not.  In fact, we can watch him better at home than they can there just due to staffing and protocols.  So home we came.  And here we are.  But the other part is that he's got some liver and heart labs that are wonky, more than usual.  And I don't like it.  At. All.

My friend died last night.  I don't even know how to process this.  It's been coming, but still, to have it here...  I ache for her husband and kids, and the whole neighborhood. She was, IS, an amazing person.  Like I said, I don't know how to do this.

And then there's school.  17 credits is a LOT.  And today was supposed to be spent in study, working on my papers, my mid-term, my term paper, and the group classes I really need to get teaching.  Um, nope.  Didn't happen.  Don't get me wrong.  I am LOVING what I'm doing.  This is what I'm supposed to do, who I'm meant to be (just wish I'd figured it out 30 years ago).  But it's hard.  And while I'm working on how to help others, how to help them process the difficult things in their lives, I'm realizing that today, right now, I'm not processing.  I'm shoving it down, trying to ignore it, and trying to write a paper on racism.  

So there I am.  My friend is gone.  My son is struggling.  I spent the whole day at the hospital which is just EXHAUSTING, and now I'm need to set that aside until "later" to process.  Except that I decided I couldn't do that.  So here I am, writing, processing, untangling the knotted up threads in my mind.  And you, if you've gotten this far, have a front-row seat to my insanity.  

And maybe now I'll be able to focus a little more, and maybe even get some sleep tonight before it starts all over again tomorrow.  I love you, Traci.  I hope I can someday be like you and like Aaron.  

“If there ever comes a day when we can’t be together, keep me in your heart, 
I’ll stay there forever.” 
—Winnie the Pooh

Sunday, September 5, 2021

And Then There Were Two...

Yesterday, Joseph moved out to go back to school.  We're down to two.  TWO.  Not quite sure how this happened but it did.  It's Michael and Aaron.  Just two at home.  (Plus two dogs, which is almost like two toddlers, but whatever.)

And Michael is a sophomore and playing football, and Aaron is in 6th grade.  I just started my social work master's program.  Michael and Aaron both seem to be enjoying school, I'm loving it!  Totally overwhelmed and feeling like I know nothing, but it's fascinating.  I've been assigned to two grade schools for my practicum and love getting to know the kids and staff.  

In the month (plus) since I wrote, Aaron has kinda struggled.

Anyone remember what an ear infection feels like?  That hot needle poking into the eardrum?  The electric shock you get every time you swallow, or the throbbing pain when you like down?  Yeah, the ears...

Anyway, the beginning of August, we started seeing some drainage from one ear and he wasn't as happy.  A couple other things came up and on the 9th, I made plans to take him in the next day, probably to Primary's but not quite certain.  Aaron decided he was done playing around.  He'd been having a rougher time all evening, needing to be bagged pretty often but able to maintain with that kind of support.  I figured I got off work at 1:30, would try to get a few hours of sleep, and then take him in.  Um, nope!  At 1:35 he took over.  Even bagging him we struggled to maintain 70's saturation.  (Remember, most of us hang out about 96%.).  So plan B (or G or Q?? who knows how many versions by then.) I grabbed the hospital bag, William and the nurse worked on Aaron, and we called 911. 

Guys, it's been long enough since we called them that I didn't know them, and they didn't know me!  That's actually kinda a good thing.  I did have to tell them I was riding in the back, within arm's reach of Aaron.  He's complicated enough that they just said, "okay."  Good thing.

Anyway, due to some pain issues we did x-rays of lungs, hips, legs, etc, ran all sorts of labs.  Everything came back good, except his ears.  Bilateral nasty ear infections.  Bring on the pink stuff.  (I remember taking that, it tasted good!  Too bad his goes through the g-tube.) He starts to get better and we discharge on the 13th

Fast forward ten days.  You know what is significant about ten days?  That's the time it takes to go through the antibiotics.  He's struggling again.  This time I didn't wait for him to take charge and took him to the pediatrician.  New antibiotic, not quite as yummy, but stronger.  He does better again, and is actually happy and laughing for the first time in quite a while.  For about ten days.  Yeah, that again.

In the meantime, school starts and the usually back to school crud starts popping up.  He's doing well, but some in his class are getting sick.  And then we had some difficult things happen mid-week as well.  He struggles more, we start suctioning blood tinged secretions.  And he needs more oxygen.  And some more.  And his nose gets a little snotty...

Which brings us here.  To the ER.  Again.  The good news is that his left ear is definitely infected.  Yes again, and yes that's good news.  His chest x-ray looked like him in my opinion.  So now we're waiting on labs, but hopefully we'll be headed home sometime later.  Still waiting on the labs.  

But man, this poor kid!  And he can't have tubes because there is no room in the middle ear for them.  The structures in there are either malformed or under developed so not an option.  

Through it all, he just maintains. He tries to smile, he watches his movies.  He doesn't sleep well, but again, it hurts to lie down.  He's my hero.  They were trying to get an IV in and he just endured it.  He shook, he grimaced, but as soon as they were done, he was fine.  He didn't fight or cry.  He just did it.  I hope when I grow up, I'm like Aaron.

A true hero isn't measured by the size of his strength, 
but by the size of his heart.
Zeus, from Hercules

Thursday, July 29, 2021

Life and Death, Death and Life

Future so bright, he's 
wearin' shades.
Years ago, when Aaron was tiny, a doctor told me that if he lived, I would get to the point where I was planning for life instead of waiting for death.  I didn't know what that would look like, but it crept up on me and moved in.  I realized when I was waiting with Michael to catch the kindergarten bus and thinking about Aaron's school bus experience, that I had made that change.

But still, death lurks, sometimes hidden more than others, but always there, waiting, in the dark recesses of my mind.  

I haven't written lately not because there hasn't been anything to say, but because there's been so much, and much of it is hard to process.

I've been to more funerals for children than adults in my life, and that's saying something.  

But child or adult, each one leaves a hole, a giant hole in the lives of their loved ones, and a smaller but still significant hole in my own life.  

A neighbor lost their one-year old son a few weeks ago, and two weeks ago yesterday, one of my posse lost her daughter.  A dear friend and neighbor is coming to the end of her fight with cancer, and it's hard to wrap my head around it all.  

Six years ago we spent the summer in and out of the hospital, which was better than some who spent their whole summer there.  But four of us really bonded.  A nurse dubbed us the "Posse", and we kinda were.  We watched out for each other, and our children, sitting with them when one of us left the hospital, meeting up for meals, hanging out and chatting.  

Almost two years later, we were in the ER with seizures and being put on medications which scared me to death.  This same mom was also there, and walked me through what life is like with seizures and meds and everything.  The doctors diagnosed, she made life doable.  

Last week she posted, "I've heard that unicorns never die, they just become legends..." and my heart broke. 

And in addition to the heartache for her and the others around, survivors guilt and anticipatory grief are real, too.

But at the same time, Aaron is here, and he's alive and well, at least the way we define "well."  (Side note, I wanted to enroll him in a Covid study.  He obviously met the first criteria, between 6 months and 12 years, but the second question asked if he was in good health.  I thought about putting yes, because it's good health for him, but figured they'd laugh me out of the building if we showed up.  Oh, well...)

So we're moving forward, planning for life.  He said "see you in two (years)" to his older brother a few weeks ago.  We're getting ready for the new school year.

This fall I'm starting a full-time master's program as well as working full time.  We've discovered that Aaron does much better on a blended diet than formula, but out of necessity, he still uses formula five days a week.  Blending twice a week isn't bad, but given that I'm not sure how to juggle things I've got now, anything I can eliminate is critical.  Enter my sister...

The baggie on the left in the middle 
picture is the finished product.
Totally shelf stable for 25 years! 
From time to time, I've made food for Aaron ahead of time, but then it needs to be stored in the freezer, and there truly is only so much space there.  I was visiting with Mara and she mentioned that her neighbor freeze dries her husband's smoothies.  Aaron's meals are a lot like a smoothie!  And Mara owns a freeze drier.  (Can I say, freeze dried watermelon tastes like cotton candy!)

So I'm in the process of putting together enough food for Aaron for twice a week for the school year, and she is freeze drying it for me. It's a lot of work, for both of us.  But in the end, I'll have enough to get him through the year in a shelf-stable, no refrigeration needed, still completely nutritious state!  Totally. Worth. It!!! 

If you look close, Aaron signed his
name just under the American flag.
'Cause we're planning for life.  Although, there is that little voice in the back of my head that says, "what if he doesn't end up needing it all?"  I mean, we are in a pandemic, and the turkey has also decided his latest trick is to undo his  trach ties.  I mean, what could go wrong?  

But I'm telling that little voice to shut up.  I'm not listening.  I will move forward.  A month ago there was a beam signing for one of the big support beams for the new hospital.  It opens in 2024.  And I'm planning on him being seen there.  It's going to be his hospital, 20 minutes from home.  And to do that, he has to stick around.  

I'm planning on it.   

“It does not do to leave a live dragon out of your calculations, 
if you live near him.”
― J.R.R. Tolkien