Showing posts with label DKA. Show all posts
Showing posts with label DKA. Show all posts

Thursday, March 1, 2018

The Price of Being Different



I hate spending money.

It is the possibility I am reluctant to part with. In my pocket, $20 could be a pack of diapers or a half a tank of gas or a couple of groceries. Once you spend it, all the possibility dissipates. Since I was little, I have preferred saving to preserve option to spending. Spending feels so final, so...decisive.


The topic of money is vulgar to me. Don’t like to talk about it, don’t like to think about it. Do not care for the fact that it is an unavoidable, definitively adult undertaking. It is kind of like toilet paper to me--everybody uses it, each in their own way, but please let’s not discuss the particulars, shall we?


Money is distasteful. On “Cutthroat Kitchen” when the contestants are first handed the cash, what do they always do? They raise it to their face and inhale that horrid smell. The smell of books, new or old, now that is intoxicating--it is the smell of adventure, prose, romance. The smell of money is sweat and butts and squandered potential.


So, if I dislike it so much, why talk about it?


It is one of the things people are most curious about. Probably because it is a borderline taboo subject--it would be impolite to inquire about someone else’s finances, in any scenario. We know the statistics though. Raising a child with special needs or chronic medical concerns is hair-raisingly expensive and we have three. I have panic attacks when confronted with it because need is where possibility and decision collide--inaction is rarely an option.


We have been incredibly blessed. At exactly the right time, the Lord has provided for us, through the kindness of others or an open door, talking to the right person at the right time that points us in the right direction. He has guided us through.


It is a substantial consideration on our part, whether I like it or not, a determining factor in a lot of our decisions. I figured I would offer you a glimpse of the inner workings here, some of the elements at play.


We are a single income family. I have been unable to work, largely due to Gabriel but also because of Benjamin and more recently, Tula. Daycare runs about $35 a day for a decent one, but in this town, the waiting lists are substantial for any reputable child care in town. It amounts to $500-$600 a month, or the bulk of anything I would be able to bring home. Jobs that have the same hours as school can be obtained, but I have to be available to pick up kids afterward or pay for after school care, which would deplete the rest of whatever I could earn. There are no after school programs that accept children with disabilities; there are no after school programs that can manage the girls’ diabetes.








If I could work, Emerald and Tula have to have doctor’s visits every three months; Gabriel has to have doctor’s visits every three months in Lubbock. Which accounts for at least three missed days of work--one to travel to Lubbock, one of the doctor’s appointment, one for the girls if I take them both at the same time--every three months. Those are specialists, they still have to see their regular pediatrician, and like any child they will get sick occasionally.


Gabriel’s school calls an average of two to three times a week for me to come up there. Children with autism often present with chronic gastrointestinal issues and Gabe is not exempt, so often he has had a bad poop and I have to bring him home to shower and return--sometimes it is a blowout, sometimes he gets into his diaper and smears it. Disgusting, but it is something we have to deal with. Other reasons they call are because he is agitated and not calming himself down, he is being aggressive, he is having issues with his clothes or shoes and needs me to deliver new ones, he is falling asleep and cannot keep himself awake, or because he is “just not acting like himself”. Between me and Michael, my hours off are quantifiably worth less than his, so I end up taking off again and again.


Let’s establish--that is just out of the ordinary stuff, not accounting for school trips or class parties and other parental involvement activities, most of which I am still unable to attend because siblings are not allowed (after all, I am of limited help when my arms and attention are full of baby).


We’ll do Diabetes first because I am holding Tula so it makes logical sense to me.


Insurance will cover 100 test strips--the little strips that we use to monitor the girls’ blood glucose levels--a month. Emerald has to test her sugar a minimum of four times a day, six on PE days, for a total of around 140 test strips used a month. Tula has to test her sugar around 6 times a day, for a total of 180. That is if we never get an error reading or they never have high or low blood sugar and never get sick--those all call for additional strips. The test strips we buy--the cheapest on the market--are $0.18 each, for about $40 out of pocket a month after insurance covers $60. Glucometer, the meter that reads the blood sugar, can vary. The ones we use at home the pharmacy actually gave us for free because insurance won’t cover those particular test strips (Glucocard). Insurance prefers the Tru Metrix test strips and meter, so we have two meters for each of the girls at home--one that uses the test strips insurance covers and one that uses the less expensive test strips we have to pay for out of pocket.


To complicate matters, Emerald actually has a THIRD glucometer at school--ReliOn Prime--that we provide test strips for. It is a cheap one, only costing $15 so it can be replaced as needs be.


Tula also has a third monitor, but that one is a combination Ketone and Glucose monitor that we only use for the former purpose. Whenever the girls’ blood sugar is over 300 or whenever they are getting sick, we have to check for ketones in their blood so they do not go back into ketoacidosis. Emerald has strips that you check her urine with; Tula has one that checks her blood. Neither of those are covered by insurance. Tula’s NovaMax Test Strips are around $2 a piece, but will last a few weeks because she doesn’t go high very often. Emerald’s are considerably cheaper at about $0.15 each, but she has to be tested more frequently. Combined, it is about $37 a month.


Lancets are cheap--we use them to poke fingers and toes to draw little bits of blood for testing blood sugar. They run about like $5 for a box, but insurance covers those and they last forever. Alcohol swabs run out quickly and are not covered, $2 for 100 for a total of $8 a month. We use those to clean before we prick or poke and wipe off the top of the insulin. Diabetes logbooks were $5 each and last the whole year. Emergency sugar supplies are like packets of sugar or honey that we have leftover if we eat out, but we could also put dum dums in there. Negligible stuff. Pen needles are the mini needles we put on insulin pens; they are $9 a box of 50 generic. We have to buy four of those a month--insurance covers $36, we cover $36.


Syringes, which we have to use for Teeny Tula’s half dosages, cost $30 (covered) a month.


Insulin gets tricky. Medicinal insulin has been around since the 1900s, so you’d think it would cost less. Generic will actually raise your insulin resistence, meaning you will need more and more over time. We invest in the better stuff. Both girls have Lantus Solostar pens, which are $280 a box. A box has six pens, each with 100 units of insulin. One box will last Emerald a little over two months. Tula has a vial of 100 units that costs $190; it will last her about a month.


Insulin is only good out of the fridge or open for a month so we have to toss it after that or it can jack with their sugars.








That is their long acting “basal” insulin. The also have bolus insulin--Emerald has Novalog Flexpens that are $600 for a box of six pens. Those will last us about a month because she has to take it more frequently, after each meal and for correction. Tula is on Humalog pen that is about $550, but because she eats so very little carbs and only gets the tiniest little doses, it will last her a while.


They both have to have the glucagon emergency kit in case they crash. Most families do not have to use it, but you always have to have it on hand and replace it once a year. It is sort of like an epipen. They are $300 apiece. Zofran is a medicine that will prevent them from vomitting when they are sick because it could cause them to crash which would be dangerous; we get a supply of that a year for $250.


So just for medicine and supplies, most of which is covered (thankfully) under our insurance, runs us about $24,000 a year for both girls. We are personally responsible for about $1500 of that, if insurance is playing nicely and there are no issues.


Emerald’s insurance lapsed last year so we had to pay for it out of pocket for a while; that was kind of killer. I thanked God every day that we were able to do that.


Visits to the endocrinologist happens for each of them every three months; we have no copay, but the visit would be around $120 because they do discounts if you pay up front. That adds up to $960 a year for both. Each time they go, they also have to run full blood work including a1c, totalling around $1000 or $8000 for the year. We meet with the registered dietitian at each visit ($100 an hour, times two for each girl, times four visits a year for a total of $800 a year). If there are no hospitalizations and we keep up with our routine office visits, that is just shy of $10,000 a year.


I don’t want to get into hospitalizations because YIKES and because I am sincerely hoping none of that happens. Normally, we will make an emergency room run once a year because we can’t get things under control and they need fluids or if we run out of insulin before insurance is willing to cover it again. Depending on what needs to be done, an ER visit will set us back about $1200. I also won’t go into things we are not currently doing, like special camps or insulin pumps or continuous glucose monitors because while I could look up the information on that, it would be meaningless--they do not currently affect us.


Whew. That was a bit of an odyssey. Catching my breath before I move on to Autism.


Alright, took a quick Facebook break and now I am back.


Autism Speaks estimates it takes around $60,000 a year to raise a child with autism; $90,000 if the individual also has an intellectual disability. That is roughly four times higher than the cost of raising a neurotypical child.

I did the math after a friend of friend asked me. All things considered, Gabriel costs $46,000 a year more than Benjamin. That is counting incontinent supplies, medication, specialists, therapists, personal care services. Breakdown is something like this:


-Personal Care Assistant: $1000/month ($12,000/year)


-Incontinent Supplies (diapers, wipes, changing pads): 200/month (2400/year)


-Medication (clonidine, risperidone, hydroxyzine): 450/month (5400/year)


-Therapy (speech, occupational, physical): $28,800/year*

*This one actually went down substantially because we cut back—insurance doesn’t cover Applied Behavior Analysis so we had to pay out of pocket for each session; got too costly and we had to quit. We also scaled back, dropped PT at home, decreased at PT/OT school so that he could have a little break. It was getting to be a lot.


-iPad maintenance and repair: $130/few times a year. Because it’s his communication device, we have kept it available, but that means it has had a few accidents. He ruins cases, takes it into the bath with him, leaves it outside, or gets mad and cracks the screen. Currently, he’s taking a short break from screens because he has annoyed us too greatly by being uncareful. It also covers new chargers.


-Specialists: $250/visit($1000/year) he see a developmental pediatrician, which we have to travel to Lubbock for, so tack on another $40 in gas.


There are other costs like locks for the fridge and pantry, bolts for the front door, back door, and our bedroom door. We get items to work with him between therapy—trampoline, swing set, weighted blanket, compression garments, sensory brushes, hammock, exercise ball, privacy pop, noise canceling headphones. Those vary in price from $10 to a few hundred. We were doing horse therapy for a while, but have taken a break. That was at no cost.


All of that adds up to...right under $50,000 annually for Gabe, before calculating for lost wages. As he gets older, the price will increase exponentially to include a nurse or residential living (though we hope he wants to stay with us), transportation, and other expenses.


I try not to think about all of this, but when it comes together…


Yuck. No wonder I don’t like thinking about money.


When I do think about it...it’s a tangible, definable way to express how God has cared for us. A lot of families of special kids go bankrupt trying to handle it all; though we rarely have excess, we always have what we need when we need it. I think that is such a beautiful thing. I am very thankful for it, because it once again opens my life up to possibility.





—Andie

Saturday, January 6, 2018

Tula's Bad Day, Part 2

Warning for all you delightful readers out there:

This next section is going to be tough to read at times. It was a difficult time for all of us, but
particularly for Teeny 9-month old Tula. I write because it is a moment that needs to be
remembered in all its ugly, painful glory. Feel free to skip and jump in next time, when we are
on the upswing and things start getting a whole lot more optimistic.

Continued from “Tula’s Bad Day”

Tula had been poked and drained and hooked up to every machine to monitor every function
of her little body. She had, blissfully, slipped into unconsciousness, which we knew from
experience she would likely drift in and out of for the next twelve hours. (This educated guess
brought to you from five years prior when Tula’s older sister went into diabetic ketoacidosis and
went through this very same thing.)

The charge nurse called Amber at the pediatrician’s office and told Dr Shah that he was
needed back. Knowing they had made only one hospital referral that day, Amber knew to
who she was referring. She must have been so scared. I wish I could have spared her that.
As it was, I was outsourcing all communication relating to my mother and Michael so I could
focus on the situation at hand.



Dr Shah and Amber discharged the rest of the patients for the day, asking them to come back
tomorrow. We had gone up right at around lunch time, so Dr Shah didn’t even get a chance
to eat. He just came up there and sat with us or nearby until we left.

They moved us to another room. There are no endocrinology specialists at the hospital
where we were, so we would be careflighted to a children’s hospital a few hours away.
This concerned me quite a bit, but we were going to do what needed to be done.

The first person I had asked my mother to call was the children’s minister from our church.
A short while after we were moved, Jennifer showed up to pray with us. She had let the
elders and church know, which was a comfort.

Tula looked so very calm and peaceful; it was hard to know how bad it was.
All of the hurt was inside and anything outside was covered by a hospital blanket.
If she could sleep through it, how bad could it be?



She wasn’t allowed to eat until she was taken off of IV insulin so they could very gradually
bring her blood sugar down while rehydrating her. Pushing it too quickly could have catastrophic
consequences—seizures, cerebral edema, coma, death. Though we have been introducing
solid foods at home, the bulk of her nutrition comes from me nursing her. We had to ask the
nurse to track down a pump so that I could express the milk she wasn’t drinking. Food was the
last thing on my mind, but I hadn’t eaten anything all day. Michael made me sit down and
eat a veggie burger and hummus and pretzels.

The weather was foggy and dreary; it had already iced over and was expected to snow,
so the helicopter couldn’t come get us. In its place they sent an ambulance which would
arrive in a couple of hours. In the meantime, I would be able to hold her, carefully.

I set up in a recliner next to the bed with a nest pillows and blankets on my lap. The nurse
helped settle her in my arms so she wouldn’t be laying on anything painful or uncomfortable.
It made me feel better to hold her.

Two leaders from our church came to visit while I loved on her. I’m sure I wasn’t the best
company, but it meant a lot that they were there.

Michael’s parents drove up from Lubbock—together with my family, we decided on a plan
for how to handle the rest of my kids. Our personal care assistant and brother Jarrod were
both at the house keeping them. It was decided Gabriel would fare best with Jarrod, who is a
special education teacher. Mom would take Benjamin. Rhonda would pick up Emerald and
bring her and Michael to the children’s hospital. Tula and I would ride together in the ambulance.



They asked us all to leave the room so they could try and place an arterial line.
We stood outside the door and listened to weak cries impotently. It was pitiful and painful
and nearly unbearable. They were unable to complete the procedure.

At around 5, the transport team arrived. They were so very nice. They strapped my little
baby to a gurney and we loaded up and we’re on the road by six.

I had to sit up front, which felt very, very far away. I couldn’t reach back and touch her,
couldn’t hold her hand, couldn’t stroke her hair. I also couldn’t get in the way.



On the rearview mirror there was a camera that showed what was going on back there,
sort of like a video baby monitor. On the dashboard, there was a clock. Knowing the ride
was going to take about two hours, I allowed myself to turn around and check on her every
ten minutes and no more. The entire way I sat straight and still and silently, glancing occasionally
at the time to know how long it was before I could turn around again.

When we neared the metroplex, the driver turned on KLTY, Christian radio. I remember
the song that was playing—

Be strong in the Lord
Never give up hope
You’re gonna do great things,
I already know
Gods got a hand on you, so
Don’t live life in fear.
Forgive and forget,
But don’t forget why you’re here
Take your time and pray,
These are things I would say.

It helped.

My grandparents met me at the hospital so I wouldn’t have to be up there alone.
They held T’s hand while I filled out paperwork and the staff went through all the stats checks.
We arrived around 8, Michael followed at 9. Though she doesn't have many words yet, she opened her
eyes and said, "mama? Mama!" She grabbed my hand and wouldn't let go, sinking back into unconsciousness.



The first night was rough. I had been up all the night before with a vomiting baby; now
they came in every hour to do blood sugar checks and blood gases. One of the IVs had clotted
so they were unable to draw from there; they had to poke her fingers and toes and heels and
milk them for blood. There were so many cuts on her hands and feet that it looked like
she had crawled through glass.

In PICU, there was a straight backed chair and one of those hospital sofas that you’re
supposed to sleep on. I got the first shift on the sofa—it was so cold, I piled blankets on me,
curled up in ball hoping to rest. At 2.30 we switched, and I stayed up the rest of the night.



Slowly but surely her blood sugar came down, but as it did, Tula became more awake and
more aware. She was cold, in pain, scared, but mostly importantly, she was hungry.

The only thing I was allowed to give her to eat or drink was a sponge on a stick soaked
with a bit of distilled water.

You could hear her stomach growl over and between her cries, watch her greedily and
desperately suck the sponge dry. She gets food and comfort from nursing and she didn’t
understand why mommy was holding her and not feeding her. It made her so angry and she
screamed and thrashed; I’d sing and rock her to sleep and hope the next time she woke she
would get to eat.



Unfortunately this was Sunday, New Years Eve. Which meant we were waiting for the
doctor to visit and adjust her care plan to allow for food on not only a weekend, but a holiday.
It felt cruel.

We were not allowed to eat in there, which meant we could either leave her side or just go
hungry. You can guess which we chose, at least until she was able to eat herself.

Tula was fully awake and aware now. There was an IV pumping insulin, antibiotics,
fluids, electrolytes, and sugar on her right arm. On her left hand was an IV that had clogged.
She had heart monitors all over her chest, a pulse ox monitor on her big toe, a blood pressure
cuff on her calf.

They needed to draw blood but all her major draw spots were shot; her vessels are so itty
bitty to begin with. So Michael and I have to physically restrain her while they stab, dig, dig,
pull out a little, dig, remove the needle, stick her again in a new place. This happened over
and over again for forty five minutes. At first, she fought so hard I was afraid she was going to
pop her shoulder out of socket trying to get away. After a long while, she just sort of whimpered
and squirmed, like she had given up and was resigned to it. I’m not sure which was worse.

Finally—finally—they got a spot and drew enough blood for the two tests...and it immediately
clotted. All of that, and for nothing.



That was so emotionally taxing, I asked Ken and Rhonda to sit with Tula while Michael and I
went to the cafeteria. I didn’t feel like eating but I had to get out of that room, even for a little while.

A regular room opened up; we moved up a floor. Things were more relaxed. They took one
IV out and let Tula take a bubbly bath. Her face was dried out and red; I had to rub aquaphor
all over it. She got to put on clothes for the first time in a day. When daddy walked in the room,
she gave him the first smile we’d seen from her in a while.

Emerald wanted to celebrate New Years, so she brought streamers and noise blowers and
hats and poppers. She tied the streamers to Tula’s crib bars.



She kept messing with and kinking the remaining IV until it just got pulled out. They decided
it wasn’t worth replacing, much to all of our delight. It meant that she could crawl around and play.
I laid some blankets out for her and gave her a little compact mirror, a plastic bottle, a noise blower.
She was so happy, so much more herself.

I made up that awful couch bed with blankets and she slept in my arms. It was the first time
I had rested since this whole thing started because I felt like she was safe.



Everything after that point was moving us closer to going home. She improved so very
quickly, adapted to getting shots and finger pokes. Now she just looks at you curiously,
doesn’t even cry (most of the time anyway). They figured we had been through so much
training already, there wasn’t a reason to keep us there. So they packed us up and sent us home.

The hardest part was…well, the most challenging part of developing her diabetes plan was
that she is almost exclusively nursed. We have introduced food, but her carbs come primarily
from me. We have had to work on figuring out how to handle insulin when you can’t know how
much milk/carbs she’s getting. When she does eat people food, it isn’t enough to count for much
of anything. Her insulin does are so small, microunits, that just a few drops off can be detrimental.
Yesterday we were off by 0.5 units of fast acting insulin and she dropped from 416 to 20. She was
so weak she could barely cry.

I don’t know if we can handle this….all of this. I do know that we don’t have much choice,
and that we are going to rock it the best we possibly can. Because this furious, beautiful, perfect,
strong little girl is worth everything in the whole world.

—Andie


Wednesday, January 3, 2018

Tula’s Bad Day

Saturday morning, in the group text that includes my mother, brother Jarrod, and sister Amber, I mention that Tula had a bit of a rough night. She was running the smallest fever—100.3, that borderline zone where yeah it’s a fever, but only just. She had vomited a handful of times.

Amber suggests bringing her in to Saturday clinic at our pediatrician where she also works as insurance and billing. Mmmm...I waffle. She hasn’t been sick that long. She’s just on the border, just a little sick. If I take her, I’m exposing her to other kids’ illnesses when most likely she’s got a virus. Thinking about keeping an eye on it for a little while, taking her in Monday if there wasn’t improvement over the weekend. Mother experience: 99 times out of 100, this stuff passes with no need for intervention.



Amber puts us on the schedule for 11 that morning, in case I decide she needs to be seen. I figure, might as well. Just in case.

We spend the morning laying around the house with Tula resting, just being  lazy. It’s gross cold outside, kind of drizzling, so I doubt again taking her in—I’m going to get this little baby out in this weather and she’s going to get even sicker and they’re likely not going to be able to do much. Ahhh, might as well, I guess.

When we get there, we hang out with Amber for a little while, drinking coffee. Joking because Tula seems a little out of it. Poor baby.

Dr Shah comes in to see us. He’s not our regular pediatrician, but another one in the practice that sees kids on the weekends. He is super nice. We haven’t been concerned about Tula getting enough fluids because she’s nursing well and still having wet diapers. I don’t like that her lips are chapped—that’s pretty strange in a baby. He examines her, asks me some questions. Routine visit, ending in not unexpected diagnosis:

Ear infection, little bit of dehydration.

To get her rehydrated quickly, she’s being admitted to the hospital for IV fluids. Probably won’t be there long, but there are no guarantees. They’ll give her antibiotics for the ear infection, and she’ll be right as rain.

The hospital is right next door, so I call Mike and let him know what’s going on, ask him to let his parents know what’s going on, and I drive her over myself. Shoot my mom a text asking her to run me something for lunch on her lunch break if she can; she works in the lab at the hospital. I don’t get a response which is not unusual—she doesn’t have her phone on her unless it’s break.



Everything is so calm and quiet. Because it’s the weekend, there isn’t a ton of personnel around, hardly other patients. This isn’t a bustling metropolitan hospital, just a sleepy little place. Tula’s trying to fall asleep again on my shoulder, keeps jerking awake. It reminds me of when I had to take Emerald to the emergency room when she was diagnosed. We just thought it was dehydration, but she had gotten bad so rapidly. That was a scary time.

I wasn’t quite connecting all the dots in my head yet.

The charge nurse buzzes us in right away and we start the check in process. They weigh her—18 pounds, a little down from her 6 month check up. Hmm, that’s not good. Lost a lot of fluids. Take her measurements, her head circumference, height. Time to make her mad: they have to check her blood glucose. After vomiting last night and this morning, she’s probably a little low.

She doesn’t wake up or flinch when they poke her. Huh.

The glucometer counts down and flashes: >500.

Huh.

They get a new machine, test it again. Same result. I might have dropped a low-grade expletive. Things have officially clicked into place, the last bit of the puzzle revealed.

I step away from the nurses that are taking care of my baby and I make a phone call: “Michael, call your mother. It’s happening again.”

This is not my first time at the horror show, so I am able to calmly notice how well these nurses are managing the situation. They let me know that I shouldn’t worry but that we were going to have a lot of friends join us, just so we can get everything going as quickly as possible.

From a floor that felt practically deserted before, a dozen professionals come in. I stay near her head, smoothing her hair and holding her hand, while they try and get blood drawn, two IVs inserted, a catheter placed. You’d think it would be noisy with so many people in there, but everyone is being so respectfully subdued the can focus. Someone turns out the lights in the room, and the delicate web of Tula’s blood vessels are illuminated by special lights. Because she’s dehydrated and her vessels so small, it is hard to get the lines placed.

My hands full with Tula, I ask if someone will call my mom down in the lab and ask her to come up. The charge nurse takes care of it. My sole focus is completely on my little baby. When the door swings open to let more people in, I faintly hear the intercom announcement: Code blue, code blue. That’s sad, I think—I hope whoever they are that they’re okay.

The catheter causes issues because as soon as they take off her diaper, she pees all over the bed and everyone gathered around, not to mention all the sterile equipment laying around her. When did that get here?

After multiple failed attempts to place IVs in the crooks of her arms, her hands, her feet, for the first time they gently ask if I can step back to make room. I can come right back and they’ll hold her hand until I do, it will just give them a little more elbow room. Sure, that’s reasonable. Makes sense.



I step back and watch the crowd swallow Tula until I can’t see her anymore, and I noticed Mom made it up. I have no idea how long she’s been standing there, so absorbed as I was by the situation. She’s pale and visibly shaking.

Oh. WE’RE the code blue.

Whatever they’re doing to Tula, I can’t see, but I do know: she’s not crying. Not fussing. Not making a sound.

Michael arrives, and we stand feeling impotent and superfluous, waiting. The crowd dissipates and I use the opportunity to sneak back in. There are purplish bruises forming on the right side of her head and on the right side of her neck. Goes with the track marks up and down her little arms. But the IVs have been placed—one is on her right elbow and the other on her left hand. Both have been thoroughly taped to boards so she can’t mess with them, but she doesn’t look much up to playing at the moment. She’s down to just a diaper and you can see by her stomach sucking in how hard she is struggling to breathe. The pulse-ox monitor taped to her big toe tells me that she’s getting enough air, but she is working hard for every breath.

Without her clothes, you can tell how very small and vulnerable and fragile she is. She is unconscious, which is the most frightening kind of blessing, but even so, you can see how hard she is struggling. She’s a tough girl, and she’s not going down without a fight.

Everywhere, there are people, people working on her, fetching things, watching, waiting. I see all of this and think:

It was just an ear infection.

Part 2 to Follow

--Andie