Nearly a year after a truck hit her as she was riding her bicycle in Mayfield, 10-year-old Alivia Shoemaker has confounded doctors with her progress.
"She is just so aware and can do so much that wasn't expected to be done," her mother, Ann Shoemaker, said.
Alivia can point with her left hand. She signs "I love you." She can eat some pureed foods and stand with assistance during therapy. Her new power wheelchair is on order, and the family is looking for assistance to build her a wheelchair ramp at home.
"It's day to day," Ann Shoemaker said. "Each day we see something new."
The family moved to Madisonville earlier this year to be closer to Alivia's doctors and therapists, as well as Ann's brother.
For Ann, time is divided into two segments: before that moment on Sept. 17, 2018, and afterward.
That Monday evening it was Alivia's turn to pick what was for dinner, and she wanted tacos. As the family, including Alivia's sister Autumn and a friend, Bella, got ready to walk toward Save-a-Lot for the groceries, Alivia asked if she could ride her bike.
Alivia was a few feet in front of the rest of the family. Ann said she watched to make sure she stopped at the stop sign at North 13th and Housman streets, then glanced down at the mail she had picked up from the mailbox. A driver topped the hill and said the sun was in his eyes. He said he didn't see Alivia until it was too late to avoid hitting her.
"I heard a big boom and about right then Dell (her fiancé) grabbed my arm and said, 'Oh my gosh! Just come on,' and that's when I realized what had happened," Ann recalled. "I flipped out completely. I didn't know what to do.
"Dell had flipped her over and started CPR," she continued. "The next thing I knew, they had put her in the ambulance and told us to meet them at Baptist Health."
From there, Alivia was taken to Vanderbilt University Medical Center in Nashville, Tennessee, where she was placed in a medically-induced coma to help her heal. The collision had caused a blood clot in her left leg, so she was put on a blood thinner.
What the family didn't know is that Alivia also had a tiny brain bleed. The blood thinner turned it into a massive one. Three weeks after the wreck, as she was just starting to come back to consciousness, the brain bleed caused a stroke and Alivia had to be rushed into brain surgery.
Doctors removed a bone flap from her skull to allow Alivia's brain to swell unimpeded. Then they waited for her to wake up.
They exercised her limbs. And waited.
They rubbed her with lotion. And waited.
They talked to her, sang to her and bought her a unicorn-shaped balloon because unicorns are her favorite. And waited some more.
They sent her to Frazier Rehab Institute in Louisville, where therapists tried putting sour candy in her mouth to get a reaction.
"That didn't start turning around until we came home from Frazier at the end of February or first of March," Ann said, talking about how slowly Alivia woke up.
What was the first sign she was aware of her surroundings? "Her smile," Ann said. "She gave us a big smile."
Progress wasn't consistent at first, and doctors warned her Alivia might never regain more function.
"It was a week to week thing," Ann said. "One day would be good and the next would kind of be bad, but once we got her home and got her into a routine, she really started making a complete turnaround. She started focusing with her eyes, tracking with her eyes. She's really aware of what's going on right now."
Some of the doctors who first treated Alivia had a chance to see her recently. "They were blown away," Ann said. "They couldn't believe she was smiling. They couldn't believe she was tracking. They couldn't believe she was following commands. The neurosurgeon said 'I'm eating my words.' I said, 'Well, there's a higher power than you, and his name is God.'"
Recovery has not been without some setbacks, though. Doctors replaced the bone flap in Alivia's skull in June. She developed a staph infection and had to be rushed back into surgery. She is now on six months of antibiotics and continues to see an infectious disease specialist as well as her neurosurgeon.
In all, Alivia has had five surgeries, three of which have been on her head, and two of which have been on her stomach.
To go through everything she has, Ann says, she's doing well. Doctors can't tell the family what Alivia's recovery might look like. "We're dealing with a traumatic brain injury, but we're also dealing with a stroke. You can't really put a timeline on that."
Doctors do say that whatever function she regains in the first two years after her injury is likely what she will have the rest of her life. So her family, her doctors and her therapists keep encouraging her to do more.
This fall, that included going back to school. "She goes to school, and she's got a little friend at school," Ann said.
On Tuesdays, Alivia has therapy all day. Once every three weeks, she sees her doctors.
She hasn't said a word since the accident, but Ann said if you're reading her a storybook, she points at the pictures. There is talk of getting her a set of pictures to help Alivia indicate what she wants. Sometimes it's like "20 Questions," Ann said. The other day she kept gesturing toward the door. Dell had said he was going to Walmart. They finally figured out Alivia wanted to go, too.
"She knows what's going on," Ann said. "She just can't get the words out to tell us."
Sometimes there are happy surprises. The other day, as her sister was painting, Alivia took an interest.
"She just grabbed the paintbrush up and started painting with her," Ann said.
Small successes are celebrated.
"People need to cherish every day because you never know when something could happen," Ann says, the only time her voice breaks, near tears.
The family hopes to hear Alivia talk again. They hope she won't need her feeding tube at all in a few months. They hope to see her take her first steps.
"I don't know if that will happen in a year, but I'm not losing hope. She's doing really good with standing," Ann said.
Hope is a big word in Alivia's family. When doctors in Nashville were telling Ann that Alivia might never come home from the hospital or that if she did she would never be aware of her surroundings, one doctor at Frazier Rehab, Dr. Catherine Shuster, had a different message, and it is one the family has embraced.
"She told me never to lose hope," Ann said. "I've never lost hope. I've never stopped praying."