++computerHackingSkills

There's never a perfect time for anything.  A couple of weeks ago, I was presented with an opportunity to brush up on my software engineering skills.  My company was offering a series of courses online through a university that would result in a C++ certification.  I have been thinking about doing something like this for some time.  The position I am currently in provides me with a little bit of programming practice (mostly in the form of scripting), but almost nothing in terms of actual software design and engineering.  I would like very much to change this, but I feel the effects of skill rot.  Without recent practice, I would not feel very confident representing myself to a hiring manager.

I took a look at the course descriptions.  The first of four courses would be a cake walk, the second one looked interesting, and the third and fourth looked very intriguing.  I have been wanting to get more experience working with the design patterns since college. The earlier courses feature using the STL and Boost libraries, which I would like to be more proficient at. 

So, I requested the challenge exam in order to skip the first course.  There would be no sense in lulling myself into a false sense of an easy course, only to be shocked by the work load later on as I encountered truly new material.  That, and I don't want to spend my precious time learning something I already know.  I have a wife and kids who deserve better.

The challenge test was a three-part assignment that appeared to have been the final exam for the previous year.  I was given a week to complete the assignment, which was about how long it took me (I finished testing it early the evening before it was due), working on it during the evenings after work, and most of Saturday. 

I don't want to commit myself to something that will take more time than I have, especially with Elizabeth working, and she, Shoshana, and Abigail needing me to spend time with them, but as I said before, there is not going to be a perfect time to make this move.  The intensity of Shoshana's treatment will decrease in the coming months, and I am working on the paperwork to officially hire Kristen as a nanny.

Even after just taking the test, I am much more confident in my skills and ability to perform, both in general as a programmer, and specifically using C++.  There were several things I had to look up online, but I knew what to look for.  I haven't gotten the results back, but I would be surprised if I did not pass.

Of course, if things get too crazy, I may need to drop the course or stop early, but even in that case, it will not be a vain effort.

Shoshana: New Blog

And no, I don't mean "new blog post", as some do when they say "new blog".  There's a whole new blog, with its own posts (or at least, future posts), in store for you.

I decided to break out my regular posts about Shoshana's Leukemia into its own blog, so that it would not be interrupted by the other things that normally occupy this blog, assuming a degree of normalcy returns, or some new definition of normal, in which her care does not consume such a majority of my time, energy, and thought.

I may occasionally still post on this blog about Shoshana and her care, and I may occasionally link from here to there, or there to here.  My intent is not to draw a barrier between aspects of my life, but to make them more comprehensible and digestible to those who care to read about them. 

I would also like Elizabeth (and perhaps some others) to contribute posts to the Shoshana: Leukemia blog.

Without further ado, here is the link: Shoshana: Leukemia

As you read, please be praying for us, and especially for her healing.

Shoshana: Intensive Care

The last few weeks have been a roller-coaster.  Shoshana was in the ICU when I last posted.  She has stayed there most of the intervening time, and is there currently.

Shoshana and Daddy

This is due to her respiratory condition.  One of the chemo drugs she was on--vincristine--caused vocal cord nerve damage, resulting in lots of throat pain and also vocal cord paralysis, to the point of preventing her from adequately breathing on her own--especially while asleep.  This morning I learned that Shoshana is the 6th girl on record who has had this kind of reaction to vincristine, and vincristine is an old drug.  Usually this kind of symptom clears up in a matter of weeks.  With Shoshana, it might take months.  I hope it's just months.

Mommy and Abigail with Shoshana

Abigail in the playroom on the cancer floor

Shoshana started her second phase of chemotherapy, 'consolidation', two weeks ago.  Thus far, only observable side effect of the new drugs has been nausea in the past couple of days.  Vincristine was scheduled for her as part of consolidation, but they will not administer it unless and until her current symptoms from it are resolved. 

The doctors kept expecting Shoshana to recover quickly.  She was doing pretty well, only on the BiPAP while sleeping at night or napping during the day--and not on the nasal cannula at all during her breaks.  They transferred her from the ICU to the cancer floor at the beginning of this week, hopeful that she could be discharged on Thursday (today).

Shoshana and Grandma playing with Play-Doh

To determine if she was ready to be at home, they stressed her system by having her sleep without the BiPAP for as long as possible one night (she made it until 5:00 AM, and then proceeded to sleep on the BiPAP for 11 more hours), and then the next night, they did a sleep study where they monitored her in half a dozen different ways while she slept.  She slept for three hours like that, at which point she was doing so poorly that they put her back on the BiPAP.  At 7:00 AM she spiked a fever, and was transferred to the ICU, where again she slept until 4:00 PM.  She was on the BiPAP pretty much constantly for the next day.

Wednesday morning, Elizabeth's mom Kristen called me and said she couldn't fill in for Elizabeth while she went to work for a few hours because she was sick (staying in the hospital with a kid on chemo with no immune system while you are sick is a no-no).  I called in to work, and came up to be with Shoshana.  When I arrived, Elizabeth told me that she, too, was feeling sick.  A few hours later, she called and told me that she had a fever.  She went to bed and basically slept all day, so I've been here at the hospital, and anticipate staying here until at least Sunday night.

Visitors

Shoshana seems to be doing pretty well, considering recent events.  She is on the BiPAP only to sleep.  However, the doctors seem to be coming to terms with the fact that Shoshana's vocal cord damage is not going to clear up any time soon.  They would like to give her a tracheotomy, which would provide immediate and sustainable relief from her difficulty in breathing, and would not cause long-term damage.  (They had before suggested the possibility of removing part of her vocal cords, which would have permanent effects on her voice.)  They are confident that she will heal quickly, and that the risk of infection will be manageable, even while on chemotherapy.  They would wait to perform the operation until her blood counts go back up (they are currently at a low due to where she is in this phase of her chemo).

Painting

She was slated to return to the cancer floor today, but there isn't room ready for her at the moment, so we will spend one more night in the ICU. 

These past few weeks have also been rough on my family.  Abigail has been sick with an ear infection this past week, and thus not able to visit her sister, or be visited by her mommy, daddy or grandma.  Our dear friends Ian and Amanda have been taking care of her.

Elizabeth and I have had some pretty heated arguments, misunderstandings, distrust, and hurt feelings (as well as some burnout).  We are on the mend, and it has resulted in some changes for the better, but needless to say it has been very difficult on both of us, and trust and hurt feelings will take time and consistency to rebuild.

Last Thursday was Elizabeth's birthday.  We had been planning to go out to eat, but Elizabeth suggested that we also go swing dancing.  We did, and we both had a good time.  I definitely need to be getting more exercise (Elizabeth, on the other hand, had better stamina than she was expecting, thanks in part no doubt to joining a rec volleyball league).  I also threw together a surprise party with some of our friends on Sunday, although in order to get her to actually leave the hospital, I had to spoil the surprise.  I tried and tried other angles, but she didn't see any compelling reason to leave Shoshana's side.

Tickles

Please pray:

• That Shoshana would recover quickly from the damage to her vocal cords.  That she would respond well to treatment, and live a full life to the glory of God.
• That each member of our family will be healthy and strong: Shoshana, Elizabeth, me, Kristen.
• For me, that I would be given strength and endurance to do all that I need to do.  It has been difficult to be away from work so much lately.  I have become less dependable, and understandably have not been given many critical assignments as a result.  It can be difficult to stay motivated when you feel like what you've been given to do is not very important.
• That Elizabeth and I, that we would be able to love each other and communicate and work together in love without misunderstanding or falling into unhealthy patterns of thinking.  That this difficult time would drive us closer together, and not be an occasion for destructive friction.
• For Shoshana and Abigail, who miss each other and their parents very much.

Sharing berries

Add-a-cat app

Blowing bubbles: fun and theraputic

Also fun and theraptutic

Proud artist

Shoshana: Respiratory Failure

A lot has happened since I last posted.  Shoshana has been in the hospital for the last two weeks.  Elizabeth has once again stayed with her almost 24/7.  I have been coming up in the evenings, often bringing Abigail so she can see her mommy for a couple of hours before going home with her grandma.  Elizabeth's mom has been taking care of Abigail most of the time, or leaving her with friends and coming to the hospital to help and relieve Elizabeth.

Shoshana has been in and out of the ICU a few times.  The cause of the pain in her throat, which we initially thought was her NG tube, and then thrush, has apparently been a very uncommon side-effect of vincristine, one of the chemo drugs.  Vincristine toxicity has caused her vocal cords to stop functioning properly, as well as be a constant source of pain.  We have had to increase her pain medication dose several times, and added new drugs to help the pain medication to be more effective.

Her vocal cords aren't doing a very good job when she swallows, which means that any liquids she has need to be thickened.

The worst part is that her vocal cords aren't getting out of the way for her to breathe.  They just sit there, closed; in the way.  The night after she was admitted to the hospital, she had to be intubated, which means putting a tube down her throat for her to breathe through.  Her diaphragm was not able to get enough air into her lungs to breathe, so her chest muscles had been helping out (in medical terms, this is known as stridor).  After this had developed over two weeks at home, her body was tired, and she would stop breathing in her sleep.

Shoshana intubated

She was intubated for about 48 hours, after which she was put on CPAP, which is a mask worn over her nose that applies a constant pressure.  The pressure pushes out on her throat, widening the passage between the vocal cords.

This has worked, more or less, ever since, though now she is on a BiPAP, which allows increased pressure while she is inhaling.  She can be off of the BiPAP for an hour or so at mealtimes.  She isn't able to eat much at once, because her swallow muscles wear out.  She has been getting formula (and breastmilk from mommy, and vegetable juices from grandma) through her NG tube.  She has still lost a lot of weight.  The most activity she has been up for is sitting up in bed for a few minutes at a time.  I miss our bike rides.

Meanwhile, she had been getting steroids.  The original idea behind the steroids was that the laryngal dysfunction might be caused or exacerbated by swelling, and therefore anything that would reduce the swelling would help.

No swelling had ever been observed.  In fact, when we first brought her in to the emergency room, they stuck a scope down her throat, and didn't see any swelling.  Elizabeth had been skeptical of the large doses of the steroid ever since she had been intubated:  prednisone wasn't helping (and that reduces swelling), so why would dexamethasone?  Additionally, the dexamethasone was preventing Shoshana from getting a good night's sleep, which was the very thing her exhausted body needed desperately to recover.  Additionally, with such high doses, coming off the drug would cause swelling, since her body would have compensated for its presence.

After discussing this with the doctors, Elizabeth was surprised to see that Shoshana was still getting the high doses of dexamethasone!  She went mamma bear on them.  I'll let her tell that story.  After about a two day standoff, everyone was pretty much back on the same page, and she is being weaned off of the steroids.

I find I've been taking and posting a lot fewer pictures of Shoshana.  I like to capture the happy and hopeful moments; the smiles and giggles.  We didn't get any for a while.  As she has become a bit more stable over the last few days--relatively so, she's still in the ICU--she has been able to play with Abigail when she visits (although Abigail is prone to pulling on lines and anything else she can get a hand on, so we need to keep her out of reach).  She definitely misses Abigail when she hasn't seen her in a while, and asks for her.  She has been able to talk to people about things other than her pain and needs, and play with toys and sticker books in the last few days, which is an improvement over the previous couple of weeks or so.  There haven't been any bike rides, but I'll take what I can get.

My brother Josh's 3rd and 4th grade class wrote letters to Shoshana, and I was able to show them to her.  I also received a video from a friend's three-year-old daughter describing a letter and drawing she was making for Shoshana.  Shoshana really appreciated these things, and she seemed to especially enjoy them because they were from kids.   They brought me to tears, especially the statements of trust in God expressed in the letters from the kids in Josh's class:  the same kind of faith God expects from wise-to-the-world grownups.

Please keep asking the Lord to heal her vocal cords, restoring their function from nerve damage and relieving her of constant pain.  (Luke 18:7)

We definitely enjoy visitors.  Both to see Shoshana, and visitors for Mommy and Daddy to have a taste of normal social interaction and distraction.

We have depended on the meal plan set up by our church, to supply us with two or three dinners a week.  I have been going from work to the hospital, and then home to sleep, and Elizabeth is living in Shoshana's hospital room.  The burden taken off of us by these provided meals has allowed us to focus on Shoshana's needs and care.

Please ask the Lord to supply us and the doctors with wisdom, especially Elizabeth, who is in the front-line position of coordinating all of Shoshana's care over the long haul.  She and I need wisdom especially to know when to defer to the doctors' expertise, and when to put our foot down.  Shoshana is very blessed to have such a capable and knowledgeable nurse at her side and on her side so faithfully.

Still Waters

I just spent about half an hour eating my dinner in the ICU Family Lounge with a pair of men from Djibouti, who poured me a glass of juice and practically dumped encouragement in Christ into my soul.  One of the men I had seen before with his family in the ICU.  His six-year-old son has had a tumor on his head for two years.

It was refreshing to see and hear the peace and joy that we share in Christ gush out in broken English, and it was encouraging to me in ways that I know my soul needed.  Rough times may be ahead for our family, but I know that we belong to the Lord.  We have a heavenly Daddy who cares for us, a Savior and Redeemer who has suffered through worse than this, and knows the full extent of temptation, having endured it all without giving in, and a Spirit who lives in us, and is one with the Father and the Son.  He knows our circumstances and pain, and He will speak His word into our hearts, full of precious promises.

How good is the God we adore!
Our faithful, unchangeable Friend,
Whose love is as great as His power,
And knows neither measure nor end.

'Tis Jesus, the first and the last,
Whose Spirit shall guide us safe home.
We'll praise Him for all that is past,
And trust Him for all that's to come.