Diplomatic

James had the casts sawed off his lower legs today.  It was slightly nerve wracking to watch Nehal use an electronic saw to carefully cut through the seams of each cast. I could see the tension in James's face and hands as he gripped the sheets.  He now expresses fear without a filter, much as children do. The sliced casts will be utilized as ankle position booties on James's feet at night to keep his feet in a dorsiflexed position.  After only three days wearing the casts, James's posture was markedly improved today. He walked standing tall with the walker and even sitting, appeared to have less difficulty keeping his head erect.  It amazes me that despite all the technological advances in medicine, it is the technique of wrapping bandages around legs to keep the feet in position that is the magical cure for James as well as all the therapists knowledge of the body--their hands on James are the ultimate treatment.

James had an exhausting morning focused on standing exercises. There are so many aspects of our living body that we take for granted every day!  To watch James move with such effort and thoughtfulness for each gesture, especially the transition from a sitting to a standing position, makes me realize how many muscles are required for simple movement and the brain's connection to those motions.

James was directed to place a variety of plastic vegetables and fruit in a basket an arm's reach above his head while standing (James's doctor visited while he was performing this task and joked that the basket that was hung on a high tech piece of equipment transformed the machine into the equivalent of an expensive hook).  Jack, his occupational therapist, directed James to name the fruit or vegetable, how it was used as an ingredient in a dish he prepared, and then, place it in the basket with his left hand (the weaker side of his body).  James tried to sneak them in using his right hand but Jack would take the item out and place it back on the table.  Jack also had James move from one side of the table to the other with short side-steps to reach each item rather than stretch his arm across.  There is a kitchen for patients to use in their therapy near the gym and Jack told me that their goal is to have James cook a signature dish before he leaves, using the skills he was reinforcing through today's exercises.

The comment made me hold my breath for a moment.  Less than a month ago, I was thinking that James would be permanently paralyzed on the left side, if he even survived, and now, I am being told that he may make me his signature marinara sauce before he is discharged!  It frightens me to repeat it, no less, write it down--I do not want to tempt fate.  I think Jack is being very optimistic but I do trust his judgement.  James told him that corn was an ingredient in the sauce which it is definitely not.  The last item was a pear and Jack joked that he assumed that James was not including it in his pasta sauce.  James confirmed that pears are used for desserts.

James was completely spent after the basket task which took thirty minutes to complete with rests taken in between, sitting in his chair.

In the group session, each patient had to choose a word that described themselves.  Independent seemed to be a popular one.  James arrived late to group and had to catch up.  There was a new member to the group so the facilitator asked the other patients to describe James to him.  It was amusing to hear the facts that the patients recalled, "artist, teacher of adult students at the 92nd Street Y, oil painter!"  James looked very pleased by the descriptions.  When asked for his word, James said, "Diplomatic."  That confused everyone in the room, including the facilitator.  One of the patients asked, "Why, why diplomatic?"

James took a breath (he has a hard time projecting his voice with the trach and has been told to breath deeply and sit tall) and launched into a sweet description of his teaching philosophy for classes at the Y. He explained that his students have different professional backgrounds, histories, personalities, and that he strives to create a balance in his classroom so that each individual student would be able to create and contribute to the general positive energy of each lesson. He has to be a diplomat.  This was a revelation for me to hear because only two weeks ago, James was unable to recognize his students from photographs.  One of the patients was very excited and said, "I am going to take your class James. When we get out of here, I am signing up for your class."

The enthusiastic patient that wanted to take James's class asked a follow-up question, "What painters inspire you?"  That was such a loaded question. I was wondering what part of his artistic career he would pull from to respond to such a wide inquiry.

James explained that he was originally from California and that the Bay Area figurative painters, (and here, he injected an aside which was that the painters may not be as well known outside California, which I thought was very cute, rooting for the underdog) such as David Park and Richard Diebenkorn, were an inspiration to him.  I could not believe how clear and easy it was for him to summarize his early influences and name them.  James continues to surprise me.  He could be completely frightened with the removal of his cast and then, give an extemporaneous speech on California painters.

I am exhausted.  We had a birthday party for Imogen on Sunday that began with a sky-diving simulator lesson (insanely surreal and totally fantastic) in Yonkers with our dear friends, the Hassebroek family (big shout out thank you here for sharing that experience with us) and ended with cake at our apartment with friends from the neighborhood.  I felt guilty about not seeing James on Sunday and rushed to visit him this morning. He was visibly relieved seeing me walk in the door.

He said the usual, "I am so glad you are here."  It kills me every time.

The rehab team met today and they are aiming for an end of May discharge but all of us are hoping that the insurance company will let James receive treatment into June.

All those that pray out there--set your thoughts on that June date--we want James to spend as much time in rehab with the team as possible!  Send thought messages to override the insurance company algorithm.  We need to show that love has power over machines.  We want him making pasta sauce for our welcome home potluck party.