Postpartum in a Pandemic Pt. 2
Saturday, December 19th
All the tears that I felt I couldn’t release over the last few months surged to the surface. I questioned him, hoping there could be a chance it was a false positive. He assured me that false positives are very rare, plus he had symptoms. They came on hard and fast.
He woke up at 3:30am with a bad head ache, body aches, a fever, and chest congestion. He thought at first maybe he had the flu considering the onslaught of symptoms. He has said that the flu often hits quick, at least in his experience. Covid seems to present slowly. Patients complain of symptomssuch as congestion or head ache and the symptomsincrease as time passes. He told my Mom that he did not feel well at all. In classic Mom fashion, she told him he was being hysterical and he was probably fine. As the morning progressed and he felt worse, he decided to get a rapid test.
“Access to testing is critical for multiple reasons. Course of treatment available is dependent upon making a diagnosis. I had a result within 2 hours of onset of symptoms as opposed to 1-7 days.”-Dad
My Dad, the protector of us all, had contracted Coronavirus. As soon as he knew he had it, he told my mom to mask up and quarantine from him. That night they began sleeping in different rooms.
My Dad has taken such caution and care for so many months. He has taken it on himself to ensure the safety of his family, his office staff, his patients, and various family friends. He has guided countless people on what precautions to take, what supplements to take to beef up their immune systems, what symptoms to look for if they think they may have been exposed.
I remember the first couple months into the pandemic, my mom told me he was up at all hours on the computer and on the phone researching what he could trying to decipher the ins and outs of the virus. When my dad is faced with a medical problem or any problem for that matter, he will obsess over its solution, especially if the problem endangers his loved ones.
The rumor of the virus being an intense flu was believed by many because of the similar symptoms. But behind its flu like mask, the Coronavirus can be a full body assault. It can cause blood clots and inflame the vital organs throwing the body into a battle mode so intense that the immune system goes into overdrive. There are 3 phases of the disease.
My dad’s description of the 3 phases:
- Viremia – period of viral invasion, attachment to ACE2 receptors on the endothelial cells lining all of our blood vessels – the shear numbers of endothelial cells is enormous in the small blood vessels in major organs (lungs, heart, liver, kidney, brain). Invasion into endothelial cell leads to replication, release and more invasion (endothelial damage).
- Phase 1: variable symptoms, 40% no fever at all, maybe just diarrhea, decreased appetite, fatigue, or what I had. I had low fever 99.4 but lots of sudden myalgias, severe headache, deep cough, shaking chills. It’s over in 4-7 days and the circulating viral levels are controlled in that time frame in most patients. But the vascular damage (oxidative damage to endothelial cells, release of clotting factors stored under the cells, along with a robust immune response to the vascular damage) is already done setting the stage for multi system complications and failure.
- Phase 2: feeling tired, maybe some cough, maybe low grade on/off fever and muscle aches. This can last 2-7 days before progressive symptoms of organ dysfunction in next phase.
- Phase 3: hypoxia, Covid “Pneumonia”, myocarditis (heart inflammation), hepatitis, renal failure, strokes, brain inflammation. Only 30% have fever maybe in the > 100 range.
The process at this point is not controllable at the vascular level. Permanent damage to some degree and death in those with preexisting vascular impairment (damage). Almost everybody has damage to some degree starting around age 45 in this country and progressive into our 60s.
It’s scary to me that you don’t know how your body is going to react to it until you get it. I suppose that’s how it is with anything, but this virus is so new that there is nothing to go off of. Some older people make it through with nothing but a cough, while others die and the same goes for young healthy people. Some people have long lasting effects, while others don’t. Scientists are learning as they go. Sadly, many people continuously discount the scientists because they have changed many of their conclusions over the course of the year. I guess they can’t seem to remember the basics of the scientific method that we all learned in school.
When my Dad found out he contracted it, he knew it was time to employ the tactics that he spent months studying and implementing with his patients who had contracted it. The Coronavirus had chosen a well educated, well armed adversary. It had no chance against my Dad, but damn, it certainly gave it a hell of a try.
I hung up the phone and cried to Zach. The what ifs shrouded my vision like a dark cloak. My postpartum hormones, combined with the scary news, gave me no chance of thinking clearly or reacting calmly.
What if he ended up in the hospital? What if my Mom got it and she ended up in the hospital? What if they never got out? I had seen in the news couples contracting it and dying together. I don’t know what any of us would do without my parents. Was it my fault? I had been visiting them more often in the two weeks prior and I didn’t wear my mask. I had no other exposure to people outside of my family, but this thing is unpredictable. Could I have gotten it somehow and had no symptoms?
Since I was a child, I’ve had this idea of my parents as eternal beings. Even now, the thought of not having them around one day is never on my mind. But that reality plowed into the forefront after my Dad called me. What would I do if something happened to Mom and Dad?
On top of being worried for my parents, I had mom guilt. There is a lot of blame and shame that goes with Covid. If you get it, you had to have gotten it somewhere and from someone. But that’s with anything, even the common cold. I don’t blame my Dad at all. I knew that going ANYWHERE was a risk. Going to my Mom and Dad’s house was a risk I was willing to take. I knew how careful he was being and I trust him and my Mom to no end. I was also aware that no matter how careful people are, they can still get it. I had spent so many months keeping Zachary and Lucy away from so many people and places. I was the reason they were exposed. I blame nobody but myself. I also really NEVER thought my Dad would get it. You never think something bad could happen to you or your loved ones. Every day there is a possibility something bad could happen, but we don’t think that way. It would drive us mad. He even seemed baffled as to how he got it. Considering how safe he is at work and his lack of exposure there, he is convinced he got it at the grocery store.
Late Saturday, my brother John texted us and told us Dad was going to the hospital, not because he was sicker, but because they were offering a monoclonal antibody shot. Monoclonal antibodies are laboratory-made proteins that mimic the body’s ability to fight off harmful viruses. The shot had only been approved six weeks prior. John and Brian (both physicians) agreed it was a smart idea to get it. In typical Dad fashion, he insisted on going alone. His car drove him to the hospital and he got the infusion. The next day, he couldn’t believe how many of his symptoms subsided. His chills and aches were nearly nonexistent. He was starting to feel better.
“Bamlanivimab infusion was completed 16 hours after onset of symptoms. It works best when given ASAP after onset of symptoms (viremia) – it doesn’t help if given late in phase 2 of the disease. It reduces the viral load almost immediately, reduces severity of phase 3 complications, reduces the need for admission to hospital and transfer to ICU, ventilator, ECMO, and death.”-Dad
Sunday December 20th
I felt a little more at ease knowing Dad was feeling somewhat better, but I became convinced I was getting sick. I felt feverish, but my temperature was normal. My head hurt, my body ached, I felt exhausted. I didn’t want the babies to see me upset, but I could not settle myself.
I called my parents.
I asked them endless questions about how they were feeling and the specifics of the virus. I apologized multiple times because I didn’t want to impose all of my worry on to them. I wanted to be strong for them, but I couldn’t be. I explained how I felt and my mom said it was probably from worrying so much and being up late with the babies. I think I was having some sort of panic attack. I’ve never have had a panic attack before, but I think that weekend I did. Raging hormones and a panic attack is a crazy combination.
My Dad reassured me that he was going to be okay. He reassured me that my exposure was limited and that the babies would be fine, but to monitor them just in case by taking their temperatures twice a day for the next few days. They reassured me that they weren’t worried, so I shouldn’t be either. We knew what to do and how to approach it and we had the resources if things went south. Our privilege of having access to immediate medical knowledge and resources became so aware to me. I think I am always aware of it, but I don’t often actively appreciate it. I feel guilty for being so ignorant to our access in the past. Anytime anything seems medically wrong, I have the advantage of being able to call my Dad or my brothers for advice or they can contact someone quickly to get any answers we need.
After I talked to them and shed some needed tears, my aches and chills dissipated. 33 years old with two babies and I hid in my room to cry to my Mom and Dad. You never stop needing your parents.
As the next couple days marched on, Dad said he could not believe how much better he felt. He felt so sick that first day that he had mentally prepared himself that he was going to end up in the hospital. He was convinced the antibody shot kept him out of there. He felt tired and he had a cough, but no fever, no aches, no chills. He and my mom were in separate rooms most of the day and slept separately too. She continued to feel fine and exhibit zero symptoms. He had her tested and she was negative.
“I cannot believe your Mother doesn’t have it. She is going to test positive at some point. I am certain.”
I said to him, “I don’t know, Dad. You hear in the news about a person gettin it and people living in the same household never get it.”
He disregarded that information and was so worried that something was going on inside her and she just wasn’t registering positive for some reason. He was actively fighting the virus himself and all of his concern was for my Mom.
I took my mom’s negative tests as a good sign for me and the babies. If my mom who is with my Dad every day doesn’t have it, then the babies and I were more than likely going to be okay.
Zach, the babies, and I were feeling fine as well, but we also quarantined for two weeks. I called the pediatrician and she advised me to monitor Zachary and Lucy and quarantine them for 10 days starting from day of exposure. She insisted they didn’t need a Covid test unless they had symptoms. I was tested 6 days out from exposure and I was negative. My Dad explained to me the importance of the timing of a test. He told me since I exhibited no symptoms, I should wait 4-6 days post exposure to be tested. If I had symptoms, testing would need to be done right away. I found out on Christmas Eve that I was Covid negative.
Christmas Eve, Christmas, and Christmas weekend
We had been going back and forth before about what to do for Christmas. My mom wanted to have a drive by and give everyone sandwiches and have each family come safely in shifts to pick up presents. After finding out Dad had Covid, my Mom (the comic relief in chief) said, “Well, now we don’t have to figure out what to do for Christmas!”
This was the first Christmas ever that my parents spent alone. If you know my parents, you know they are the most welcoming, generous, accommodating pair around. They live to host family gatherings. They’re happiest when their home is full of people, laughter, and love. To have to spend Christmas in a big, quiet house alone was almost a worse blow than Dad’s Covid diagnosis. To me, that is one of the saddest parts of this virus, the isolation from loved ones. It’s bad enough to be sick. To be isolated from your support system when you’re at your lowest is crushing. My Dad has often said a support system is key when fighting a disease. I could tell the separation took a psychological toll on my Dad.
We tried to make Christmas Eve as festive as we could for the kids. We video chatted with Zach’s parents and they read “Twas’ The Night Before Christmas” to Lucy and Zachary. Funny enough, my family had texted out an invite to do the same thing, so the kids got a double dose of a classic Christmas tale. It felt weird not having to get the kids dressed for mass on time or prepare the house for visitors, but then again it was fun to relax and lounge around all evening. We watched Christmas movies and made cookies for Santa.
Christmas Day we did our Christmas morning tradition. I went down first and exclaimed that Santa had come. Zach brought the babies down and we exchanged gifts. It was sweet. Lucy was more excited about the cookie crumbs Santa had left than any of the gifts we got her. Simple man Zachary was happy with trying to eat the wrapping paper and seemed uninterested in the teething toys. Zach’s sister Sarah and her husband Brian came by to exchange gifts. They came to the patio door and stood outside. It was drizzling out. We were all masked up. My first inclination was to welcome them inside, but we decided it was safer to keep it distant. A dreary Christmas morning.
I was grateful Zach could see them and they could see some family on the holiday. They don’t have any family around the area except us. This was one of those eye opening moments into Zach’s experience of being away from family. I could never begin to understand how it is for Zach living as far as he does from most of his family. But moments like this help me appreciate and understand better. I am so grateful we could provide a safe way for them to see each other. Here I was being sad I couldn’t be with my family on Christmas, but at least I could get in the car and physically see them from the window. It really helped his spirit to see his sister and brother-in-law in person.
We had a breakfast video chat with Zach’s family and we opened the gifts we had all mailed to each other. The babies enjoyed it and we spent a long time laughing and enjoying the virtual company. We made the best of a weird day.
It was nice not to have to rush to get the kids ready to go anywhere, but we did eventually get dressed up for Christmas photos. We prepared a roast. I put on a new table cloth and we used the nice silverware. We tried, we did. But that feeling of emptiness lingered. Zach never said it out loud but I could tell he felt it too. I of course felt guilty about it because we have each other and we have our babies, so who are we to complain? If this is what a “different” Christmas looks like for us than we’re doing okay. It was so hard feeling cheery when I was thinking about my parents sitting at home alone masked and separated from each other.
Before dinner, we did a drive by their house. They came outside and we spoke, masked and at a distance. “Masked and at a distance,” the theme of 2020.
Dad said he felt pretty good. He was tired and short of breath on occasion. He had started taking some dexamethasone, a powerful steroid that treats inflammation, to ease the inflammation of his lungs. He said that had helped his breathing. I felt at ease hearing him say he was feeling okay, but he didn’t look like himself. He looked rundown. Dad never looks rundown. I don’t think I had ever seen him like this. My Dad is a strong and active guy, always going from one thing to the next, working his ass off from sunrise to sunset and never seems to break a sweat. He looked beat that day. His face looked drawn and weathered.
I could see the sadness and frustration in his eyes. My mom too. They put on smiles as they looked at the babies through the car window, but I could see they were sad and scared. Zach and I and my Mom and Dad stood in a semi circle in the driveway. A few of us staring at our feet, willing ourselves to make it feel like Christmas.
It was a holiday, we needed to pull it together for each other. We needed to focus on the positives. Thank God we lived near them so we were able to do a drive by. Thank God Shane and his wife Nina were able to come in safely from California and stay with my aunt Clare. We couldn’t hug or be at the same dinner table, but at least we were able to say hello in person.
Christmas night we video chatted with my family. Little John set up an online Christmas trivia game for us to play. My parents joined. They sat next to each other masked. We were all able to enjoy ourselves a little bit and put the current reality on the back burner.
Christmas weekend we played with the kids and their new toys. I checked in on my parents every few hours each day. I could hear the frustration in their voices. They missed each other. My mom said she hadn’t hugged my dad in almost two weeks.
I would call and say, “How is Dad?”
She would say, “I think he’s okay. He is upstairs. Give him a call when you’re done with me.”
It was like they were living in different houses. A positive of having a big house, you can easily quarantine from each other. I wonder if the “ability to safely quarantine from each other” was at the top of their list when they bought the house 30 years ago. Mom continued to feel fine, so the separation was worth it.
The next few days I continued my daily calls and FaceTimes so they could see the babies. I was able to begin to relax a little bit and enjoy my family during Zach’s time off.
Dad woke up in the middle of the night with AFib. Dad has a history of Atrial fibrillation. AFib is an irregular heartbeat that can lead to blood clots, stroke, and other heart-related complications. He hadn’t had it in a long time. He had kept it at bay by exercising more regularly and getting himself in better shape. Waking up with it was a warning sign for him. Something wasn’t right.
His fever was higher, around 101, and his pulse ox (oxygen level) was 88%. For reference, a patient monitoring their Covid symptoms at home wants to make sure their oxygen level is at or above 90-92%. He had shortness of breath and had to sleep on his belly to ensure proper oxygenation. He, with the guidance of my brothers John and Brian, scheduled himself a CT scan. It’s worth noting that just a few weeks before all of this, Dad, John, and Brian were all voted Top Doctors of the Mainline. Hematology/Oncology for Dad and John. Palliative care for Brian. A top doctor down with Covid cared for by his top doc sons and his certified nurse wife. If you’re going to contract Covid, these are the people you want in your corner.
On the last day of 2020, day 16 of the virus, Dad had a CT scan that revealed what he and my brothers had suspected, double Covid pneumonia. The virus wasn’t done with him. It wasn’t going to let him get away as easily as we all thought.
Dad was really sick.
I remember calling my Mom later that week to check in and she had told me he had gotten worse. She sounded worried. Through most of the journey, each time I called she sounded upbeat. She would say, “I’m fine. Your father seems okay. You know him, he can be a baby when he’s sick. I really think he’ll be fine. It’s all going to be okay.” Her voice was different now. Mom, the unstoppable force that holds our family together, was scared.
Covid pneumonia can be fatal. My Dad has said, even before he contracted the virus, that it’s not a pneumonia in the terms most people think. It is not an air space disease. The similarity is the impairment of gas exchange. Pneumonia is an air space disease that impairs gas exchange. Covid pneumonia is a vascular clotting disease that impairs gas exchange. The vascular assault is what makes it far more dangerous than regular pneumonia.
Covid pneumonia spreads rapidly in small areas of the lungs. It then uses the lungs’ own immune cells and the blood clots spread over many days or weeks. The long duration of its course is possibly why it causes greater damage than regular pneumonia. If Dad didn’t know to get himself scanned, it would have gotten worse and he would have been hospitalized.
“I was on oral anticoagulation pills during phase 1 and 2 – it helped but was not as effective as full dose anticoagulation would have been with Heparin or Lovenox. I had Covid pneumonia and myocarditis (inflammation of the middle layer of the heart wall), neurological symptoms, and slight inflammation in liver and kidneys. I could probably have prevented this with Lovenox.”
Dad strayed from the course that was working for his patients and friends he had treated because he was convinced he kicked the virus from the start. The way he felt when he got the antibody shot was so dramatic and striking. If he had stayed the course that he applied to his patients, he may have completely avoided the trouble he ran into.
My dad’s office began taking a certain approach to the virus back in April 2020:
- “Anticoagulation – right now it’s generally accepted that full anticoagulation with Heparin or Lovenox is helpful and safe only in patients in early phase 3. We have been doing that since 4/20 for phase 3 patients and we are now even using full Anticoagulation with heparin or Lovenox earlier in phase 1/2 in selected patients who likely have underlying vascular disease (everybody over 55-60, and 40 year olds who are obese, hypertensive, untreated elevated cholesterol, diabetes).
- Dexamethasone – this is the most potent anti-inflammatory steroid medication that we standardized for inpatients in April 2020, 3 months before the data from the U.K. that documented the reduction in death rates when used the way we did. This is widely given to admitted patients in phase 3. We started to use it in outpatients in phase 2 in April 2020 and now extended it to selective patients in mid to late phase 1 (day 4-5 depending on symptoms).
- Remdesivir is given 5 days in hospital and does basically nothing – should be given within days of viremia phase 1.
- Continuation of Dexamethasone and Anticoagulation for periods that are still undefined for patients emerging successfully out of phase 3.”
Working with my Dad and brother John for five years, I was given an up close look at how their practice (Consultants in Medical Oncology and Hematology) provides exceptional, unparalleled care to every patient. It didn’t surprise me that they began implementing a particular and successful course of action for Covid before anyone else. Dad and his group are always ahead of the curve. He and his practice have helped many people (patients, family, and friends) avoid fatal situations from Covid.
I went over to my Mom and Dad’s house alone to visit with her. I asked my brother John if it was safe. Dad had a blood test to confirm he was no longer contagious, but John said I should still mask up, keep my distance, and wear my glasses instead of my contacts, just in case.
I sat with my Mom in the fully decorated library. Both of us masked, sitting over 6 feet apart. The Christmas tree was set up behind her. They make it look the same every year, I don’t know how they do it. It looked like a smaller version of the Rockefeller Center tree, it was beautiful.
“Look at this. It looks ridiculous. All set up and nobody to see it. I feel like I am in a Christmas prison,” she said.
My instinct was to hug her, but to be safe I knew I shouldn’t. She was feeling fine and had tested negative again, but you never know with this virus. I assured her it wasn’t ridiculous and that we’d all be able to come by soon and enjoy it. It looked magical. Sitting in there filled me with the familiar Sprandio Christmas magic that we all direly needed to feel this holiday.
She talked about how scary the week had been. Dad was really afraid he was going to end up in the hospital. He was afraid to go to sleep at night for fear that he wouldn’t wake up. She told me how she had to check on him every 3-4 hours through each night to make sure he was breathing okay and sleeping on his belly. She had to make sure he walked the steps to get proper blood flow and had to check his pulse ox after walking and at rest. These are the exact things they would have done if he was hospitalized. Dad is so lucky he married a nurse.
She said she missed hugging and kissing him. She hadn’t gone this long without hugging him in over 40 years.
She found herself thinking, “What the hell am I going to do if he’s gone?”
Hearing my mom say these things broke my heart, but also made me feel connected to her in a way I hadn’t before. I wasn’t just her daughter in that moment, I felt like a fellow woman. She was confiding in me, she was being vulnerable with me and I so appreciate that. As scary as it was to hear that Dad was struggling and as scary as it was for her to witness it, it felt good to know exactly what was going on. And I think it was good for her to talk about it. For me, it’s better to face the facts than run from them. This was our reality and I didn’t want to shy away from it.
While I was there, John came in to check dad. He was wearing medical goggles, gloves, and a mask. When he was finished he came down and said Dad looked pretty good. He was able to walk up and down the hallway and up and down some stairs and his pulse ox was good. John and Brian aided him in getting on the proper dose of medications as soon as they were aware of the double pneumonia. John was confident the medicines were working and the next couple days would be crucial.
I asked John if it was okay if I saw him. He said it was okay, but to keep my mask on and stand in the doorway as an extra precaution.
I walked upstairs and stood in the doorway. Dad was lying in bed on his phone, classic Dad. The room was pretty dark. We exchanged pleasantries about the kids and then the conversation jumped right into what I came to hear.
He explained to me that he knew exactly what was happening inside his body. He said the CT scan showed he had blood clots on both his lungs and he was certain he was at the point of the virus when all his major organs were inflamed. I didn’t even know that was a thing the virus did.
He was having AFib because his heart was inflamed. He had trouble breathing because his lungs were inflamed. Knowing the course of the virus the way he did, he could only assume that his liver and kidneys had slight inflammation as well.
He shared how scared he was a couple days before that he was going to end up in the hospital, but with each passing hour he felt confident that the dose of meds he was on would keep him out of there. I remember asking him if he was absolutely sure.
He said to me, “Kate, I am definitely on the road to recovery now, but for a couple days there this damn thing was really vicious.”
Brian and John helped him get on the correct dose of Dexamethasone for the inflammation and Lovenox for the blood clots. He believed that if he went in the hospital they would have pumped him full of the wrong stuff and he would have gotten sicker and he never would have come home. He was also certain if he hadn’t gotten the antibody shot when he did, he would have been in the hospital sooner.
Most doctors don’t have a reputation of being tolerant patients, my Dad is one of those doctors. When he said he was certain the hospital would make him sicker, a story came to mind. There was a time years ago when he was young, he got in a car accident with his friend and part of his scalp was ripped back. We have this frightening photo of him with stitches across his forehead up on to his head. He looks like Frankenstein. Anyway, his friend Jack recalled my Dad barking orders at the doctors as to how to take care of them. “We need MRIs here, CT scans!” Even with half a scalp, Dad was trying to control his own care.
Hearing him speak about himself this way, openly expressing his fear he may die, was unnerving. Like the conversation I had just had with my mom downstairs, I felt a new connection with my Dad. He was talking to me like I was a grown up and no matter how scary the subject matter was, I very much appreciated it.
When I left there that night I felt more at ease than I had in weeks. I walked in the house and hugged Zach.
“I am confident now that my Dad is going to be okay.”
With each passing day, Dad got stronger. The boys kept a watchful eye on him and mom continued his bedside care. Thank God, the medicine was working. There are hundreds of thousands of people who got just as sick as Dad and had a fatal outcome. They did not have the luxury of knowledge and proper care in their own home. I think he realizes now more than ever how blessed he is to be able to rely on my two brothers and my mom, to rely on all of us to step up and be there when we are needed.
By January 8th, we had Christmas. We all came over in our masks and we gathered in the living room so the kids could open their presents. Mom and Dad sat in the middle of it all. Basking in the glory of the insanity they so sorely missed on actual Christmas Day. There was wrapping paper everywhere. Babies, toddlers, and children laughing, crying, and running amuck. Mom and Dad were in their element. I remember talking to him that night and really looking him in the eye. I saw an actual twinkle in his eyes. They were glistening. The smile on his face was one I had never seen before. It was the smile of a man who fought and won against a vicious virus.
I got home that night feeling light. It could have been the two glasses of champagne I drank, but it was also because I knew Dad was okay. Mom was okay. I was able to breathe easy knowing that when the next challenge comes our way, my family will be able to face it the way we faced this, together.
Texts with Dad from January 31st:
“If you can formulate what your emotional response has been to all of this, I’ll also implement that. I know it is tough to formulate emotional responses considering you are a robot.”
“Two words: sobering and humbling.”
“Sobering came after your steroid high I am sure.”
“No, it came despite a steroid high. But confidently looking ahead to the next challenge….on the horizon.”
“My mind is still boggled over the fact that you had it.”
“The unbelievability is reinforced every time someone I’m talking to on the phone says that I sound short of breath while talking.”
Dad returned to work January 14th. He noted some of his neurological symptoms still lingered. Forgetfulness, scattered thoughts, foggy moments. He found himself asking silly questions that he otherwise would have known the answers to.
On February 1st he had told me he was still on injectable Lovenox and low dose Dexamethasone. His symptoms started 12/18/20 and it was 2/1 and he still wasn’t back to his baseline level of strength and endurance.
It’s now March. His endurance level is back and he is exercising again. His mind feels sharper than ever. His thoughts are more cohesive and he’s speaking more fluently. He faces each day with a new appreciation and gratitude. We all do.