I would keep the birthday well wishes very, very simple.
I'm very sorry to see you've had several visits to the ER. Stress plays a big role in our lives, especially during this time. Slow down, take a deep breath and pray.
Sit quietly, the answers will reveal themselves when you least expect them to. The past is gone, the present is a gift and you need to focus on today, allow the future to reveal itself when it is ready.