Surprise! Matt’s extended family had organized a birthday celebration for him, who, in turn, shared it with his father, his forever birthday partner. Their very first birthday banner read Happy Birthday to My M & M’s. They cherished this unique bond each year, opening gifts and blowing out the candles together. Matt rarely missed the opportunity to be together, even traveling home from Oregon one year. The day was joyful and sad in the same breath—it was nearly impossible to cast off the past, full of its happy memories, and live exclusively in the moment. Nine people gathered in the cafeteria, festively decorated with party tablecloths, napkins, cake, and candles. The M&M’s opened presents, and we sang Happy Birthday—assuredly off-key. And not to be forgotten, Matt mouthed Happy Birthday to Mike. We enveloped him with love from all sides, lavished accolades about his achievements, and offered positive wishes.

An unusual and atypical gift, but perhaps the best one, came from the Neuropsychologist who reported that Matt’s memory and comprehension were coming along nicely. When shown five words and four squiggly lines, followed by a five-minute gap, Matt was able to identify the correct word or squiggly line from sets of two images—eight out of nine times. And best of all, his Coma Recovery Score had improved to 22/23!

Once Matt’s swallowing was operational and up-to-speed, Mike devised a special treat and arrived weekly bearing cider donuts fresh from a country store purchased en route to the rehab facility. Matt eagerly anticipated and gobbled the proffered treat. Cider donuts were linked to memories of family outings in the fall, apple picking, and waiting in line for a bag of mouth-watering yummy donuts still warm from the oven. Matt had fancied them enough to perfect a homemade recipe and experimented on the best method to freeze them for optimal enjoyment later.

To give Matt an option to play a game or activity, it often required 20 questions to identify his preference and further nail down the specifics. On one such occasion, Matt chose to play Sorry—no simple task. It involves many skills: remembering the sequence of steps involved, locating his pieces on the board, and the dexterity to manipulate the cards and game pieces. To promote self-esteem, we gave him ample time to figure out what to do before unobtrusively guiding his moves. Routinely, he counted one too few spaces. Nonetheless, he showed interest and initiative, which counted in my book. In addition, we played tic-tac-toe and filled Connect Four and puzzle boards to work on visual scanning, matching, and coordination and to foster a commitment to see a job to its conclusion and, of course, to have fun.

In the third week of July, I posted a plea for prayers. Matt had been despondent for two days. We didn’t know if he was discouraged, sad, or hopeless. What we did know was that he wasn’t cooperating in therapy, and his interaction with staff and us had declined. We assumed he was struggling with the reality of his current situation, the uphill battle, and the demanding work ahead of him—which was understandable, however unbearable it was to witness. It was especially difficult for me. My stalwart belief in Matt’s potential and my can-do attitude teetered and faltered.

Blessedly, this change was short-lived, and the tight grip choking my spirit released. A urinary tract infection (UTI) was the culprit, and after five days of antibiotics, he started to perk up. I wished I had known earlier. Nursing was aware of this cause and effect but had not mentioned this or reassured us it was temporary. It had been so hard not knowing what was going on. Although he regained his prior level of function soon after—it was, in my mind, a lost week of forward momentum. 

This wasn’t the first and wouldn’t be the last hiccup to interfere with rehabilitation. Previously, he had been sent to nearby Ellis Hospital for observation regarding a possible seizure followed shortly after by the UTI. Then he went back for cardiology to run an echocardiogram and blood cultures to rule out a possible heart infection, known as endocarditis, which he did not have. Matt did not like being in the strange hospital environment with different staff and routines and appeared bummed out—another two more unproductive days.

On a different front, the inevitable loomed before us. Matt’s stay was approaching the 100-day limit his health insurance plan authorized for acute inpatient rehabilitation. Bringing him home shortly obviously seemed premature. Even with our physical therapy background, it would be challenging to care for him. Before that happened, we desired he learn to do more for himself, which was contingent on daily intense therapy and nursing care. The insurance case reviewer could conceivably extend his time at Sunnyview if, in her assessment, his progress didn’t plateau. However, without a straightforward way to predict which way the wind would blow, we considered our options. Proactively, we explored available sub-acute rehabilitation facilities in the area. Although offering less than here, the rehab would be more than available at home, help his function, and buy us some time.