I had a follow-up conference with three of Gene’s top doctors at Cedars-Sinai on October 21, and another earlier today, and there was an important change from our meeting the previous week.

The doctors reported that they were seeing substantial improvement in Gene over a relatively short period. Compared with what they had observed on October 16, he seemed more mentally present, better able to understand what doctors and nurses were asking him to do, and more responsive verbally.

Given how seriously ill he has been, even being able to respond with more than a sentence was considered meaningful progress.

That was encouraging news, especially after the much more discouraging assessment at our previous meeting. It does not resolve the larger questions about Gene’s prognosis or future care, but it does matter that the doctors are seeing a change.

We also discussed the imaging findings indicating that Gene has experienced two small strokes. The doctors characterized these as not unusual with age, although we did not go into a detailed discussion of the precise findings or their significance for his recovery.

His hearing remains a major concern.

The audiology department has not identified a definitive intervention and raised steroids as one possible option. The doctors were strongly opposed to using steroids because of concerns that they could interfere with healing.

We also discussed trying a personal voice amplifier, sometimes called a pocket talker, which could make spoken communication easier for Gene to hear. I believe this is worth exploring. As I’ve mentioned before, he can sometimes read and answer written questions more effectively than he can respond to spoken ones. We need to give him every reasonable opportunity to understand what is being said to him.

The conference also brought us back to some very difficult decisions about Gene’s wishes and medical care.

We discussed his POLST, the document that records preferences for life-sustaining treatment, and what should happen if his heart stops. One question is whether doctors should attempt CPR or allow a natural death without resuscitation.

The doctors explained that CPR can fracture ribs and cause additional physical trauma. We also discussed the uncertainty surrounding how much of Gene’s mental functioning might recover, even if resuscitation were successful.

These questions are not simply about whether a treatment is technically possible. They are also about what that treatment might mean for Gene, what kind of recovery might be possible, and whether the burdens of treatment would outweigh the benefits.

We discussed the broader options, from continuing full treatment to limiting certain interventions or focusing primarily on comfort.

I understand why these conversations are necessary, but they carry enormous emotional weight. I am taking them seriously and trying to make sure that any decisions reflect Gene’s interests and wishes as clearly as we can determine them.

No final decision about his POLST or resuscitation status was made during this conference. These remain matters for careful consideration.

There is also the very practical question of where Gene can go next.

Finding a suitable long-term care facility continues to be extraordinarily difficult and increasingly time-consuming. My goal is to find somewhere as close to Cedars-Sinai as possible, but Gene’s complicated medical needs, the exceeded limits on available covered hospital and skilled-nursing days no longer paid for by his medical insurance, the substantial co-pays now required going forward, and other specialized placement criteria make the search increasingly challenging. We need a facility that can actually manage his care, not simply one that has an available bed.

I also asked the doctors what would happen if Gene were to die in the hospital. It was a hard question to raise, but I wanted to understand the process rather than leave those arrangements entirely unfamiliar should we ever need to face them.

They explained that he would be taken to the hospital morgue, that the family or designated person responsible for arrangements would select a funeral home, and that the hospital would coordinate his transfer. They recommended making arrangements in advance so loved ones would not have to navigate every practical detail in the middle of a crisis.

I want to be clear that I asked these questions as part of preparing responsibly. I was not reporting that Gene had died, nor was I told that a death had occurred.

What I took away from my other meetings so far this week with Gene’s doctors, as well as with his social worker and later his case manager yesterday, was a mixture of relief, hope, and continued concern. The improvement the doctors described is meaningful, particularly after how bleak our previous meeting had been. But there are still substantial uncertainties about his recovery, his hearing, the treatment decisions ahead, and where he can safely receive care.

I am encouraged by the progress being observed, while remaining realistic about how much we still have to work through.

I’ll continue sharing updates as I learn more.

Thank you for taking the time to read this.

Alexa