According to her neurologist Emily has reached Level IV on the Rancho Los Amigos consciousness scale. At this level she's likely to be very agitated and confused. We saw that clearly throughout the day today. The Physical Therapist warned me that this will be the most difficult phase. Bless her heart - she wasn't there for that first night, or the first 72 hours when we couldn't see much of anything beyond the ICP monitor, or the pneumonia, or the subsequent lung congestion, or that week+ when we weren't sure if the nerve for her right eye would heal. She obviously has a different perspective on "most," but I already love her dearly. She is so knowledgeable and caring and inclusive. It makes this whole ordeal so much more bearable if we actually get to be part of the therapy.

Even more difficult for Ken and me, for the first time since the accident we've seen facial expressions that indicate she's in pain. We think she's having muscle spasms and cramps as a result of the muscle tone and spasticity. There are medications that can relax tone, but they tend to have a sedative effect and since Emily was so significantly affected by sedation in those early weeks, the neurologists have hesitated to give her anything that could act as a sedative. Now that she's in pain, that concerns has to take a back seat.

On the positive side she's doing really well tracking objects and responding to her therapists. The goal for the weekend is to continue her visual tracking exercises, her range-of-motion exercises (which also help with the muscle cramps), and start some tactile stimulation. Hopefully by early next week we can start getting some yes/no responses. Her vent weans continue to go well and hopefully she's on track to be off the vent by the end of next week.

We love you all and can't begin to express our thanks for you love, prayers and support. Please bear with us as we start the vistation part of this process. We know all of you can't wait to see Em and that seeing you will help her. Please just bear with us as we do our best to follow the doctor/therapists instructions for the appropriate level of stimulation.