On the occasion of this past Thanksgiving weekend, I thought I would share a very recent story how VERY THANKFUL I am. That is because, my Mom is today is in very good health considering that just over seven weeks ago, she was rushed to the emergency room after having a stroke. As proof of her remarkable recovery, here is a picture of her having a great laugh with my brother after our Thanksgiving Dinner this weekend.
“Blessed is the one who perseveres under trial because, having stood the test, that person will receive the crown of life that the Lord has promised to those who love him.” James 1:12 (NIV)
Before I tell the full story about her stroke and road to recovery, however, I think some background will be helpful to understand how my Mom’s journey has been so impactful to my own. I introduced my mom here in My First Year in Annapolis. As I shared in that story, her love for me is what helped carry me through my freshman year at the Naval Academy. What makes my mom’s story unique is that she is a Japanese immigrant who lived there until her early 30’s. She grew up in Toyama, a coastal city located on the Sea of Japan west of Tokyo. During World War II, her city was firebombed by the Americans late in the war. My mom narrowly escaped the bombing as she had been working in a uniform factory in that city during this time. After the occupation by American Forces, my mom chose to move to move to Tokyo in the mid-1950’s.
It was there where she she met my Dad while he was stationed at the time on a US Navy Destroyer out of Yokosuka Naval Base. They were married in 1960, and had my brothers, Don and Ron (twins) in 1962. Then my Dad changed duty stations to Portsmouth, Virginia in 1964. I then came along in 1966. Shortly after my birth, we moved to Long Beach Naval Station where my Dad served on Amphibious Transport that carried over Marines to Vietnam. After that tour of duty we moved to San Francisco for the year I was in Kindergarten. We then moved again to Fresno, California where my Dad served as a Navy Recruiter. This became the last time we would move as it turned out, as my Dad ended up having his first heart attack and was forced to retire in 1978 at the rank of Senior Chief. It worked out in that he and my Mom decided that it was good for us to kids to be able to stay in the same schools and he had just been promoted to Master Chief and would have had to back to sea duty. The context of my Dad’s naval career and how that influenced my joining the Navy myself is a story for another blog post later.
My mom’s story is one that really inspires me as I know having to learn a second language in life, particularly English, as it is the native language is particularly difficult. To be able to fit in with a community like the one she landed in the mid-1960’s in Virginia was particularly a challenge. There were not a lot of Japanese immigrants in Portsmouth and with both the past World War in the Pacific Theater, Korea and now the Vietnam War ramping up, it was particularly hard for anyone of Asian background to feel welcome in that particular part of the country. The honest truth is my mom was discriminated against during our time in Virginia being called things that I will omit here out of politeness. She became so uncomfortable that she convinced my Dad that he needed to be re-stationed back to the West Coast else she would go back to Japan. My Dad graciously supported her wishes and got reassigned to Long Beach Naval Station. Learning all about what my mom had endured later only after I had my own children made me truly appreciate how we treat immigrants to our country today. It certainly has made me think twice about presuming that those who come here to escape persecution should be considered perpetrators of the very things they seek refuge and acceptance from. Our country is a nation of immigrants, and I am proud and grateful to say my Mom is one who has made that transition in her own lifetime quite successfully, but it hasn’t been without its trials and challenges.
My mom’s transition to life in America steadily improved once we moved to California. In Fresno, one of her first jobs was waitressing at Tokyo Gardens, a restaurant in Downtown Fresno, which is still there today. Back then, she wore a very traditional Kimona each night and the atmosphere was very surreal, almost like what I imagine it would have been like in Japan. They had the traditional Tatami Rooms, where you took off your shoes and sat on mats on the floor. I have many fond memories of going to Tokyo Gardens when I was in my pre-teen years for lunch or dinner while my Dad worked at the nearby Navy Recruiting station down the street. In fact, I still go regularly to Tokyo Gardens where Toshi-san, the cook back when my Mom worked there, now owns the restaurant.
My mom would go on to work in other Japanese Restaurants over the next 10+ years. One of the last places she worked was Furasato’s, owned by our dear family friends, Jack and Hiruko, who hosted a Karaoke night most every weekend. I would go there regularly with my parents and even later after I joined the Navy came back with my now wife Leah who would sign along as well. My mom is a very accomplished singer, but my Dad not so much, yet he would sing most every night, the “Green Green Grass of Home” off key of course. That memory is so strong for my Mom that she has other men sing that song for her and it always causes her to tear up now that my Dad has passed.
Over the last 20 years since my Dad passed away, my Mom became involved in a group of traditional Japanese cultural singers who sing in a style called “Shigin”. It’s much like acapella singing, done completely without instruments. Shigin singing requires much training and discipline to sing well and my mom has become very accomplished in this. She is highly regarded in the California Shigin community for her abilities which makes me quite proud of her given almost all of this she learned since my Dad passed away while she was in her late 60’s. Because of all her ties to the local Japanese community in Fresno, my Mom now enjoys the company of many Japanese friends and even attends Japanese Chapel held in the back of the North Fresno Brethren Mennonite Church in Fresno, where she was baptized back in Spring 2012. I know she is truly loved by these folks and I have felt the power of their many prayers for mom have been answered. Praise God!
I share all this background on this story worth telling because it provides backdrop to the trial our family has been through over the last few months. On Friday, October 6, 2017, my mom while at home alone experienced severe disorientation and slurring of her words. While she had been dizzy getting up in the morning in the past, she knew immediately that this was much worse than anything she had ever experienced. She immediately called both my brothers separately. Ron picked up the call first while Don heard the frantic message on his voicemail and immediately sped over to the house on his bike (he lives roughly 5 minutes away). Knowing she was having a stroke, Ron got off the phone and called me knowing I could drive and possibly get over there right away. I was in a business analysis course I was taking at Fresno State at the time. I saw him call in and texted him see if it was an emergency. When he indicated it was, I excused myself from the class and called him back and confirmed I was in a place where I could drive over to her house right away and that I would head over immediately. Not knowing each of us had already done so, we all three called 911 and gave them notice of my mom’s emergency. I’m sure I broke a few traffic laws rushing to her house, roughly 5 miles away, and it turned out that her front door was in fact locked so the 911 dispatcher called me back to ask when I would arrive. I was by that point only just a few minutes away, and just as I arrived Don had gotten there as well, but in that time my mom, still conscious, managed to get to the door and open it for the ambulance.
As I arrived, the ambulance ET was tending to my mom and then asked me where I would like her taken. My immediate instinct was Community Regional Medical Center (CRMC) in Downtown Fresno as I know they have a world-class Stroke Unit / Program so I instructed the Ambulance team accordingly. Don got into the ambulance while I went separately in my car to meet them at the hospital. Knowing she was on several medications, I also grabbed her prescription bottles near her bed to ensure I had those to show the doctors in the emergency room to confirm they knew what she was taking at the time. I caught up with her and Don in the “Red Zone” of the emergency room, the area reserved for those requiring the highest level of attention.
Her ER bay is where my brothers and I would stay with mom for the next 10 or so hours. In that time, the emergency room physicians confirmed by CT imaging that mom had indeed had a Intracerebral Hemorrhage (ICH) Stroke on the right side of her brain. Less common than an Ischemic Strokes (blockage of blood flow related), ICH strokes tend to occur due to Hypertension which my mom is diagnosed with and being treated for with blood pressure medication. Thus, the immediate goal was for the ER doctors was to get her blood pressure stabilized which took much of the day to confirm. In fact at one point, her blood pressure got too low and they had to back off on the medication they administered to her through IV. The other condition that was important to confirm was whether the size of the blood pocket that had entered the brain had grown or not. If so, then this would be evidence that her stroke condition was worsening. Fortunately, the size of the hemorrhage was small and got no larger then the original CT showed. Thus, the on-call Neuro-Surgeon evaluated that surgery would not be needed. That prognosis was promising, and my brothers and I began to breathe a sigh of relief. As the day wound down, I remembered that I had bought tickets for Leah and I to see Chicago at the Fresno Fair as an anniversary gift. Our anniversary had actually been the day before all this had happened, and it was pretty evident that our $250 tickets were not going to be used unless I could find someone else to go. Mom’s ER nurse, Natalie, who had spent most of her 12 hour shift caring for my mom was about to finish up, and so I offered the tickets to her and she gratefully accepted and ended up going to the concert with her boyfriend. At my request, she took some pictures of the band, and a short video to text to us later. I was so delighted someone worthy got the tickets as she had done such an excellent job caring for my mom.
By roughly 7:30pm, mom’s blood pressure had stabilized well enough to transfer her to the 10th floor Neuro-ICU unit where the after effects and consequences of her stroke could be monitored and a longer term care and recovery plan could be formulated by the Stroke Program experts. Exhausted by the long day spent in the ED, my brothers, our wives and I were relieved to have my mom in ICU where she would be carefully monitored and allow us to leave with some peace-of-mind until the next day. When we arrived the next morning, we were relieved to find out that she had been quite stable and in fact there was already discussion about moving her to the Neuro ‘Step-Down’ Unit given her situation did not require the careful monitoring that a patient with a more serious stroke would require. By that evening, mom was moved to the 9th floor step down unit where they would continue to monitor that her blood pressure remained under control. Mom continued to get excellent care from the nursing staff and patient care assistants including Mike in the Neuro-ICU, Nancy, Theresa and Charlene during this time.
As mom recovered, I began having discussions with Jeff, the In-Patient Rehab Unit Liaison. I had worked on a project with Jeff, and so I was relieved he remembered me and was very helpful in arranging for my mom to get set up to move into the 6th Floor Rehab unit as soon as the Hospitalist determined my mom’s blood pressure was stable enough for her to be discharged. While we had the option to move her to an off-site Rehab hospital, I knew the care she was getting at CRMC was world class, and that it would be safer for her to be in the hospital should her condition worsen during the course of her rehab. After spending her second full day in the Step-Down unit, the Hospitalist gave the order to have her discharged and transferred the following morning to the 6th Floor Rehab unit.
Mom’s stay in the Rehab unit ended up being for a total of ten days. The recovery we witnessed there over this time was nothing short of miraculous. Though her blood pressure had been quite stable and the size of the hemorrhage stayed stable up until arriving in Rehab, we were really initially quite unsure how the rest of mom’s recovery was going to go. She had trouble with swallowing and was on a very limited soft food diet. Even drinking water or other viscous liquids was quite a challenge for mom. Initially, for the first day in Neuro ICU she was required to use a bedpan. By the step-down unit, she was able to go to the bathroom only with careful supervision as her balance was very tenuous. The first evaluation of her condition was the first Tuesday morning she was in the unit. Each Tuesday, Dr. Edwards leads a multi-disciplinary team to evaluate each patient’s condition. My brother was able to witness this and saw that mom’s recovery, though promising from when she first arrived in the ER, still had a significant way to go before it would be safe for her to go home. As mom was at CRMC, near my office, I was able to regularly visit mom and monitor her progress with my brothers and our wives each regularly visiting her during this time.
Despite how well mom’s rehab PROGRESSED, it was in these ten days, that our family relationship were truly tested. Up to this point, I had felt a lot of control over the course of my mom’s care. As an employee for over fourteen years for Community Medical Centers (CMC), the hospital network CRMC was part of, I naturally felt I knew a good deal about what unit my mom should be in and what care/treatment was available to her. While that knowledge did factor into ensuring she got the proper care initially, it was becoming obvious that these decisions were beyond what one person can shoulder alone. Initially, I did make it an objective to ensure that my brothers were involved in every decision impacting mom’s course of care. We talked through the decisions about her getting care in the In-patient Rehab Unit rather than some other location, for example. While in-patient care, treatment and therapy was an easy decision, what was much less straight-forward was what would happen to mom once she was discharged. My chief concern was how we would provide 24/7 care for her which she would clearly need until she could be independently mobile once again.
Fortunately, with ten days in the In-patient Rehab Unit, we had time to figure things out, and it turns out we needed every one of those days to be ready as a family for mom’s eventual discharge. I have to give much credit in this to the combined care team made up of our Case Manager, Laverne, mom’s Rehab Physician, Dr. Edwards, and the many Therapists, Nurses, and Patient Care Assistants (PCA) that provided their amazing skills and experience in helping my mom’s recovery as well as factor in where our family was in being involved in each care decision. This included in particular, Mai (RN), Megan (PT), Janet (PT), Shannon (OT), Susan (SLP), Diana, RN Supervisor. Speaking for our family, we are extremely grateful to these rehab professionals for all the wonderful care they provided mom!
While mom’s recovery was noteworthy with each passing day, we came to the increasing realization that this improvement was only going to be sustainable if we, her family, became more educated on what care was going to be needed for mom once she got home. This is where I realized my biggest shortcoming on being focused primarily on what care she would need in the hospital. This is not uncommon as not many people know how to handle someone with a stroke until you experience this as a family member for the first time. Here are a list of three lessons we quickly learned
- Immediate Goal fixation, getting Mom to a safe place first, left tending to our others loved ones needs and other less urgent matters unattended
- Letting go of control is difficult when you view your decisions and perspectives errantly as flawless
- Thinking the crisis was just mom’s health alone was a shortsighted view that deferred/masked a more underlying problem in our extended family’s interrelationships
The most important lesson of all we learned in time was that we, the Family Caregivers for mom, ALWAYS will hold the most important role in the “Care Team”. The hospital team to include doctors, nurses, therapists are absolutely essential initially to stabilize mom’s safety, to this fact there is no argument certainly. However, once the patient recovers well enough to be discharged, family loved ones MUST remain an integral part of recovery for gains to continue and become sustainable beyond the hospital stay. And for family caregivers to be most effective to recovery of a loved one in a crisis such a stroke, their relationships between one another being healthy becomes critical. To this point, initially my brothers and my focus on mom encouraged us to be cordial to one another, but the demands on each of us individually strained those relationships to the point of conflict.
My brothers and I were all in agreement that mom first needed to be first and foremost safe. Those first few days mom was in the hospital, we worked hard to ensure we were in alignment on mom’s care. However, as things progressed, many years of neglected investment in our relationship with one another became increasingly evident as the decisions that faced us became more complex. I think it important that I own my negligence here, first and foremost. I fell short in particular with my active listening skills lacking particularly with both my older brothers. As things progressed in mom’s care plan, I tended to want to expedite decisions rather than talk things out first. As my mom transitioned to less intensive care in the hospital, I knew that my brothers and I needed to talk through what mom’s care would like post-recovery, so I suggested we meet and discuss privately. Feeling justified by my working for the hospital my mom was in, I felt the need to control decisions impacting her care. While I say I ‘suggested’, I’m sure they both felt it more a ‘mandate’ that we meet. This effective demand served only to stress our already strained relationships. My brothers and I had for ten straight days not taken more than an overnight break as we each wanted to be present for key decisions being made leaving very little chance for downtime to have anything but short conversations in the hallway between our overlapping visits of mom in her hospital room.
Things came to a head when my mom asked for over the counter sleeping aids that were not prescribed to her in her first week in rehab. She was having trouble sleeping each night, and having grown accustomed to using these aids at home, she asked me (us) several times to bring them to her in the hospital which I knew was not allowed. Feeling very stressed and accountable for what might happen if we allowed this, I was rude to my brother, Ron, and his wife, Runy, rebuking them for what I had presumed was their involvement assisting my mom in this and not complying with hospital policy. After a few heated words, I left the hospital room angrily my mom in tears. I later found out I had made this accusation unjustly, worried more about what might happen to me in my work role, rather than the damage it might due to my relationship with my brother and his wife.
While making a tough situation even more strained, I believe it was a pivotal moment when things got to this point. My brothers had agreed to meet to discuss things out at my mom’s home which we were readying for her return to later that week and Ron made it clear that he and Don wanted this to be one of several topics about my controlling behavior. This would be a chance to talk through what had happened with this conflict as part of a larger discussion in general about how we would care for mom once she got home. I already knew in my heart, however, that I was wrong in how I handled this situation, something that was affirmed when I went to church that Sunday and heard a message from our pastor titled “Communication Breakdown”. As had happened before to me and many others who go to my church, I felt the pastor and his sermon was speaking directly to me. That sermon inspired me to own my role in causing and now how to best improve the situation. I asked for prayer of several of my closest confidantes that God would use this situation to HIS purposes and NOT my own.
My brothers and I met on a Wednesday. Inspired by the sermon, I deferred leading the conversation but accept the direction my two brothers wanted the conversation to go. We first agreed on principle that support of mom’s recovery was the absolute non-negotiable goal and that we would keep any disagreements we might have from impacting this objective. I then received what I had earned which was a healthy rebuke of all the things I had done wrong in this particular situation as well as other past conflicts where I chose to view myself as “justified” in making the decisions I felt were in mom’s best interest. While humbling, I felt it important to accept their joint rebuke of my behavior. I truly was culpable and thus accountable for those past actions. I sorely needed to be a better active listener not only at this moment but in most moments where i have a habit of communicating my being right on things. Prior to discussing and accepting their rebuke for what I had done wrong here, I did choose to share what both my brothers have done well in the care of my mom over the years, as a means to avoid suggesting what I might have felt justified myself for doing.
Two days after that meeting, and exactly two weeks after her stroke, my mom was discharged and we took her home. Her progress in that first few days home continued to be quite remarkable. While we were either issued at discharge and/or purchased safety equipment for her, mom was committed to not needing much of it. For example, her wheelchair was not immediately available when we left the hospital on Friday, so I had to pick it up the following week. Mom ended up never needing it and would become discouraged to even see it in the house. She saw it as a victory to get rid of it, so I returned it unused as it was a rental piece of equipment anyways. By the second week of being home, mom began to assist in cooking her own meals and cleaning up afterwards. She diligently did her daily exercises that she learned to do from her in-patient Physical Therapist (PT). Even the belt she needed to wear around her waist and her walker to prevent an inadvertent fall, mom was ready to get rid of by her first scheduled outpatient PT appointment, scheduled exactly two weeks after her discharge. Mom was too proud to be seen with either of these outside her house and since she felt she was ready to go for a walk by this point, we took the risk of letting her walk with just her cane. Fortunately, we gambled the benefits outweighed the risks correctly, and her outpatient PT, Amy, remarked that she would just need one more PT session to just confirm her balance and body strength remained sustainably stable.
This left the balance of her therapy that Medicare would permit to be scheduled with her Speech Therapist (ST) to focus on her swallowing difficulties, and slurred speech, and with her Occupational Therapist (OT) to evaluate her readiness to resume driving. Mom’s eye sight after her stroke, complicated by double vision caused by a cataract surgery that did not go well long before her stroke, limits her ability to immediately return to driving. We are hopeful, with the OT’s help, she will correct her eyesight well enough to have the option to drive again early in 2018. Her speech, remains, her greatest challenge ahead as mom is quite an accomplished Shigin singer and would ideally return to doing this again in the coming months. We are prayerfully optimistic that with her commitment here, she will be back to where she was at before the stroke as well. As with the inpatient rehab care team, we are very grateful to the Neuro Outpatient Rehab Center (NORC) for the excellent care they have provided to continue the recovery process for mom. Specifically I would like to thank Anna (Scheduler), Amy (PT), Erin (ST) and Charles (OT) for their excellent service and compassion they have shown mom!
Here are some more pictures of us all at our Thanksgiving 2017 Gathering
As for me and my brothers, I believe the dialogue that we had before mom returned home has helped build a foundation on which our relationship can now improve beyond where we began before my mom’s stroke. We are planning to meet again for the second time to continue the dialogue going forward. There is still room for improvement in our relationships and our actions in the days, weeks, and months ahead will speak more loudly than our words can do alone. That said, I feel we are in a position to be not only a healthy support to my mom and her recovery but a more loving support to one another in the years ahead.
I am grateful to my brothers for coming alongside me in this time as we seek to not only improve my mom’s health but our brotherly relationships as well. I am also grateful to my church family from both Clovis Hills Community Church and the Japanese Chapel at the North Fresno Mennonite Brethren Church as well as my Christian brothers at work for their continued prayers for my mom, me and the rest of my family.
Also, I want to recognize my CMC Management Team, and specifically Brandon, Director of EHR Support Services and my direct supervisor for helping direct me to use Family Medial Leave to take care of my mom, and his team, particularly James, Reporting Team Supervisor, and Greg, Reporting Team Lead for offering much support and encouragement during this life transition for our family.
Above all, I praise God that HIS word as heard through my pastor’s sermon spoke directly to my heart in this. I also praise God that he used a tragic circumstance in my mother’s stroke to help bring our family closer together. That she is today back to near full health is a small miracle in itself, but that it also predicated our family coming alongside her and one another in the process demonstrates God’s PERFECT plan at work.
“And we know that in ALL things God works for the good of those who love Him, who have been called according to his purpose.” Romans 8:28
I stand amazed and grateful to our Lord and His Love for all of us!
TRUELY a MOST memorable HAPPY THANKSGIVING!