Ava's Wish

2010-11-03T05:04:00.000-07:00

Please come out and support Ava and the Lopez family for Fashiontini this coming Thursday, November 4th at Hotel Valencia. Doors open at 6:00pm. $10 at the door with a portion of the evening's proceeds benefiting Ava's Wish. For all you fashionistas, there will be a runway show by Julian Gold. Don't miss Ava's debut on the catwalk. Hope to see you there!

Happy 3rd Birthday Sweet Ava!

2010-09-29T04:57:00.001-07:00

Happy Birthday My Sweet Girl……September 28, 2010

Today is Ava’s 3rd birthday and it gives me chills to be able to say that. The birth of a child is one of the most amazing gifts a person can be given. The rebirth of a child and the feelings that go along with it are almost unspeakable. Time and time again I have mentioned how blessed Manny and I are as parents to have been given a second chance with Ava. The way that our community, family and friends have supported us throughout the past year and a half just goes to show that we all were given a second chance….for this I will be eternally grateful.

Take time to laugh a little longer, hug a little tighter and be thankful for what you have. Let Ava’s recovery story be a sign of hope in your life!

-Traci

Vote for Ava's Wish!!!

2010-09-28T20:19:00.000-07:00

PLEASE VOTE!!!
So many good causes today are in need of good graphic design. And so many designers have a heart for a good cause. Unfortunately, lack of funding often stands between them and the good that they could accomplish together.

Worth Higgins & Associates, Virginia’s largest sheet fed commercial printer, announces Worthwhile: Designers for Good, a competition to bring good design and good causes together for the good of all.

With your support, Ava’s Wish and graphic designer, Diane Hammons, could win this competition. Don’t forget to vote ONCE A DAY!

1. Visit the Worth Higgins & Associates, Inc. Facebook page and click "Like" (first time only)
2. Go to http://www.whaworthwhile.com/
3. Click Vote
4. Scroll down to the heading "Out of disaster, a foundation for kids rises" to vote for Ava's Wish
5. VOTE ONCE A DAY

Thanks for your support!

Ava update - September 2010

2010-09-10T18:23:00.000-07:00

It has been quite some time since I last posted an entry on Ava’s progress. For that, I apologize. It amazes me that the summer is almost over and school is back in session. Ava restarted her vision school in mid August and will continue on at a PPCD (special needs) program when she turns 3 later this month. We spent the summer working on improving Ava’s fine motor skills with occupational therapy three times a week and gross motor skills with gymnastics once a week as directed by her physician. She also continues with vision therapy and mobility and orientation therapy. After meeting with a few specialists a few weeks ago it is being suggested that we put Ava back in physical therapy three times a week as it appears that she is starting to fall even more behind in her gross motor skills. I try to come up with a plan on how that is going to work into the schedule and it seems almost impossible. To think that the majority of time Ava is awake during the day is spent going to therapies is mind boggling. Amazing that the therapies are available, but sad that she has to endure this on a daily basis. As a Mother I feel powerless.

Ava continues to wear her helmet to protect herself from falls. She also wears her glasses which seem to help her eyes to focus. According to her doctor she has a very difficult time seeing anything without her glasses. It is still unknown as to the extent of damage to her vision. It may be quite some time until we have some definitive answers. She has become a cane walker at school and has even asked for it at home a few times. I think she finds some sort of comfort in it. An object I once looked at with fear, I now see as an amazing tool.

I wanted to briefly mention the legal side of this as many people are wondering what has taken place. The trial date was reset once again. It continues to amaze me that the victims in this are the ones that have to continue to suffer. My hope is that one day the person who did this will take responsibility for her actions. As always, I will continue to advocate for my daughter. This will never be forgotten.

A more positive side to this is our formation of a charitable organization called AVA’S WISH, INC. The purpose of the organization will be to provide support services to patients and family members affected by pediatric head trauma and related disorders. I have listed a few of our first events that will be taking place in 2010.

Ava’s Wish has an event that will take place on November 4th at the Valencia Hotel in San Antonio. The event is called Fashiontini. Part of the proceeds raised that evening will be donated back to Ava’s Wish. There will be more details to come. If you can make it out for this wonderful event we would love to see you.

The San Antonio Rock-n-Roll Marathon is quickly approaching. It is scheduled for November 14th. We will have an Ava’s Wish team. If you are interested in joining please contact me at avaswishinc@yahoo.com.

Ava’s Wish, Inc. just became a 501(C)3 nonprofit organization. We are currently working on a website and will notify you when it is up and running.

Thank you all for your continued prayers and kind words…….

MIRACLES DO HAPPEN

Thank you

2010-04-26T18:22:00.000-07:00

Thanks to everyone who attended the "All for Ava" service. It was a magical day! Our dear friend/photographer, Lilianna Story, has the gift of capturing children's raw emotions. How she manages to get the most perfect photos with three children in the shot, I'll never know.

Enjoy this breathtaking slideshow of the Lopez children:

www.liliannastoryslideshow.com/lopezchildren2010

Fiesta Week - Please Drink Responsibly!!!

2010-04-20T18:21:00.000-07:00

Fiesta week has kicked off here in San Antonio, which means there will be more partying and celebrating than usual. Enjoy this fun San Antonio tradition with your friends and families, but remember to drink responsibly and DON’T get behind the wheel if you’ve been drinking. Let’s keep our families safe!

"All for Ava" service - April 23, 2010

2010-04-15T18:20:00.000-07:00

On Friday, April 23rd there will be an “All for Ava” service held at the Crosstimber (Rogers Ranch) clubhouse. As a reminder, this is where we held the rally for Ava last year. It is our way to come together as a community and celebrate Ava’s continued recovery. All are welcome to attend. It will start at 6:00 p.m. and will most likely last 30-45 minutes.

Please wear pink!

Thank you for your continued prayers and support.

The Lopez Family

Reflecting on April 23rd....

2010-04-11T18:18:00.000-07:00

April 23rd is quickly approaching. To many, this date may seem insignificant but to our family it was the day our lives changed forever. It amazes me to think that an entire family's life can be changed in the blink of an eye but it happens. Many people have asked how I am going to spend that day and I really don’t have a response. While I view it as a very tragic day, I can’t help but to focus on the positive side to this story. The outpouring of love and compassion from family, friends, neighbors, people all over the world that I have never even met. It brings a smile to my face to know that my daughter has brought so many people together in such a positive way. Days after the accident my neighborhood was full of pink ribbons. All over houses, cars, trees…..wherever there was a place to tie a ribbon, one was found. The pink ribbons then started to travel beyond our neighborhood to schools, day care centers, churches, other states and even out of the country. Unity! What seems like such a small thing signifies so much more.

Getting back to the April 23rd question, it is my wish to see as many pink ribbons as I did in the days that followed the accident. I am not asking that they stay up for a long period of time. I am simply asking to make April 23rd an “All for Ava” day. It will serve as a reminder of the senselessness of the act that put us here but more importantly it will remind us of the unity of those near and far that have given our family the strength to live day to day.
Thank you ALL for your continued prayers and support!

Manny, Traci, Jack, Isabella and AVA

Ava Update - February 2010

2010-02-15T18:15:00.000-08:00

Several people have asked for an update on Ava and I apologize that it has taken me a while to do so. Besides the fact that it has been a busy couple of weeks, it has been emotionally draining as well. Sometimes I think when I am having a difficult time it is just better that I not write. To others, writing is therapeutic and I am hoping today’s outcome is just that because for some reason I can’t seem to get out of this funk!

Ava started her vision school almost two weeks ago and is adjusting beautifully. To say that she is a super star is an understatement. The class provides her with a security that she will need to get her thru the next stages of her recovery. There are 5 children in the class, three legally blind and two with severe visual impairment. Our hope is to learn how “severe” Ava’s impairment is so that we can develop a plan that best fits her needs. While our hope was to be able to mainstream her next year, it looks like Ava will spend time in a PPCD program or another way of explaining it a “special needs” classroom. A family that we never thought we would be a part of but we are truly blessed.

As mentioned in a previous post, Ava started wearing glasses a few weeks ago on a full time basis. We were told that the glasses will hopefully correct the eye crossing the she is experiencing. If it does not then she will require surgery. Something we may not know for a while.

Within the next few weeks Ava will begin what is called “Orientation and Mobility” therapy. In addition to Ava’s left visual field cut and limited vision in her right eye, there is now concern that she may have a lower visual field cut as well. For those of you around her frequently you may notice that when she walks she looks straight ahead. Because of this she often runs into or over things. With the new therapy they will be able to work with Ava in training her to be aware of her surroundings. One way of doing this is with the use of a cane. The hope is that Ava will not need to use this on a continual basis but the possibility exists. I also just learned that long term there may be a possibility that Ava may never read due to the disorganization in her brain. I was then told that the teacher may start to introduce Braille. Another kick in the gut. My eyes started to tear as I listened once again to the aftermath of a careless woman out of control.
Ava saw the neurologist a few weeks ago. While he is optimistic that her stability will continue to improve he is concerned that she is at risk of injuring herself. She is now wearing a helmet to protect her head and will continue to do so until he sees enough improvement to say that it is safe to take it off.

AS for the legal side of this that unfortunately exists….the trial date was reset by the defense attorney. We have been told that we may not have a new date for several months. It truly amazes me that this is the way the legal system works. Fortunately all the time in the world can pass by but this will never be forgotten or forgiven. I maintain my confidence in our legal system and am hopeful that this case is prosecuted to the fullest extent of the law. It would be a shame to send the message that it is okay to drive while intoxicated, plow down a family and flee the scene of an accident. Not only has our family suffered because of this but people, young and old, all over the country have also been affected. Thank you to all those people that have written letters to District Attorney Susan Reed. I ask that you send another letter and this time in addition to sending the letter to Susan Reed also send a copy of the letter to State Senator Jeff Wentworth and State Senator Leticia Van de Putte. The contact information is listed below.

The Honorable Jeff Wentworth
925 N Frost Center
1250 N.E. Loop 410
San Antonio, TX 78209

OR

P.O. Box 12068
Capitol State
Austin, TX 78711

Leticia Van de Putte
Texas Senate District 26
700 N St. Mary’s Street, Suite 1725 A
San Antonio, TX 78205

OR

P.O. Box 12068
Austin, TX 78711

District Attorney Susan Reed’s fax number is
(210) 335-2884

Sorry if this sounds a little redundant….. it is just that when Ava continues to fight for what was taken from her on a daily basis, I feel the one thing I can do is to continue to be her advocate. Continue to be an advocate for all of my children, friends and family that believe this person needs to take responsibility for her actions. We live day to day knowing that this woman is still living right up the street, able to come and go as she pleases. It is gut wrenching when I run into her at Target and she stares at me blankly. And then to have my four year old daughter say is that the lady that hit us and Mommy why isn’t she in jail?...I have no words for her just pain and all I can do is hug her!

Thank you all for your continued prayers and support. Traci

Spin to Joy

2010-01-17T18:13:00.000-08:00

At the early age of two, Ava has already taught us so much about life. She’s taught us to never take the gift of life for granted and to never give up when faced with adversity. Since the accident, Ava has had to endure countless hours of therapy to relearn the simple acts of swallowing, sitting up, seeing, walking, and talking. She continues to be challenged with her vision impairment, but through it all Ava never shows signs of defeat. There are countless children just like Ava who are struggling with deficits every day. “Ava’s Wish” Foundation has been created to support children and families facing pediatric head trauma and disorders.

Another organization that is doing amazing things for children is the Ironman for Kids Foundation. They purchase and donate special needs bikes to children that physically cannot or do not have the ability to ride a bike. Much like Ava’s KidWalk, this equipment is highly specialized to the individual and very expensive. When Ava was learning to walk again, the KidWalk was so instrumental in getting her to where she is today. These bikes will allow many children to experience a simple joy in life that so many of us take for granted. The “Ironman for Kids” foundation will be holding their annual “Spin-to-Joy Spinathon” to raise money for this great cause and we’re asking for your support. The Lopez’ dear friend and cycling guru, Didi Kolkebeck, is forming “Team All for Ava” to raise awareness and show support for this fellow foundation. The goal would be to fill all 40 stationary bikes with “Team All for Ava” during the 9:00 – 10:00am time slot. Please see below for all the details:

What: “Spin to Joy” Spin-a-thon
Where: Tri-Point YMCA (281 S. & St. Marys St.)
When: Saturday, January 30, 2010
Time: 9:00am – 6:00pm (Didi is teaching the 9-10am slot)
Who: Open to All
How much: $20 donation – gets you a t-shirt and chance for more prizes
*** Getting sponsorships and/or increasing your donation would be greatly appreciated!
Register: Go to www.ironmanforkids.com
Click on “Spin to Joy” tab
Click on “Register Today” link
Click on “Register Now” box & begin your registration
Team: Indicate “Yes” when asked if you’re with a group & type in “Team All For Ava” in the Group box

Thank you in advance for your support! You’ll be helping some beautiful kids with special needs to experience the joy & excitement we can relish anytime: riding a bike.

Happy 2010!

2010-01-11T18:12:00.000-08:00

Happy 2010……

I wanted to send a quick update on Ava’s progress. She had an ICP placed on December 30th and then monitored in the ICU for 24 hours. The doctors were able to remove the monitor on the 31st and we were able to ring in the new year with good news that Ava’s pressure in her brain was not elevated. The good news, actually the great news is that she will not require a shunt. The not so good news Is the fact that we still have no answer as to why she has an acute 6th nerve palsy. For the time being I am okay with the not knowing. Ava continues to exceed all of our expectations and she does so gracefully!

Ava continues to receive physical therapy three times a week, speech therapy twice a week and occupational therapy four times a week. Our plan was to try and put her in a school environment to help facilitate her socialization skills and independence….to give her the chance to do what most two years olds should be doing and that is enjoying the simple things in life. A week before Christmas I had a vision therapist approach me with the idea of Ava attending a VI school. Basically a school that specializes in children with severe visual impairment/blindness. I had to fight back tears as I had to be reminded once again of the carelessness that caused this visual impairment in my daughter. I was able to visit the school last week and was overly impressed with the teacher, her qualifications and her drive to help these children. Although a little hesitant with the idea at first, we have decided to start Ava in the class within the next few weeks. I am certain they will be able to foster her continued development.

As promised I wanted to give you all an update on the court case. I was notified Friday that it has been reset to February 1, 2010. Many people have offered to show their support and we are truly appreciative of that. I will continue to keep you all updated as the case evolves. People are welcome to attend the first hearing however I wanted to let people know that there is a chance that it may be reset a second time. Also, I feel that the time for people to attend should be after jury selection. This way the court is able to accomplish what they need to in a timely mannerJ It may take several days, months or even years to prosecute BUT please know that I will be my daughter’s advocate forever. Time will not change that fact. Time will also not change the fact that our family will continue to need the support of each and every last one of you so that this case is prosecuted to the fullest extent of the law. Someone said to me just last night and I have heard this over and over again…. there are consequences for peoples actions……this case is the perfect example!

Thank you all for your continued prayers and support!

Please send your letters to District Attorney Susan Reed:
300 Dolorosa
Suite 5072
San Antonio, TX 78205

Reference case numbers: 2009CR994 and 2009CR993

Love,

The Lopez Family

Ava Walks and Walks and Walks...

2009-12-13T17:46:00.000-08:00

AVA WALKS AND WALKS AND WALKS………..

Over the past few weeks Ava has made great strides….literally! After Thanksgiving break we noticed an increase in the amount of steps Ava was taking and she is now to the point where I can officially say AVA IS WALKING. Several people have seen her and asked why I never put an update on caring bridge. My response to this was that I needed to wait until she was walking without falling every other step. Once again, Ava has beaten the odds. While it is an amazing thing that she is walking we still don’t know how much she is able to see. We are also unsure as to how much damage was done that is contributing to her lack of balance and coordination. At times she will walk into objects and at other times it appears as if she is just aimlessly walking around and not really focusing on anything. She continues to receive physical therapy three times a week, occupational therapy four times a week, vision therapy once a week and speech therapy twice a week.

As promised I wanted to give everyone an update on Ava’s appointment with the Neurosurgeon. A few weeks ago I mentioned that Ava now has a sixth nerve palsy in her right eye which was diagnosed by her opthamologist. Usually this is caused from increased intracranial pressure in the brain. After much discussion, the Opthamologist and Neurosurgeon have decided that on December 14th Ava will be re-evaluated. If she still has the 6th nerve palsy she will need to have an intracranial pressure monitor placed in her head and receive monitoring in the ICU for one to two days. If the pressure is increased she will require a shunt. Something that she will have long term. She is also going in for an MRI of her spine. She has complaints of pain in her lower back and we need to rule out a few things. I am not a doctor so I don’t even want to attempt to explain all of this. I am asking all of you to please say an extra prayer for her this weekend. While she is a strong little girl she doesn’t deserve any of this.

With that said, I am asking that all of you PLEASE send a letter to District Attorney Susan Reed asking her that this case be prosecuted to the fullest extent of the law. Our first trial date is set for January 19th. I will follow up with details. It is an open trial so if you are able to come and show your support for Ava our family would truly appreciate it. The address for Susan Reed is: 300 Dolorosa, Suite 5072, San Antonio, Texas 78205. Please address the letter to the attention of District Attorney Susan Reed. Email is not sufficient, we need written letters. Thank you all in advance. I would hate to see this happen to another innocent child or family.
Until next time….stay safe!

Love,
Traci

Thanksgiving

2009-11-26T17:45:00.000-08:00

THANKSGIVING
Thanksgiving, in my mind, is a time to reflect on what we have to be thankful for. Growing up my brother always said that Thanksgiving was/is his favorite holiday. His reasons valid- to have time to spend with those you care about, no concerns about gift giving or receiving, a time to reflect on what matters most in life. It wasn’t until this year that I really have gained an appreciation for his feelings.
This past April my life changed forever. There are many days that my heart aches but just as many days if not more that I hear myself say ‘Wow, I have so much to be thankful for’. I want to take this special time of year to say THANK YOU. To all of my family – for your heartfelt dedication over the past 7 months, for listening to me when I just needed to cry, for being my strength when I felt I had none. Please know that although I may not say it often enough I love you all very much and am wishing you all that Happiest of Thanksgivings.
To my dear friends, thank you for your unconditional love and support. I think of you all as my family. You have been my pillars of strength during one of the most difficult, if not most difficult time of my life. You have made my family your own and for that I am eternally grateful. I hope to be the same kind of friend to each and every one of you.
To the city of San Antonio and those people around the world who have been praying for our family, especially Ava….thank you. I really do believe that all of the prayers have allowed our family to find strength during such a horrific time.
To all of the staff at University Hospital, Christus Santa Rosa and Rehab Associates…..thank you for saving my little girls life. Without your expertise I am certain we would not be where we are today. You all have a special place in my heart.
To Ava’s special friend Rosie….thank you for the countless hours of play therapy/OT you have done with Ava. Thank you for helping to give Ava some sense of “normalcy” to her life. There is a reason she lights up when she sees you because she realizes what an amazing person you are.
To Lilianna, for your beautiful pictures that have helped capture every moment of Ava’s recovery. Thank you for sharing your amazing gift with our family.
To my husband and children……THANK YOU FOR BEING SURVIVORS! I love you all more than words can describe.
With the last part said, I wanted to give a quick update on Ava’s recovery. A few weeks ago Ava had to go in for another cat scan. Unfortunately we were told that she has a new bleed in her head. We have also learned that she has a 6th nerve palsy in her right eye. A few nights ago she went in for more testing…MRI/MRA/MRV. The good news is that the MRV and MRA appear normal. The MRI confirmed the new bleed and also showed a mass effect. This basically means there is some pressure/swelling on her brain that needs to be evaluated. Ava will see a neurosurgeon early next week. Please say an extra prayer that all goes well. I will keep you posted.
HAPPY THANKSGIVING!
May you take this time to reflect on what you are thankful for. Don’t let time pass you by!
Love,
Traci

All for Ava Party Pictures

2009-11-09T18:29:00.000-08:00

Enjoy these beautiful slideshows of Ava, her family, friends and countless supporters at the All for Ava Party! It was an amazing day!

http://www.liliannastoryslideshow.com/avabirthdaygirl/

http://www.liliannastoryslideshow.com/ava%27sbirthdaycelebration/

Coming out of the fog

2009-10-26T13:31:00.000-07:00

Over the past 5 1/2 months I have felt like I have been living my life in a fog. Saturday, October 17th,the fog lifted for the first time and the sun shined brightly. It was the first time in 5 ½ months that I have seen a constant smile on my children’s faces. Saturday was a celebration of the ongoing recovery of our entire family and we were so happy to have all of you to share this special day with. Ava received so many special gifts and cards and I wanted to take this time to thank everyone for their thoughtfulness.

There were several people that were instrumental in making Saturday a success. Please know that I love each and every one of you and I will never forget the efforts you all put into making this day so special. Thank you to all of our family members and friends (far and near) that were able to come to the party. For those of you that were unable to attend, thank you for your continued love and support. It is with ALL of your help that we are able to keep fighting. Believe me there are certainly days that are more difficult than others.

As I have mentioned in the past, we are in the process of forming a charitable organization for pediatric head trauma and disorders. We feel we have been so blessed with the support we have received throughout this entire process. By forming the organization we hope to be able to provide for others in the future. The name of the organization is “Ava’s Wish”. I will continue to keep you updated on the progress of the organization.

The San Antonio Rock-n-Roll marathon is just around the corner. It will be held November 15th. We have been forming an “All for Ava” team which is so exciting. I will be placing an order for shirts within the next few days. The shirts will be a dri-mesh material. I anticipate the cost to be between $20.00 - $25.00. They will be pink for the women and gray for the men. If you are interested in purchasing one, please send an email with your name, phone number and size to lopeztraci@yahoo.com. I look forward to seeing everyone at the raceJ

Lopez Journal

2009-10-11T10:41:00.000-07:00

Even if you can’t make it to the All for Ava party on Saturday, October 17th, you can still be a part of this memorable day. We will be compiling a journal for the Lopez family, which will include all of your heartfelt notes, thoughts and prayers. For those of you who are out of town or unable to make it, please send your notes to Kerri Thompson @ kerrithompsonaz@hotmail.com with a subject: Lopez Journal. We will have a table set up at the party for guests to write in the journal, as well. This journal will provide strength and comfort to the Lopez family as they continue to heal and recover. Thanks for your continued love and support.

Happy Birthday My Sweet Miracle!

2009-09-28T04:21:00.000-07:00

SEPTEMBER 28, 2009

Today is such a special day…..today is Ava’s 2nd birthday. After being told the late hours of April 23rd that there was a strong possibility that Ava would not make it I have to say that today is monumental. Birthdays come and go yet today I don’t want the celebration to end. I feel like Ava has been given a second chance at life and we as parents have been given a second chance to love this little girl with every inch of air we breathe. Today I don’t want to think about the negative that surrounds this situation. I want to focus on the lasting impression Ava has made on so many people’s lives. I want to focus on the fact that I have three beautiful children, an amazing husband and wonderful family and friends. I want to embrace today with everything I have because I can.

HAPPY BIRTHDAY MY SWEET MIRACLE!

Ava's progress and party details

2009-09-08T13:44:00.000-07:00

With summer coming to an end and the start of another school year I thought I would give an update on the progress Ava has made. It has been a little over four months since the accident occurred. If anyone were to have told me that Ava would be functioning at the level she is today I would have never believed them. Ava continues to receive PT and OT 5 days a week. She had been receiving speech therapy at an outpatient facility but will soon start to receive speech therapy at home. Vision therapy will be starting this week. Over the past few weeks Ava has mastered crawling. She is also pulling herself to a standing position in her crib and often will try to stand if someone is there to hold her hands. While she is still not walking and will most likely not for quite some time her desire to do so remains strong. I see it on a daily basis thru her frustration, anger and tears. As a parent this breaks me apart. If there was some way that I could walk for her I would . I see a now 22 month old that doesn’t quite understand why it is that she can no longer walk and why she has difficulty seeing to do it. She is certainly not old enough to understand although I’m not sure that an older child would really understand the severity of what has happened either. All that we can do at this point is remain positive for Ava and believe that just as everything else has come back so to will be her ability to walk. Ava is now wearing an AFO which is a brace on her leg that helps with some of the overextension problems (causing accumulation of fluid around the knee) she is having . She has had improvement with her left sided weakness but it still remains as does her facial weakness. She continues to wear a patch on her left eye to help correct the vision in her right eye. We saw the opthamologist a week ago and she said that Ava’s vision continues to improve. We have been able to decrease the length she wears the patch from 4 hours a day to 3. The doctor also said that her right visual field continues to improve and that her left visual field (which had been completely out since the accident) is starting to show signs of improvement. People ask me every day if Ava will ever see like she did prior to April 23rd and I answer by saying that I don’t know and unfortunately we may not have the answer to this question for quite some time. It is obvious that she has a deficit but she continues to fight for her vision just as she has with every other part of her body. Did I mention how amazing I think she is?????Ava continues to use the kid walk on a daily basis. Jack and Isa have been instrumental in her “walking therapy.” They use ice cream as an incentive to get her to walk. They like it, she likes it, everyone is happy.

On a lighter note, Manny and I have decided to run in the San Antonio Rock and Roll marathon/ ½ marathon on November 15th. We are forming an “All for Ava” team if anyone is interested. We have already had several people tell us that they would love to join us. We plan to wear “All for Ava” shirts in her honor. We are also in the process of forming a charitable organization in her name and will send you the details as soon as they are available. Lastly, our family would like to thank you all for your continued prayers and support. We feel like you all have such an important place in our lives…..to help guide the recovery of our daughter. Words will never be able to describe how much that means to us. Thank you for your strength…..we could not be where we are today without each and every one of you.

Love,
Traci

Please join us in celebrating Ava’s recovery: October 17, 2009
Rogers Ranch/Crosstimber Community Center
3:00 p.m.- 7:00 p.m.
WEAR PINKJ
More details to come

Pictures to last a lifetime

2009-09-05T13:53:00.000-07:00

Lilianna Story did an amazing job capturing the love between the Lopez children. Hope you enjoy this heartwarming slideshow. It is breathtaking! Ava, we're so happy to see that vibrant smile again. We love you!

www.liliannastoryslideshow.com/lopezchildren

Meal Calendar has been reopened

2009-07-20T09:51:00.000-07:00

We have opened up the meal calendar until the end of August due to overwhelming requests. If you're interested in signing up, please use the following link and log on credentials:

www.carecalendar.org

Calendar ID: 15804
Security Code: 9927

Thanks for everyone's continued support!

Baby Steps for Ava

2009-07-20T09:36:00.000-07:00

Update on Ava’s recovery…….

We wanted to again thank you all for your continued thoughts and prayers for our family, especially Ava. Ava remains in therapy 5 days a week. She is in physical therapy 5 days a week, occupational therapy 5 days a week, speech therapy twice a week and visual therapy. She seems to be making improvements on a daily basis. To us that see her every day they seem like baby steps but to those who see her maybe once a week it seems like she is making great strides. The bottom line is she continues to improve and that is the most important thing. Her speech is still slurred at times but her vocabulary is back to where it was pre-accident. We have to prompt her most of the time to say specific words but she does repeat them. She will say Mama, Dada, Jack, Isa, Grandma and Callie without any prompting which is music to our ears! She is starting to sit by herself for longer periods of time and is able to transition from lying to sitting pretty effectively. She is also starting to crawl….more of a military crawl but we’ll take that for now.

We finally received the kid walk last week. We had been using the demo at Christus Santa Rosa for the past several weeks. It is not always Ava’s favorite thing however it seems like the time she spends in the kid walk(her tolerance level) increases with each time she is placed in it. She is able to take small steps using the kid walk and I am certain that this will be instrumental in helping her to regain the skills necessary to begin walking again. Ava’s vision is still impaired and we aren’t certain to what degree. We do know that she has a left visual field cut and that she is able to see in her right visual field. Her doctor said that the amount that she is seeing in her right visual field is improving. The last time we visited the eye doctor she noticed that Ava’s right eye has the tendency to deviate to the outside. Most likely due to the fact that her vision is better in her left eye which causes her to ignore her right eye. We are currently patching her left eye up to 4 hours a day. The goal is to make the right eye work more and hopefully the vision can be restored. It is amazing how complicated vision is….sorry that I am not able to break it down like Fred does so beautifully.

Ava continues to fight the fight! She gets easily frustrated but to some degree I think this is what keeps her going. She wants to be running and playing with all the kids just as much as we all want it. Someday soon I am hopeful that she gets exactly what she wants! Until that day (and always) we will be here to love and support her! Thank you all for the kindness you have given to Ava and our family over the past three months. We are in a better place because of each and every one of you!

Love,
Traci

We will not forget

2009-07-13T22:56:00.000-07:00

I was on-call this weekend at Brooke Army Medical Center covering the Radiology Department. A woman bicyclist had been brought in to the ER after being hit by a car. She was in her late 30’s… an athlete, you could say… good physical condition prior to being hit… but this was no minor “accident.” The severity of her injuries were such that she could have easily died before making it to the operating room to have her internal injuries repaired. I have thought of her often since seeing her lay helplessly in the CT scanner… alone.

Early the next morning (Sunday) I went down to the cafeteria to get something to eat. The cafeteria was essentially empty with the exception of a few lone hospital workers eating some breakfast. In one quick glance you could guess the total number in the dining area as less than 10, but there was a cluster sitting at one of the tables. A group of adults sitting at a table talking…eating breakfast… but not really eating. Clearly, they were civilians by their attire. Family members of someone who was now a patient at the hospital… I presumed. It was early in the morning, but this group had not just awakened. These were vigil watchers. While I do not know who they were there worrying about… praying for… crying for… I imagined that they were the family members of the bicyclist that I had seen come in the evening before. I imagined them receiving the call…”your loved one was just hit by a car… You need to get here immediately… They may not survive.”

Your heart sinks as you think of receiving the call. Your stomach feels empty and sick. “I wish that I could vomit… if it would only help with the void and helplessness that I now feel.” As I walked by them I was quickly reminded of the first hours/days/weeks that were spent in the hospital with the extended Lopez/Southerington family… Ava’s Army. I remember that pain very well.

This story is not too dissimilar from Ava. One person with the promise of a lifetime… doing the right things… taking care of themselves… and in a fraction of an instant… it all changes.

But this story reminds me of something else… as I walk by this family my mind plays a trick on me… it makes me feel like I am back at University Hospital that night… I am again peering through the back of an ambulance watching my friend tremble as he tries to breathe life into his daughter… I see Traci sitting on the curb with blood smeared across her leg and arm… my stomach feels weak for a moment at the thought of it. The psychology of it all is curious. Why are we this way? Is our mind trying to protect us by not letting us forget how these things felt? Is it trying to make sure that we steer clear of the “danger?” Perhaps.

Interesting… and I am a guy… a typical guy… not overly sensitive… analytical… “rational.” I am even somewhat removed from it all. It wasn’t even my child. I didn’t even witness the event. Yet, I am affected by it, nonetheless. My thoughts take me to others… women… who tend to be more compassionate and empathetic than us insensate men.

I think about Jennifer, who witnessed the Lopez family being run-down in their yard… I know that she has not forgotten how that felt.

I think about the Lopez/Southerington families… I know that they have not forgotten how they felt.

I think about Manny… I KNOW that he has NOT forgotten how he felt.

I think about Traci… I KNOW THAT SHE HAS NOT FORGOTTEN HOW SHE FELT…
Nor will she… anytime soon.

The “void/emptiness/sickness” that you feel in your gut when something like this happens is called a “visceral reaction.” Your mind makes your body feel it. Traci’s mom nearly falling as she saw her daughter for the first time following being hit, is a “visceral reaction.” I got sick once after eating at Chili’s restaurant when I was going through chemotherapy. I have not eaten there since and still feel a twinge of queasiness whenever I drive by it. I see soldiers everyday whom have been burned and busted by the atrocities of war. What psychological demons they must face in their sleep every night.

PTSD (Post-Traumatic Stress Disorder) is a term that we are all quite familiar with, but many do not know that it is a spectrum of disease… mild to severe. It is not limited to soldiers at war and can occur after any “stressful” event. Our bodies heal long before the brain forgets. We must remember that psychological wounds hurt too. They can be hard to see… and they can take very long to heal.

Similarly, the Lopez family continues to heal from physical wounds at an exceptional rate. It has been less than three months since Ava was nearly killed (23Apr09). Her physical recovery has been meteoric to this point, but the wound to the Lopez family from the psychological trauma was deep… and it will take much longer to heal.

There was an encounter a few days ago…

The message was an uncompassionate… “get over it.” (in summary).
For those who share such sentiment I want to remind them that no one is making you participate in any way. The people who are participating in this community event do so out of the goodness in their heart… and they will be repaid in kind in the future… maybe not by this group… maybe not in this life… but one day they will need help… and they will receive it from the goodness of others… because they have been recognized as “being good.”

When Ava, Isa, and Traci were “injured,” those of us who care about them committed ourselves to them for the duration of their healing…

“For the duration of their healing.” What does this mean? When the bandages come off my responsibility is done? No.

Healing comes in many forms… physical and psychological. They are our friends. We have committed ourselves to them. We have committed to support them until they are whole again… in every way.

While Ava’s physical condition has improved dramatically, she is not yet whole… and neither is the Lopez family. And even when Ava is walking and running again, the psychological wound will remain… and so will their friends.

Just as I would not enter the bicyclist’s hospital room tomorrow and tell her to “get over” her extensive physical wounds, we cannot expect psychological wounds to heal just because we think that they should have healed by now. They will heal when they heal… and not any sooner than that.

Do not be angry and petty that this family has received so much attention and support. Be happy that their remains such goodness in this difficult world. Extend yourself to those who need it… It will pay dividends later… in this life… or the next.

Ava, the party waits for you.
fw.

Sign of Hope

2009-07-11T11:15:00.000-07:00

Over the past few months a transformation has been taking place……the transformation of our side yard where the accident happened on the evening of April 23rd. There have been several neighbors/ friends in the Rogers Ranch community as well as friends/neighbors outside the community that have demonstrated the true meaning of “Community Support”. While this is something we never expected we truly appreciate all the effort that has gone into this special project. Instead of looking at our side yard as a place where lives were changed, dreams shattered and innocence lost I am hopeful to be able to look at it as a sign of hope. Hope that Ava makes a full recovery, hope that our family can continue to heal and grow together as one unit and hope that there will be a positive message to come from this horrific incident. We are very fortunate to have the support that has been offered since April 23rd.
To all of Ava’s angel’s….thank you again for exceeding our expectations.

Love,
The Lopez Family

Ava is the victim!

2009-07-09T18:18:00.001-07:00

This is an extremely powerful and must read letter from Traci...

I had a difficult time sleeping last night and I wanted to share the reason why. Someone recently told me that a neighbor of the person that hit Ava, Isa and I feels as if she (the woman who hit us) is the victim in all of this. I have thought about this statement over and over and just can’t seem to get it out of my mind. I’m not quite sure how to react to this statement except to invite this neighbor to my house and introduce him/her to Ava….the 18 month old innocent child that was plowed down by his/her extremely impaired neighbor. I would like to show him my child that is unable to walk, crawl, stand, sit for any length of time without getting agitated or let alone see to help facilitate all of the above. My daughter who prior to April 23rd was all smiles and now becomes extremely frustrated and angry multiple times throughout the day because she has had a major brain injury and can’t understand why she is unable to do the things I just listed above. I would like this family to spend just one day with my daughter going to therapy, going to doctor’s visits, feeding her and reminding Ava that she needs to chew and swallow when she eats her meals, holding her because she is scared to be left alone. Then at the end of the night I would like them to explain to my 6 year old son why it is okay for this to have happened? Why the person that hit us is the victim? I talked to my son Jack last night regarding the accident….one of several conversations we have had since the accident. I told him that Ava used the kid walk in therapy today and that she did really well. She was able to bounce a ball back and forth with me while putting pressure thru her legs. I said Jack, isn’t that great’? His response was “Mommy I want Ava to be able to bounce the ball with me without that walker thing, like she used to”. To the neighbors that feel as if the woman that hit us is the victim, I ask you to put yourself in our position. I also want to know if you truly believe it is appropriate to pass along the message to our children that it is okay to drive while impaired? Fortunately for you this is not your child. You are not living the hell that I am.

To all of Ava’s angels…..I hope you understand that this needed to be addressed. I thank each of you for YOUR continued prayers and support.

Touched from afar

2009-06-30T20:04:00.000-07:00

Sunday I was at the Rogers Ranch community pool with the kids. I was tucked away under the shelter of the pavilion trying to hide myself from the searing solar rays that we have had lately. From the shade I was watching the kids and few other families that were at the pool that day. Traci, her mom (Karen) and the three kids (Jack, Isa, and Ava) were at the pool with her. They were in the shallow end, at the steps that enter the pool. They had been there for what seemed like a rather long time just cooling themselves in the water.

A woman that had also been at the pool with her daughters got up from her seat and went over to Traci to introduce herself and let Traci know that she and her family had been thinking of the Lopez family and praying for them all. She was very respectful and clearly did not want to intrude on their family time and tried to separate herself from the conversation rather quickly, so as to not offend Traci. But the conversation continued for a short while.

Just after their conversation she came over to me and introduced herself, “Hi, I am Kim.” After exchanging our introductions our conversation quickly changed to something that we had in common… Ava.

Kim and her family had not had the priviledge that I have had of seeing Ava’s recovery in a more personal light and from so near. It is almost something that you take for granted… being so close… seeing her so often… seeing the small gains that she makes… seeing and becoming accustomed to the physical deficits that remain. It is so easy to forget how many people continue to follow from afar. It is so easy to forget how many people are emotionally invested in Ava’s recovery but do not have the luxury of getting to spend time with her or them… either because they lack the finances or time to be able to travel here eventhough they feel emotionally close enough… or because they are here but do not feel emotionally close enough to the family to “intrude,” so they watch from afar.

Traci’s family, Manny’s family, Larry, the Millers, the Lawrences, the Meiers, and countless others are examples of the former case.

Kim is an example of the later case. Someone that is here locally and who’s family is emotionally invested in the story of Ava, but they lack the familiarity with the Lopez family to openly address them under nearly any circumstance. So the relationship stays as it is… distant… watching from afar.

Kim and I, and later Traci and I, discussed that herein lies the problem. The relationship stays distant because we are unwilling to breach the distance that separates us. Don’t get me wrong. Not for a minute do I think that the gap continues out of rudeness on anyone’s part. As a matter of fact, it is quite the opposite. It is the politeness of others that prevents the gap from being bridged.

It is similar to hearing of a neighbor who loses a loved one, is diagnosed with cancer or other serious illness, or some other tragedy that has fallen upon them. It seems to me that when people experience such adversity is when they are the loneliest and need the most interaction with others. Yet we avoid them. We are so fearful of offending their tender emotions that we avoid the discussion entirely… not knowing what to say. All the while they just want to talk to someone about it.

It is amazing to me how easy it is to be therapeutic to yourself and someone else by just caring enough to let them know that you are there and that you want to talk to them.

Kim was so kind and apologetic for “intruding,” but little does she know that it is that very conversation that may have provided just the lift that Traci needed that day.

Traci and I spoke of it later and agreed that the self introduction on Kim’s part was not seen as rudeness, but rather as kindness. And further interactions of this sort will only serve to make our communities more friendly and secure.

As Kim and I discussed the issue further we mentioned that a relationship must start somewhere. On Sunday her relationship with Traci and the Lopez family began. For all we know they will continue to be dear friends 40 years from now, and it all began with one woman having courage enough to breach the emotional divide at the Rogers Ranch pool, and one woman being receptive to it. This is again one of the lessons that Ava’s story can teach us.

A recurrent theme has been our emotional availability and interconnectedness with others. We just have to open our eyes to it and be there emotionally to let it happen. Sometimes we’ll initiate it… sometimes we’ll receive it… but both have to be there for it to happen. Make yourself available to others and make this a better place.

Ava, the party waits for you.

fw

From the Lopez family to YOU - Thank You!

2009-06-27T05:56:00.000-07:00

I am writing tonight to express my gratitude towards two very important people. I was picking up my daughter and her friend from an event in our neighborhood and a person approached me. The one and only other time I met face to face with this person was the night that he held my daughters head and neck so that she was able to breathe as adequately as possible after having been plowed down by a drunk driver in my neighborhood. There were two people that arrived immediately to the scene, one being a very amazing woman named Jennifer and another named Scott, the person I speak of above. I almost hesitated writing this letter because there are so many people that I am so appreciative of. However, whenever I think back to the accident, which by the way is on a daily basis, there are several images I can’t get out of my mind and two of them are Jennifer and Scott. Without the help of both Scott and Jennifer I am almost certain we would not be where we are today. Ava would not be where she is today. If I have not done so already I wanted to say Thank You for being where you both were the evening of April 23rd. Thank you for taking part in helping to save my daughter’s life.

I am thankful to everyone for their continued support. My Aunt was able to stay with Ava in the later part of her hospitalization during the evenings so that Manny and I could be home with Jack and Isa. My Mom has been with us since the beginning of June and has been a tremendous help. We have other family members coming back next month which we are thankful for. To all of our friends EVERYWHERE thank you for all of the continued prayers and support. The meals have been much needed and appreciated, the car pooling with Jack and Isa has been so helpful and has enabled them to enjoy some of the fun activities summer has to offer. To the medical community, which includes too many individuals to even begin to name, our deepest appreciation for continued efforts in getting our daughter back to the life she once lived so innocently.

To all of Ava’s angels……thank you and good night!

Fred….the party is getting closer!

Memorable Father's Day

2009-06-23T22:28:00.000-07:00

My family had the privilege of spending Father’s Day with the Lopez family. This is not anything new for us. Most holidays that we are in town together, we spend together. Mother’s Day and Father’s Day have been routine for us for the past several years. For obvious reasons this year was more special to all of us.

I could go on for pages choosing words and phrases that would try to match the grandeur of the day, but instead I decided to spend my time learning how to convert, edit, and upload a short video clip that was taken at the Lopez household on Father’s Day. Given the heartbreak of the evening of the 23rd of April, a mere two months ago, you will see why I thought that it was more appropriate to add this video rather than a neatly crafted collection of letters.

http://www.youtube.com/watch?v=X_CTX4xa08w

I have also added some pictures that were taken that day. I hope that you find them uplifting and that they prompt you to go and hug someone that is very dear to you.

Ava, the party waits for you.

fw.

We are thankful

2009-06-16T11:19:00.000-07:00

Today was a good day for several reasons. It has been a little over 7 weeks since Isa, Ava and I were hit by a drunk driver in our neighborhood……today is the first time Ava has sat by herself in over 7 weeks. Manny was playing with Ava and the other kids when all of a sudden he was yelling my name. I quickly stopped what I was doing and ran to the room where I saw Ava sitting in front of Manny. While this may not seem as a big deal, to us it was another hurdle that she has had to overcome from this senseless tragedy. Ava is currently in physical therapy 5 times a week, occupational therapy 3 times a week, speech therapy once a week and vision therapy once a week. We have also been blessed with an amazing woman in our neighborhood that has offered to help Ava twice a week with occupational therapy. Rosie has a background in OT and like many other people during this entire process has offered her services to help Ava get back to the little girl that we all love so much. Today I was able to enjoy the time I spent with Isa and Ava at the pool. Something I often have taken for granted, I now cherish. Jack was able to spend time with a friend and came back at the end of the day and seemed revived. I was able to put all three of my children to sleep tonight with smiles on their faces…..for this I am thankful.

Our day started by attending church at Oak Hills. There was a motivational speaker at the church today. Many of you may know of him, Bruce Bowen from the San Antonio Spurs. He had an incredible message that I think is worth mentioning. He said ‘you should never give up even when you are faced with life’s challenges’. I saw a man tell us the story of his life and how he faced all of life’s challenges and because of that has become a loving father, husband and very successful NBA basketball player. This accident has resulted in numerous challenges (too many to even count). Just like he did, we too will face life’s challenges knowing that things will get better. Although Manny will never be an NBA basketball player, our family will have the most important thing life has to offer…each other

We were able to meet Bruce Bowen and share Ava’s story. We left knowing that he was wearing an “All for Ava” bracelet and were just so touched to have another person looking out for her. It is because of all of you that we are where we are today. A far cry from where we were April 23rd. Does this mean that I have forgotten the reason why we are even here to begin with? Absolutely not. I am thankful though that I can hug each one of my children every night and tell them that I love them…..something I never thought would happen again.

Each day will bring a new challenge but with challenge will come change and this is how we will get Ava back one step at a time.

To all of Ava’s angels…..THANK YOU!

Love,
Traci

Life at home with Ava

2009-06-11T07:58:00.000-07:00

In case you missed the news stories that aired over the last few days since Ava's homecoming, here are the links for the videos that have been posted:

http://www.kens5.com/homepage/tab3/stories/KENS20090610-AvaLopezRecovery.681101c7.html

http://www.ksat.com/video/19709637/index.html

Please continue to pray for Ava's recovery and for the family's strength and patience as they adapt to their new life.

Golf, anyone?

2009-06-09T21:33:00.000-07:00

The Sharing & Caring Foundation is a charitable organization started by Keller Williams associates with the mission of responding to meet the needs of persons within the local community. Their mission statement states that “success will result through our faith, hope and love of all God has created. We hope to create opportunity as we breathe life into unfortunate circumstances and change the lives of those we will touch.”

The Caring and Sharing Foundation sponsors a golf tournament every year with the proceeds going to support various causes. This year the tournament is being held on Monday, June 29th at Fair Oaks Golf Club. A portion of the proceeds are being donated for Ava’s recovery.
Each Player receives a “Member For A Day” Replay Certificate from Fair Oaks Ranch Golf & Country Club, Breakfast Buffet, Lunch, 2 Drink Tickets, A Goodie Bag, a T-Shirt, Golf Cart, Warm Up Balls, Bag Service, Professional Scoring, Hole In One Opportunity and Green Fee’s.

Fair Oaks Ranch Golf Course & Country Club
Monday June 29, 2009
Registration at 8:00 AM and Shot Gun at 10:00 AM
Lunch at approximately 3:00 PM with Awards to Follow

You can get more information about the golf tournament and registration at http://www.sharingandcaring.org/.

Ava is home!

2009-06-08T03:01:00.000-07:00

I am sure that most of you are aware by now that Ava returned home on Friday. There was a small, intentionally unannounced “welcome home” at the Roger’s Ranch community pool on Friday afternoon. Many people from the community were there to welcome Ava and the Lopez family and to let them know that they have been thinking of them and praying for them. As Ava was brought in to the pool area, an applause broke-out.

The applause was warming not only because of the community heartbreak that has been felt over these past six weeks, but also because Ava’s personality began to show itself to the community. As the applause continued, Ava waved like the homecoming queen sitting on the top of a convertible’s backseat during a parade. She is a character… and there are many people who are breathing a heavy sigh of relief to see these pieces of Ava’s character re-emerge.
Jennifer was telling me that when they took Ava home for the first time since 23Apr09, that there was no doubt as to whether or not she recognized her surroundings or seemed to feel comfortable. Upon entering the Lopez’s house a tiled hallway extends straight ahead until it opens up into a carpeted sitting area with a high vaulted ceiling and a connected, open kitchen. As you enter the sitting room there are a collection of children’s toys immediately to your left, on the floor. Upon entering the room, Ava immediately started reaching for the toys as if there was no doubt who they belonged to or whether or not she could play with them. These were her toys… and she knew it. Welcome home Ava.

The Lopez’s spent much of the weekend like any other family in June… poolside. If you were unaware of the tribulations that had fallen upon this family, then you would not think too much of seeing them at the pool… Jack swimming with his friends... Manny and Traci trying to teach Isa how to swim… Grandma sitting in a chair on the side of the pool holding the baby and watching the others from under the shade of the pavilion. Much of the time Manny or Traci would hold Ava and twirl around with her in the chest deep waters of the pool. To the outsider, there is nothing particularly different about this family, but to those of us who know… we know that there is something very special about this family frolicking in the pool in early June.
“Well what about ‘Ava, the party waits for you?’ Why wasn’t there more fanfare?” Well the party does wait for Ava, and while she has returned to her home, her rehabilitation continues and there is still much healing that is left to be done.

Lilliana Story and I were talking earlier today. She recounted to me that she was at an unrelated function and happened to meet someone who was on the Anesthesia team that helped care for Ava the night that she came to University Hospital. This person had not particularly followed along since that time. Lillian told her that Ava came home and gave an update regarding her nothing but miraculous, on-going recovery. The reply was essentially, “SHE IS ALIVE?”

Oh yes, Ava is alive. And of course I do not mean in the “her heart continues to beat” sense. Ava is ALIVE!!! Like “she will live her life and be a testament to this time in all of our lives” sense. She will be a testament to the invincibility of youth…of hope…of love…of determination…of prayer. She will one day have children of her own, and grandchildren. And she will be the matriarch to an entire lineage of people who almost never existed. And you should smile… knowing that you helped make it so.

As for Ava’s party, there will be one. It will be well publicized through this and other venues and all will be invited, but it is still a little early yet. Once a few more uncertainties are resolved, then we will start talking party plans. Everyone has been so very gracious and respectful through this trying ordeal. I am sure that everyone understands and anxiously awaits the “please come and celebrate with us the miracle of Ava’s life…”

While laughter has returned to the Lopez house, much work remains to be done. Sincerest appreciation for your continued prayers, support, generosity, and encouragement. Keep it coming.

Ava, the party waits for you.

fw.

Ava is coming home!!!

2009-06-03T23:00:00.000-07:00

Ava’s recovery has continued to be stellar. She is now able to sit in a high-chair and feed herself. Her body strength continues to improve, which allows her to sit-up for longer periods of time. She still does not have the strength in her legs to support her body weight, but this will improve with time… especially now with the assistance of the KidWalk.

Ava is using the KidWalk daily. Currently she moves by extending her legs in-front of her which consequently pushes the KidWalk backwards. This is a natural progression for kids as they learn to navigate the walker and improve their ability to get around and explore her environment. The KidWalk is especially nice because it does not require the use of her hands. She can get around and continue to touch and feel things in her environment, which helps to encourage her to move around. All of this exercises her lower body more and gets her one step closer to walking without it. Then it will get passed on to another child who will one day learn to walk with it… and then another… and another… and so on.

While all of this is great news… it pales in comparison to this…

AVA IS COMING HOME ON FRIDAY!!!!

Yes! It is true! Her recovery has been progressing so well that she is anticipated to be released from Christa Santa Rosa Hospital Friday afternoon following the completion of her physical therapy sessions that day.

This is an amazing recovery in an amazingly short period of time. Granted she will still require extensive physical therapy, but she is coming home!!

72 hours… check
Extubation… check
Out of the PICU… check
Alert and talking… check
Eating… check
Out of the hospital… check (well, should be on Friday)
So what else is left other than walking?

As we have discussed before, Ava had a right occipital lobe infarct (dead brain tissue on the back right portion of her brain). This area is primarily responsible for vision. I am sure that many of you have heard that the right side of your body is controlled by the left side of your brain and vice-versa. The vision works similarly, but different.

You look with each eye but your brain merges the images from each eye together so that you only see one thing; otherwise you would have double vision all of the time. Essentially, when you look straight ahead everything to your left is seen by the right side of the retina in each eye, and everything to your right is seen by the left side of each retina. Your brain then merges all the stuff that you see to your right in the left occipital lobe and merges all the stuff that you see to your left in the right occipital lobe. As above, a significant portion of Ava’s right occipital lobe died as a result of her injuries from 23Apr09. So if the right occipital lobe is damaged, then this would affect things that are being seen by the right side of each retina. The right side of each retina actually sees the things that are in your left visual field. Because of this injury Ava cannot see things that are to her left, if she is looking straight ahead. This is called “Bilateral Left Hemianopsia.” Bilateral – both eyes. Left - left visual field. Hemi – half of her visual field. Anopsia – no vision… Bilateral Left Hemianopsia.

This is what we need to continue to pray for… her vision.

It is expected that given her young age that she is likely to recover from this too, but until it happens, she is still without complete vision and is not yet whole again. We need to continue to pray for her, for them, for her vision, and for her continued recovery.

Much appreciation for your continued prayers, support, generosity, and encouragement. Keep it coming.

Ava, the party waits for you.

fw.

Ava's KidWalk is a reality

2009-06-01T22:53:00.000-07:00

Sorry for the long interval since our last update. This one will be short, but with nothing but good news.

Thanks to all of you, Ava’s KidWalk is a reality. She looks amazing, and all of you have been so instrumental in helping her make it this far. If you are still interested in helping financially, you can contribute via the donate button on this blog. The Lopez’s are exploring starting a foundation whose mission will be to help children and families affected by pediatric head trauma.

Ava continues to make improvements every day. She had the feeding tube removed at the end of this past week. She now has no medical support devices sustaining her. She is doing it all on her own. She is gaining more strength in her torso and is able to sit up in a high chair and be fed.
Another first…Manny and Traci told me that they heard her laugh for the first time today since her injury on 23Apr09. It was so refreshing to see more levity return to their lives as they described her giggle. While we did not speak of it, I am sure that part of it is a sigh of relief as the reality of the return of Ava’s personality is starting to show itself more and more. How wonderful to have come so far in such a relatively short period of time, especially given the severity of her injuries.

Sincerest appreciation continues to be extended to all of you for following along, spreading the word, contributing in whatever way you have been able, and praying for Ava and the Lopez family. You cannot be thanked enough for your thoughts, love, and support. Please keep it up.

Ava, the party waits for you.

fw.

Lemonade for Ava

2009-05-31T06:45:00.000-07:00

Nadia Soufi may be just a child, but she was determined to do her part in raising money for Ava's KidWalk system. She proudly set up a lemonade stand at the Rogers Ranch pool grossing $200.00 towards this great cause. A big thank you to Nadia, her friends and all those that contributed to making this a huge success.

YOU can help!

2009-05-28T22:29:00.000-07:00

Kerri Thompson has done a fantastic job setting up the website with the donation link. It is really nice... complete with music and pictures.

The description for the KidWalk is in the right tool bar. The link to paypal for donation is at the bottom of the description.

http://avalopez.blogspot.com/

Thank you again for everything that you have provided to the Lopez family... hope.

I will not be writing again for a few days. Thank you all for being so wonderful.

Ava... the party waits for you.

fw.

Ava's need for a Kidwalk system

2009-05-28T00:28:00.000-07:00

Yesterday I had said, “What’s left?” regarding Ava’s recovery. One of the big hurdles remaining is ambulation (walking, running). Currently Ava’s core body strength cannot support her to even sit up, but she does have some strength in her legs. Probably not enough to support her body, but enough to kick, and this should be enough to get things going. But how do we translate this into ambulating and exercising her muscles to increase strength so that she can eventually walk on her own?

Christa Santa Rosa Hospital has borrowed a medical device named “KidWalk,” which was developed in part by Stanford University. The device is very much like a wheel chair, but instead of having a chair-like seat, it is more like a forward facing bicycle seat. The seat is set low, at about the level of the wheelchair axles so that a small child’s feet can touch the ground. There is a back-brace/harness system that supports the child’s torso so that they can sit in the chair while their feet are on the ground, without having to support the weight of their body. Their legs can move and they can walk where they want to walk without requiring the strength or coordination that is required to walk without assistance. (I have included a link below so that you can see it in action).

Amazingly, I have been told that there is only one such device in all of south Texas for rehabilitation of children. The one that Ava has used at Christa Santa Rosa was brought as a temporary loaner from the device representative. It is shared between other hospitals in South Texas, and is not always available for Ava.

Psst… This is where the favor comes in…

We are wanting to buy one for Ava’s use during her rehabilitation. The cost? Base unit… about $3000. With all the bells and whistles… about $4000, or so. Detailed information, with pictures and a video demonstration of how this works/looks can be found at http://www.primeengineering.com/pages/products/kidWalk.html.

Once you see the video demonstration, then it does not take much to understand, “yes, this is what I would want for my own child if they were unable to walk on their own.”

The hope and expectation is that our prayer warriors will continue to deliver on Ava’s healing, and she will graduate from needing such a device. The Lopez’s will be donating the KidWalk to Christa Santa Rosa for use with other rehabilitating children, without concern for needing to rely on the instrument companies charity to bring it to the hospital and allow them to use it. This would be good not only for Ava, but many other children and families that are much less fortunate than us.

Kerri Thompson is setting up a separate blog (secondary to obstacles with donating directly from the Caringbridge website) with a link to a PayPal account for Ava. We have explored many options with how to handle this and keep coming up with certain roadblocks. Firstly, establishing a non-profit organization so that your donations could be tax deductible takes time, which takes away from the usable time for Ava’s rehabilitation. Secondly, directing the donations through Christa Santa Rosa also requires time and limits our ability to control the use of the funds for the intended purpose. Thirdly, directing the donations through some other organization may stand in opposition to some of the beliefs of others and again may limit the control of the funds for the intended purpose… getting Ava a KidWalk to assist in her rehabilitation. We should have a link to the blog posted tomorrow.

How much is needed? Only modest amounts, but we don’t want anyone donating money who is not in position to donate money. You all are great people and your interest in Ava’s story and offering prayers and words of encouragement to the Lopez’s is valued beyond measure. These are financially hard times for a lot of people right now. If you are tight for cash, then don’t even consider it… you are loved just the same. If you have a little money to spare, then contributing some of it to this cause will not only help Ava, but it will also help other children just like her in the near future.

What will you do if you come up short? Ava will have her chair (period).

What if there is an excess? Every dime donated will go to better the facilities that have been instrumental in Ava’s recovery. There is no plan to spend money that we don’t have, but suffice it to say that all of the money will be spent so that it will serve the betterment of many other children and families, not just the Lopez Family.

Is the donation tax-deductible? No. Unfortunately, time is important to us and has limited our ability to set up such an organization in a timely enough fashion that would allow the donation to be tax deductible.

Your prayers, acts of kindness, and encouragement have continued to sustain the Lopez family. Thank you again for continuing to be there for this most deserving family and for spreading the word “far and wide.” Keep passing the message along. Ava’s story continues to work in the most amazing ways and in the most unsuspected lives.

Ava, the party waits for you.

fw.

Preliminary ophthalmology results

2009-05-26T22:07:00.000-07:00

The past few days were really good for Ava and the Lopez family. I had not mentioned everything over the past few days so let’s catch-up a little.

We have discussed Ava’s eyes and not being sure whether or not she is focusing on/tracking objects that are in her field of view. Given her occipital injury (the posterior part of the brain that is responsible for vision) this was a big question mark. That her eyes didn’t seem to be fixing on anything made it an even bigger question mark.

Ava had an ophthalmology exam last week (by the way, one of the questions on my ophthalmology rotation exam in medical school was “How do you spell Ophthalmology?” I'm telling you, med school was tough! It is O…P…H…T…H… In case you were interested). So at any rate the result of the exam was that she had no retinal or optic nerve atrophy. This was very reassuring because it gives her a good opportunity to rewire areas of her brain that may not be able to see. Everyone has a small blind spot on each retina. We never see it because the brain fills in the area with what our brain thinks should be there, the background pattern. The thought with Ava right now is that she has some blind spots and she is changing her direction of focus to try to see around the visual deficits that she currently has. As you can imagine this can be quite difficult. Your central area of vision is responsible for almost all of your visual acuity. Try looking at this “X” but read the words just two or three lines away from it. It is nearly impossible. Your central vision is critical, especially in a child that has all of her education ahead of her. Fortunately, she is young and her brain has a chance rewire and fix itself, better than ours would.

All in all, the ophthalmology appointment was reassuring. Ava still has a good chance of recovering what visual deficits that she has now. Weeks 4-6 after the injury tend to be the critical times for such recovery/injury. Last week was week 4. She will have another Ophthalmology exam this week and again next. This will give us more information.One of the more incredible developments has been the rapid improvement in muscle control of her head and neck. One week ago she had essentially no muscular neck tone. Today she went through a one hour long Physical Therapy session without needing any head or neck support. This is great for her and those caring for her and is one more box to check on her road to recovery.
Another box to check on our list is “eating.” Ava passed her swallow study earlier today. Yeah!!! Manny tells me that she went to town chowing on some pears, applesauce, mashed potatoes, peas and green beans earlier today. You would think that this girl hasn’t eaten in a month, the way she munched on those pears. Like Manny’s nose wouldn’t be enough to hold over the hungriest of babies. All kidding aside, I can only imagine how succulent pears would taste after not having eaten in a month.

She still has the feeding tube (which was switched to her left nostril to try to encourage her to grasp at it with her left hand) which will stay in place for the next several days to ensure that she will continue to tolerate solid foods well. She still has some difficulty swallowing thin liquids but this should improve as her tone increases.

So what is left?

Ava still has very little body tone and cannot sit up on her own, but 4 weeks ago she couldn’t breathe on her own. Three weeks ago she couldn’t move. Two weeks ago she couldn’t speak. One week ago she couldn’t hold her head up. Just imagine what amazing things she will be doing a month from now.

Please keep up the prayers and the Lopez encouragement. You all are doing a phenomenal job of helping this little girl recover.

Beatrice, your baby misses you… and so does Ava.

Ava, the party waits for you.fw.Tomorrow, I have a special favor to ask.

Pretrial hearing tomorrow

2009-05-26T22:06:00.000-07:00

Housekeeping: Pretrial hearing tomorrow. 226th District Court in the Bexar County Court House at 300 Dolorosa. The court room is on the 2nd floor. If you are lost, then call District Court information at 335-2311/2011 (opens at 8am). Judge Sid Harley is presiding. The arraignment should occur between 8:30 and 9:00 am. It is intended for discovery of prosecutorial evidence. The accused may or may not be present. You are all welcomed and encouraged to come and show support and interest in this very important case. Bear in mind, this will not be like the drama of Law and Order. This is not the trial. This will likely be a quick proceeding and you may even miss it if you are not paying close attention. I mention this not to dissuade you from attending, but don’t want you to have too high of an expectation of what will be occurring tomorrow.

Beatrice's Devotion

2009-05-24T09:42:00.000-07:00

Housekeeping: Kerri Thompson has opened up the June meal calendar for the Lopez family. Here is the necessary information: www.carecalendar.org

Calendar ID: 15804
Security Code: 9927

A quick Ava update: She continues to make small gains everyday and continues to gain slightly greater muscle control than days before. Most notably she is having more neck muscle control as is evidenced by how often she thrashes her head from side-to-side while lying down. As of yet she still does not have enough neck strength to hold her head upright, but this will come and we’ll be here to let you know when that happens.

Now, a much deserved, “thank you…”

A recurrent theme during this chronicle has been the heartache that a parent feels for their hurting child and at what lengths they would go to relieve them of that suffering. How easy it is to rationalize our own pain, but not the pain of our children. How easy it is to set aside your own interests for those of your children. How painful it is when you are unable to do it. How you ache internally with the realization that you must let them go, to travel their course alone.
There has been one person that has been hardly mentioned during the accounts that I have put on Caringbridge, that deserves special recognition for her efforts. She has been with Manny, Traci, Jack, Isa, and Ava every minute of every day since arriving in San Antonio in the early hours of 24Apr09… Manny’s mom, Beatrice.

Think of how difficult it would be in your own life if, without any advance warning, someone were to call you right now and say, “You need to be at the airport in one hour and you will be gone for the next month.” I know that in our own house it takes three days of preparation for a two day trip. Beatrice put her own life and work on hold in the few seconds that it took for her to be told of the trajedy that took place in her son’s family’s life. And I am certain that there was absolutely no hesitation in doing so.

Beatrice has been an unsung hero through much of this, burdening her own pain in silence. Many people who do not even know the Lopez family have been brought to tears by Ava’s story, and it is so easy for this to happen if all you do is think about a child that you love very dearly. Now imagine the pain if it really were that child. This is how it must be for her, yet she is often overlooked because her pain is “minimized” by the pain of Ava’s parents.

Beatrice has been there to help in whatever capacity she can… feeding, baths, bedtime routines, overnight stays in the hospital,… whatever… wherever… whenever.

There have been many contributors from both the Lopez and Southerington families, but tomorrow Beatrice returns to Los Angeles and leaving her son and his family. Tomorrow will likely bring a similar pain that she felt when first learning of this tragedy… an emptiness.
For those who are here in San Antonio please acknowledge her and let her know how much you care and appreciate her… and for those who will receive her again in Los Angeles… please acknowledge her and let her know how much you care and appreciate her. She deserves it more than any of the rest of us who are trying to lend support to this most deserving family.

Ava, the party waits for you.

fw

Scars from April 23rd

2009-05-21T22:50:00.000-07:00

I would like to start this entry with an apology of sorts. Obviously, I am not with the Lopez’s every minute of every day and will miss some of the most touching moments that occur during Ava’s recovery, for that I apologize. Also, the writing works best for me if I just pick an emotion that I am having and go with it. This is what tonight’s entry is, and this is why I am apologizing. I wish that I could tell you that “She walked today!” but that hasn’t happened yet and I don’t have any further news of her recovery other than “SHE SPEAKS!” which should be enough to sustain us for awhile yet. You may even want to fire me after tonight’s entry because it may appear a bit melancholy. If you aren’t in the mood for it then you may want to wait for another entry.

Well, let’s get on with it.

A simple thing stood-out to me when we were visiting with Ava and Traci the other night, and my mind just wouldn’t let it go for some reason.

Last night I spoke of Traci getting out of the rocking chair so that Jennifer and Lilliana could hold Ava. Traci stood to the right of the head of Ava’s crib, while we stood and talked about a variety of things. Traci was wearing a form-fitting gray cotton pull-over shirt with half sleeves that came to the elbow. While we spoke, she would occasionally cross her arms and adjust the sleeve ever so slightly so that it would expose her elbows. Standing directly across from her it is nearly impossible not to notice her elbows… they are scraped and scarred from being thrown across her yard and into the fence or even concrete. They are a bright pink, like the color of red grapefruit. The linear streaks across her elbows are pitted on the right and remind me of the blood that dripped from it on the evening of the 23rd of April. There is a small divot that remains in the center of the skin on her right elbow that was a hole the size of a pencil eraser on the night of her injury. The “abrasion” was bad enough to bleed, but not so bad as to require cosmetic or functional repair. On the evening of the 23rd of April, this is one of the injuries that your eyes would have been drawn to, given the persistent slow bleed while she lay on the ER gurney. Maybe this is one of the reasons why my mind would not let it go the other night… I am reminded of it. But this is why I am talking about it.

The scars on her elbows are a reminder to Traci, and to those who know, of the way things are and the ways things could have been. The scars are a reminder to us of this healing process. They represent so many things. They represent the injury of the 23rd of April to the Lopez family and so many others. The fresh redness of them reminds us that while healing, the wounds (emotionally and physically) are still fresh and are occasionally tender. The scar represents to us that it is continuing to heal and that it is not yet finished. The scar will continue to remodel and strengthen the tissues that were once injured. The bright redness of it will slowly fade with time. The skin will not be so tender forever. It will soften and smooth as it heals itself. Eventually, she will even forget that they are there for brief moments of time, then longer and longer.

But unfortunately, or fortunately, being a scar… it will never fully go away. From my perspective this is fortunate. May it continue to serve as a reminder to Traci and to all those who glance upon it, of the preciousness and fragility of life. May we see them and give thanks, privately or publicly, that Ava is alive and for the treasures that you have been able to maintain in your own life.

I think of these scars on Traci’s elbows and think how proud she should be to bear them. While the rest of us require an intentional act to put on our Ava gear to show the world our support of her/them, Traci alone bears the physical scars. It is her mark. It is a symbol of strength, devotion, dedication,… and healing. May it be a reminder to all of us, and may she be proud of them.

Ava, the party waits for you.

fw.

Challenges

2009-05-21T03:39:00.000-07:00

Tonight, let us talk Ava logistics.

As before, when you enter Ava’s room, there is a small entry way with a sink and vanity on your right. It is similar to a small hotel room in that you have to take a few steps in before it opens up into the rest of the room, only smaller. In Ava’s room, it opens to your right. There is a wooden rocking chair with a high back that is always hidden immediately behind the vanity (from the entrance) in the right corner of the room and right next to Ava’s hospital crib.

When we first entered the room on Tuesday evening, Traci was sitting in the rocking chair with Ava (at the end of this you will see some pictures on Lilliana’s slide show link of this very moment). Ava looks so big now, and it is further accentuated by Traci’s small frame. Logistically it can be sometimes difficult to transition from one position to another given Ava’s size and her very low/absent muscle tone and control of her head and extremities. As we have discussed before, in many respects she continues to function as if she is a newborn baby, requiring total care. It is often challenging enough to navigate tasks and positional changes with a newborn, but fortunately they are usually relatively light weight (10-15lbs, even aged a little) and small enough to cradle with one arm. As you will see with the slide show pictures, there is no way that you could cradle Ava with one arm, not to mention her weighing 25lbs.

When we (wiedenhoefers and Lilliana Story) were there the other night, Traci was wanting to get up from the rocking chair. It was obvious that it was not so logistically easy to do, which is only worsened by recovery from her own injuries. She was getting up so that Jennifer and Lilliana could sit and hold Ava. In helping with the transition to her bed a short while later, I could see how challenging this could be. It is one thing to watch someone do something… you know… “oh, I could do that.” Then you have to do it, and you think, “wow! That is a little more difficult than it looks!” This is how it is with moving Ava.

Firstly, you have to support her head/neck. Any person who has ever seen a baby knows this. Then the rest of the body… torso, arms, legs. Simple enough… when the baby is 20 inches long and weighs only 7 lbs! It is a whole different matter entirely when she is Ava’s size.

The thought process is something like this…“Okay, one hand behind the head.” Head goes forward. “Okay, maybe behind the neck.” Head goes back. “Okay, maybe somewhere in between.” Better. “Now, support her body… wow this kid is long…one hand behind her back…too low… too high… better… oh crap… what about her legs?... oh, my… there goes her arm… help!” Not that it is impossible, but this is no newborn, and I have held a lot of them. Fortunately she isn’t slippery, covered with amniotic fluid, vernix (that white cheesy stuff on a baby when it is born), and blood. Then it would be extremely difficult.

This is how things are. And this is how things are much of the day… baths, diaper changes, changing clothes, physical therapy, holding… a lot of holding.

I mention these things just to remind people of the little tasks of daily living that continue to go on and continue to present small challenges to this most wonderful family. It is not a plea for sympathy, as I know that the Lopez family is greatful to be where they are right now, but rather a reminder of how their life is different… at least for a while.

Here is the link to some great pictures that Lilliana took that evening…
www.liliannastoryslideshow.com/visitwithava
Ava, the party waits for you.
fw.

Ava spoke

2009-05-18T20:33:00.000-07:00

I wrote the following last night and decided to wait to put it in until today…

It has been more than three weeks since Ava, Traci, and Isa were hit in their side yard. Ava is recovering slowly and with an unknown endpoint. I only mention it in such a fashion (with a pessimistic tone) because of the duration of time that it has been and the natural tendency to have emotional fluctuations and even a point of emotional exhaustion and frustration… but this is not what I have seen. Whenever you see Manny or Traci they are positive, upbeat, friendly, welcoming, encouraging, embracing, conversant, thankful, appreciative, and loving. You come to visit Ava and the atmosphere is similar to one that I have seen many times on the postpartum ward… a stream of revelers and well-wishers have come to join in the celebration. I am certainly not trying to imply that anyone is glad that this has happened, as much as it is that I am trying to convey the atmosphere in Ava’s hospital room. Whenever I have been over there, regardless of whom else is there visiting, the room has been filled with smiles, hugs, laughter, and pleasant conversation. And the more that I think about it, the more wonderful I think that it is. This is not a wake. We are not attending a funeral. Ava is alive and she improves with each passing day… this is and should be a celebration of life. And I think of Ava lying there, gradually registering her environment… gradually picking up and relearning the complicated social texture of the interactions and emotions around her… maybe not understanding the words but certainly understanding the tone of the emotions. Compassion… friendship… concern… love… laughter. If you were a fly-on-the-wall, then this is what you would see. If you were Ava, wouldn’t this be how you wanted the environment of your room to be? How could this positive energy be anything but helpful to her… to them… to all of us. As I write these words it makes me proud of all of you and makes me want to tell everyone else… “look at the great things that these people (you) are doing for this family!” You should be very proud because this loving environment has certainly served to prop up the Lopez family and allow them to continue to feed the positive energy that is felt when you enter that beautiful little girl’s room. I think how easy it would be to feel alone and losing hope without such support… but then there is you… writing, calling, visiting, sharing, hoping… spreading the word… praying…

While I do not feel so comfortable as to assume the emotions of Manny and Traci during such a difficult time, there is one thing that I truly feel that they would be in complete agreement with… that is… I know that if I were them, then I would say… “If I have done great things, then it is only because I have been lifted-up on the shoulders of giants… you.” Thank you for continuing to lift them up. You should be very proud of what you are doing for this very deserving family.

Ava… the party waits for you.

fw.

Then there was today…

Something occurred that I did not expect to happen for some time yet…

Manny was at the hospital by himself this morning, holding Ava. Part of Ava’s physical therapy is the equivalent to teasing. Give her a taste of her pacifier, then take it away from her. Leave it just out of her reach enough to have to try and get it… maybe just leaving it against her lips but not in her mouth… close enough that she knows that it is there but just centimeters away. Manny was doing a little “physical therapy” not letting her have her pacifier. She started to whine and whimper, even cry, then the unexpected… “Mama.” Then the “physical therapy” really started. “Say it again!... Say ‘Daddy.’”… “Dada.” AMAZING!!! There is just no better way to put it… AMAZING! AMAZING! AMAZING! And no one was there to witness it! Don’t worry it didn’t end there. Traci, Tina Frazier, Kym Pharris, Jeff Larkin and Manny were having lunch at the hospital together. Jeff was saying his goodbyes and had yet to hear her speak. Traci went to Ava and coached Ava, “Say bye-bye to Larkin.” Then… weakly…and slowly…“bye-bye.” AMAZING! AMAZING! AMAZING!

Ava continued to be coached, reiterating a variety of things… “Isa, Jack, Cali, peas (that’s please in baby speak).” AMAZING! AMAZING! AMAZING!

Jennifer called me crying this afternoon… “Ava spoke.” The visitor flood gates are sure to open now. I described a celebratory atmosphere in her room even before she spoke… it is gonna be Fiesta, Cinco de Mayo, the Chinese New Year, St Patrick’s Day, (and any other festive holiday that you want to include) all rolled-up into one. This is truly a day worth celebrating!!
We previously spoke of Traci’s heart melting when she got to hold Ava for the first time since her injury. I am sure that hearing Ava speak for the first time in more than three weeks made her heart fill with so much joy that she just wanted to erupt and yell down the hallway… “SHE SPOKE!!!”

Traci described this as “the best day of my life.”

AMAZING! AMAZING! AMAZING!

Ava, the party still waits for you, and thanks to today it is seeming a little closer now. Today we celebrate… tomorrow we forge ahead.

fw.

Ava's story continues to touch us all

2009-05-17T23:27:00.000-07:00

I have continued to be impressed by the grace and indomitable spirit that the Lopez Family has continued to show through this strife. While there are many examples of this, one occurred during a conversation with Manny this evening.

We were talking of a friend of his and his wife that had come to visit with them earlier today. His friend had relayed information regarding Ava to another person who did not know the Lopez’s personally. He almost apologetically asked if that was okay, not knowing whether or not the Lopez family preferred for this to remain more private. Of course Manny’s reply was to spread the word… far and wide, but the message is not exactly what you would expect at first blush. It is deeper and more humanistic than “punishment for the offenders and preservation of life.” While these are certainly important messages to send, there is a deeper hope and desire that comes from Ava’s story…

Most of you probably do not even drink that often or that much. Most of you would probably never drive a vehicle if you were intoxicated or even had only one drink. So you are not where a life would be saved. This story doesn’t prevent you from doing anything that would result in the demise of another human being. This story is merely preaching to the choir… or is it?
Ava’s story has touched all of us. We have been more thoughtful and considerate of others. We have paused to take note of the precious lives that surround us, whether it is with our family, friends, neighbors, or even complete strangers. We have looked at our own children and thought how devastated our own lives would be if such a tragedy befell them and have tried to make them feel more loved as a result. We have come together as communities (including the on-line community) and have said, “we are here for you.” So maybe Ava’s story is saving lives in ways other than the mortality count… and passing her story along makes us all more humane and interconnected. Maybe Ava’s story will serve no purpose other than to make someone’s life better, if even just for a day. But isn’t that a worthwhile thing, too. Manny understands this. This is his hope… that Ava’s story touches the lives of others… and makes them better… however that may be.

Ava… the party waits for you.

fw.

Hungry for Daddy's nose

2009-05-16T14:38:00.000-07:00

Ava has continued to shed some of the vestiges of her injury this week. Two major medical support devices remained. She has continued to wear a cervical spine collar, which given its small size looked downright adorable, but those of you who know Ava also know that Traci could dress her up in a potato sack, and she would still look adorable. The cervical collar was also pathetic, in that it reminds us of the tragedy that occurred on the evening of the 23rd of April, 2009, that should never have occurred. The cervical collar was placed two weeks ago to provide extra support to Ava’s neck due to a concern on the MRI that some of her neck ligaments were injured. She had further imaging studies done this week that allowed the doctors to feel comfortable in removing the C-collar.

A secondary benefit that the C-collar provided was supporting Ava’s head. (“Psst… Fred… I think that you just said that this is why she was wearing it in the first place.”) Let me explain… If you were in a car wreck, then you may have to wear a C-collar to prevent you from moving your head/neck in a way that could result in your paralysis; however, the muscles that control your head/neck still work fine. In Ava’s case she needed the C-collar to prevent injury to her spine; however, her neck muscles are not working so well and her head is floppy… like a newborn. The C-collar has provided support to her head, keeping it from being floppy when she is held. Not having this support may actually help with her rehabilitation some, given that she will now have to start using those muscles more.

The last major support medical device that she has is the nasogastric tube. The tube is about the diameter of the charging cord for your i-pod. Come-on. I know that you all have one and that it is probably right in front of you. It is even more similar to your charging cord given that it is almost a milky color, actually tan, given the tube feeds that are in it. The tube enters her right nostril and courses down into her stomach. The remainder of the tube is taped closely to her right cheek with a piece of very thin, clear tape. The tape is so thin that you cannot even tell that it is there unless you look very closely. It makes it appear as if the tubing is just stuck to the side of her face. The remainder of the tubing is often draped over her right ear and pillow and is connected to a bag hanging from an IV pole to the right of Ava’s bed. The bag is clear and contains a liquid that looks like a cappuccino.

When I was visiting with Ava yesterday, she would reach around the right side of her face with her right arm and catch the tubing, pulling it forward. Speaking from experience, it can be quite annoying having such a thing sticking out of your face and down your throat. Have you ever had a scratch in your throat? It is always there, irritating you, but you can do nothing about it. You swallow, hoping that it will rinse away, but it doesn’t. The swallow does nothing but make it ache more. Ugh!! The futility.

This device remains in order to feed Ava and keep her nourished. It will come out once she regains enough control of her pharynx (that area of your throat that is behind the uvula – the dangly thing in the back of your mouth). The pharynx is very important. Without ever having to think about it your pharynx/epiglottis is a very important sorting mechanism. It separates solids/liquids (sending them down the esophagus) from air. Sometimes people lose control of this function and their body doesn’t know when to close the airway and shunt solids/liquids down the esophagus. As you can imagine, this could be a very bad situation if your body is diverting food into your lungs, even just a little bit. Earlier this week Ava underwent a swallowing study to see how well her swallowing mechanism was working.

The swallowing study involves taking her to Radiology where a fluoroscopy study is done. This is a real-time x-ray where the doctors/speech pathologist will have her swallow liquids, crackers, etc that are coated with barium to see if they are going down the right way. They watch it real-time on a television screen right next to her. Ava did very well during the study, with everything going the right way, but at the end of the study a small amount went into her trachea and she didn’t cough. The fact that she didn’t cough is slightly problematic because if the feeding tube were discontinued and she aspirated her feeds, then possibly they wouldn’t know, because… she didn’t cough. They keep feeding, she keeps aspirating, no one knows… problem. As a result the feeding tube remained in place. Overall, the study was reassuring and will likely be repeated later this coming week. Given the strides that she is making, I hope and expect that the next time will be “normal” and the nasogastric tube will be out.

This is a necessary thing to get the feeding tube out for a variety of reasons, but also means that a new task will result… feeding. This task I am sure that Manny and Traci will be thankful to have, because it will be one more indicator of recovery. I also know that they have no shortage of people that would just love to sit with Ava and feed her. I am not quite so sure why mothers seem to love this task so much, but they do. I think that feeding is a continuation of nurturing/nourishing that is so endearing to mothers. Maybe the solitude and comfort of being with your child when they are so focused on you as their provider.

This reminds me... A few days ago Ava gave everyone a very good indicator of how ready she is to get rid of the nasogastric tube and have a Happy Meal. When I went to see the Lopez’s at the hospital yesterday, I noticed that Manny had a tiny red dot at the tip of his nose that looked very much like a pimple. As it turns out, he was holding Ava on Wednesday and was gently rubbing his cheek against hers, touching nose to nose, feeling the softness of her skin and lips with the tip of his nose… then CHOMP!!! Ava clamped down on the tip of his nose. The first solid food that she had had in weeks! While she may temporarily have many features similar to a newborn, she still has the teeth of an 18 month-old. One more indicator of recovery, and something that Manny is not soon to forget.

Ava has continued to make small gains everyday that are almost imperceptible to those that are closest to her, but are so very prominent to those who only see her occasionally. In our last entry regarding Ava’s recovery, we had discussed that she was kicking her legs, but was not very active with her arms. This has changed a lot during the past few days, now with seemingly purposeful movements. While she is not doing fine motor movements with her hands, such as picking up an object, she is using her arm to brush things away from her face and even used the back of her right hand to push her pacifier back into her mouth last night. These achievements may seem little but are very significant. It is like your newborn child making small coordinated movements. Each few days or so they are able to do some small task that they weren’t able to do before. This is thrilling as a parent for an otherwise healthy child that is expected to meet these milestones anyway. The “thrill” that the Lopez’s must feel with each fragment of a task that Ava re-accomplishes must be 10-fold greater… as it should be. These skills were taken from her… from them. Each one regained is a victory.

Fortunately for the Lopez’s, Ava’s recovery has been meteoric up to this point, but now we are in a rehabilitation phase. No one knows exactly what to expect, including the providers that are caring for Ava. There is no time frame for expectation of meeting certain milestones. This is indeed frustrating for everyone involved. It reminds me of being a child and the agonizing wait for those things that you so very much desired… Christmas, spring break, summer vacation, a party, etc. They seemed so far away. I knew exactly what they were like and couldn’t wait for them to come. I could picture the joy that I would feel when they finally arrived. But no amount of “wanting” would make it happen any sooner. This is how it is with Ava’s recovery, with one very unfortunate twist… no one knows the date that she will be considered “fully recovered.” The waiting would be so much more tolerable if we at least knew how long we had to wait. But not to worry, it will happen… and we will still be here. Ava… the party waits for you.

fw.

Lopez' heartfelt thank you

2009-05-13T20:53:00.000-07:00

Dear Ava's Angels,

Over the past 3 weeks Ava has shown a miraculous ability to survive the horrific trauma that threatened to take her life. Our focus during this time has been solely placed on Ava, yet we realize that the reason that she has been doing so well is because of the prayers that all of you have been saying for her and our family. We have felt that we have been under water for the past 3 weeks and just now have come up for air. As I sit here next to a medically stable Ava late at night we have so many people to thank. There are so many that have been there for us that we prefer not to name anyone for fear of leaving someone out. Please understand that our family is eternally grateful to all of you that have supported us and prayed for Ava. The people include family, old friends, recent friends, and people who have never met us. Thank you to all of you that read this website on a daily basis and have provided such wonderful heartfelt comments.

Why a tragedy like this has to occur may never make sense to any of us, but it is our responsibility that some good come from this. Three weeks ago there was “a good chance” that Ava would not survive. Today she is well on her way to a hopefully full recovery. We know the recovery process will be long, but at least she is here to go through the process. There are many families that have been less fortunate. The story of Ava has touched thousands of people all over the country. Let’s use that power to support MADD and strengthen the consequences of reckless acts of drinking and driving. Locally we can contact our District Attorneys office as well as State Senators Wentworth and Van De Putte to let them know that this senseless act will not go unpunished and that we will not rest until justice is served. God and our family will eventually forgive the person that nearly killed three members of our family, but in a free society there are consequences for reckless acts.

On a lighter note, one person that must be named for their efforts is the primary author of this Caringbridge journal, Fred. For those that don’t know Fred, I’m sure you would like to know a bit about him. Fred and I met about 15 years ago in medical school. Fred was president of our class all 4 years which was no small accomplishment considering the strong personalities within a medical school class. Fred like Ava is a survivor. Fred was diagnosed with an advanced colon cancer almost 6 years ago. He underwent extensive therapy which he documented on his own Caringbridge site back then which I followed daily being moved by his ease of the written word as he described his struggles with the therapy. Fred, as you can imagine has an amazing family and incredible friends that supported him during his fight against cancer, just as Ava is supported by all of you. To give you an idea of Fred’s dedication to his family, Fred became an Ob/Gyn after medical school. Five years after completing his residency, Fred realized that his job was keeping him away from his family (wife Jennifer, two daughters Abbie and Sadie, and two sons Nathaniel and Evan). Instead of just saying oh well, Fred took the brave action to apply for a radiology residency here in San Antonio. So 10 years after graduating medical school, Fred is now a 2nd year resident in Radiology with 3 more years to go after this one. So keep in mind as you read his updates that he is writing them as he is being an amazing dad and enduring the daily grind of being a resident. Thank you Fred for being an incredible friend!

Lastly, this Friday May15th Col Joe Brennan is starting his 6-7 month deployment to Afghanistan to be the Head and Neck surgeon at Baghram Air Base. Please pray for Joe’s beautiful family as the deployments are always harder on those back at home, and pray that Joe has a safe return home.

God bless you all for all that you have done.

The Lopez family.In case you haven't had a chance to see the amazing slideshow that Lilianna Story put together, please take a look at the following link:

www.liliannastoryslideshow.com/avarally

Also, be sure to check the previous post for t-shirt and the MADD walk info.

"All for Ava" t-shirts

2009-05-13T14:39:00.000-07:00

Hello dear friends,

MADD has graciously agreed to handle the "All for Ava" shirt orders from this point forward. Please e-mail Jessica Cullitan at jessica.cullitan@madd.org for shirts. She will need your name, address, phone number, e-mail address and the size/quantity of shirts you're interested in. Shirts come in Youth - Small, Medium, Large, as well as Adult - S, M, L, XL, XXL. Payment needs to be received by MADD before order is placed. Also, MADD will place the order when they reach approx 150-200 shirt orders. Please send payments to the local San Antonio MADD office at 110 Broadway, Ste. 442 San Antonio, TX 78205. If you live locally in San Antonio, we ask that you please pick up your shirt(s) from the address listed above once you have heard from MADD that they are in. MADD can be reached at 210-349-0200. If you live outside of San Antonio, MADD will make arrangements to get shirts mailed to you, but there may be an additional charge for shipping. If you placed an order through Jennifer Smith over the past couple of days, please check your e-mail to see how to proceed with your order. A picture of the shirt has been added to the Photos tab within Caring Bridge.

We can't thank you enough for your continued prayers and support. Continue to proudly wear your pink shirts and Ava buttons. Everytime someone asks what the shirt or button is for, keep sharing Ava's story. It could save someone's life. This is the least we can do for the Lopez family. Next time you sit down to pray for Ava and her recovery, please say a special prayer of strength and patience for Ava's family.

Don't forget that it is not too late to register for the Walk Like MADD event this coming Saturday, May 16th at Brackenridge Park. For more information, please see the previous journal entry. If you don't live in the San Antonio area, check out the website below to see when the MADD walk will take place in your area.

http://support.madd.org/site/PageServer?pagename=wp1_cities

I know we will all be anxiously awaiting Fred's return to hear more about Ava's baby steps towards recovery.

Take Care

Contact your elected officials

2009-05-12T01:20:00.000-07:00

Housekeeping:

1. Please remember to contact the following elected officials to tell them that you are interested in the Ava Lopez hit and run case and that you feel that San Antonio needs to be sending a stronger message regarding this crime to serve as a deterent to others.

a. The District Attorney is Susan Reed, but the contact person for the DA’s office is Amanda Strickland at 210 335-2311.

b. Northside State Senators for San Antonio are Senator Jeff Wentworth (District 25 – Northcentral San Antonio at 210 826-7800), Senator Leticia Van De Putt (District 26 - Northwest San Antonio at 210 733-6604).

c. If you are in San Antonio and are not sure who is your state senator, then you can find your district at the Bexar County Elections Department website. A complete list of the elected officials for Bexar County can be found at http://www.bexar.org/elections/Electeds/electeds.html, complete with addresses and contact numbers.

2. There is much interest in the “All for Ava” t-shirts and Ava buttons. We are currently looking into a more efficient way of handling the ordering and distribution of these items. As you can imagine, Jennifer Smith is going to get crushed if she takes this on for herself (the receipt of checks, getting the shirts/buttons, and mailing them to people who are out-of-town, etc). For those of you who are local, contact Jennifer Smith, as mentioned in the previous journal entry for today. For those of you who are out-of-town and want t-shirts or buttons, please give us a few days to see what we can do before we annihilate Jennifer with this task. All the proceeds will be going to MADD under Ava’s name.

3. Many people have been wanting to send cards, etc to the Lopez family. We ask that if you desire to send something, that you mail it to The Lopez Family, c/o Kerri & Chad Thompson at 18414 Rogers Place, San Antonio, TX 78258.

4. Least importantly, I will be unavailable for a few days and likely won’t post another entry until Friday evening. Please keep offering up support to the Lopez’s via the guestbook. It has been hugely uplifting to their spirits.

Incrementally Ava continues to improve and the Lopez family continues to heal. As I entered Ava’s room this evening, Manny and his mom, Beatrice, were “relaxing” (if such a thing is possible when your baby is the patient) in the vinyl love seat that is positioned against the left wall of the room. Traci was standing over the foot of the crib taking pictures of her three children. Isa and Jack were standing on stools on opposite sides of Ava’s bed. Jack was on Ava’s left and Isa on her right. They were leaning on the sides of the bed next to Ava offering their best smiles for mom. A new “normal” develops.

As I walked into the room Manny saw my reflection through the mirror on the wall and offered up a “Freddd!” that was very reminiscent of “Norm!” on the sitcom Cheers. It was comforting to me and served as a barometer for what was happening in the Lopez’s world today. How natural it is seeming for all of them now. It is now possible to come and carry on relatively normal conversation, complete with laughter, without fear of upsetting the delicate balance of life and death. How fragile those times were and how far away they are starting to seem… thankfully.
Ava continues to increase her neurologic control every day. They are little gains, but gains nonetheless. Her eyes continue to be wide open and seemingly search around the room. She does not track yet, but has on a few occasions seemed to look at something that comes near her. Whether or not this is coincidence is uncertain. She has seemed to gain more control of her legs in recent days. She lays there just kicking away. Her legs were active nearly the entire time that I was there this evening. She seemed to be intentionally kicking at the stuffed animals at her feet. Her arms are another matter. She has been moving her arms some, but not nearly as much as her legs, especially her right arm. Manny and I spoke about this openly tonight. It is as if she is starting over again with these almost fetal-like movements. It appears to be the neurologic equivalent of a system reboot. It is; however, a little peculiar to me that she would regain leg control prior to arm control, but it all depends on which neurologic tracts were most injured. Maybe next time we will discuss DAI (Diffuse Axonal Injury), which Ava suffered as a result of the head impact (I chose this word combination intentionally as to not lessen the severity of the negligence that resulted in her being here).

But to me the most notable gain was that of a whimper. Ava has been completely silent since her initial injury without any vocalization of any kind. She is now starting to vocalize with little whimpers. They are not quite cries and are a long way from verbal communication, but this is where it starts… with a whimper. We believe in you Ava and know that you are coming back… 100%.

See you in a few days.

fw.

Join us in the "Walk Like MADD"

2009-05-11T21:04:00.000-07:00

Hi all,

Due to the overwhelming response we had to the "All for Ava" t-shirts that were sold at the rally, we are going to put another order in for those who are interested. Ava's Uncle Tony was the mastermind behind the shirt design. I'm going to try to attach a photo of the shirts so you can appreciate how precious they are. The shirts are $10 with all proceeds going to MADD. If interested, please e-mail Jennifer Smith at jensmith@satx.rr.com with the size and quantity you're interested in. She will respond to you with further instructions on where to send the check. The deadline for ordering t-shirts will be end of day Friday, May 15th. Thanks for your support.

If you live in San Antonio, we'd like to encourage you to come out to Brackenridge Park this coming Saturday, May 16th at 9:00am to participate in the Walk like MADD event. Let's support Mothers Against Drunk Driving since they will be by the Lopez family's side for life. The "All for Ava" team has been formed so please join this team and look for the army of pink shirts when you arrive.

To join the team, please click on the following link or paste this link into your internet browser:

http://support.madd.org/site/PageServer?pagename=wp1_san_antonio

Click "Participate" --> "Join An Existing Team" --> Select the city "San Antonio" -->Type in "All for Ava" in the Team Name field and click "Search for a Team" --> Search results will appear and once you click on the All for Ava team, just follow the registration instructions.

We look forward to seeing you there!

Jack's day

2009-05-10T00:27:00.000-07:00

Today was Jack’s day.

His dad returned to coaching the pitch & Tee baseball team today, and Jack played really well.
He learned how to ride a bike for the first time, and he was beaming… and so was his father.
Both of his parents got to give him good night kisses and good night hugs tonight. This was the first time that this has happened in more than two weeks. And tomorrow will be the first time that he and Isa will awake in the morning to have both of their parents in the house to give them good morning kisses and good morning hugs (Beatrice has hospital duty tonight).
I am glad that you had a good day Jack. You deserve it.

Happy Mother’s Day everyone. Happy Mother’s Day Traci. I am sure that this one will be very special.

Please leave this day to them and take this day for your own families.

fw.

Longing to hear your sweet voice, Ava...

2009-05-09T03:56:00.000-07:00

Thank you to everyone who was at the rally last night, in person or in spirit. It was such a great event. Jennifer, Jennifer, Kerri, Marty and others… we are all very appreciative of your efforts. It was a great thing for Traci. It was a great thing for the Lopez family. It was great for all of us. Please remember to put pressure on your local politicians regarding this case. If by our efforts only one life is changed, then it is worth it.

Housekeeping: This Sunday is mother’s day. The Lopez’s would like for you to focus on your families this day and not concern yourselves with them. They are going to take the day for themselves as well. Code break: Let’s give them a day without phone calls or visitors. Don’t worry… food arrangements been taken care of by a neighbor of theirs. You can restart supportive efforts anew on Monday morning, because they are still needed. Great job everybody!!!

I am sure that many of you have heard in the news that it has been one year since the devastating earthquakes in China’s Sichuan province, where many thousands of people were killed and a region devastated. I was listening to a piece on NPR this evening on my way from my work hospital to Ava’s hospital. It was a radio segment of an artist who was recording the sounds of the rebuilding and putting it to music by incorporating the voices of some of the displaced children.

I am sure that many of you are now thinking… “where is he going with this, and what does it have to do with Ava or the rest of the Lopez’s?”

Well many, many children have been displaced from their homes (and from their parents) to be placed in “relocation schools.” Many of these children come from rural areas of the country and do not have ready access to regular communication with their parents. The recording artists came across a boy who sang to them a Chinese sonnet a cappella. The story of the sonnet is that of a child who is displaced from his mother, and he is unable to speak to her. So he sings to the moon and asks the moon (because he knows that his mother can also see the moon) to tell his mother that he loves her, because he is unable to do it himself. The artists took the recording and found his mother and played it for her. She broke down in tears at hearing it and replied, “I will always support you.”

I am sure that she cried for many reasons. She cried for the longing to see her son again. She cried knowing that he was alive and well. Previously, her pain was likely held back by the emotional restraint that we all exhibit much of the time. Hearing her son’s voice caused her emotions to flood (joy, sadness, desire, hope) and the tears became a sort of emotional spillway for her.

It struck me (listening to this piece) how similar Ava and Traci’s story is to this (and Manny, too). Here is this boy, who loves his mother dearly but is unable to communicate it to her and asks a medium (the moon) to convey his love because he is unable. He knows that they still share the moon, despite the distance that separates them. And then there is the tearful (for many reasons) mother who says, “I will always support you.” This statement implies so much… coming from a parent. It says, “I will freely, and without hesitation, give whatever I have, for you.”

Here is Ava, lying in a hospital bed, physically two feet from her mother and yet at the same time she is a thousand miles away and unable to give even the slightest gesture indicating that she is aware that Traci is with her. But Ava is there… and we all know it. And she is asking the moon, “please tell my mommy that I love her, because right now I am not able.” And there is Traci saying, “I will always support you.”

Arriving in Ava’s hospital room this evening was such a great way to end the week. She was wide awake and appeared to be just looking around the room. She still does not track objects, but her eyes are aligned. What does this mean? It is unclear what Ava is registering from her environment. She does not respond to visual stimuli. If you were lying still with your eyes open and something came into our field of view then your eyes would turn in its direction to focus on it and see what it is. Ava does not do that… yet, and consequently I am not sure what she registers or if she can even see. But there is the alignment. You know how when you are talking to someone and they totally glaze over (or maybe that is just when they are listening to me when I get a case of verbal diarrhea) you can see it in their eyes. They get kind of a “thousand yard stare,” like their two eyes are not even focusing on the same thing. People who are blind will often appear to be looking in opposite directions completely. They lose the visual cues that allow them to align their eyes so that they don’t have double vision. Prior to tonight, this is how Ava appeared to me… but tonight, her eyes were aligned. She looked like she was looking around the room. She still did not track on objects that were put in her line of sight, but this was better than two days ago, when I saw her last. And two days from now she will look even better… and two days more… and two days more… until, “do you remember when Ava was in the hospital and we were praying for her recovery? Wow, look at her now!”

Tonight I felt, “she is going to make a full recovery… 100%” And inside I smiled… and outside, too.

Ava's Road to Recovery begins at Christus Santa Rosa

2009-05-08T01:06:00.000-07:00

Today was Ava’s first full day at Christa Santa Rosa Hospital, and she apparently had a full schedule… OT (Occupational Therapy), PT (Physical Therapy), Speech Therapy, and her favorite today… a bath. Manny told me that she had a good day and continues to do well. Thanks to those who included links in their guestbook entries to the news clips so that people could see her, as well as Manny and Traci.

The “All for Ava” Rally this evening was very powerful in so many ways…

Seeing so many people wearing pink, in support of Ava.

Seeing all of the children running around, reminding us of why this is so important.

Seeing the number of people that came from other communities to show support.

Seeing the kids with posters from their schools.

Seeing people who had come sharing, talking, hugging, crying… together.

Seeing the generosity of others, wanting to contribute to this cause.

Seeing the news media’s interest in this story.

Seeing the number of people who came together to make the rally happen.

But the most powerful things at the rally…Manny’s mom, Beatrice… Jack… Isa… and Traci.

Jennifer, Jennifer, Kerri, and Marty did a great job getting this together with the help of many, while I have been assigned only the most envious jobs. Tonight I had the pleasure of picking up Traci and escorting her to the rally. When we got into the car to go to the rally, she was quite apprehensive about going, about seeing Ava’s pictures, about seeing everyone, and about the media coverage and about them wanting to talk to her. I joked that she should just consider me her body guard, but “God help us if we actually need one.”

On the way to the clubhouse we discussed how to handle the media if they start asking about controversial things and had agreed upon a signal for us to intervene, if things started to get overwhelming. Fortunately, the signal was never needed.

As we walked up to the Roger’s Ranch clubhouse the blown-up pictures of Ava prior to, and after her injury were unavoidable. Traci started to cry and said that she wasn’t sure if she was ready for this, but after a minute or two, she reiterated what I have heard her say many times over the past weeks, “I can do this. I have to be strong for Ava,” and she was.

The environment was almost carnival like with the news crews and reporters. MADD getting petition signatures. The shirts, the buttons, the ribbons, the balloons, the music, the posters, the signs, the people… It was awe inspiring to watch you all talk and mingle and be a part of a community of concerned people.

Prior to the planned speeches, Traci spent some time with Melissa Montgomery (Manager of Victim Services for MADD). Melissa was very sympathetic and gave Traci a long hug upon their introduction to one another inside the clubhouse. I was struck by the discussion regarding impaired driving in San Antonio and the discussions that they have already had with candidates for high ranking office in San Antonio and the mounting pressure to be more strict with our current laws and development of new legislation, as a result of Ava’s case. Melissa, reiterated… “Ava will be a poster child for MADD. It is hard for a story to be any more compelling than an 18 month-old girl, her sister and her mother being hit by a drunk driver in their own yard.” AGREED!!! She told Traci, we are here for you and for Ava “for life.”

Jennifer (my wife) spoke saying some very kind words regarding her love for the Lopez family and the honor it is to her to be their friend. Jennifer also recognized Manny’s brother, Tony, for designing the shirt logo and for printing the CaringBridge entries every day and taking them to Manny and Traci to read. “Keep your support coming.”

A prayer was said by a Deacon from a local church and a passage was read.

Kerri Thompson gave me a very nice introduction and allowed me the opportunity to share my thoughts with you. The following is pretty close to what I said…

“Thank you: State senator Wentworth, District Attorney: Susan Reed, Melissa Montgomery: MADD, doctors and nurses of University Hospital, especially the Pediatric Intensive Care Unit, and the Rogers Ranch Community and all of you for coming to support the All of Ava rally.
Jack, Isa, Manny’s mother, Beatrice, and Traci Lopez.

Two weeks ago to the day, on the 23rd of April, a Hit-and-run drunk driver carelessly and irresponsibly left the roadway, jumping a sidewalk and hitting Traci Lopez, Isa Lopez, and 18 month-old Ava Lopez while they were in their side yard, enjoying time with each other. The psychological effects struck deep to the Lopez’s, the Rogers Ranch Community, and concerned parents across the United States.

The tragedy of this incident is apparent to all. On the evening of the 23rd of April my heart broke as I watched my friend of 15 years and neighbor try to breathe his own life into his 18 month-old daughter as he gave her mouth to mouth resuscitation. Consider the emotional agony.

My heart broke as I watched Traci Lopez weep uncontrollably for her daughter, despite her own injuries. My heart broke as I watched Isa and Jack Lopez watch in confusion as their sister was taken away and their parents were in a state that they have never seen before.

Ava Lopez was air-lifted to University Hospital were her injuries included a severe head trauma with a skull fracture and large amount of bleeding into her head. She also had multiple rib fractures, a pulmonary contusion, and an adrenal hemorrhage. Ava’s prognosis upon arrival to University Hospital was very poor and it was thought that she would not survive. Miraculously Ava has survived, and her body is healing well. Unfortunately Ava’s mental state remains in question. She does not respond to her environment or her parents. It is unclear whether Ava will ever progress beyond where she is right now, which is the equivalent of a newborn infant. However, our faith remains strong. And we have gathered here tonight to say that we believe in you Ava.

I have spoken at length with the Manny and Traci Lopez about this evening and the message that need to convey. Manny and Traci know that Ava represents all of our children. If this can happen while standing in your side yard, then it could have happened anywhere and to any of our children, any of our families. While we gather tonight to pray for Ava’s recovery and for the Lopez family, we also gather as a community from different communities because symbolically Ava is our child, and had this happened to any other child in any other community it would have been just as tragic. While it is emotionally painful to gather for this reason, just imagine if there had been a funeral instead.

This rally is to increase awareness of the safety of our children within our communities. Our families should be able to feel safe in our own yards and neighborhoods.

This rally is to bring attention not only to drunken driving or driving under the influence of other drugs. This rally is to call attention to the carelessness regarding driving that surrounds us in our own neighborhoods… speeding, running stop signs, failure to yield to school buses, driving while using the cell phone and any number of other driver distractions.

The communities in which we live are extensions of our homes. Our children, nor us, should live in fear of a driver, carelessly operating a 4000lbs vehicle. Operating a motor vehicle is a responsibility that we cannot take lightly. We all know who is going to pay the price when a 4000lbs vehicle going 30-40 miles per hour collides with a 25 lbs child, and her picture is right here.

Ava is a real child with real parents and they live in this very community… but it could have just as easily been your child. While the driver that hit Ava was intoxicated, it could have just as easily been texting on a cell phone, running a stop sign, etc.

This rally is to call attention to the numerous children who are injured or killed every year in such tragedies. If by our efforts, we only prevent one injury or save one life, then it will have been worth it. For that one life may be your own child.

May this rally serve as a reminder to all of us to be especially mindful of the responsibility that we bear as drivers.

Let this rally serve as a call to action within our own communities to be more aware of our children and their surroundings.

Let this be a call to action to push for stricter traffic control and enforcement n our communities.
Let this rally be used as an impetus to support MADD and similar organizations in their push for stricter drunk driving laws and enforcement to serve as a deterrent to others in an attempt to protect our families.

We are here tonight to let the Lopez family know that we are here for them and that we believe in Ava. We are here tonight to spread awareness of this issue and to make people think about their actions when deciding whether or not they are okay to drive and what they are doing while they drive. Please continue to wear your Ava buttons and t-shirts and spread the word about Ava’s story to bring awareness to this issue.”

At the beginning of the evening there was no expectation that Traci would speak tonight, but it was so moving that she did. It was inspiring to see her strength in the face of emotional adversity. What more powerful message than to hear Ava’s mother speak on behalf of her daughter? It was so great to see Traci address all of us because it told everyone that she was emotionally strong and gave us reassurance and comfort to see her strong and well. It allowed everyone an opportunity to share with her, to be with her, to be a part of her and her pain. I looked out into the audience while she was speaking and saw so many teary-eyed faces. I know that their hearts pained at the thought of having to live the hell that the Lopez’s have been through these past two weeks. It is so very important for us to feel that we are a part of this, and it is very important for you to realize that you are.

Afterward, I could see the relief in her face and the peace that being with all of you tonight brought her. She said afterward that she was really glad that she was there. While we did not have much opportunity to talk of it later, I am sure that it was emotionally cleansing to have an opportunity to thank you all personally and to be with so many people that love them and are praying and pulling for Ava every day.

I was glad for her tonight and proud of all of you for filling her with so much love and encouragement. After the speeches were finished, Traci had a “receiving line” that continued for the next hour and a half. She left exhausted, but was renewed. Thank you all for coming tonight and showing your support for the Lopez family.

Special thanks to Jennifer, Jennifer, Kerri, Marty, and others for organizing such a wonderful event for all of us. I am only sorry that it was for this reason. I am honored to be associated with you all.

“All for Ava”

fw.

"Two steps forward" day

2009-05-07T00:28:00.000-07:00

Today was really a great day for Ava and the Lopez family! This was definitely a “two steps forward” day.

Ava did well last night and was transferred to an in-patient rehabilitation program at Christa Santa Rosa Hospital, in downtown San Antonio. She was transferred in the morning, with much of the day being devoted to “settling-in.” Afterall, this will be there home for the next 5-6 WEEKS!!! This is the duration of time that they were told to anticipate Ava being a patient there.

Despite the length of time, the two of them were on cloud nine today… well, floor nine (room 9212)… same difference. They were very relieved that Ava was well enough to leave the PICU and is beginning this long process called, “rehab.” Many of the medical issues that have been plaguing them over the past 1-2 weeks are behind them now (intracranial pressures, breathing issues, infection, elevated white count, seizures, muscular spasticity, vomiting, tube feed difficulties, low sodium levels, etc). The uncertainty of her fragile medical condition is now not so uncertain. Ava will survive. This has brought much relief to the Lopez family. Manny said this evening that today he felt his shoulders relax knowing that they are moving on to the next phase of her recovery.

As you get off of the elevator on the ninth floor, there is a panel of windows immediately to your right that look out the front of the hospital. The floor is brightly colored and the sunlight coming in through the window makes it seem that much brighter on the ward. The nurses station is to your left and is positioned in the center of the ward. Ava’s room is straight down a short hallway to the left of, and behind, the nurses station. Her room is about the second or third door on the right. When arriving in Ava’s new hospital home this evening, I felt like I was in a child’s bedroom, with a few small hospital type devices on the wall. As you come into the room there is a sink, counter and mirror to your right and an armoir against the left wall. The room is fairly small but big enough for Ava’s crib/hospital bed, a small vinyl love seat, a rocking chair, and a folded-up roll-away bed like you would get at a hotel. The opposite wall has a small ledge at about waist height that is loaded with stuffed animals and cards. On the right half of the opposite wall is a window that looks out, into the surrounding buildings. The walls are covered with posters supporting Ava with many, many signatures and words of support. Taped to the wall, near the ceiling there are childrens drawings taped side by side nearly circling the room. Soft, classical music plays on an i-pod in the opposite corner of the room.

As you come into her room you approach the foot of her bed from her left side. Ava’s hospital bed is like a tall crib with side rails that lower all the way to the bed level. 10-15 stuffed animals are at the foot of the bed. Two rosaries are pinned to Ava’s pillow. A silver one with crystal beads is pinned to her left and a plastic one with pink beads is pinned to her right. A photograph of Jack and Isa is taped facing Ava, above the stuffed animals at the foot of the bed. A single fluorescent ceiling light is above the bed. The brightness of the flourescent light is slightly muted by a light covering which shows the underside of three hot-air balloons in the sky. But the highlight of the room is Ava, of course.

When I walked in tonight she was “all dolled-up.” Her hair was up in pig tails. She was wearing a pink Disney princess pajama gown featuring Cinderella. Her eyes were wide open! They would occasionally start to drift downward and her eyelids would start to close, then she would force them open again, to start the process all over, like a small child that is fighting sleep. It is still unclear what she is registering, and she is still not tracking objects or people, but she looked great! Consequently, Manny and Traci also looked great. Manny and Traci gave an interview today with Karen Grace that aired on the local 10pm news. Rather… I should say Traci gave an interview tonight. They showed several clips of Ava, as described above. Search for it on the internet. If anyone finds it, then please post an entry into the guestbook for everyone else to check it out. She looks so cute!! I mean it!! Sorry, but it is just after midnight now and I have to get up in less than 6 hours so if someone could find the link, then we would all be greatful. Assuming that there is one, of course.

Jennifer Wiedenhoefer, Jennifer Smith, Kerri Thompson, and Marty Harkleroad (with the help of many others) have worked very diligently to organize an “All for Ava” Rally for today, Thursday, May 07, 2009 at about 6:30pm at the Rogers Ranch Clubhouse. Please come and show your support for Ava and concern for children everywhere that continued to be injured by drunk drivers and other carelessly driving people.

As always, Manny and Traci, and their families are so very, very, very appreciative of the support that you have given them. They have said many times that they have been overcome by your love and generosity and have been brought to tears because of it. Please keep them and Ava in your prayers. She continues to have a long way to go and your prayers and support will help get her there.

fw.

Tough road to rehab ahead

2009-05-05T23:59:00.000-07:00

Ava’s body continues to heal, thanks to your prayers and support for her. She was taken off of the oxygen entirely today and was breathing only room air with a little “blow-by” oxygen (This is just where they let oxygen blow into the air near her face). She tolerated this very well. Her white blood cell count has continued to come down. It isn’t quite normal yet, but has improved a lot and should continue to do so. Her biggest problem over the past day or two was her intestines not working too well. Today she continued to poop, which is good. She was also taken back up to full tube feeds. If she does well tonight, then she should be ready for transfer from the Pediatric Intensive Care unit tomorrow to an inpatient rehabilitation program at Christa Santa Rosa Hospital. AMAZING!!!! Thank you for your prayers.

Now… we have briefly discussed this before… 1. “72 hour window”. Check. 2. Extubation/Off the ventilator. Check. 3. Discharge from the PICU. Check. Ava will have met all discharge criterion to get out of the PICU. It is possible for her to breathe, be nourished (through a feeding tube through her nose), and get rid of waste products (pee and poop). Check… However, the road to recovery will be long and rehabilitation will not be easy. Today she should be transferred to an in-patient program focusing on her rehabilitation. She will likely be there for a few weeks, maybe longer, before being able to come home.

It remains unclear what Ava is registering from her environment. While the broken parts of her body have continued to heal, Ava’s personality is yet to be revealed to us. It is very important that we remember to keep the Lopez family in our prayers and continue to offer aid where we can. When she finally does come home, caring for Ava in the hospital will be different than caring for Ava out of the hospital. The hospital environment, especially the PICU, is geared for support. No one knows what the pace of her recovery will be, and it may be slower than her meteoric physical recovery from 23Apr09. If this happens to be the case, then things have the possibility of becoming emotionally difficult for the Lopez’s. Without our continued support it would be even more difficult. Care for Ava could potentially be like caring for a 25 pound newborn. What were once “simple” tasks with an 18 month-old (e.g. bathing, feeding, changing clothes, etc) will become much more challenging. This may be compounded by the fact that there are still two other young children at home.

I suspect that one of the reasons that so many are following Ava’s progress is because they have an “Ava” in their life, somewhere. They know that if the Lopez family was disrupted while picking up grass clippings in their side yard (about the safest place that they could be), then we are all at risk of having our own lives “disrupted.” The news reports could have just as easily been about any child you know, and it would have been equally tragic.

Please know that I am not trying to be a pessimist, but I am very concerned that many of the people who are following this journal will see “Ava was discharged from the PICU!!” and think, “all is well, time to return to our normal lives.” While a degree of normalcy must return for everyone, including the Lopez family, we must remember that “normal” for them will not be “normal,” at least not for a while. These people are our friends, and they will need us. The process of grieving and adjusting to this horrifying incident has not yet run its course. I suspect that while the Lopez’s are elated that they have come so far, there will be times that they reflect on what has been taken from them. Those days will not be so joyous, and someone needs to be there to walk with them.

It reminds me of a religious story… A man dies. He has the opportunity to look at his course in life as footprints on the beach. One set were his, another set belonged to Jesus. The man noticed that during the most difficult times in his life there was only one set of footprints on the beach. He inquired… “why would you leave me during such difficult times?” The reply, “I would never leave you. It was during those times that I carried you.” I do not want to come across as being overly mellow-dramatic, but I think of the Lopez’s and can’t help but to interject my own life into their circumstances and think of the loneliness and sorrow that I would feel from time to time… will feel… from time to time.

I have seen the most amazing good spring up from you. People from far and wide have identified with the Lopez family tragedy and have offered the most incredible love and support. I have been inspired and my life enriched because of your generosity and goodness. Let us remember that their need for support does not end tomorrow.
We must not forget. We cannot forget.

fw.

Join us for the All for Ava Rally

2009-05-05T22:43:00.000-07:00

All for Ava Rally

Thursday, May 7th 2009

6:30pm

Rogers Ranch Crosstimber Clubhouse (Adjacent to the pool)

*** Come support Ava's fight for life ***

Sweet Ava t-shirts and buttons will be available for purchase. A donation on Ava's behalf will be made to the M.A.D.D. organization

Due to limited parking, we encourage residents of Rogers Ranch to walk or car pool to this event. The Lopez family can't thank you enough for your continued love and support.

Manny goes home

2009-05-04T22:24:00.000-07:00

Today’s entry will be short.

Ava continues to make small gains regarding her breathing and overall recovery. Her tube feeds were stopped for a little while but restarted again after she had two bowel movements today. Yeah, Ava! Who would have thought that such a basic bodily function would be such a triumph? Well, it is today! The plan is to get her to an in-patient rehabilitation facility later this week.
Traci is spending the night with Ava at the hospital, and Manny is spending his first night at home since Ava was injured on 23Apr09.

Go Lopez’s!!!!

fw.

Ava's distended belly...needs some relief

2009-05-04T00:19:00.000-07:00

What a difference a day makes. Seeing Ava this evening was great! She looked great!
Today didn’t start great, but it ended well. Manny told me that her belly was looking distended this morning, and she looked uncomfortable. Her pulse and blood pressure were also elevated, and her belly was tympanic. Tympany is the hollow reverberation that a drum has when you hit it, but duller, kind of like thumping a watermelon. When the abdomen (stomach/intestines) fill with air to the point that the abdominal wall is tense, then tympany results. You tap on the belly and it makes a kind of hollow sound. This can be worrisome because it usually means that the patient has a bowel obstruction or an ileus.

What is the difference? A bowel obstruction is usually mechanical, meaning that something is blocking it. It may be twisted (volvulus), stuffed inside of itself (intussusception), pushed through an area that it isn’t supposed to go through (hernia), or be pinched from the outside (scar tissue or adhesions). There are some other causes also, but less likely. As it is, she doesn’t have any good reason for having a mechanical obstruction. An ileus; however, is just where the intestines aren’t working very well for a little while. It is like they are asleep and are having a hard time waking up. The intestines need to be awake for anything to get through; otherwise, it just keeps building up until it comes back up the direction that it came in. That is what happened early this morning when Ava threw-up on Manny. It looked like used “coffee-grounds.”

When medical people hear “coffee-ground emesis (vomiting)” it means one thing… blood is in the stomach and the stomach acid is making it look like coffee grounds. This is most likely because of her ICU hospitalization. It is common for patients to get a gastritis (gastro – stomach; itis – inflammation) or inflammation of the stomach with resultant bleeding. She was started on medicines today to minimize this problem, and they generally work well.

Despite her vomiting, her abdomen was still distended and her pulse and blood pressure remained high. A tube was put down her throat and into her stomach to suction things out. They removed a lot of air and fluid and immediately her distention went down and her vital signs improved… Oh… and Manny felt a lot better, too! This happened one other time in the day, with the same treatment and same result… and Manny felt a lot better.

The extra air is likely related to the oxygen that she is still getting by nasal canula. Invariably some of that air will be swallow and build up in her stomach, especially with an ileus.

Now all of this does have an unwanted side-effect. Her discharge from the hospital may be delayed. Because of the ileus, she can’t take full tube feeds and intravenous fluids needed to be restarted. She won’t be discharged from the hospital if she still needs IV fluids and won’t be discharged from the hospital if she can’t be fed properly (via the nasogastric tube).

Her breathing is better. She still drops her oxygen saturations some, but not as deep and not as long. She still needs oxygen but not as much. These are all good things.

One other problem arose today… her white blood cell count (which is an indicator of infection) was pretty high today, over 26,000. That is pretty high. It is usually between about 4,000 and 10,000. They removed the big IV in her groin/leg today because that could be a source of infection causing her high white count. She doesn’t look infected otherwise, and doesn’t have a fever, so hopefully this will help get her white count back down. Unfortunately, they still needed an IV to give her medicine and fluids and had a difficult time getting IV access. They eventually ended up putting on in her foot. It is working and that is what matters.

As for her neurologic status, she is looking much better. The spasticity that I have described in prior entries is improving. Her arms and legs are much more relaxed. Tonight she looked like a sleeping child, complete with an occasional yawn! It was great seeing her look so good.
Manny and Traci are also looking good. You can see their tensions start to fade. It is a wonderful thing!

I was again instructed to pass along how indebted they feel to all of you for your support, compassion, and love. They truly believe that Ava would not be doing so well if it was not for your prayers and love. They have been reading your guestbook entries which have continued to rejuvenate their spirit and determination. They feeled blessed to be able to call you “friend.” Much appreciation and affection.

Please continue your prayers and efforts. Ava is not running down the sidewalk yet.

fw.

Recovering from the pneumonia

2009-05-03T01:25:00.000-07:00

I mentioned yesterday that last night was an important test for Ava, given that this was her first night without the ventilator. That she remains off of the ventilator is certainly a good sign, but last night was not wholly uneventful. Manny sleeps in her room with her in a heavily vinyled hospital chair that converts into a single person bed. It is positioned directly to her right with only enough room between vinyl bed and her hospital bed to put his feet down and stand up to help her.

While she is no longer on the ventilator, she is still recovering from the pneumonia and the pulmonary contusion (big lung bruise), not to mention several broken ribs. These things have caused her to have some thick lung secretions. While she was on the ventilator she required frequent suctioning. Frankly it was a little easier then. The endotracheal tube goes directly to her lungs. The tubing connected to the ET (endotracheal) tube has a long, thin tube attached to the end of it. In a way it is like a retractable antenna. Most of the time it is fully withdrawn from the ET tube. When Ava needs suctioning then they just attach the suction to it and push it forward and into the endotracheal tube, and hence, into the lungs, where the secretions are. It will clear some of the secretions out and allow her to breathe a little easier for a while.

Eventhough the ET tube has been removed, the pulmonary problems have not completely resolved and consequently she still needs frequent suctioning. This is compounded by the fact that Ava does not have cough mechanism to clear the secretions (I don’t fully understand why). If you or I had some gunk in our lung we would give a good cough and hack it up. Ava is unable to do this currently.

Through the night last night, Manny described hearing her breathe with a deep, coarse, raspy sound that he could hear from any location in the room. Her oxygen saturation should be in the high 90% range, essentially all of the time, but last night was dropping into the low 80% range fairly frequently, and that was with oxygen supplementation with a nasal canula (small tube that blow oxygen into your nostrils). Not that it is extremely harmful to drop in the low 90s or 80s for a short period of time (minutes), but it isn’t “normal.” And she needs to be “normal” before she will be released from the hospital. The concern for Manny last night was that if she continued to drop her oxygen saturations, then she would need to be put back on the ventilator, which would require reintubation. Remember… “the only thing worse than being intubated once is being intubated twice.” This was Manny’s concern. Fortunately it wasn’t required.
Without the endotracheal tube in place, you take a long segment of suction tubing (which for her is about the diameter of a stir straw) and push it through one nostril and into the back of the nasal cavity. You keep pushing until you have put enough in to reach into the lungs. You don’t really know if you are in the lungs until you apply suction and see what you get. Of course when you apply suction it is like trying to breathe with a vacuum over your mouth, because the suction is pulling all of the air out, too. This process is repeated over and over until you feel that you have satisfactorily removed enough gunk to allow them to breathe better.

The suction canister for the secretions is mounted to a wall suction device. The canister is clear with markings on the side to allow for measurement and generally holds about one liter. Manny described to me that her early morning secretions were very thick and looked like old blood (brownish). Her later secretions were thinner but still… (Manny searched for the word to describe it, glancing around the room a little bit as if he was going to find the word that he was looking for written on the wall) “…here,” as he pointed to the suction canister mounted to the wall. My reply…”dude, that is gross. It looks like dip spit.” It even had the little frothy layer on the top and the chunky stuff on the bottom. Manny was a little concerned that the women reading this wouldn’t know what that looked like, but I said, “Manny, most of these women are from Texas. They know what dip spit looks like.” Needless to say, if they were suctioning that out of her lungs, no wonder she wasn’t oxygenating well.

Most of her day was actually quite peaceful. She was oxygenating well with intermittent suctioning and only small oxygen requirement by the nasal canula. He described to me how peaceful she was when Traci was lying in the hospital bed with her today. She seemed to settle herself much better when Traci was lying beside her. I am sure there was the familiarity of Traci’s scent, the melody of her voice, the warmth of her body. So interesting how soothing these things must be to her. I was told that the only time during the afternoon that Ava seemed to have more difficulty was when Traci got out of the bed to leave.

At the hospital this evening, the thing that struck me was how natural and routine “this life” is becoming to them. Their anxiety about the survival of their daughter has been replaced with the routine of her care. Positioning her, suctioning her, stretching her arms/legs, changing her diapers, tube feeds, etc. This is becoming their new life. Manny talked with the nurse (calling her by her first name) about suctioning and the raspiness of her breathing like it was just the routine of the day. They were colleagues caring for Ava. It struck me that this is their new life and could possibly be this way for some time to come, and while I am hopeful and expecting that she will continue along her recovery, it is at least possible that she could grow into an adult child, still requiring the same level of care.

I mentioned the ease at which he addresses these issues and cares for Ava now. He replied that this is Ava now and it feels natural, almost like this is how it has always been. “I almost don’t even recognize that Ava anymore,” pointing to a photograph taped to the wall of an active and lively 18 month-old girl with brown hair and big eyes.

We spoke of the lifetime that has been lived in the past nine days. If ten days ago, you would have told them what “their new life” was going to be on 02May09, the reply would have been a laugh… “No way! You’re crazy.” I spoke at a cancer event this evening (Relay for Life) and related that “right now, somewhere in America there is a person driving down the road and thinking about their distant future life… Where they will be, what they will have, what they will be doing, et cetera… and 10 seconds from now a driver is going to vere into their lane, and in a fraction of a second their life is totally different than the 20 or 30 years that they were mentally planning out just seconds before.” I have recounted such an example to other people, for other circumstances… I just never truly thought that one of my dear friends would be the example.
Now don’t fire me just yet. I am very optimistic regarding Ava’s recovery, and I fully expect to watch her grow up like every other kid in the neighborhood, but for a while their life will be different than what it was just 10 days ago.

“Their life will be different.”

“Their life” will be different.

“Their life.” As Jennifer and I were driving Traci back to her house tonight we spoke of “their life.” Jack and Isa. Manny and Traci both mentioned how they are seeing definite signs that Jack, in particular, is having some difficulties with this transition to a “new life.” He is too young to be able to even think about the verbal construct required to explain his emotions. I am sure that without his conscious awareness of it, his thoughts must be “what happened to my sister? What happened to my parents? What happened to my life?”

We candidly discussed that no degree of community involvement can replace the normalcy of having his family unit intact. I am sorry for you, Jack and Isa. You hurt too, and you probably don’t even know that that is what it is… hurt.

I know that things will either restore themselves to the way they were, or they too will acclimate to their “new life,” but it doesn’t make it fair… It doesn’t make it right.

Please keep them in your prayers.

fw.

Dodgers Love and Support Ava

2009-05-02T13:00:00.000-07:00

Two steps forward

2009-05-01T23:29:00.000-07:00

Today we took “two steps forward.” Ava was taken off of the ventilator and extubated. Hoorah!!!

Today is a day to celebrate. We have many days ahead of us that will be difficult, but today we should be happy that we have met this very important milestone. Your prayers have been very key to Ava’s recovery and in giving Manny and Traci strength to endure this hardship. Tonight we give thanks.

The work is not done and tonight is still important. If she does well through the night and does not have any breathing difficulties, then it is very unlikely that she will need it again. Even Manny acknowledged that if things go well tonight that he will feel more at ease. I am praying for that for all of them.

Today we took “two steps forward,” and we are thankful. Tomorrow we start again.

fw.

I want my Ava back

2009-04-30T23:41:00.000-07:00

This is the third entry that I have written for this evening. Each time I have struggled with what to write, what to share, and what to keep private. My internal debate struggles between trying to be supportive, trying to give hope, trying to be the historian of this tragedy, and just trying to tell things how I see them. I will likely fail at some point if I try to do the first three. It seems to me that the beauty of something like this is the rawness of it. It is up to you to do with it what you will. It is up to you to see the goodness or ugliness of it. It is up to you to decide its value and impact on your own life. It is up to you how your life will be different because of it, if at all. I can only tell things how I see them. So this is how I see them…

Ava is still in bad shape, despite the gains of the past week. I think that it is important for you to understand Ava’s condition so that you can have a framework from which to work. Ava opened her eyes for the first time just a few days ago, and this was an amazing achievement, especially given that the discussion in the ER Thursday night was, “Prognosis is very poor. She likely won’t survive.” Ava has suffered a tremendous head injury and has an infarcted (dead) area of brain as a result. (We discussed this two days ago… the occipital lobe infarct). While Ava has opened her eyes, it is not the same as when you wake up your two-year old and they are a little disoriented. They look around the room a few times, thinking “where am I?” Looking inquisitively at you, thinking “who are you?” You know that they are registering their environment and will make the connection very soon and be the same loving child that you knew before they went to bed the night before. This is not so with Ava right now. She can open her eyes but stares blankly ahead. Her eyes do not track and it is unclear what she is registering. She has some spasticity of her arms and legs. Her fists are clenched tightly. Her arms are tense. Her legs are firmly extended and her toes pointed, as if she were trying to stand on her tippy-toes. These things are the result of a bad head injury. I am not trying to bring you down, but it is important that you know the reality of what is ahead of this family. Ava will survive, this is clear… and for this we must thank God, but the road that is before them now will likely be long, and all of us will be needed.

Ava has already had special shoes ordered to help flex her feet into a normal position and help minimize the contractures (shortened muscles) that will likely result from her immobilization and spasticity. The necessary physical therapy will be demanding. I helped flex her legs and arms yesterday. This is not like moving the limp arms and legs of your kids when they are asleep. This is the equivalent of you trying to move their arms and legs when they don’t want you to. Please do not be lulled into thinking that the sequence of events will be… 1. “72 hour window.” Check. 2. Extubation. Check. 3. Go home and life is grand again. This child has a lot of recovering left to do, and there will be many difficult days ahead for Traci and Manny both. We cannot forget this. They will need us even more in the coming months.

I went to the hospital to see Traci, Manny and Ava this evening. Jennifer had told me earlier in the day that Ava had several seizures through the night and that as a result, she would not be extubated today. I was disappointed and reminded of a conversation that I had with Traci last Friday evening. “Fred, do you think that she will be alright?” “Yes, but it isn’t going to be easy all of the time and it won’t happen right away. Recovery is often two steps forward and one step back.” This is how the past two days have been. Yesterday we were all so hopeful that she would be extubated today, only to find that not only was she not extubated, but now she is having seizures! One step back.

Ava was started on an antiepileptic medication today because of the seizures. As a result her ability to breathe on her own was affected early in the day, and she was not able to be weaned from the ventilator. She just couldn’t wake up enough to do it on her own. Her doctors offered to try again later in the afternoon, but Manny declined out of concern for her tiring-out and then needing to intervene in the middle of the night, when there is only partial staffing to address the problem. It is almost always better to address these issues early in the day, when there is full staffing, their minds are fresh, you can be better rested and have your wits about you in the event that you need them.

When I arrived in the PICU, I saw Traci sitting in a chair facing Ava’s bed, holding Ava. Ava was reclined across Traci’s lap and facing the doorway. The green and yellow lights of the multichannel IV pump was a backdrop, silhouetting her head. Traci had clearly just been crying. Her eyes were still wet and her face was somewhat reddened. Traci had her left arm supporting Ava’s head and neck and her right arm wrapped gently over her, caressing Ava’s arm and face. The endotracheal tube remained in place, with the piston-like sound of the ventilator in the background. Manny’s mom and Traci’s aunt Diane were standing off to the side of the room. Everything was so quiet. No one was speaking. Manny’s mom was standing to the side wiping a tear from her eye, watching Traci. Aunt Diane was also watching her, silently. The nurse was at the head of the bed adjusting the tubing from the ventilator. Traci was staring at Ava through teary eyes. I felt like I had just walked in after some terrible news, and that I was the only person in the room who didn’t know. I waited there quietly for several minutes before anything was said by anyone. I couldn’t help myself any longer, “How is everything?”
As it turns out the tears were joyful, as Ava had just been put in Traci’s arms again for only the second time since being hit by the car last Thursday. We sat and talked for a little while. Her emotions ranged widely. Anger and guilt, sadness and joy, hope and sorrow. So much pain still encircles them. So much uncertainty still lies before them. It is my belief that we need to continue to encourage Traci and Manny to talk openly about these things and not try to fix them. They are entitled to their sorrow and need to get it out if they are ever going to be able to get past it. But what do I know?

I just know that I sat there with Traci tonight as she cried, “I want my Ava back,” and realized that I couldn’t make that happen. All I could do was listen, and that that was okay. Please continue to pray for them and hope that tomorrow we take two steps forward.

fw.

Care Calendar

2009-04-30T22:49:00.000-07:00

First off, we can’t thank you all enough for the generous outpouring of love and support you have shown the Lopez family. It is overwhelming. We have all been forever changed by Ava’s story. As parents, we want to shelter our children from harm and make them all better when they’re hurt. Ava has an incredible team of doctors/nurses who are doing everything in their power to heal her. So many of you have called on our Heavenly Father to protect Ava and provide strength and healing. In just seven days, God has performed miracles and we know this is just a small glimpse of what is to come.
During these times of crisis, it’s wonderful to see humanity at its best. Many of us feel completely helpless and are yearning to do something. Manny and Traci have an incredible support system of family and friends around them, but it is our duty to ensure that we keep them healthy when their physical and emotional health is compromised.
If you or a few families would like to provide dinner to the Lopez family, please log on to http://www.carecalendar.org/ with the following credentials:
Calendar ID: 15804
Security Code: 9927

Once you have scrolled to the May calendar, you will notice that the word dinner appears every other day, beginning tomorrow, May 1st. Once you have found a date that works for you, make sure the word dinner is in red. If the dinner appears in green, then it is already covered. After you click on the red dinner, a screen will appear prompting you to enter helper information (ie. Name, Main Dish, Phone and E-mail). Please be sure to enter the Main Dish you are preparing to avoid overlap.

Our goal would be to have a 5-6 person dinner delivered to the Lopez home around 7:00pm every other night. In the event that a family member is not able to be at the home, a close friend will be there to intercept the meal.

This is one less thing the family would have to worry about as they focus all of their attention on getting Ava better.

If you have any questions at all, feel free to contact me (Kerri Thompson at 210-764-1252 or kerrithompsonaz@hotmail.com). Until we have a P.O. Box set up, you may send mail to:

The Lopez family
c/o Kerri Thompson
18414 Rogers Place
San Antonio, TX 78258

I will ensure everything is taken to the Lopez’ home.

As new needs pop up, we will continue to use the calendar for these requests. Thanks again for all of your love and support.

Awaiting Extubation

2009-04-29T23:48:00.000-07:00

Tina Fraser has made a very important contact for us that you all need to know about. Melissa Montgomery is an activist and speaker for MADD (Mothers Against Drunk Drivers). MADD is a group with much political clout and can help us make sure that this tragedy is not merely given lip service and forgotten. Far too many families have been affected by drunken driving and every effort should be made to put an end to it. If even only one life is saved by MADD’s efforts and our own, then it is worth it. Please e-mail Melissa.Montgomery@MADD.org telling her that you are concerned about Ava Lopez and the Lopez family and that you want the District Attorney to pursue this case, in an effort to prevent and deter future such tragedies. Please include your name, phone number and/or e-mail address. This is the equivalent of an electronic petition. Please do this for Ava. Much appreciation to Tina for getting this information.

Tonight we should talk a little medicine. For those of you who want the short and sweet… small gains continue to be made. They were not able to take Ava off of the ventilator today, but will try again tomorrow and are very optimistic that they will be able to do so. She is slightly more alert than yesterday, but is still not tracking people or things with her eyes. Her chest x-ray was a little better, but she continues to need suctioning pretty often to get some of the secretions out of her lungs. Manny and Traci’s spirits are very high. They look GREAT! (I feel like Tony the Tiger… “They’re GREAT!!”). They are so happy now that they know they will have a future with Ava, regardless of the obstacles they face getting there.

For those of you how are interested in a little doctor/nurse speak… read on.

I have mentioned previously about the endotracheal tube, the ventilator pushing air into Ava’s lungs, the need for the ventilator to push air into her lungs because she would not be able to pull air into her lungs on her own; given her injuries to her rib cage and lung. We should discuss extubation (removing the endotracheal tube and ventilator support)and weaning her from the ventilator.

Getting her through the “72 hour” window was objective number one. Check.
Objective number two is getting her off of the ventilator and getting her breathing without assistance.

Why is it so important? The longer the tube stays in, the greater risk of further infection and the greater chance of causing the trachea to scar and narrow. The longer she stays on the ventilator the greater the likelihood of damaging the lungs. And, of course, she must be able to breathe on her own in order to go home.

We rarely ever actively think about breathing. It just happens. Take a few slow, deep breaths with me and pay attention to the following…The diaphragm contracts and pulls the lungs down. The intercostal muscles (muscles that connect between the ribs) contract and pull the ribs up. These two things together do one thing… they increase the volume in your chest. The diaphragm goes down. The ribs go out. Physics again. If the volume in your chest increases, then one of two things must happen… either the air pressure in your chest goes into the negative (like trying to take a breath with your hand over your mouth and nose), or air gets pulled in (breathing). Fortunately for all of us, it is almost always the latter of these two.

Why even mention this? It is to help you understand why getting her off the ventilator can be difficult. If you have ever been sick and stayed in bed for a day or two, you know that when you try to finally get out of bed, your muscle tire very easily. You haven’t used them. Your body has quit wasting resources on what you are not using, hence your muscles weaken. Breathing is not much different. As the ventilator has assumed the job of getting air into her lungs, her diaphragm and intercostal muscles have not needed to work, hence they weaken.

So how do we know whether or not she can breathe on her own? Well, as you can imagine the only thing worse than being intubated once, is being intubated twice. The doctors/nurses would really like to assure themselves that she will be able to breathe on her own, and continue breathing on her own, before removing the endotracheal tube. This is not so simple as just shutting off the ventilator and seeing whether or not someone turns blue. The endotracheal tube is still in place. Have you ever tried to breathe through a straw. It takes a lot of work. It is impossible to sustain. There is a lot of extra resistance in pulling air through the narrow tube and for the extra distance that the straw adds. Doctors get around this by putting her on CPAP (pronounced “see-pap”). It stands for continuous positive airway pressure. The CPAP pushes just a little bit of air into the straw continuously, but only enough to overcome the resistance that the straw creates. This way it is much like breathing normally, without the straw.

Today, the doctors put Ava on CPAP and watched her oxygen saturation and how hard she looked like she was breathing to get the oxygen that her body needed. Things that they look for, other than oxygen saturation, are her rate of breathing and how hard she has to work to get the air that she needs. When a person, especially a child, is trying really hard to catch their breath, the spaces between the ribs indent, or get pulled inward. These are called “retractions.” This is what Ava was doing early in the day. The doctors know that if they were to take her off of the ventilator and remove the endotracheal tube that she would not be able to breathe like that for very long and eventually her muscles would tire and her oxygen levels would start to drop, then… she would need to be re-intubated. This is a form of respiratory failure. Not fun.
As it turns out the doctors tried again in the afternoon, and she was breathing more comfortably, but with a slightly increased rate of breathing. They decided to put her back on the ventilator and try again tomorrow.

If she breaths comfortably, then they leave it like that for a while, then give her a break, then try again later. Once they feel comfortable that she will be able to sustain her breathing on her own, then the endotracheal tube comes out. This is what we are hoping for tomorrow.

fw.

Hugs and heartbreak

2009-04-28T23:59:00.000-07:00

The things that I want to convey to you today regarding Ava’s recovery have the potential to make this a long entry. This is an upfront apology. Well, let’s just see where this goes… Hugs and heartbreak.

I had not thought too much of either of these things in Ava’s recovery prior to two separate conversations this evening. Let us start with the heartbreak.

I was speaking to Jennifer about her most wonderful visit with Traci, Manny, and Ava today at the hospital and our conversation took my emotions down a path that I was not expecting. Follow along with me. Like all of you, I have been (and continue to be) elated to hear of today’s earlier news. Ava is doing great, given the horrific abuse that her body has endured. She is opening her eyes, moving her arms and legs, then Jennifer told me that she just wanted to cry thinking about how confused she must be right now and not being able to explain it to her or relieve her of it. I had not thought of that much. I tried to imagine myself in the PICU room, watching her, seeing her look around the room through a cloud of injury, pharmacology, and youth. Her last recollections were of a happy time with her sister and mother… now this? It would be difficult enough to understand as an adult, and she is a mere baby. The irritation of the tape and tubing against her skin. The sounds, the commotion. The strange faces. The strange environment. The inability to escape any of it. We all understand the necessity of it and how elated we are to even be at this point given the direness of the situation less than one week ago, but how can she be expected to understand all of these complicated issues? My heart goes out to her and reminds me of another thing for which to pray… peace and solace be upon her.

Hugs. I spoke with Traci on my way home from work this evening. It was an extremely uplifting discussion that made me want to weep for them… with them. Today, Traci held Ava for the first time since this senseless tragedy began. At this very moment any mother who is reading this just crossed their hands over their chest and pressed firmly, their heart melting, for they know exactly of what I speak. Has your heart ever longed for someone so badly, actually yearned is a better word, that you felt empty inside and wanted to do nothing other than to hold them against you and never let them go? Having children I have on a few occasions witnessed their heartbreak and wanted nothing more than to hold them close in some vain attempt to absorb their pain unto myself and relieve them of their suffering, and I am not a mother. Having been an Obstetrician and Gynecologist for many years, I firmly believe that this is a relationship that few men can truly understand. Sorry guys, but I include myself in the “not truly understanding” group. While I don’t truly understand, I do understand that this relationship between a mother and child is special… very special. The comfort that is offered to both mother and child from a consoling hug is immeasurable. I have seen it first hand with Manny and his mom when they met that first night. I was not present with Traci and her mom, but know that the heartbreak and yearning were there from the accounts of others. And these are adult children… and then I think of Traci and Ava. Seeing her little broken, lifeless body on that ICU bed for days on end, without being able to hold her, I can think of no better word than “yearning.” How her heart yearned to hold Ava and remove this pain from her. How her heart yearned to hold her and receive comfort from it. How she yearned to see Ava awake and know that it would all be better soon. Ugh! It pains me to even think of it all… and I don’t even truly understand. I am sure that you have traveled with me and know the elation that my heart felt for both of them when Traci said, “I got to hold Ava today.”

fw.

MRI results...

2009-04-28T10:25:00.000-07:00

The latest word, as of 3 minutes ago...

"She is doing great! They stopped the Versed last night (Versed is the medication that keeps her sedated while on the ventilator), and... pause... pause... Fred, she just opened her eyes!!! She is moving her arms and legs and is looking around!

"Traci was in the room with him at the time. I can barely type, I am so excited for them... for all of us!!!

As for some residual medical issues...Her MRI of the brain from yesterday showed some "Right occipital lobe ischemia." The occiput (pronounced ox-a-put) is the the area of you head that contacts the pillow when you lay on your back. The occipital lobe of the brain is mostly responsible for vision and some speech functions. It is unclear at this time whether or not these areas are seriously affected. It may be unclear for a longer period of time given her young age and that she has not met many of these developmental milestones as of yet. Again, time will tell.

The MRI also showed some ligamentous injury to C1/C2. The cervical spine is numbered from the top/base of the skull to the bottom. The cervical spine has 7 vertebra and is number C1...C7, then thoracic, then lumbar, then then sacrum. C1 and C2 are unique vertebra. They are not like the others. Their function is critical to allowing you to look around, turn your head, look up/down, etc. Disruption or injury to this area can allow the cervical vertebra at that level to sublux or shift on one another. If that were to happen, then the spinal cord would be pinched and possibly severed. Any disruption of the spinal cord higher than C3, you are not able to breath without a ventilator and you would not have use of your extremities. To treat this concern for ligamentous injury/laxity she will wear a cervical spine collar for a few weeks or so. This is very similar to the cervical spine collar that Traci was required to wear after her injury just days ago. Again, Ava's young age benefits her and gives her a good chance of complete recovery from this.

As for her lungs, she continues on the antibiotics for her pneumonia and continues to be assisted by the ventilator. The ventilator assistance now is mostly being continued because of pulmonary edema (swelling of the lungs). The pulmonary edema would make it hard for her to breath on her own. The ventilator is able to generate more pressure and overcome the resistance of the pulmonary edema; therefore, push more air into her lungs. Her body should start getting rid of this on her own and will be excreted through her urine. The medical team will watch urine output closely. When she starts making more urine than fluid she is getting, then this is an indicator that the body is getting rid of the extra fluid, hence the pulmonary edema improves. They watch other things as well, but this is one of them. Hopefully tomorrow she may be extubated, but again... time will tell.

As for Ava's family. Their spirits are high and want me to convey to you how deeply indebted they feel to each of you for your persistent pray, compassion, thoughtfulness and understanding. They recognize that you have been their foundation of hope and love. Please know that you are also in their thoughts and that they feel blessed to have you as friends. Manny reiterated this point to me many times. "Please let everyone know how much we appreciate everything!!" "Yeah... I got it Manny. You're sorry you can't talk to everyone. Hugs and kisses all around... Yeah... I got it!... Yes, I am sure... I got it.... Manny sorry, buddy, but I gotta go... okay... I'll tell them..."

You get the picture.Please continue your prayers. fw.

Awaiting MRI results

2009-04-27T23:19:00.000-07:00

I spoke with Manny again this evening. His spirits sound high and he expressed optimism regarding Ava's condition.

As stated earlier the intracranial pressure monitor and EEG were discontinued earlier today. She had an MRI performed this afternoon, but the results will likely not be available until tomorrow.

As we spoke this evening I could hear the joy returning to his voice. He almost laughingly spoke as he described Ava holding on to his finger. This is indeed great news!!

She continues to be sedated secondary to needing to continue on the ventilator. These issues tend to be addressed day by day. The team comes to round in the morning. They discuss the events from the prior evening, most recent labs, vitals signs, current ventilator settings, etc and what the plan will be for the day. Sometimes the prior evening, etc gives them the green light to press forward on weaning certain medications and support, sometimes it results in a pause in therapy. Tomorrow will tell. Again, the most reassuring thing is that the "72 hour" window has come... and gone... Thank God!!

Prayers for Ava's continued healing and full recovery are needed.

Appreciation for being there for the Lopez and Southerington families can not be expressed enough. They feel blessed beyond measure by the kindness and thoughtfulness that has been expressed and displayed by all. I don't think that my keyboard would bear the typing that would be required to describe it all. Suffice it to say that they have been moved to tears by the sadness and joy that has come from such a senseless tragedy.

Continue to pray for Ava and her family. Your friendship will never be forgotten.fw.

72 hours has come and gone

2009-04-27T21:07:00.000-07:00

I just got off the phone with Manny. Firstly, the "72 Hour" mark has come and gone and Ava is weathering the storm. Her intracranial pressures are good, her EEG is good, her vital statistics are good, the doctors are optimistic regarding her recovery. A light appears.The plan will be to remove the intracranial pressure monitor tomorrow, followed by an MRI and start weaning her from the ventilator. She may even have the endotracheal tube removed tomorrow. This is amazing. I had chills when speaking to Manny and knowing how dire things appeared 72 hours ago.Manny commented that if anyone said to him 72 hours ago,"I can put Ava in X condition (where she is right now) or you can take your chances," then he would have said, "DEAL!!" He is very relieved to see her in the condition that she is in at this time, now that the 72 hours has come and gone. The 72 hour mark is typically the time frame that no further swelling should be expected and resolution should begin. This is why it is so uplifting to have her medical situation where it is right now. Please continue to pray for them.Secondly, he wanted me to convey to everyone how greatful their family is to have you all as friends. They have been overcome with the outpouring of prayers, love, and support from all of you. They are sorry that they have not been able to speak to each of you personally, and hope that you understand that their emotional bank has only so much in reserve and that it must be saved for her and them. I told him to shut-up. Not a one of us is offended, and if you are then I am going to beat you myself, and I am bringing with me a few thousand other people, so be prepared (this is where you can have a slight tension-relieving laugh).In sincerity, the Lopez/Southerington family is breathing a sigh of relief and knows that your thoughts and prayers played a role. Please know that you are loved by them and they could not endure such hardship without such a loving foundation of friends.Please continue to pray for a full recovery. All their love, The Lopez Family.fw.

Ava opens her eyes

2009-04-27T13:16:00.000-07:00

Ava continued to do well through the night. The Neurosurgeons removed the intracranial pressure monitor this afternoon, and discontinued the EEG (electroencephalogram) monitoring. They are very pleased with her progress.She will have an MRI done this evening to look at her brain tissue. The plans to wean her from the ventilator may be slightly delayed as she has a small pneumonia now.The greatest news of the day... Manny told me that she tried to open her eyes this morning!! Amazing! Given that she is becoming more arousable, she will need to be sedated to keep her from fighting against the ventilator.Keep your prayers coming, they have been working.fw.

Glimpse of Optimism

2009-04-26T17:06:00.000-07:00

Ava's intracranial pressure has stayed below 20. Thank you for your prayers. Currently it is around 16. The plan is to remove the intracranial pressure monitor at around 8pm (72 hours after the injury) if her pressures remain less than 20. They will likely do an MRI tomorrow and extubate her after that. Traci asked the doctor whether or not he was optimistic and he replied, "very!" Ava would still have a lot of recovering to do, but her injuries, including the brain issues, should fix themselves in time. Traci stated that this is the most at ease she has felt since this began nearly 72 hours ago. Your prayers are still needed. Please continue to pray for them and respect their need to focus on Ava and not be distracted by our good intentions (i.e. No calls, no visitors).Thank you for your loving concern and prayers for her full recovery.fw.

Uncle Tony's Gift

2009-04-26T12:00:00.000-07:00

Ava's Uncle Tony (Manny's brother) coined the phrase "All for Ava" and is the mastermind behind the beautiful sketch that was used on the t-shirts. Tony, thank you for pouring your heart and soul into this inspirational artwork.

Tough night

2009-04-26T10:03:00.000-07:00

Manny just called a few minutes ago. Last night was difficult. Ava's intracranial pressures went up to 26, but didn't stay there. Her intracranial pressure is now around 14. She was having difficulty with being ventilated, but that is also somewhat better, and she is anemic again. They want to get another CT scan but feel that she is too unstable. She now has continuous EEG monitor to look for any worrisome changes in her brain activity.All of us (you) are so appreciated by the Lopez family but they request that you pray for Ava and let them focus on their family today. Please resist the temptation to call or visit. Go to church, pray, let others know to pray, but allow them to focus their energies where they need to be during this critical time.Pray, pray, pray for them. Do not call or visit.Thank you for your love and concern.fw.

Please pray for Ava

2009-04-25T23:50:00.000-07:00

Manny and Traci are entering a very trying time. Ava's injury occurred just over 48 hours ago and the "72 hour" window still looms over them. This evening Traci called to let us know that Ava's intracranial pressure has increased to 19. The concern for irreversible brain injury is high when the pressure rises above 20. Everyone is obviously very concerned about them, but please allow the Lopez family some time to focus on their family. They are so very moved by the love and affection that people are extending, but feel more stress when they don't feel that they are properly acknowledging your concerns. We are all keeping our distance for the next day or so, but keeping our prayers close to them. Their only need and request at this point is for all of us to pray for Ava. Either Kerri or I or someone will update this as soon as we know something more. This will most likely not come until they call us, because we are keeping our distance too. Please pray for them all, for their lives are one. Manny, Traci, Ava, Jack, Isa please know that you are loved.

The first 48 hours

2009-04-25T17:43:00.000-07:00

My name is Fred. Manny and I have been friends for nearly 15 years, since attending medical school together. I am sorry but I can only recount what I know. Many people have done many wonderful things these past few days, and I can’t even begin to know the half of it. I know that it is long, but I am trying to recount to those who are not able to be here the things that I know about, so that you can know. One thing to be certain your prayers are needed and wanted. Your love is appreciated.

For those of you that have children, a pet, or anything in your life that you care about, the following account will hopefully make your cherish what you have more, hug them longer, and realize the fragility of life.

The house that Manny, Traci, Jack, Isa, and Ava Lopez live in is the corner house on the entrance to a small cul de sac. The front of the house faces the street of the cul de sac, but the side of the house is on one of the busiest roads in our subdivision as it is just before one of two entrance/exit gates to the community. As you come in the gate you travel uphill and the side/back of their house on your right. As you leave the community, the hill slopes down and you approach the front/side of their house, across the street on your left. There is a stop sign at the intersection next to their house, but people often disregard it. As the road slopes slightly downhill, toward the gate; consequently cars are often traveling somewhat faster as they are heading to the exit.

On Thursday evening, the 23rd of April, at about 8pm Traci, Isa, and Ava had been in front of their house playing with the Larkin family, who live across the street from the Lopez’s. Manny and Jack had been at baseball practice and were returning home. The Larkins went in for dinner. Traci and the girls wanted to pick up some grass clippings on the side of the house before going in for the evening. Ava in particular wanted to be helpful and put grass in the garbage can herself, but was not tall enough to reach the top of it and wanted Traci to lift her. Traci recounts it as a fun and loving moment, one that makes you smile inside about the perfection of your life, as it is. It was the simple joy of being together and a loving moment of harmony. Traci set Ava down so that she could pick up the last few clippings and noticed a Convertible Mercedes from the periphery of her vision. The car was heading toward the exit and coming down the slope at a high rate of speed. She noticed from her periphery that the car should have been on the other side of the road, but rather was approaching close to her house. She looked up to see the car hit the curb and leap up onto the sidewalk and part of her side yard. The car hit all three of them and a large garbage can, throwing them into the air and against the outside of their wooden privacy fence. Jennifer Wiedenhoefer was approaching their house from the gate at the same moment and saw their three bodies thrown effortlessly before the abrupt halt of the fence line. A scene she describes as, “one of the most horrible things that I have ever seen. It was awful.” The driver of the Mercedes straightened the vehicle, steered around Jennifer, and left the subdivision, despite pleas for help. She had two blown out tires, a broken front headlight and a broken windshield and was only slowed by the bodies she hit.
Traci’s moment of harmony had become one of horror as she saw Isa, conscious but against the base of the fence and looked for 18 month-old Ava. Ava had come to rest several feet away and was lying lifeless, facedown in the grass. Despite her own injuries she went to her and rolled her over to see her non-responsive and with little respiratory effort. She gave Ava a few breaths and then was aided by a physician neighbor, Scott Thomas, who had just moments before avoided the woman in the Mercedes who was driving in the wrong lane, when he heard a loud crash behind him. He helped stabilize Ava initially and tended to the others with Jennifer.
The Larkin family was now aware and came out to help while waiting for the ambulance. Jeff Larkin called Manny, to tell him to get home right away. Manny called him back, “Jeff, what is going on? You’re scaring me.” “Manny, Ava was hit by a car, get home.” Manny arrived minutes after the ambulance and began assisting with Ava’s care in the back of an ambulance. I arrived a few minutes later on the tail of an emergency vehicle.

As I came up, a fire truck, three ambulances, and police cars were all around. Traci was sitting on the curb with Isa and was being tended to by a paramedic. Blood and dirt was smeared across her legs and arm. Her right arm held stiff and straight because of the pain. The tragedy of the situation was apparent on the faces of the neighbors that had gathered. Anxious for news of Ava, I was sent to find out how she was. I looked through the back window of the ambulance to see Manny giving mouth to mouth resuscitation to a lifeless Ava. The pain of that moment was heart wrenching. There was so much despair in the few minutes looking through that window that I can barely describe. A father with the medical knowledge enough to fix most anything, but a lifetime of schooling can’t prepare you for that. How do you cope with wanting to breathe the very life that you have into your child and not being able to do so? You could see the thoughts of desperation, despite the surety of his actions… “Dear God, not her. Not her. Take my own breath from me, but not her.” The recollection of the event makes my tears flow freely.
She was intubated in the ambulance a few minutes later with Manny’s assistance and supported with a breathing bag that you squeeze by hand to push air into her lungs. I saw the tremble in his hand as he continued squeezing air into her lungs, tears flowed.

The sound of a helicopter approached. Manny exited the ambulance and it departed to meet with the helicopter so that she could be flown to the nearest trauma center, University Hospital. Some discussion ensued between the ambulance drivers/EMTs as they tended to Traci and Isa, as to which hospital to take them to. Manny insisted, “She is going to University with Ava!!” “You will take her to University.” It seemed like a good deal of time assessing Traci, who was now on a stretcher and a C-collar before being able to leave. Several people offered to take Manny to the hospital to be with Ava, the response, “I am not leaving Traci.” More waiting… “What is taking so long? We have to get to the hospital!!” Not long after, they were on their way to University Hospital.

Eilene Larkin was the first to arrive at the hospital and spent much of her time with Isa, who was evaluated and miraculously released later with only a few minor scrapes to her arm. This allowed Manny to split time between Traci and Ava. Manny came and sat with me, while Eilene was with Isa, and tearfully said, “we’re gonna lose her.” The neurosurgeon had given Manny a very grim prognosis… her pupils are fixed and dilated, she is non-responsive, the gray-white matter differentiation is lost (I’ll explain later). These are all the bad buzz words in head trauma for a potentially unrecoverable head injury. Her list of injuries: skull fracture, subarachnoid hemorrhage, multiple rib fractures, pulmonary contusion, adrenal hemorrhage.

We spent the next several minutes together as Manny talked of Ava’s personality and smile. He spoke of how just the day before everything was so perfect. One day earlier, they had watched American Idol together as a family. After it was over, they all walked hand-in-hand upstairs to go to bed. For those of you with several children, you know how rare that event can be… your children, willfully, lovingly holding hands. The disbelief of the situation is firmly entrenched. “How can this be?” “I can’t go without seeing her smile again.” Several more minutes were then spent with Isa sitting ever so quietly, as is her nature, in Manny’s lap. His face pressed into her hair, gently kissing her head, and offering gratitude in the form of “I love you,” to her over and over.

Eilene then took Isa, and Manny went back to Traci. I went out to the lobby to update several people who had gathered in the ER waiting room, anxiously awaiting news. As they waited the ER televisions played the lead story for the local news: a woman and her two young daughters that were victims of a hit and run. The other people in the waiting room watched in disbelief of such a senseless trajedy, little did they realize that the Lopez family was just down the hall from where they sat.

Jennifer and I went back to the treatment area to see Traci and Manny. Shackled men in orange jumpers with police escorts seemed to be quite normal for this ER. Ava was being admitted to the Pediatric Intensive Care Unit. Traci remained on a stretcher, in a C-collar, with cuts and bruises along her right side. The extent of her injuries was not yet known. More imaging and evaluation needed to be performed, but she was stable. The neurosurgeon returned to talk to Manny and Traci and talked of some of the things that will be happening soon. “We need to find out what the pressure is inside her head. That is very important for us to know whether or not our interventions are working. We do this with an ICP Monitor (Intracranial Pressure Monitor).” This is also called an intracranial bolt. It is a screw that gets tapped through the skull and reads the pressure inside the head like a tire pressure gauge. Traci and Manny almost replied in unison, “Do anything that you have to do to help her.” “We are getting her up to the PICU now. You will need to sign some consent forms.”

“We need to get her music box. She listens to it every night. It plays ‘You Are My Sunshine.’ She loves that . We also need to get her polka-dotted blanket.”

Traci pleaded with Manny to go be with Ava. Minutes later the nurse led us through a back hallway to an elevator that put us at a back entrance of the PICU. Her room is a typical ICU-type room. Large sliding glass doors with easy visibility into all of the rooms from the nurses station. The privacy curtain was partly closed. We stepped around it to see Ava intubated and lifeless on a large hospital bed that was nearly big enough for an adult. She was dwarfed by the size of it. The head of the bed partly elevated so that you could see her face so clearly. A ventilator was at the head of the bed. Oxygen, suction, and monitors were to the right of the head of the bed. A multichannel IV pump was to the left, with colored tape and hand-written labels taped to the different channels, “3% NaCl” “Epi” “NorEpi” etc. The monitors were reading the electrical activity of her heart, pulse, oxygen saturation of her blood, respirations, blood pressure, central venous pressure, urine output, and soon the intracranial pressure. As we walked into the room a pediatric fellow was on Ava’s right side, trying to place an arterial line into her right wrist. Her body was partly covered by sterile green towels as the doctor worked, trying to place the catheter. Manny crossed to the other side of the bed to hover over Ava’s head and whisper inaudible words to his youngest, kissing her intermittently. Work paused as the doctor painfully watched Manny interact with her. After a moment being face to face with Ava he noticed small puffs of air coming out of her mouth and nose as the ventilator blew air into her lungs. “Does she have an air leak(around the endotracheal tube)?” “In babies, we mostly use straight, uncuffed endotracheal tubes. Some air usually leaks around them because there is nothing there to keep some of it from blowing back.” An uncuffed tube is like a drinking straw. It is just a straight tube. If the trachea is just a little bigger than the tube then the air will go to the place of least resistance. Most of the air goes into the lungs, but some of it will leak out as the ventilator pushes in more air and generates more pressure. A cuffed tube has a small balloon on the end of it that gets filled with air to make a seal with the trachea and prevent air from leaking out and allows much greater pressure, and consequently more air to be pushed into the lungs when needed. In babies, uncuffed endotracheal tubes are often used because their endotracheal tissues can be fragile and are small. When the balloon is blown up it can create a sort of pressure ulcer against the inside of the trachea which can ultimately lead to scarring and narrowing of the trachea.

After a few minutes, the Neurosurgeon arrived to put in the intracranial bolt. Here are the consent forms, here are the risks,” blah, blah, blah,” were the words that I am sure that Manny heard. I watched him be respectful, while I could see the agitation… “just where do I sign?” appeared to be the thought in his head. We went to an adjacent, empty ICU bay while they finished placing the arterial line and the intracranial bolt. Desperation still loomed. “Manny, she is gonna be alright. The neurosurgeons mostly deal with adults. She isn’t an adult. Kids her age are like superballs, they bounce back from anything. They recover from the unrecoverable. The same injuries in you or me would like be the end of us, but not her. I know it in the depth of my soul. She is gonna be alright.” This is a true statement. It is amazing how plastic pediatric patients are. It will be an amazing world one day when medicine is finally able to tap in the regenerative and healing abilities that we had in our youth. Manny nervously joked about telling this story on her wedding day, then cried at the thought of it.

Manny called his mother, who was already aware and had left to come here. He called his sister, Tika. They we heading to the airport and would be here in a matter of hours. More tears. While we waited, much of the time in silence, Jennifer called. “You have to get down here and get Traci moved along. She needs to get up to see Ava. Around the same time Jennifer Smith and Kerri Thompson returned from Traci’s house with the things that she wanted for Ava, and other things. I went to the ER for both while Manny stayed with Ava.

When I arrived downstairs more trauma cases were coming in to the ER. Bloodied, shirtless, young men with lots of tattoos get wheeled in on gurneys just feet from where Traci lay confined. They were now consuming the attention of the nurses and doctors. Traci is emotionally beside herself regarding Ava, but is unable to be with her. She is desperate to see her. Tears continue to flow. A few wails of painful desperation echo through the ER, but go unnoticed amid the chaos that surrounds us. It makes me want to cry for her, for them. So helpless they all are right now… Manny waiting for the doctors stabilize his daughter; Traci lying imprisoned on ER gurney with her heart torn from her; Jack and Isa confused; and Ava seemingly lifeless being manipulated and proded. I am prompted by Jennifer to do something to “get Traci out of here,” but feel somewhat helpless myself as I see the battle-hardened veterans deal with the ugliness of life. I approach Traci’s nurse, who is with a group of people attending to a bloodied man who is hand-cuffed to his gurney, wrists and ankles. She looks at me with an expression of someone who has been taken advantage of too many times and will not ever allow it to happen again. She has hardened herself to the heartbreak that is seen in this place routinely. She seemed wholely unmoved by the tragedy of the Lopez’s situation and seemed unwilling to make concessions for them or even offer a sincere expression of sympathy. At nearly the same moment a Trauma surgery resident came up and started disconnecting Traci’s monitor preparing to take her to Radiology himself so as to move her through the ER so that she could be with Ava. The nurse initially protested weakly about moving her. Another male nurse arrived and took Traci’s cause upon himself and assured us that he would push her through the system and get her up to see Ava, and he did, but after her x-rays were completed.

I returned to the PICU with Ava’s things. At about the same time the neurosurgeons had finished placing the bolt. We went in to see her again. Two wide pieces of white tape covered the top of her head, securing the very thin pressure catheter from being inadvertently pulled-out. Manny was told prior to the bolt being placed that they want the pressure to stay below 20. Injury to the brain is unlike a sprained ankle. When you sprain your ankle the tissue can swell and expand outward, swelling can rise into the leg or down into the foot. But even in the leg, if there is too much swelling then the pressure within the tissue gets higher than the pressure within the small arteries. When this happens it becomes simple physics. The blood pressure can’t overcome the tissue pressure, then tissue starts to die. In the head this is so much more fragile. When the brain gets injured, it tries to swell also, but as it swells it has no where to expand to because of the skull. As a result the pressure builds up faster. Worse yet, the brain is very sensitive to not getting oxygen. Brain tissue starts to die after only a few minutes without oxygen. If the intracranial pressure rises above 20, then we should be very worried.

The 72 hours following the injury are critical. Just like if you were to break a bone, immediately after it happens the tissue around it is still normal. It has not had time to recruit the cells from the blood stream and tissue that cause the swelling that comes later. The brain is no different, the swelling will likely peak by about 72 hours, then should start to decrease. These three days will be critical, how things are now, is not necessarily how they will stay. We know that the reassuring gains can be lost in a moment. Let us pray that they are not lost.

The initial intracranial pressure measurements were 12, then 5, then even as low as 1 at times that first night. Manny resumed his position at her bedside. I brought him the music box which he continued to wind and play for the remainder of the night.

Then the most reassuring thing happened… she moved. Not just a deliriously looking for any sign of hope movement that was really the result of the nurses moving some tubing or something… She really moved. She tried to raise her arm and moved her feet. This was huge. In order for her to have such a movement, her brain is still getting oxygen and is still working. Hope!!

Traci, Jennifer, and the male nurse that promised to get her to Ava arrived. She was in a wheelchair that was big enough for someone four times Traci’s size. Her fears were confirmed as she saw her daughter for the first time since the moments after the intoxicated driver irrevocably changed their lives. Tears. Traci demanded to stand and kiss Ava. It was emotionally painful to watch her navigate her own pain while wearing a C-collar, keeping her neck straight, and trying to be careful not to move Ava in any way.

The male nurse and Jennifer then went to Traci’s hospital room on the 7th floor, for the first time. Ava appeared to be stable and we sat in her room, as Manny recalled some of the loving times with Ava. Continuing to wind and play the music box.

Traci returned with Jennifer and was in tears. “I am not going back to that hospital room. The woman sharing the room with me told me that I needed to ‘move on and focus on the other children.’”Ugh! Sometimes people can say the most senseless things.

It seemed like just minutes after she returned to the ICU, one of Ava’s alarms started sounding. It was her pulse oximeter. It monitors what percentage of her hemoglobin/red blood cells are carrying oxygen. It is a measure of how well her lungs are working. They put the suction tubing down her endotracheal tube and suctioned out some blood from her lungs. A minor improvement. Then it dropped again… 80’s… 70’s. They would take her off of the ventilator and use a bag ventilator that they squeeze by hand, forcing air into her lungs. Every time they stopped and put her back on the ventilator, her oxygen saturation would drop again, despite 100% oxygen. It seems that the multiple rib fractures and pulmonary contusion (bleeding into the lung tissue or big lung bruise) have begun to cause problems of their own. The damaged lung tissue has begun to swell and fill with some blood. This increases the lung’s resistance and requires more and more pressure to push enough air into it to get the oxygen into her blood. Too much air pressure and it will start to leak out of the lungs, causing a pneumothorax. If this complication were to occur, then this would require another intervention… a chest tube.
The pediatric fellow was on her i-phone talking to her attending, keeping him/her abreast of the situation, and feeling somewhat nervous as Ava’s physician-father watched her anxiously. “Switch her to a cuffed tube,” were the instructions. This is not such a simple feat, like changing a band-aid. The ABC’s of emergency care begins with “A-irway, then B-reathing.” If you lose an airway, then you are in a world of hurt. Everything depends on having a reliable airway… everything!!!

Anesthesia arrived to change out the endotracheal tube. We left the room and went to the adjacent vacant ICU bay. We talked of prayer and hope. We talked of the good indicators, like her low intracranial pressures and her movement. We talked of her young age and that this will help her. In the background we continued to hear the alarms sound. When will it end?

Finally the ET (endotracheal) tube was replaced. She was placed back on the ventilator and her oxygen saturations were 100%. A sense of relief returned. Everything seemed to calm itself. No more alarms or scares, other than the reality of being in the PICU with Ava. The next few hours passed with small conversation and tears. The music box continued to play.

Jeff Larkin called and was on his way from the airport to the hospital with Manny’s mother, sister, and brother, Tony. It was about 420am. They arrived shortly before 5am. We went to the security doors outside the PICU to meet them. Manny and his mother had a long embrace the moment the door opened. A mother tries to comfort her child. Tears. I could see the helpless and loving expressions on the faces of Manny’s sister, Teka, and brother, Tony, and friend, Jeff Larkin.

Jeff, Jennifer, and I left shortly after the family arrived. I learned the following morning that Ava’s head CT was maybe somewhat improved and that she had a normal EEG (Electroencephalogram). This is like and ECG (electrocardiogram) of the brain. Doctors can put monitors on the head and record the electrical activity of the brain. Just like an ECG can show signs of a heart attack or other heart problem, an EEG can show brain abnormalities. A normal EEG in this circumstance is very reassuring… more hope. The neurosurgeon expressed cautious optimism… more hope. Still the “72 hours” continues to loom.

Traci’s mom arrived in the mid morning on Friday. A group of the neighborhood women took her to the hospital. Traci is staying in a two patient room. I was told that as she entered the room she glanced at a young woman who was in a cervical spine collar and thought to herself, that poor girl. A moment later her legs weakened, and she stumbled to one side, being braced by the women accompanying her, as she realized that the “poor young woman” was her daughter, Traci. Yet another mother is heartbroken by the injury of their child.

Friday, during the day, a good friend of Manny’s and fellow Iraq War Veteran, Colonel Joe Brennan brought Manny home to shower and change clothes and spend some time with Isa and Jack. The hope was that he would also sleep, but Manny refused and insisted on returning to the hospital to be with Ava. Much of the day was status quo. Ava had still not regained consciousness, but her vital signs remained stable and the intracranial pressure remained low. She was started on hydrocortisone for steroid support given concern regarding her adrenal gland injury. The adrenal glands are a pair of glands, one positioned just above each kidney, in the back, next to the spine. They make steroids for your body for a variety of important functions.
Yesterday, Traci was to be discharged from the hospital, but was kept as an in-patient to speed up an MRI evaluation of her neck to exclude a cervical spine injury and hopefully get her out of the C-collar. The MRI was not done until the late evening and the results would not be available until today. She was in a fair amount of pain as the soreness from the trauma the day before took hold. After the MRI was completed, she was finally discharged, between 11pm and midnight.

Manny and Traci spoke at Ava’s bedside after being told that she will be discharged, and she agreed to go back to their house to sleep and spend some time with Jack and Isa. A decision that was very difficult for her. She continued to insist that she be called if there was any change and stated that if anything were to happen, and she were not at the hospital to be with Ava, then should would never be able to forgive herself.

Eilene Larkin and I packed up her things and drove her home. She was very upset about leaving but needed to get some rest. As we were driving back to the house Traci fell asleep. After she had been asleep for a several minutes she suddenly threw both of her arms forward and kicked her legs forward as if she was trying to block something. Nothing was said, and she quickly settled back down, but I had to wonder whether or not this event was replaying through her dreams.

She refused to drive in the back entrance, by her house, and expressed anxiety about even going back in her house. She didn’t want to stay there. She closed her eyes as we approached the area where they were hit and didn’t open them until it was out of view.

Teka and Tony helped get her settled in her bed. She was is a lot of pain. We gave her some pain medications and Benadryl, to help her sleep. Teka told me that she slept for about 5 hours or so, then got up and went back to the hospital. As for Manny he stayed at her side, with the expectation that he would come home today to get some sleep.

During the night Ava’s intracranial pressures had gotten as high as 16, and reminds us that “72 hours” has not passed. The intracranial pressures are now lower, at around 12, and will intermittently fluctuate, but I can only imagine the anxiety that they were experiencing as the number gradually increased from its prior low. Seeing it drop again brings hope.

Despite these small glimmers of hope, Ava remains unconscious. Manny and Traci, and their families have maintained a constant vigil at Ava’s side. One or both of them have been with her constantly.

The vigil continues, and the music box continues to play.

Pink ribbons for Ava

2009-04-25T14:15:00.000-07:00

Let's all support the Lopez family by tying pink ribbons to our trees. They feel our love and now they'll be able to see our love. Thanks for all of your support!!!