Every Note Played

After the choking incident, Karina takes Richard to the ALS clinic, where his doctors determine that his ability to swallow has decreased significantly. The next day, he undergoes surgery to attach a feeding tube directly to his stomach. The doctors also provide him with a BiPAP, short for bilevel positive airway pressure, which is a machine with a mask attached that helps him breathe at night.

Three weeks pass, with Karina continuing to care for Richard, including administering food and medicine via the feeding tube. Richard fantasizes about his favorite foods, but this is dangerous since it increases his saliva production, which interferes with his breathing.

During the night, Richard’s BiPAP occasionally loses its seal, which sets off an alarm. As a result of waking up several times each night to adjust the BiPAP, Karina becomes increasingly tired.

As Karina places the BiPAP on Richard one night, he feels a desire to apologize to her for all the wrongs he committed throughout their marriage, including multiple affairs, instead of making excuses as he usually does. He says, “I’m sorry,” but his voice is too weak for her to hear over the sound of the BiPAP.