EVERY PRACTICING NURSE has a mental album filled with memorable patients. One of our most remarkable patients was a young man named Joe, whom we cared for in the early 1990s. Joe was 16 years old, smart, social, and mischievous, with a wicked sense of humor. Joe was diagnosed with a severe and progressive neuromuscular disease when he was a toddler. Now at age 16, Joe's disease had progressed to the point that he had minimal strength and motor function below the level of his chin. He required a tracheostomy tube and ventilator to support his breathing. Joe was able to make good use of facial grins, grimaces, and eyebrows to communicate with others.
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