Dad's new "school" is an outpatient extension of Sheltering Arms, in another part of Richmond, Bon Air, a little over 20 miles from Matt's house. A family member is required to go with every new patient on their first day and spend the day with them. I arrived at Matt's house a little before 7 a.m. and Matt had things well in hand. He was helping Dad get dressed upstairs, Dad's lunch was packed and in the refrigerator, and his medicine was out and ready. Dad came downstairs with little trouble, made it to the breakfast table and began telling Matt what medication Matt needed to get for him. While he ate breakfast I gathered up the belongings Dad would need for the day. When it was almost time to leave we realized the pharmacy had not filled the one prescription Dad had to have at lunchtime. Matt quickly called the pharmacy and got the situation straightened out but had to run out to pick up the prescription. This left me getting Dad into the car. I spent most of Monday afternoon in the family training, where the inpatient staff taught Matt and I how to help Dad up and down stairs, in and out of the car, help him with dressing, transferring, and getting in and out of the tub. It was all fine and dandy when you had therapists, aides, and nurses standing by but now I had to do it myself. I don't know who was more nervous, Dad or me. We did great getting to the back door, o.k. down the steps to the wheelchair, and I rolled him out to the car. Then it got more difficult. They had taught Dad to get into the car from his walker but Dad was in his wheelchair. I tried to talk him into going from the wheelchair to the walker and then to the car but he would have none of it. He was determined to go straight from the wheelchair to the car--something he had never done before. I looked out for Matt--no Matt yet-- stalled a few minutes--still no Matt. Dad was starting to get a little impatient so I took a deep breath, said a quick prayer and told Dad, "O.k." It wasn't the most graceful transfer but we accomplished it. Matt arrived with the medicine and we were off--as Dad would say-- like a herd of turtles.
The day went well. Dad met with each therapist to have a new assessment completed on his current level of functioning. It made me realize how far he has come when I saw three patients still on tube feedings. Dad's walking was wonderful and he even did a few new things such as walking up a ramp, going down a curb with only his walker and walking down steps backwards. He continues to be impulsive in the way he does things often starting out before given directions. Probably the biggest challenge still to come has to do with Dad's apraxia (Apraxia is where a person loses the ability to execute or carry out skilled movements and gestures, despite having the desire and the physical ability to perform them). Dad would try as hard as possible to complete fine movements, such as picking up small objects, with his left hand but you could see him struggle as his face would wrinkle with concentration. The good news is that Dad is able to pick these things up it just takes about three to four times as long as with his right hand. More good news Dad's hand grip is equally as strong in both his right and left hand. The strength of his finger grip is much less in his left hand which would go along with his symptoms. Another part of apraxia is difficulty or inability to coordinate activities with multiple, sequential movements, such as dressing, and bathing. Again the good news is that Dad can do this but it is a slow struggle. Finally, they did a very interesting test much like you would see on psychological testing. They would show Dad a symbol at the top of a page and he had to match that symbol with one of four at the bottom of the page. Dad did this well. He started to have difficulty though when they took out parts of the symbol. For example an arc in a circle was missing. Dad had to point to how the symbol would look if all the lines were filled in. Dad missed about 50% of these. What I didn't realize is that our brains "fill in the pieces" when we see only "part" of an object. For example, we can visualize our coat in the closet by just seeing the sleeve sticking out. Even more importantly, we see a child's head over the hood of a car and realize a "whole child" is behind the parked car possible getting ready to run out into the street. The implications of this in our daily lives was staggering to me. Well, enough of the details.
Just as in Mechanicsville, the staff at Bon Air were wonderful. They were very patient with Dad who had a new audience to tell all of his stories to. The nurse, who is a die hard Hokie, didn't even hold it against Dad for being a Wahoo. After getting a full history she explained to Dad that one of the main goals of intensive day treatment is to rebuild his energy and to work as hard as possible, even during down time, to regain his lost skills. To that extent they are only allowed two 15 to 20 minute breaks a day and their lunchtime. During the other times when they are not in therapy they will practice the skills they've learned. This is done through games and activities in the day room. They even have a Wii to play. I think we will probably have to teach Dad a little about it first so he doesn't throw the controller through the T.V.
Dad and I left about 3 p.m. tired but a lot less nervous. It was nice driving back to Matt's house, talking about the day, the weather, and those small things that make up our lives. These are the moments that remind me of the miracle we have seen over the past several months. My father is truly a miracle, surviving against all odds and now not only surviving but making progress beyond what any of the professionals ever believed. As for me, he's my Daddy and I still believe, just like I did as a child, Daddy can do anything.
