Hopes for a great New Year

What a busy day....We had a couple Doctors stop in this morning to check in on Mark.  Renal gave us only water restriction today.  We could not drink more then 1 liter of water, but as for diet...that was a different story.  It was what we call a "free" day!  Mark could eat whatever he wanted today...NO diet restrictions at all!  Tomorrow that will change a little bit.  We will start working on our diet and documenting everything.  The only other thing we did was a chest x-ray this morning....This is now his 9th x-ray since we have been here!

We started with a big meal...and went from there!

The rest of the day was full of fun...Finally!!  We moved out of ICU back to our old room.  We only has a couple of interruptions from Doctors.  They just wanted to take a quick listen.  Then we played all day long....We also had a total of 14 visitors today!  They all picked a great day to see us....but boy are we tired!  Here is a look at all the fun we had today :

Dr. Mark

Nap time!

Mail man

We even built a fort!

Fishing

There was no better way to spend the last day of this year.  Hanging out with so many loved ones and feeling much better.  We sang, we danced and we played like crazy!  Now as we end our day we rest our heads, and have many hopes for a great New year!

Holding him tight

Last night was a somber night in ICU.  I had never seen or heard it so quiet since we had been down here.  The floor was loaded with patients still.  There was one child that was about three doors down not doing well.  All of the ICU staff was in and around the room for hours.  The childs' parents were in so much pain, pacing, crying and holding each other.  I just felt so sad for them.  Just watching what they were going made me cry.  It was almost like all the other kids on the floor knew and they just slept.  At one point I just reflected back on how lucky we are and climbed into bed with Mark.  Laying there holding him tight, feeling so lucky to be where we are.  Unfortunately that other child lost his fight last night.  Today I would take a moment to hold your children.  No matter how big or small....Just hold them tight.

This is how he was sleeping...With the new head lamp from Evy & Bobby!

This morning ENT  came in early to have a look.  They will be ordering one more x-ray.  After that they are turning his care to the ICU Doctors, unless there are any other issues.  If all goes well we will see them in a couple months.
As far as I know we will not be doing dialysis today!!  It is going to be a day to recover, play and hang out.  We just need the Renal doctors to get in here to talk about his diet.  With the holiday I think everyone is on a slower schedule today.  Never mind do I not know what day it is....I only knew it was a holiday because, I went to the lobby to get coffee and it's ghost town down there.  So we will sit and wait for the rest of the doctors to round, and our visitors to arrive.

Do you like vanilla Mom?

This afternoon was a bit painstaking...Mark was miserable after his dialysis treatment.  All he wanted to do was eat and drink.  He was so upset all afternoon about his situation.  He was sick of waiting for the Doctors to come and get him!  They were suppose to be here at 3 to bring him down to the operating room.  

That time came and went with no sign of any Doctors.  We were told that they were really running behind down stairs today.  So we waited...waited...and waited!

This is not the best picture...but it has been a long couple of days.

Finally after all that waiting the Doctor showed up.  He took another look at Mark and decided we would not go down to the O.R. after all.  He said we have the time booked and if Chris and I felt strongly about going down we still could.  He felt that Mark had made a bit of progress with his breathing over the course of the day.  We agreed that it would be great not to go down.  If need be things change we can always go tomorrow.   All we wanted to know is when can Mark eat and drink???  The Doctors said that he could start right then we just need to go easy.  Our Nurse ran down the hall to get water right away.  We started with a half cup of water and went from there.  As soon as he had the water he wanted to eat...so we had a vanilla pudding.

First bite of pudding...first bite of food in 6 days!

After Mark got warmed up he was wanting more water and more pudding.  Maybe a bagel too, I told him not to be pushy.  When he was eating his second vanilla pudding (which is not his favorite) he said..."Do you like vanilla mom?"  He was just so happy to be eating....Look at this picture....

The rest of the evening was spent playing with Papa and all the stuffed animals...the stickers Aunt Evy and Bobby sent.....also one attempt to jump out of bed....Finally we are getting better :0)

To Go or NOT to Go....That is the question

After waiting Mark out this morning with no mask on, he finally woke up!  Boy oh boy was he demanding.  He wanted to try to play, but was still to tired so found himself getting very angry.  He also wanted to talk lots about food and water...Maybe not talk but dwell on it.  This of course gave us a true picture of Mark.  We were seeing him talk at length with out the help of the mask.  As he became more frustrated we called the Doctors to come down and have a look...we actually called twice!  Mark was loosing patients waiting for them.  They were on their way to answer the question we were all waiting on....To Go or NOT to GO?   With the Doctors arrival and one quick look at Mark, he answered the question.  He said "we will see him in the operating room this afternoon."

So lets move on to bigger and better news!  The Renal team came in and had some great news.  His levels looked good after yesterday.  We are  starting the day off with another 2.5 hour treatment and most likely will be able to skip treatment tomorrow.  This will be the start of our every other day schedule.  This is all very exciting news to us!

Our day will hopefully go smooth...We started dialysis about an hour and half hour ago, and we will be preparing to go down stairs early afternoon.  All we can do is hope for the best and maybe even be able to have water tonight!  Can't wait for Chris to get here...he is bringing me a surprise lunch...I'm actually really excited even though on a normal day I hate surprises!  

Tick Tock

It is so quiet in this room this morning you can hear the clock.  While we're on the subject of clocks I need to get a new alarm clock.  Preferably not the ENT team.  This is day two waking up in such an unpleasant manner!  I even went to bed early and set my alarm for 7.  They did a stop in at about 6:45!
When they were here they took a listen and had me finish signing paper work for this afternoon.  He seemed pretty convinced he is going to bring Mark in to have a look.  When they are in the operating room they will use a different scope, and take pictures.  After his exam this morning he wanted us to wake Mark.  They want to hear him breath and watch the stats as he gets more and more agitated.   So we all tried to wake Mark and there was no success.  Just as Bethany said the other day "he is just like his mother in the morning."  Besides the both of us shouldn't have to be woken by the ENT team!
  This brings us to a little stand still....he is sleeping with no mask, he stats are okay, not perfect...but not to low!  After he wakes it will be the deciding factor on his trip to the operating room this afternoon.  Now we just wait for the other Teams to do their rounds and fill us in!  I love this part of the day...It's when we receive our daily report card.  Usually a nice recap of the days prior and a plan for the the new day.  We will have dialysis on the early side today, due to the possible afternoon plans we tentatively have.

Mark this morning with a break from his mask!

I will be sure to keep you posted on the days events as soon as a hear anything :)

Butterflies

Mark did really well with dialysis this morning.  He is up to 2.5 hours!  All of his levels are looking pretty well.  The dialysis nurse said that she needs him to be at a 70% with his levels.  Yesterdays labs reported Mark to be at about a 53%.  I'm not sure how she gets the percentage out of all his numbers.  I think I may need one of my nurse friends to help me on that!  After dialysis Mark was starting to become a bit unsettled.  It was the icing on the cake when the ENT  team walked in to do the scope.
They wanted to get another look at Mark because it has taken him so long to heal.  When they were done with the procedure they had said that the swelling was still there.  Although it had looked as if it had gone down a little bit, they still seemed concerned.  At this point the team went ahead and scheduled the operating room for tomorrow afternoon.  If Mark's breathing gets better over night then they will hold off, but if not they are going in to get a further look down. We were able to go over the procedure with the Anesthesiologist (wow that's a big word to type) this afternoon, and sign all necessary paper work for tomorrow. 


My Mom was here and able to sit with Mark.  Chris and I went to the Family Center so I could shower.  It's a little bit of a pain to go there so it was nice to have Chris for the walk.  I feel like our time is so consumed when we're here together.  We don't get much "us" time!  It has only been a week...but a very long one.  Today I had crazy butterflies in my stomach when he walked in the room.  I didn't want to stop hugging him....he is my security.  He had mentioned to me tonight when we were on the phone that it felt like we were dating again.  He is so right.....We spend days together and then late nights on the phone....if only we were 18 again!

Yes I said he was right!

"Good Morning"

My alarm clock this morning was the ENT Doctors voice...."Good Morning!"  It was about 8 in the morning and not the way I wanted to get up.  I was in a good place maybe even dreaming and she ruined it all.  I think I have gotten over it now that I have a coffee in one hand and my computer in the other.  Anyone who knows me well, knows I like the morning very much :)
(BTW...I think I slept late because I was up late on the computer and eating junk food!)
So here we go....
Today plans so far:  ENT decided that they would come back this afternoon to do the scope for the 3rd time.  He may also get a trip to the operating room tomorrow if things are not better tonight.  They would just need to get in there for a better look....nothing too invasive.  They just feel as if the swelling should be down by now and may need a deeper look. Neurology is working on his med levels...although this new med does not go out with the dialysis, it's taking a bit to get the level to a good one.  The level is on the low side so we need to get it up as fast as possible.  The Renal Doctors say that things are going well, their concerns for the morning are the low seizure level and they want him to get upstairs as soon as possible so he can eat and drink!  I think they may be Mark's favorite people at the moment!!!  When I had mentioned to the Renal team about the possible trip to the OR tomorrow with ENT, they did not seem happy.  So we will see if they intervene on that one.  The only thing we are waiting on at this point is the ICU Doctors to do their rounds.  They are the overall care team and in charge of the mask. When they get here we will see where that stands.  
This afternoon we can expect the scope and dialysis a bit later....If we hold off on the dialysis it will give them a chance to get the seizure meds into him two more times before treatment time.
So that was the plan but as I type they just came into to set up dialysis...The nurse said there was a change in the schedule, but reassures me things will be fine with his levels.
Mark did wake up this morning and of course ask for water.  I said "You are doing great, but we need to wait."  He said "I have been waiting for like 20 years."  He is a bit strong willed.  I think he could make the Guinness Book of World Records, for the most times using the word water in 48 hours....Can someone look into that for me?  

He has won many medals and trophies before...Why not a plaque from the Guinness Book?

"What a day"

Today was a very quiet day....We had a flow of visitors who were are nicely scattered.  We started off pretty early with Dialysis today.  I want to say somewhere around 10 this morning.  They bumped Mark's treatment to 2 hours.  He is getting so close to a full treatment with no issues.  I'm sure the sedation is helping, but we take what we can get around here!  After the treatment was over the dialysis nurse wanted to change the dressing around Mark's cath.  He was then given a sponge bath and new bedding.  I think he was feeling refreshed and good with the mask off for that time.  The nurses had noticed he was holding his stats good so they suggested we go with out the mask, and put a call into the attending.  She agreed we could try it out and see how he does.  So when there is no mask, there is no sedation.   After a little while Mark talked here and there. 

Somethings he said:

• I want my water                                          
• I want a bagel 
• what a day...what a day
• Go to Dunkins...Can we go to Friendly's
• I'm scared
• I don't feel well 

He really loves to talk about water and food, with some select comments in between.

As time went on with out the mask you could here his breathing so they suggested another chest x-ray.  Before you knew it we had that mask back on our face.  He is just working to hard to breath along with the swelling not fully down.  I'm sure tomorrow we will see ENT again.  He had been a bit restless this evening trying to settle for the night.  The doctor agreed we would up sedation for the night and keep him happy.  We also had to replace another IV tonight....Mark did not help remove this one...it just went on it's own!  So we hope for a quiet night with lots of sleep...Hoping tomorrow the mask will stay off, and the sedation will wear off.  During that process he may be a bear, we may not also sleep...But it is all worth it in the end!

We also want to THANK everyone for all the wonderful support at this time.  We have received numbers of emails, phone calls, texts, and cards.  Also the stuff that has come to the hospital...Gifts , food, magazines, books....even a Christmas tree....Thank you all so much!

xoxo

All the snacks we could ever want!

I miss everything about you

We both had a great night sleep last night.  We have a couple doctors come in for rounds this morning.  No word of what the days plans are.
  I got up early to grab my coffee and ate some oatmeal in the parent lounge.  I was able to talk with another family that is here in ICU.  We shared stories....My heart breaks for this family.  They're here for the holiday's in Boston visiting family all the way from the west coast.  They brought their daughter in for what the thought was the start of the flu.  Not so much...It was a Brain Tumor, and a rare one.  Thank god their travels brought them here to Boston.  They say things look good after the surgery but still a long road ahead.  So that makes me think, this little girl was here for a reason and things happen for a reason...life is short, you must live, work, play your hardest and never have regrets.  This is just one story of the many, many families that are here.
  So here I'm this morning feeling a little sad.  Mark will be okay when this is all over, it's just hard right now.  I miss everything about him ....his voice, smile, songs and most of all his touch.

Oh what a night!

I left off at about 1:30 in the morning on my last blog!  Oh what a night....Mark refused to sleep from the moment his tube was removed until this afternoon.  With one cat nap at about 3 in the morning for and hour and a half!  He was very unhappy with the "Darth Vader" mask that was a mandatory device.   With many battles during the night of having to restrain Mark and keep his mask on it was not fun.   He may have asked for water about 5,000 times...this is no lie.  He would ask Doctors, Nurses even Housekeeping just for on cup of water.  It was just not allowed at this point.  Mark even had his own little victory he had worked on all night in the heat of his battles..he managed to rip out both IV's in his hands!  Boy was he a happy camper, but to his surprise he received a new IV in his foot.
After rounds with all the teams they made the decision to sedate him this afternoon so that we could keep the mask on him.  This was still important to keep on with combination of steroids to get the swelling down.  He did not receive his first dose until after 12 or so and then soon began to relax....There was a light at the end of this long night!!  I was so happy!
After Mark was so settled and relaxed we had a surprise visit from ENT again.  They wanted to do another scope check and xray to make sure it was still just swelling and they did miss anything.  They are a bit worried it is taken him so long to recover from the extubation.  To be honest all I was thinking was what are you doing waking this sleeping child??  Well the good news is they are still seeing the same results as last night, it's just taking Mark longer to recover.  We ended our day with Dialysis treatment for 90 minutes.  He is doing great from a renal stand at the moment.  His levels seem to be getting better and he is tolerating treatment.  I am thinking tomorrow treatment maybe be bumped up a bit longer.  Tomorrow is a new day....Let's all hope mark can drink water and loose the mask!
Here are some pictures of our CHB suite:

The back of Mark's bed.

                                                            

View from my bed...some think it is a bit scary.

Mark was still not available for pictures today :( 
 Goodnight.

What is 4p- and What is Dialysis

Wolf-Hirschhorn Syndrome (WHS)

Deletions of the short arm of a B group (4-5) chromosome was initially thought to be associated with the cri du chat (cat-cry) syndrome (also known as 5p-). However, patients were noted with many of the characteristics of the syndrome but without the catlike cry. In 1965 Wolf et al. and Hirschhorn et al. published reports showing that there was a syndrome with a deletion on the short arm of the fourth chromosome.

The amount of material deleted may range from about 50% of the short arm to a small break that can't be detected by normal chromosome analysis. In 10-20% of the cases the deletion can occur as a result of a translocated chromosome in the parent.

Because of this wide range of deleted material, the effect on our children varies widely. Some can walk, talk and assist in their daily care while others are not verbal and require constant care. Some are near normal height and weight while others at ages 20-30 weight only 35-50 lbs and are only 45-55 inches tall. The medical involvement also varies from near normal to severe heart and other problems. However, a common trait seems to be that our children are (for the most part) happy, loving children.

Major symptoms may include severe growth and mental retardation, microcephaly, "Greek Helmet" faces, and closure defects (cleft lip or palate, coloboma of the eye, and cardiac septal defects) and other physical disabilities .

The life expectancy for WHS children is unknown. The oldest member of our group was born in 1949, and several are in their twenties and thirties.

Mark's case being a little different, he doesn't have cardiac issue, but does suffer from kidney issues and seizures.  No two kids are alike!

What is dialysis?

Dialysis is a procedure that is performed routinely on persons who suffer from acute or chronic renal failure. The process involves removing waste substances and fluid from the blood that are normally eliminated by the kidneys. Dialysis may also be used for individuals who have been exposed to or ingested toxic substances to prevent renal failure from occurring. There are two types of dialysis that may be performed on your child: peritoneal or hemodialysis.

Peritoneal dialysis - Peritoneal dialysis is performed by surgically placing a special, soft, hollow tube into your child's lower abdomen near the navel. After the tube is placed, a special solution called dialysate is instilled into the peritoneal cavity. The peritoneal cavity is the space in the abdomen that houses the organs and is lined by two special membrane layers called the peritoneum. The dialysate is left in the abdomen for a designated period of time which will be determined by your child's physician. The dialysate fluid absorbs the waste products and toxins through the peritoneum. The fluid is then drained from the abdomen, measured, and discarded. There are two different types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD). CAPD does not require a machine. Exchanges, often referred to as "passes," can be done three to five times a day, during waking hours. CCPD requires the use of a special dialysis machine that can be used in the home. This type of dialysis is done automatically, even while your child is asleep.

Hemodialysis - Hemodialysis is performed in a dialysis center or hospital by trained healthcare professionals. A special type of access, called an arteriovenous (AV) fistula, is placed surgically, usually, in your child's arm. This involves joining an artery and a vein together. An external, central, intravenous (IV) catheter may also be inserted, but is less common for long term dialysis. After access has been established, your child will be connected to a large hemodialysis machine which drains your child's blood, bathes it in a special dialysate solution which removes waste substances and fluid, then returns it to your child's bloodstream. Hemodialysis is usually performed several times a week and lasts for four to five hours. Because of the length of time hemodialysis takes, it may be helpful to bring games or reading materials for your child, to occupy him/her during this procedure.

Mark is currently on Hemodialysis.

Information found on the 4p- and Childrens websites!

Sunday Funday at CHB

After my long winters nap last night I was ready to get up and face the day ahead!  There were big plans for dialysis to start at about 9:30....Not so much, they were in Sunday mode!  Really they were super bogged down from the big blizzard that was headed this way!  They had to catch up from Saturday and take all their Monday kids today.  This left us for a later start, I believe it was sometime around 12:30ish.  With a successful 90 minute treatment we are off to a good start for the day!  Mark was very restless today fighting the sedation, which can dangerous.  That would be why his hands are restrained down because he loves to try to ripe anything out, the tube his IV or even his chest cath!

We were again blessed with many visitors and lots of treats today.  I was also officially kicked out of our room upstairs today....So you know what that means...I had to move ALL of our stuff again.  I loaded up a big cart headed on my way looking like a homeless women!  My poor parents were stuck taking half my stuff, I'm just so sick of moving it.

Later on in the afternoon we had to head down to CT scan just to have a look after the big seizure yesterday.  The CT was about 5 minutes.  The transfer down there and back was triple that.  To pack him up and unpack what a job!

When we returned the team decided it would be a good time to remove marks tube!!!!  When the tube was removed Mark's breathing was a bit labored....I knew at this moment it was going to be a long night.  After a close look from the Doctors they decided to call the ENT Doc up for a look.  Mark was having a hard time breathing and was still needing some assistance with out the tube in.  The ENT took a look with the scope down his nose.  The issue is what they had hoped....Just a little swelling and no major injuries.  Mark would receive steroids to help swelling and remain masked for the rest of the night!  Mark is not into the mask...so this had made him very grumpy tonight!  We are coming up on almost 1:30 in the morning and he is still waking every couple minutes asking for water and being very unhappy!

Tomorrow is a new day!  Mark can't wait to see Chris.  He has been a little under the weather and has had to stay away from the hospital.  

You may notice no pictures of mark in this blog :(  He was not up for modeling the last 24 hours or so.....we can hope he has his picture face on tomorrow.

Wonder why Christmas missed us?

Santa left Mark lots of goodies!
Christmas Morning Mark woke up with a little excitement!  Santa really did come to the hospital.   We had an early start with dialysis  in our room!  So as we waited for the machines to get up and running we opened some gifts.

Trying to open with one hand

After opening a couple gifts we were a little tired and wanted to rest.  Mark was hooked up to the dialysis for a 90 minute treatment.  He did great for the 90 minutes...lasted the whole treatment with minor issues during treatment.  
We were expecting a couple visitors on Christmas!!!  We started are morning of with a visit from Nick and Rach....I think Mark was happy about that, when we told him they were here and parking their car he gave us a big smile.  I know I was happy too :)  Before they had arrived Chris and I decided we would call off the rest of the visitors for the day.  We were both really burnt out and run down, so we figured we would just hang out and watch TV.
There was one special visitor we could not call off.......

Santa and Mark
Just a little side note here...I am thinking Mark was trying to be into him and wanted to talk to him but he couldn't .  He was just to tired.  I think he was a little tacky ....I said to my dad "They couldn't get a Santa with a real beard?"

Santa came towards the end of Mark's dialysis.  After treatment they always do a set of labs and weigh him.  Then we snuggled him up in his bed for a rest.  While he rested Chris and I were able to chat with our visitors.  About 20 to 30 minutes after treatment things took a turn for the worst.  Mark began to have a seizure.  It was a bit scary and unexpected.  With in 5 minutes we had about 20 doctors and nurses in our room just trying to stabilize Mark.  As time passed he was not stopping, and before we knew it we were on our way to ICU.  Last that was reported to Chris and I was that he had seized for over 45 minutes.  After they were able to control the seizure they deiced it would be necessary to intubate and sedate him.  Although his heart and lungs are doing great, they just need to keep him sedated until they can figure out his medications.  The seizure could have happened for a number of reasons....they can come on during dialysis when calcium levels are very low.  Also Mark has an underlying seizure condition, so it may have just been that.  We do know that his med levels were and have been low, but that doesn't actually mean that that could be the cause.
So know we are in ICU as all the teams work together to try to figure this all out.  They have not told us how long mark will be in this state.  Yesterday was a long hard day for us.  Chris went home to get some rest around 5 or so, and I just went to sleep.  Now is the best time to sleep...while Mark is sleeping and has many Doctors and nurses watching over him.  I think I was able to sleep for 9 hours or so...this is the most I have had since this all started.  My phone was off and i was out for the night.
There are no words to express how hard this has been on us.  If we could just take his place or make it all better for Mark we would....It breaks us to pieces to see him like this.  When I got up this morning and sat with him he was wiggling around. The nurse said he could hear me and he knew I was here by his side.
So my question is...Why did Christmas miss us?  They only day Mark waits all year for, even over his birthday.

Round Two

This afternoon went great.  Mark lasted 40 minutes of treatment with minor issues during treatment.  He was so brave.  At one point he had mentioned how scared he was....let's just say that broke my heart.  He seemed to be really run down after treatment and had many visitors awaiting him when he returned to his room.  

Trying to get in the Christmas mood!

We had to move rooms this afternoon, just next door.  We have been here for how many days???  Only two...  I moved so much stuff, I swear it took 20 minutes.  I know I am  being a bit dramatic, but the move was worth it in the end.  This move was necessary so that he will be able to receive dialysis in his room tomorrow and as needed!
I have to say the best part of Mark's day is when Chris a.k.a. Daddy Lion arrived.  Mark was so happy to see him.  He was quiet chatty with Chris and I tonight.

So maybe the elf hat is a little too small?

We did talk a lot about Santa tonight.  We looked out the window for him and tracked him online too.
Mark enjoyed some pasta and sauce for dinner, with pudding and water.  That was his best meal yet! 

 The cookies are out waiting for Santa to arrive.  All I have to say is thank god for Au Bon Pain, and their baked goods!
Mmmmm.......... Santa will be happy with some yummy cookies and a school milk! 

Finally visions of sugar plums are dancing in his head!

So this is Christmas

Here we are with a new day and lots to do!  It is Christmas Eve, but sure doesn't feel like it.  Maybe when all the friends and family start to arrive our spirits will be up.  On a good note Eddie the Elf (Elf of the shelf) finally found us last night.  He came with gifts...A fancy new pillow pet!!  

  I think at this point I am more into the pillow pet then Mark.  Anyone who knows Mark understands his love for Christmas...He lives and breaths for this holiday.  I like to say he has Christmas in his heart all year long.

Mark after surgery and first dialysis treatment.

We will be heading to round two of Dialysis this afternoon.  Yesterday was not so good.  Although the Doc's say it was a success, it was quite scary.  Mark's blood pressure was very unstable through the first treatment.  We were hoping for a 40 minute treatment, but ended the first session after 25 minutes or so.   I will spare details, but I am okay if we do NOT have another treatment like that today!  

Yesterday my world stopped...

Meet Mark :

  What a joy he is and what a journey he has taken us on!  Today was the one hardest days of my life.  I don't think I ever really slept last night to be honest.  I had all the information replaying in my head all night long.  As I lay by the window missing my husband, watching the snow fall, and listening to Mark's heavy breathing....I just cry.  Feeling so helpless for my baby, needing my husband more then ever and just wanting to be strong but I can't.  I guess that was just a little "me" time!
  It's morning and time to be strong.  We start our day off with a trip right to the operating room.  Mark has some new equipment...IV catheter on the right side of his chest.  Now we are all set up to start Dialysis this afternoon.  The day is here that we have always feared.  His kidneys have failed,  and our lives have changed over night.