Sally's Update

Life Lines

Sally continues to progress at turbo speed, however, she is feeling great discomfort and downright pain in her troublesome foot. The goal is to find a pain medication that Sally can tolerate. However, since Sally has rarely--yes, I said rarely--taken any medication throughout her 83 years, she is highly sensitive to even the slightest side effects of most medications.

Marilyn searched the town last night for a comfortabe tennis shoe in her size, upgrading to a wide. Akin to the Amazing Race, she and Janelle raced through every shoe store they coud find before they eventually found just the right slipper for our Grand Lady! Since she must wear street shoes during her physical therapy, the hope is a wider shoe will not irritate her swollen and aching foot.

Our education continues as we research medical alert systems for Sally once she returns home. Never have I read such treasured words in an advertisement: "Lifeline can not only protect a life...it can preserve a cherished way of life by giving seniors the confidence to continue living in their own homes." Sally has always been our lifeline, it is only appropriate that she will now be accessorized with a new watch or necklace by Life Line!

Step by painful step Sally and her family are readying for her return home. We are so thankful for the prayer support, plants, cards and letters you have each provided! Sally is on four Church prayer chains, numerous family and friends prayer lists and that's not to mention the prayers we find her praying when we walk into her hospital room! We are grateful to be able to enter the throne room of God with each and every petition. He is Sally's Life Line....what an example of lasting LIFE support she has modeled throughout this entire experience. We cherish each and every lesson. When we lift our hearts from the pain of the experience and take the Hand of the One who carries us through--we find peace, comfort, joy, and victory! That is a life lesson for all!

Gordy and I are boarding an airplane tomorrow, we will be in Argentina for a 10 day business trip. I will be in contact with the Minnesota Viere clan (Marilyn, Loren, Geralyn and Tim)and hope to post updates when possible while I am away.

Thank you for your continued prayers and concern. You have been a lifeline of support throughout this valley. Your prayers and concern have raised our spirits and lightened our burden. It means so much to Sally...and her entire family.

Sally's Training for the Olympics!

As we sat waiting for the Doctor to arrive for the scheduled 4:00 p.m. family meeting, it was hard to miss the agility of this 83 year old woman who is recovering from a major heart event. Sitting upright in the center of her hospital bed, Sally pulled her left leg to the center of her core and began massaging the troublesome foot; the foot that tingles with pain due to nerve damage from the blood clot suffered after removing the heart pump one week ago. While some of her rehab is geared for Cardiac recovery, most of her focus is learning how to walk, with the aide of a walker, due to the lack of sensation or control of her left leg.

Apparently, when blood flow is blocked for any length of time, nerves die. The Doctor explained there are two types of possible damage: the milder type whereby the insulation or myelin is damaged; the recovery time for this type of damage could be as early as 3 weeks up to 12 weeks. The second type of damage is actual nerve damage. The length of recovery time for this type is much longer.....18 months+. At this time, there is no way to tell what type of damage Sally has experienced.

Nonetheless (don't you just love that word!), Sally has attacked rehab with the dedication and fortitude of a Champion. She has surpassed all expectations and will, within days, no doubt, be walking, dressing, and functioning independent of supervision or observation of medical staff. Although she is not happy about the exercises required of her, she brings her fighting attitude to the Physical Therapy room--'let's get it done!'

It now looks like Sally will skip the assisted living part of her recovery and be able to return to her own apartment, supplementing her independent living with Home Health Care and PT/OT visits. Do you hear the roar of the crowd! Sally's gold medal will be--returning to her own home.

No victory laps--just yet. There is much to get used to. The same agility that allows Sally to do near yoga postions in her hospital bed will be stretched as she faces uncertainty about limitations in movement, in endurance....in the seasoning allowance for mashed potatoes! Still, we are stunned, we are amazed, we are filled with joy as we watch our Champion move forward each step of the race....with grace, with beauty, with the strength of an Olympic athlete!

"Go Grandma!"

"We're so proud of you, Mom!"

"We love you Sally!"

"Bravo!"

.....and.......Thank you God!

Let the rehab begin!

Sally was moved to the Rehabilitation Unit on Friday afternoon. She has a beautiful room--large enough for an entire Viere Family renunion...and that's saying quite a bit! With 8 children, 8 in-laws, and a host of grandchildren and great grandchildren.....the space is well-used. Her daily routine is returning to a familiar note; gone is the lovely, ever fashionable hospital gown, replaced with Sally's own street clothes. Occupational therapy begins at sunrise, whereby, Sally is supervised as she is able to get out of bed on her own, wash her face and brush her teeth, and get dressed to go to breakfast at the Rehab dining room. Life is good!

Each day, Sally will have up to 3 hours of occupational and physical therapy. The color has returned to her smiling face and she is doing very well. Had it not been for the blood clot she experienced last week she would be very possibly be heading home! Amazing! Apparently, when the heart pump was taken out of her left leg artery (remember? the pump was assisting her heart's function early on)a blood clot developed at the location the tube was inserted. It seems when a blood clot disrupts the blood flow to any part of your body, cells and nerves die. Even when it is a short-term disruption. As Sally's blood flow was blocked for nearly 18 hours, her left leg and foot are not cooperating and she is still experiencing pain. We are told this is normal. One of her granddaughters is an Occupational Therapist and reports that the recovery process will include week's of exercise, exercise, exercise, encouraging the nerve endings to regrow. Seems no matter how old we get--we can't escape exercise! Still, Sally's spirits are high and she is ready to rock 'n roll!

We are all breathing easier this day; two weeks after suffering a massive coronary event, Sally is back! Saturday night we spent three hours as a family, sitting comfortably in her room with a view of the Mississippi River, talking about old times. With eight children, five of them boys--it was a very interesting discussion. It is no surprise she has survived losing 50% of her heart muscle--after all, she survived the antics of five boys growing up on the family farm!!!! Three hours of intensive rehab shouldn't be a problem! :)

Seasons of life

We are expecting snow today; currently, a cold rain has arrived overnight, covering the fall leaves with a gleasoning mist before sunrise. A new season is arriving, one that is predictable; still, we shudder to think of another long winter.

Historically, poets have waxed eloquently and Patriarchs have shared great wisdom regarding the seasons of life. Perhaps the most famous is found in Ecclesiastes, chapter 3: A Time for Everything. "There is a time for everything and a season for every activity under heaven: a time to be born and atime to die, a time to plant and a time to uproot, a time to kill and a time to heal, a time to tear down and a time to build, a time to weep and a time to laugh, a time to mourn and a time to dance, a time to scatter stones and a time to gather them, a time to embrace and a time to refrain, a time to search and a time to give up, a time to keep and a time to throw away, a time to tear and a time to mend, a time to be silent and a time to speak, a time to love and a time to hate, a time for war and a time for peace." (verses 1-8)

We know that Sally is in the time of her winter season. What we do not know is the time remaining. However, it can be said, and should be proclaimed; we know how she has lived throughout each of the preceding seasons of her life. As a matter of fact, her steadfast character remains strong as she lays in her hospital bed. God has uniquely designed and greatly gifted this wonderful woman of faith. Her presence in our lives has not only blessed each person she loves, it will forever influence generations to come. While winter seems bleak, it is rich in its purpose. So it can be said of Sally's circumstance.

"[God] has made everything beautiful in its time. He has also set eternity in the hearts of men; yet they cannot fathom what God has done from begining to end. I know that there is nothing better for men than to be happy and do good while they live. That everyone may eat and drink, and find satisfaction in all his toil--this is the gift of God. I know that everything God does will endure forever; nothing can be added to it and nothing taken from it." (verses 11-14)

Of Sally's life, it can be said, "[S]he is like a tree planted by streams of water, which yields its fruit in season and whose leaf does not wither. Whatever [s]he does prospers." (Psalm 1: 3) In each season of Sally's life, it is continually said, "Her children arise and call her blessed, her husband also, and he praises her; many women do noble things, but [she] surpasses them all. Charm is deceptive, and beauty is fleeting; but a woman who fears the LORD is to be praised. Giver her the reward she has earned, and let her works bring her praise at the city gate." (Proverbs 31: 28)

Today, as we remain on our knees before God for Sally's healing, we celebrate all the seasons of her life. Each lived well, each loved well. No matter the circumstances of each season, Sally's life demonstrated the willing surrender to the God of her faith. On this day, her surrender is real. Not the giving-up-kind-of-surrender, but a reliance: I'm-counting-on-your-faithfulness kind of surrender. Just as the seasons of life surrender to the other, Sally's life is a rich example of trusting the seasons God has purposed for each day of her life. May we learn from such a life, not taking one thing away from it or adding anything to it in an attempt to understand. May we simply surrender to the "God who makes everything beautiful in its time."

You raised me up....to more than I can be

I have just received a phone call from Lu: while Sally can barely speak--she has requested that Lu pray with her. Her prayer is simple: that God would take her home.

I have just received the following tribute via e-mail from my Great Uncle who is unaware of Sally's situation. I feel compelled to post this very moving and timely tribute at this very moment. http://parentswish.com/site01/big.html

By simply clicking on the link you will understand my sentiment. While we long for Sally's miraculous recovery; her prayer is different right now. She has spent a lifetime lifting those up around her, blessing each person she has loved. At this moment, this beautiful presentation has allowed me to pray, with Sally, that God's will and Sally's will will be in perfect alignment. May He know the desire of her heart and the length of her battle; may he shorten the battle and give her the strength to continue. Or, as we wrestle with Him in prayer, may He take her into his loving arms as she steps from abundant living into eternal life. Please join us in this prayer.

Sally has been moved back to Intensive Cardiac Care--from Telemetry. She experienced another acute complication: atrium fibrillation. The nurses shocked her heart in an attempt to convert her heart rhythm. It converted for a moment or two and then returned to it's rapid, irregular heart rhythm. They also gave her two medications to help convert the rhythm. Still, her heart rate remained dangerously irregular. They have moved her back to Intensive Cardiac Care....and at this time her rate has settled at 102. This is still a little high--but regular.

Please pray for Sally.

Calm the storm

Thank you for all your continued prayers and words of encouragement for my mother-in-law. She continues to be in the Heart Center and is struggling with complications each day. There are the high moments, there are the low moments.

We continue to stay by her bedside night and day; this phase of her hoped- for-recovery is exhausting. I have realized through this process the reality of the mind-numbing deception of control we seek. Each day we practice responsible living whereby, we expect a predicatable outcome. Still, as the impending death of a dearly loved one is looming--we have no control. We want the medical treatments to work, we expect miracles from new technology, we anticipate a quick resolve to our desperate need. And each day, we are reminded, that although we may desire a rapid solution--the truth remains--we do not have control over such things. It is only when we seek God in the midst of this struggle that we find peace.

I cannot tell you how comforting my MIL's faith.....blended with our own.....has been to our aching souls. For a Christian, the foundational belief that this life is not the end; it is a prelude to eternal life. For a Christian, even when we struggle, we believe that God will use our weakness for His purpose and glory. We have seen this miracle in action each day of this trial.

Blod clots, pulminary edima, internal bleeding, damaged heart muscle: each an assault to the heart and body. Yet, our faith holds strong to the belief that we have a conqueror who fights alongside our battle: Jesus Christ. We may become weary in the battle, but the real battle has already been won. This knowledge takes the spin out of our roller-coaster ride; like the disciples who entered the boat with Jesus and a storm arose. Awakening Jesus, they pleaded, "Master, aren't you afraid, a storm has arrived." Jesus rose, rebuked the squall,and calmed the storm (Luke 8: 22-24). This is our prayer for our mother: Jesus, please calm this storm.

I am home a little early this evening--waved at Gordy as he was heading to St. Cloud and I was heading home. Katie and I spent the day at the hospital with Sally--arrived to find her laying down with a damp towel on her forehead and hands folded weakly over her stomach. Apparently, she began bleeding internally, the blood in her stomach was causing significant nausea. X-rays were done to determine what was happening in her lungs and another Echocardiogram was performed to see the status of her damaged heart. Good news: The fluid in her lungs is diminishing, Less than good news: Her heart damage is not regenerating. After several hours, we were able to speak to the Cardiologist; the bottom line: she has had a significant heart infraction and the muscle is now stiff. I don't know exactly what a stiff heart means--Katie believes it means it is stiff in it's contracting. There is a medical term that she used--to which I have completely forgotten--but remember enough to understand that her heart is contracting stiffly.

We spoke with the Hospital Social Worker--and it was decided that Sally would go on the waiting list for St. Benedict's Sub-cute care unit. St. Benedicts is a beautiful facility--resembling nothing of the nursing home in her home town. We have approached Sally that this stay will be for rehab.....however, we are unsure of the duration of her stay there because everything is still in the wait and see mode. Wait and see if her heart responds at all.....wait and see what type of rehab Sally will be able to tolerate....wait and see. The Dr. did say that we will not know the total regeneration of her heart for 3 months. He says that we should expect, in all likelihood that Sally's heart, even should it not regenerate even one little bit.......should be able to sustain a reasonable life even at 50%. He said he has patients that have survived and thrived even with more damage to their hearts. This was very encouraging news.

For the past few days, we have been thinking in terms that if Sally's heart does not heal itself--she will live as she is now. He told us that was not the case. This is the period of time that will wax and wane...highs and lows.....and of course, Sally has suffered more than her share of complications. It is the complications that have made this week so difficult for her. Once she stabilizes and her heart has a chance to heal......we will know more. But the great news is this: Even if her heart does not experience any repair....she can live a normal, healthy, and happy life. She should be able to walk, although she may get winded. She should be able to live in her Senior Citizen apartment building, with some assistance. This is sometime down the road though. When she leaves the hospital, she will require sub-acute care. Pray that St. Benedict's will have a sub-acute care bed open!

We have begun to remind Sally--that the next few weeks are not representative of how she will always be. I think we all feared that this would be Sally's existence forever....this, however, is temporary. The work she does over the next weeks will only be a deposit towards her future. Hopefully, this will motivate her to eat once again--she is refusing food. She does not want to eat for a variety of reasons (no salt--no taste! and of course, she is on a low-fat heart friendly diet...which is a change for her German taste-buds!). Not too mention, with every bite she takes, she has been experiencing nausea...which is actually from the internal seepage of blood she has experienced due to the Blood thinner she has been on. They have taken her off the blood thinner. They will put her on it once again later....but for now, because this type of bleeding is normal after such an attack--she gets a respite from it now.

Bless you for your continued prayers!

Today was the best day Sally has had since last Monday. Because her heart medication was affecting her kidney's, the Dr.'s took her off the heart medication on Saturday and did not move her to Telemetry until today. Her hair was washed (with a nifty shower cap that had water, shampoo, conditioner in it) and combed, whereby Sally felt wonderful. She watched the live-broadcast of the Hospital Mass at 10:30 a.m., participated to the fullest, and then stayed awake for nearly an hour and a half. After a sound nap, she was moved to Telemetry--(we think the hospital staff waited until the Vikings squeaked through to a win!!!! at the same time!)....and she is now settled comfortably in her new room. Telemetry is a step out of the hospital--still part of the Heart Center.

She instructed the new nursing staff that she did not want any heroic efforts to save her should she have another attack. While the family discussed this with her earlier this week....she had not remembered and an hour long discussion occurred discussing other heart events...such as congestive heart failure (which she has been experiencing since her massive heart event--fluid build up on the lungs). It was decided and agreed by Sally--that the only time they would not assist her is if she has another heart attack. She agreed to assistance for any other complication (blood clots, pulminary edima, etc.)

This has been a very trying time for Sally--and for the all the Viere's. Jack is planning on returning to Dallas on Wednesday--Lu and Simone have to take their RV out of the Campground as all Campgrounds close for the winter on Wednesday. Marilyn, who has been staying at the hospital every day and night since the heart attack has returned to her home for a much needed break from the tension. We all will continue to be with Sally during the days....she will begin receiving Cardiac rehab today. For starters, this means she will be walked 3-4 times each day. Yesterday, she was sitting up unattended! And she stayed awake for a couple of hours after she was moved.....fell asleep at 6:00 p.m. for the evening.

Her appetite has not returned, and she is a little grumpy about her food choices. After 83 years of eating fine German cuisine...she is less than interested in her menu selection. She has also been the family matriarch for many years....the family has run efficiently according to her wishes for so long that she is having trouble adjusting to the lack of control! Who wouldn't.

It's interesting, after only five days of dismal news.......it is hard to believe this is a step up and out! However, her joy when the Priest comes in the room is real! The hospital chaplan arrived this afternoon at 4:00 p.m., turns out he grew up in Freeport! They knew some of the same people, he knew her Priest in St. Rosa, and they had a very nice conversation and we all circled in prayer before he left.

We are grateful for the progress she is making. We will not know for certain the end result of her heart.....for 6 to 8 weeks.....we are grateful that she is making some progress.

Another full day for the Viere siblings at the hospital. The Doctor informed them that the medication Sally is taking to help her heart is hurting her kidneys. They had planned to move Sally to Telemetry--a secondary unit, one step down from Cardiac Care. However, they took her off the medication for her heart to give her kidney's a rest....and will start her up again today. She slept most of the day, awoke to watch the live-broadcast of the Hospital Mass.

Her spirits remain about the same and her vitals are unchanged. Her heart rate is still too fast and her bottom number of her blood pressure rate remains low (27). It was a quiet day--allowing Sally to get much-needed rest--hopefully a healing rest.

Yesterday was another day filled with ups....and downs....

Sally started the day, following a full night of rest without pain, and enjoyed orange juice, coffee, and scrambled eggs. Her sense of humor remained as she announced with a grimace on her face, "Hospital food!"

The nurses got her out of bed and had her sit in a chair, however, the dizziness she experienced required that she return to her bed. Shortly after, the Priest from the St. Rosa Parish arrived and they talked and prayed for 10 minutes. Sally was overjoyed that the Priest had arrived. The hospital church mass, which is a live cast in the hospital rooms began, and Sally participated with speaking the prayers, singing the songs, and raising her hands in praise. She was able to take communion...and after the church service, received guests to her room--her two sisters and brother-in-law arrived. After about 1 1/2 hours, she went back to sleep with a smile on her face.

However, it seems that the natural progression of depression has set in. By last evening, Sally had refused to eat her dinner, and was repeatedly asking her family to withhold any medications that were keeping her alive. This includes the diaretic (which is addressing the issue of fluid build-up in her lungs) and of course, the heart medication. Currently, the Doctor has said that her heart is functioning at 50%.

After a phone call to brother-surgeon Bob--we discovered that if we stop the diaretics, blood thinner, and oxygen, she will suffer pulminary edima--and will suffer 3-4 days of a horrible death. For several hours, Sally told her family and the nurses she did not want any more help to live. This, apparently, is a normal reaction experienced by many cardiac care patients. After several days, patients begin to realize the seriousness of their condition....and depression, anger, and surrender sets in. Hopefully, if this continues, a Psychologist will speak with Sally and perhaps there is some medication that can be ordered to help her through this temporary, but usual, phase.

Please pray that Sally's emotional state will settle--she has always been such an independent, active, Senior Citizen....and this cardiac event is so huge that she is struggling dealing with the after effect. Please don't misunderstand...she is not whining, complaining, or pouting. She simply states....she has had a blessed life....and would like to die--

After a quick consultation with Bob--he informed us this is completely a natural progression and the response from the hospital will be to record her state of mind, monitor, and continue care for 3 to 4 days. IF, after that, she remains determined, they will order a Psychological assessment....to determine her state of mind. So, while the family is determined to respect Sally's wishes (which have been recorded in her living will)--this is still a deeply emotional roller coaster ride for them....and for Sally.

She is a strong woman--and has met every hurdle so far. May this be another hurdle crossed!

We have just returned from the Hospital where the day started out on quite a low note--but ended with the Hallelujah Chorus!

The Doctor had a consultation with the Viere family, announcing his grave disappointment that after two days of heart medication (to help the heart work more effectively) the condition of Sally's heart was grim. As today was the day to take the balloon (pump) out of Sally's leg artery....his prognosis was very distressing. Because Sally's heart had not responded to the medication and the aide of the arterial pump, the Doctor believed that Sally would very probably experience heart failure as they weaned her from the pump. He put her on a blood pressure medication to help raise her blood pressure....it was very low, 60/20.

At 2:00 p.m. he gave the order for the nurses to begin the weaning of the arterial pump. For two hours the pump was turned down--Sally's vital signs increased. At 4:00 p.m. the Doctor was consulted and gave the order to put the pump on "flicker" meaning that the pump would go on from time to time over the next two hours. Sally's vital signs continued to rise. At 6:00 p.m. the Doctor gave the order to take the balloon pump out of her artery--unfortunately--the two RN's that were skilled to do this procedure were tied up in another surgery--so that wasn't done until 8:30 p.m. Still, after the 45 minute procedure, Sally was able to draw her legs out of a prone position and rest comfortably in her bed for the first time in three days. Her vital signs remained at unexpectedly good numbers. While she slept throughout the day, she woke while they were doing the procedure and was in very good spirits. She announced that she felt she could maybe go home on Saturday!

This is a remarkable turn-around of events. From 11:00 a.m. this morning, the family was wrestling with the news that Sally's damaged heart may not perform on it's own. While we know she still has a long road ahead of her--we are rejoicing for this more-than-great-unexpected-turn of events. She has been given a sedative and was resting comfortably (with her legs curled up in a sleeping position!) when we left.

Please continue to pray for her healing. Her heart is beating and circulating her blood supply on its own tonight; however, we believe that the hand of God is gently aiding it's journey! For this we are amazed.....and grateful!

Thanks for your prayer support!

It was another difficult, long day yesterday---we are up and ready for another day of waiting and praying. Sally suffered pulmonary edema Monday afternoon and the Dr.'s are very reserved as to the possibility of recovery. The family met yesterday afternoon with Sally and determined her wishes for a Living Will. They may have to intabate her to allow her heart a chance to rest and recover. They are planning on taking the balloon out of her thigh artery today or tomorrow--and then her heart will be working on its own. The balloon is there to aide her heart. But they cannot leave it in for more than a couple of days due to risk of infection.

She is very frail.....and is on morphine. She sleeps a lot ....but when she wakes up...she is able to talk for about 15 or 20 minutes...then she's back to sleep. It is beautiful to watch the family interact with her! And she blesses each one of them when she is awake. There will be no unsaid words for this family!

With One Simple Life

With one single phone call a life changes. Lives are changed; hearts join together in one accord; gathering together to hold the heart of one so dear. While fear is imminent, it is not the fear of unfulfilled relationships; it is simply the raw fear of losing one who has selflessly offered the love of a mother.

No regrets of words unsaid, for she has lived her life, fully loving, with reserved abandon. No despair for things undone, each task has been faithfully extended and lovingly performed. No misgivings of love lost, for when she loves you, you know you are loved!

With one single phone call, children gather to will their mother well. Grandchildren, in-laws, friends, and family would be no where else; their hearts follow it’s conviction—they have an innate need to be near the Grandmother who has prayed for them and loved them since before they were born. With one simple phone call, a grandson living states away asks his mom if they could pray over the phone for his Grandma. Prayer is not something he visits offhandedly; his Grandma is important; he is compelled to reach out to the God that she seeks daily.

With one single life, lives are transformed. Not seeking self-indulgence, accolades embarrassing, one single life has blessed generations to come with her steadfast heart and determined spirit. It is in this one life that we have come to know, we too, can make a difference. For I have felt the difference of being loved by this one dear life. When struggles prevailed, this prayer warrior fell to her knees. When delighted, you could count on her joyful glee to light a room up. In the life of her children, her gratitude for unimagined blessings can not be squelched; she readily shares it with anyone near. With a simple good-night, she blesses her children with words of gratitude and pride for who they have become and all that they mean to her.

Daughters come to her side and lovingly assure her that all will be well. Towering over her frail body, sons tearfully approach her bedside, willing her soaring spirit to somehow, just for a little longer, forge beyond the crisis at hand. As heart monitors offer their steady rhythm, adult children return to their home—the heart of their mother. It is a sacred rhythm, with each beat of her heart a march of thankfulness and hope is offered.
Thankfulness for each and every beat of her heart, and hope that God will allow the cadence of her life to be extended for many more years to come. For it is in the life of this dear woman we find……a love….. that would be difficult to live without. Yet, we have learned within one simple life, that all things are possible when we live, simply, in such profound love.

Our Mother, who was 83 on Sunday, had a massive heart attack yesterday. She was transported to the St. Cloud Heart Center and remains in critical condition yet this morning. We are on our way to the Hospital again--after spending all day into the evening there yesterday. Her sons from Texas arrived last night and the rest of the family was by her bedside all day. They are taking a Echocardiogram this morning to determine the damage done to the heart. Her front artery was completely blocked and they put a stint in early yesterday morning. Her enzymes are very high, indicated a significant heart event. Her blood pressure is dangerously low....so the echocardiogram will assess exactly what is going on. Her son, Bob, is a Doctor, so we have an "insider" in the room...which is good.

We value your prayer support during this very difficult time. Please feel free to leave a comment--any comments will be saved and passed along to Sally as she improves.