10/2002 Blog

Author: carolarmstrong
Date Updates on Carol for OCTOBER

Carol was sleepy again today. Her nurse said she did not
sleep good lastnight. She had a long nap this evening. She woke up and
had a good visit with alot of friends and family. They said she was singing
with them and saying her usual funny stuff. I talked to her three times
tonight. She told her sister-in-law that she needed to get her bags packed.
We finally got a break today, we might have transportation for Carol from
Atlanta to Charleston at a really good price. It was going to be around
$3100 but Carol’s sister-in-law talked to someone she knew through her
hospital and they said they would be glad to do it for a lot less.


Well, Carol sounded really good tonight on the phone. I talked to her three times. She had some visitors and stayed awake until after 10:30pm. She ate all of her soup at dinner. That was an improvement. Still no word on when she will be coming to Life Center. They are working on the contract with our insurance company. They are not in our network so they are hashing out the price. I can’t wait until she comes back. It is hard being so far away from her.


Carol is scheduled to come back to Charleston Friday. Life
Care Center wants her there early as possible because they need to evaluate
her before the weekend.

10pm, I just talked to Carol. She sounded tired. She was a little under
the weather today, her temperature was 99. She lots of visitors saying
goodbye. There must have been at least 20 people. She will be leaving
tomorrow morning around 9:30am. I will meet her at the Life Care Center.
They want to get her checked in and examined before the weekend.


Well, Carol is back in town. She arrived about 2:30pm.
She will be at the Life Care Center for 30 days. It is located in the
Elms Plantation off of Hwy 78 next to the Subway and across from Wendys.
She is in the Rosewood Garden section (past the main entrance). Room 12.
Visiting hours are anytime. She will be doing therapy but I don’t know
when that is. She was a little tired when she got in but stayed up for
a few hours to visit with me. I left to go to the store and came back
about an hour later. She was sound asleep. She woke up again around 8pm
but did not last long.


11am, I took the boys to visit Carol. She was still in bed. The nurse said she was sleepy and they were not sure of how long she could stay in the wheelchair. I helped them get her dresses and in the wheelchair. We took her outside for a few minutes then came back inside because it was hot. Carol did really good with the boys. She held their hand and rubbed their tummies. I tried to get Carol to eat some lunch. She was not having a easy time swallowing so we stopped and took her to the room to get in bed for a nap. She went down about 2pm and I left with the boys.

4pm, I was at work and walked over to see if she was awake or sleeping. She was laying in bed looking out the window. I talked with her and asked how she was doing. I also asked if she remembered me and the boys being there earlier. She said she remembered. My sister came by to visit while I was there. She had also stopped by that morning before I came in. We stayed for about an hour talking. I let the nurse know that she needed to get up and when to put her back in bed. No one really knows her schedule yet because she came in late Friday and we did not get to have the family meeting.

I got a call from Linda (Carol’s sister-in-law). She was the one that
was able to setup transportation for Carol at a really good price. She
told me that alot of people talked and/or called Tony (President of Procare
Ambulance) and thanked him for what he had done. He told her to tell me
to consider the bill payed. I would like to thank him also for helping
us out. Anyone that wishes to send a little note thanking Tony can send
it to: Tony Thrash / Procare Ambulance, PO Box 567, Palametto, GA 30628.
The reason he decided to to this as a favor was because so many people
in GA thanked him for giving us a break on the price.

8pm, Went back to visit. My mom was there. She said Carol was in the
hall in her wheelchair. My mom rubbed Carol’s face and head and put her
to sleep. They had just got her in bed and hooked up for the night when
I got there. She woke up when the nurse was looking for the feeding tube.
She got to talk to her sister and sister-in-law. I showed her a few pictures.
One was of her and Alexander sitting on the couch. I asked who was in
the picture and she said, "me (Carol), and your son". I said
who? And she corrected herself and said "our son". I told her
that he was our son and she called him my son when he would act up and
get into trouble. She cracked a smile. She stayed awake until I left at


It was a long and busy day today. I took the boys to see
Carol at 10:30am. We met with a photographer from the newspaper. He was
there to take some pictures of us and Carol together. He stayed for over
an hour and a half. The boys left with my sister to go to a picnic after
about 30 minutes. Alan (the photographer) stayed for about an hour more
in the background taking pictures as I visited with Carol. He left about
12:30pm when I took Carol to eat lunch. She still has LOTS of trouble
eating. She ate about two spoons of mashed potatoes and a couple sips
of drink. I took her outside but only stayed for a few minutes because
it was hot. I got teary eyed a little because it is so hard to think that
she is hungry or wants to eat but just can’t do it. We got her in bed
about 2:30pm and I left to get a bite to eat.

4pm, I went by the store and bought her a small CD Player/ Radio for
the room. I also picked up a baby bottle. I read on the internet about
someone that had problems swallowing and they mentioned using a baby bottle
as part of the therapy. I got back to see Carol and she was awake in bed.
I hooked up the radio and played a favorite of hers from Lorreena Mckennitt.
I ate my dinner and watched her rest. She did not seem to get much sleep
while I was gone. I layed next to her for a while. She had some visitors
come by and she talked for a little bit. My sister brought the boys back
about 5pm. They stayed for a while to visit. I gave Carol some cranberry
juice from the bottle. I explained to her what it was for. It seemed like
it would do good after watching her drink from it. It exercises the tongue
and cheek muscles. She was able to drink and swallow pretty good, it just
took a while to finish the ounce of juice. We stayed until 7:30pm. It
looked like she was finally getting tired. I help get her dressed and
tucked into bed then we left.

One other thing. I was given a letter from one of the girls that works
at Life Care Center. Here is what it said:

Mr Armstrong,

My name is Tameka. I am 25 years old. I have 3 children ages 2, 4, and
6. I am married. I am currently employed here at Life Care Center and
I had the opportunity to meet Carol yesterday when I worked with her
on Rosewood. My heart goes out to you and your family and Carol will
always be in my prayers. I just wanted to say hello and to let you know
that if there is anything you needed or want for Carol, if I can be
of any help to you or your family (for Carol) anything at all,
Let me know. I will give you my home number. You can use it any time.
If you need anything or help with Carol while she is here at our facility
or after she returns home please give me a call. Don’t hesitate
you may call anytime.

God bless you, Sarah T. Sanders.


7:45am, Stopped by to see how Carol was doing on my way to work. It only takes me 45 seconds to drive from work to Life Care Center. She was awake in bed playing with a big teddy bear. Tameka left a card and the bear for Carol. She was the one that wrote us the letter above. I talked to her for 15 minutes and turned on her music. I let her know that I would be back to see her later.

10:45am, I had an appointment at 11 for a family meeting with the therapists and nurses at Life Care. I came a few minutes early to check on Carol. She was still awake. I let her know that I would be back after the meeting to visit. The meeting went well. I let everyone know what my concerns were and some specific things that Carol needed. I also talked with the nutritionist about Carol’s calorie count. I noticed this past weekend that she was only getting 1200 calories and I thought she was higher than that. I also called Shepherd before the meeting and talked with them to find out what she should be. They told me she was at 1400 and was about to get moved up to 1800 a day because she was not eating. She is not getting enough because when she was transfered to Life Care they did not use UltraCal (brand name). The brand they use has the same amount as UltraCal but Carol was on a special version called UltraCal MX+ or something like that. It had more calories per ml than the standard version. They are going to figure out her new calorie intake in the next few days. I talked with PT and ST. After the meeting I visited with Carol for about 30 minutes until PT came in. They wanted to put Carol in bed and have her sit up then get her back out and put her in again a different way. ST came in at the same time and wanted to work with Carol too. She ended up working with her first because the lunch trays were ready. I went back to work and PT was going to call me when they were ready. It seemed like a long time before she called me back. She said she went ahead and worked with Carol because she was really tired after working with ST.

4:40pm, I stopped by after work for about an hour. Carol was asleep in bed. She woke up after about 15 minutes. I changed the music and layed in bed with her for about 30 minutes then told her I would be back.

8pm, I met a friend at Life Care and visited with Carol for about an hour. She was already dressed and in bed. She was asleep but I woke her up. She had just been put to bed about 15 minutes ago. Doug and I talked for awhile. I went over her oral exercises. She did very well (the best I have seen) with all of them. When I made her do the ‘ah’ sound for as long a she could she said, “what are we doing, trying out for the chorus?”. I tucked her in and told her goodnight. I let the nurse know that I brought some new soap for them to use. Carol’s face had been much redder this weekend and thought it might be the soap they were using.


7:45am, Carol was awake. I stayed for about 15 minutes
then went to work. I came back at 11:50 to meet a photographer from the
newspaper. He wanted to get a picture of me and Carol and also see if
he could get a few shots of Carol doing therapy. Her physical therapy
session was at 12. The therapist worked with her in her room. He got her
out of the wheelchair and sat her on her bed with out the lift. He worked
on her sitting up and holding her neck up. He then had her lay down on
her side then worked with her legs. After that he sat her back up on the
edge of the bed then lifted her into the wheelchair. She seemed to do
pretty well. He showed me some exercises for her. She was a little tired
so I told him he might try coming around 9am.

4:30pm, Carol was just put in bed. She had been up in the wheelchair
since 1pm. I also talked with the nutritionist. She changed Carol’s tube
feeding to be from 6pm until 8am. That will give her 1600 calories. The
best time to visit Carol would be in the morning or after 4pm. She usually
takes a nap between 2pm and 5pm.

7:30pm, Carol was resting in bed. My mom was there visiting. I woke Carol
up and me and my mom talked with her for about an hour. I rubbed her face
with a cleanser and then wiped it off with a paper towel using water from
a cup because someone was in the bathroom. Carol said "I hope that
is not the best their warm water can get". I told her I had to wet
the towel with water from her drinking cup. She said her dad would be
proud of me. When I asked why she said because I was recycling the water
and that is something he would do. Her roommate was getting on to the
nurses and I whispered to her that she was feisty. Carol replied, "good
for her". We had a good conversation then tucked her in for the night.


I visited with Carol about 5 times today. I walk over a
few times during work and also at lunch time. I took a short break at
9am and went to see Carol. She was awake in bed. She was playing with
the call button and pressed it. Tameka came in to see what she needed
and I asked Carol if she knew who she was. She said, "that is Tameka".
She was not wearing a name badge and Carol had not seen her for two days
(since she gave Carol the bear). I left a note for PT to call me when
they were going to work with her so I could come over and watch. She had
a good but busy day. PT worked with her about 3pm. They worked with her
trunk control (sitting) and did some stretching exercises. Carol was put
in bed about 5pm. When I went to visit at 7pm OT came to work with her.
She showed me some more stretching exercises for her left arm.


7:45am, Carol was awake and talking to herself. I stayed
for about 15 minutes.

11am, Carol was a little more sleepy. She had just been put in her wheelchair.
She had a few visitors waiting to see her. My aunt Jackie and uncle Billy
came to visit. I told Carol that she needed to wake up because she was
going to have therapy around noon.

4:30pm, Carol was in bed. I saw the therapist and the reason why she
was tired was because he worked with her between 9am and 10am. The nurse
came by and showed me what they planned to do about her tube feeding.
They are going to up the rate to 125ml per hour for two days then up it
again to 140 if she does ok.


7:30am, Carol was awake. I stayed with her for 30 minutes. My sister called me around 9am and said Carol was wide awake and doing really well.

12pm, I went to see Carol at lunch. She was resting in bed. They had given her a shower and it made her tired. While I was there the nurse and a couple of other people that rent equipment came in and hooked Carol up to the CPM (continuous passive motion). It moves her left leg up and down to help get rid of the calcium buildup.

3pm, I helped Carol with PT today. They worked on her sitting up on the edge of the bed and did some stretching. He then transfered her to the wheelchair without the lift.

4:30pm, Carol was out in the lobby by the TV. I put her back in the room and worked with exercising her legs, arms and neck. She watched some news on TV and looked at some pictures.


Carol took it easy today. She was on the feed tube until 10am. She then got cleaned up and dressed. They had to hook her up to the CPM machine at noon so she did not get out of bed. When I went to visit her that night she was eating a lollipop. She had licked most of it then started to chew on the tootsie center. She did pretty good. I gave her some Dr Pepper and she watched Smallville. I did some exercises with her then they came to put her in her night clothes and hook up the CPM machine again. She went right to sleep after getting settled in. There should be an article in Sunday’s Life section of the paper.


Carol has had a pretty good day so far. I went to visit
at 10am. The staff was reading the article in the newspaper about Carol.
They said it was good. She was in bed, waiting for the CPM session to
finish. I helped give her a bath and get her dressed. I took Carol outside
and she rested for awhile while I cleaned her nails. My sister came and
we took Carol to the family room and I went to the store to get some finger
nail polish remover. We gave Carol a French manicure. Her nails look really
good now. Carol good friend Shirley came to visit. She did really good.
I took her back to the room at about 4pm and went to pick up the boys.
I had received two calls already from the newspaper article. One lady
works at MUSC and was offering her service when she was off work and I
needed a break. Another has an electric hospital bed and wanted to know
if I needed one.

7pm, Went to see Carol. She was sleeping. I kissed her until she woke
up. I gave her a little taste of a lemon-berry slush from Sonic. We watched
a new show on her laptop. When I got up I noticed she was wet. She said
she was sweating some. I looked it a little more and found that the folie
was leaking again. It had done that once before. The nurse came in and
found the problem. The bag tube was attached but the cap was left on.
She said they don’t have too many people there that have these and would
make sure she lets them know what they did wrong. After getting everything
changed, sheets and all Carol was pretty tired and ready for bed. I kissed
her goodnight a few times and left.


It was a really good day for Carol. She participated a
little at the craft activity they had. When I got there she was just about
to go outside. I took her out and I ate lunch while she looked around.
We stayed outside for about an hour because it felt good. It was really
cool today. When we went back inside OT came and showed me some exercises
for her left arm. We went over that for awhile then speech came in and
worked Carol really hard on some mouth and tongue exercises. She gave
Carol about half a container of yogurt. Carol was talking really good.
She did not whisper at all today. PT came by and wanted to try Carol in
an electric chair. By the time everyone got done with her and they moved
her into the chair she was too tired to do anything. They put Carol in
bed about 4pm to take a nap. She stayed awake from 10am to 4pm.

6pm, Carol was awake. She was still doing well. I brought Alexander to
visit while we were waiting for my sister to drop off Jaime. Carol talked
to Alexander and rubbed his back. He kissed and hugged her and told her
he missed her. We visited for a few hours. She had to get on to the boys
a few times because they were fighting. When we left at 8:30 she was starting
to get sleepy.


Carol had a really good day. She stayed awake from about 10am to 5pm. She had PT, OT, and ST. When I came back at 4:30pm I was told she went to a craft fair and picked out something she liked. She also liked the music they were playing.

7:30pm, I worked with Carol’s left arm, doing the exercises that OT showed me.


Carol had another busy day. I came over around 10am when PT called me and helped them out. They showed me how to do the assisted transfer from the wheelchair to the bed and back. It wasn’t too hard. Carol did really well sitting up. She is still very weak with the back and stomach muscles.

4:30pm, My sister was outside with Carol. She was extremely tired. She had been up all day. We had the nurse put her in bed at 5pm.

7pm, Carol was awake in bed. I brought over a neck massager and hooked it up. Carol liked it alot. I also brought over a new CD of church music. We stayed for about an hour while Jaime was at scouts.


Carol was not feeling very good today. Very sleepy. I also noticed that there seems to be some spinal fluid buildup on the right side where the brain had been removed. I brought it to the nurses attention and she called the doctor so he could check it out. He did not seem too concerned because there was not any pressure. I don’t know how long it has been this way, I usually check out that area but maybe I did not feel above her ear much. They are keeping a close eye on it to make sure it does not get worse. I took off of work to stay with her all day.


7:45am, Carol was awake and seemed to be doing better. I brushed her teeth and talked to her a little before I went to work.

12pm, Carol was awake and in her wheelchair. I took her to her room so I could eat lunch and ST came in to work with her.

4:30pm, Carol was by the window. I was about to take her outside when PT came over and wanted to work with her. I stopped and talked to OT on the way to the gym. She said Carol did really good today. She said she was talking alot and was saying some funny stuff. I went over and helped Carol at PT. They worked on sitting at a table. Carol was also able to hold herself in the sitting position for a while. She could also pull herself forward a little using her stomach muscles. They will be starting her on an anti-depressant tomorrow to see if it will help her stay awake. There were times today where she did not know who I was. I think it has alot to do with the fact that the right side of they brain is what processes an object and assigns a name to it.


Carol had a good day. I spent most of my time there with
her. We went outside for awhile and watched a movie.


11am, Carol was just getting in her wheelchair when I got
there. I took her outside and she took a nap. When she woke up I read
to her for awhile. Speech came outside and worked with Carol for about
an hour. She was working today because her schedule for next week would
be messed up. Carol did really good. The medication that they put her
on to keep her active seems to be working now. I had to make her take
a nap because we were having a birthday party today at Life Care for my
sister, brother, Jaime and Dad. She slept for about 45 minutes then I
took her to the room where we were going to have the party. She stayed
a sleep for another 30 minutes then I woke her up. We had a good time.
She watched the boys play and talked some. I took her back to the room
at 5:30pm so she could rest and get in bed. Before I left I asked her
if she wanted me to come back tonight and say goodnight or stay home.
She asked me to come back. Her friend Sandra was there with her when I
left at 6:15pm. She called me at 7:30 and said they had a good talk. Carol
was asking her to find out some information about her condition and medication
because she felt left out of the loop. Carol was asking about the plate
in her stomach. I think she was remembering the bone from her skull that
they put there. When I went back to visit at 8pm she was still wide awake.
The nurse said that the three firemen that responded to the 911 call had
come to visit with Carol. We got Carol hooked up to the CPM machine at
9pm and she started to get heavy-eyed. She was asleep in no time.

Carol and Alexander at Party


Carol had a yucky day as she would put it. She had a fever
of 101 and looked like she did not feel good. The doctor prescribed an
anti-biotic and one other medication. She will have a chest x-ray tomorrow
along with some cultures. She did not get in to the wheelchair until 1pm
because they were late putting the CPM machine on her left leg.

4:30pm. I brought the boys to see her. She sang happy birthday to Jaime.
We stayed for about an hour.

8:00pm, Carol was still in the wheelchair. They had her hooked up for
feeding. They were real busy and would get to her around 9pm. Her pants
were wet again. It seem the folie tube is getting kinked when she is sitting
in the chair. I laid her back in the wheelchair and noticed some red splotches
on her chest. I went to get the nurse to look at them and by the time
we got back they were gone. They will keep checking to make sure she is
not having an allergic reaction to the anti-biotics. They came at 9pm
to put her in bed. I helped get her changed. She scared us because she
reached up and grabbed her forehead and said it hurt really bad in a loud
voice. We immediately put her head up on a pillow and it went away as
fast as it came. I was afraid something wrong was happening and said a
silent prayer. She seemed normal afterwards. I stayed another 30 minutes
and asked her to say a prayer then I said one also. I hope it was just
a sinus pain from laying flat.

11pm, I called the nurse and checked to see how she was. Her last temp
was 98 and they will be taking another one soon. She is scheduled to be
turned at 1am.


Carol stayed in bed today. She said she did not feel like getting up. She was a little warm. The chest x-ray was negative. It will take a few days to get any results from the cultures. I stayed a little longer after work because I was not going to be able to come back later. I called my mom while she was visiting around 8:30pm and talked to Carol. She seemed a little better.


8am, Carol was wide awake laying in bed. She seemed to
be feeling better. She looked better also. We talked for awhile then I
read her a letter (10 pages) from her good friend Shirley. It took me
awhile to read it all because I got a little teary-eyed and my nose got
stuffy. It was a very touching letter. I might see if I can get permission
to post it here (it was kinda of personal). On my way out I said hello
to the nurse and she said Carol was feeling a little better lastnight.

11:30am, I went and helped with PT today. They worked on Carol sitting
on the edge of the bed with her arms supporting her and also with a table
in front. They did some stretching exercises also.

4:30pm, Carol was in the rec area. I took her outside for awhile and
worked with her left arm stretches. I took her inside about 5:30 and we
got her ready for bed. She looked like she was getting tired. I left the
news on for her to listen to.

8pm, Carol was awake in bed. She looked like she may not be feeling good
again. I let the boys say good night and tucked her in.


Carol was feeling a little sleepy and sick this morning. Later in the afternoon she seemed to be a little better. She was out with the group. They were eating pumpkin pie and she was looking out the window. I took her to her room and gave her some icecream. She ate it all and watch Smallville. PT and OT came by to work with her and said they would come back. Later at 4:30pm she was in bed. She got tired from the workout. OT was there but did not have a chance to work with her. She has a urinary tract infection. When I went back to see her at 8pm she seemed to be doing better. She was talking a little more. She sounded a little stuffy in the nose like she was catching a cold. I had a good visit with her until 9pm.


Carol did ok today, still a little tired. It might take
a few more days until the anti-biotics and other medications kick in.
I had a family meeting today to go over Carol’s progress and plans. They
said she was showing improvements. We discussed her options and that I
would pay for her to stay one more month. They are checking with the insurance
company to make sure they will cover the therapy. My sister said she had
a long good conversation with Carol this morning. I saw her for 20 minutes
before work and seemed to be doing well. She had a shower today which
usually tires her out. When I went to see her after work speech came in
and worked with her. I had to leave and take the boys to a church activity.

8pm, Carol was in bed wide awake. The boys said hello. Carol liked Jaime’s
green hair (halloween party). I talked with her for awhile. She was doing
very good. She had to get on to the boys for acting up. I said they get
at each other and Carol responded "yes, but they can take it too
far sometimes". I tucked her in and told her goodnight.

Carol and boys after Halloween Party

The Sunday October 13th newspaper
article can be found here.


Carol had a good day. Her brother Ted and his family came
down this weekend to visit. She stayed awake and had a nice visit all
afternoon. We left her about 4pm then came back at 7:30pm. She was awake
in bed. We had another good visit. We left at 9pm.

Carol and nephew Bryan


Bad day for Carol. She slept most of the day. When she
was awake she did not talk any. She must still be feeling bad.

6pm, I talked to her sister-in-law. She said Carol was wide awake and
talking loud. This usually happens at night time. I will be going to see
her at 7:30pm.


Carol had a much better day. She was awake a lot more during
the day. PT called and wanted to work with her at 4:30pm which works out
great for me because that is when I get off of work. We worked with her
in the room. Did some reaching exercises. She kept looking to the right
so we tried a blinder on the middle of her face. Shepherd Center tried
one but they put it on her right eye. That did not do any good because
she can not see out of the right eye anyway. Once we put the blinder on
Carol did much better. She started looking more to the middle and reached
with her arm better. I got out the nerf football and would make Carol
reach for it and take it. She would then toss it back to me. The therapist
also sat Carol on the edge of the bed and had her sit for awhile then
did some more stretching. He commented after we were done that this was
the best he had seen Carol.

I came back later that night and helped get Carol ready for bed.


7:45am, Carol was awake looking at the bed rail and holding
her arm out. I talked to her until 8:30 then left for work. She was getting
sleepy by then.

11:30am, Carol had just finished taking a shower and they were putting
her in the chair. We watched some TV and I worked with her left arm.

4:30pm, Carol was in the PT room. They had her in the electric wheelchair.
She still has trouble moving the joystick with her fingers so they are
looking at a different controller. She did pretty good after I showed
her the Dr Pepper and told her to get it. She would move the chair forward
until she could reach the drink. We did that for about 30 minutes then
we went back to the room. I gave Carol a weight attached to a pulley on
the wall and she would pull it back and forth. She did that for about
5 minutes then we worked with her reaching for cones on a table. After
that PT sat her on the table and worked with her sitting. She sat by herself
for a long time. She had a good workout again today. It lasted for over
an hour and she did not fall asleep like she normally does.

7:30pm, Carol was awake. My mom had just got there to visit. We stayed
for about an hour. Carol was doing really well. She finished the lollipop
I had given her earlier. I usually give her one a day because it looks
like it helps with her mouth and swallowing.


Carol did ok today. A little tired. She was at PT when I went to visit for lunch. We worked on sitting mainly. She was able to sit on the edge of the bed for 10 minutes with no help. During that time we also had her reach for objects with her right hand.

4:30pm, PT was working with Carol again in her room. We did not do much because she was tired. We practiced using the hoyer lift.


Carol had a pretty good day. She was still in bed when
I went to visit at lunch. They got her dresses and in the wheelchair before
I left. I had a meeting with the disablilities board HASCI division. I
need to see if Carol can get Medicare somehow.

4:30pm, I worked with PT again. Carol was a little tired but we did it
anyway. She worked on sitting and did some more stretches. On the way
back to the room ST stopped me and said Carol did really well today. She
said her goal was for her to swallow in under 20 seconds and the longest
this time (while eating icecream) was 17 seconds. I told her that I have
been giving Carol a lollipop each day and that seems to help her exercise
her tongue and mouth.