Things I am grateful for, or an epistle to the powers that be

Dear Life:

You and I have had our ups and downs this year. Mostly downs, by any measure, but let's not quibble over the finer points therein. Suffice it to say that in general, 2010 has been unmatched in this Troubadour's experience of "rough patches," "tough spots," "suboptimal circumstances," or any other euphemistic label you'd like to slap on it -- despite multiple appeals for relief. To which I have to ask, at the risk of sounding repetitive: WTF?

I have not, in the past, been a big bright-side seeker. I lost my innocence a little too early on to develop the habit. But I'm willing to try almost anything at this point, given the November you've served up so far. And as tomorrow is Thanksgiving, I figure now is as good a time as any to start. So whatever you are -- an entity indifferent to the human plight or one whose intentions for me have yet to make any sense -- listen up.

In the last week, I was grateful for the following:

• Getting to see one of my dearest friends from college, who happened to be interviewing in Seattle for a medical residency at the UW and needed a place to stay. Never mind the kidney infection you decided to make apparent to me with a raging fever and teeth-rattling chills, about the time her flight was going to arrive. The ER was on the same route as the airport, so it was convenient for D to drop me off and continue on to pick her up. A reunion in one of those skimpy hospital gowns was not what I'd envisioned, but I have never been happier to have company. The laughter that came from behind the curtain in my ER bay for the hours we were stuck there should be proof enough of that.


• Having my white cell count remain oddly normal in the ER, despite the fact that the infection had already spilled into my bloodstream by the time the poor nurse assigned to me found a usable vein to get the IV antibiotics going. (Is laughter, indeed, the better medicine?) The delayed immune response fooled the hospital into discharging me on the same night rather than admitting me for what was actually a much more serious condition (bacteremia, with the potential to turn into straight-up sepsis). It was nice to get to spend a few extra hours with my friend outside the hospital, which we used not wisely but very well. We took the conversation home and didn’t end it till nearly 3 a.m.


• Having the blood cultures come back soon enough the next day to get word to my urologist, who promptly called in the extra antibiotics I would need to make sure the infection was properly treated (the ER doctor prescribed only 7 days' worth; turns out I needed 14). Without them, I would have been short on meds for the length of my research trip. Which brings me to ...


• Getting to go on said research trip, despite the severity of the aforementioned infection. I know the party line, per the infectious disease consult ordered by the urologist, was to cancel my plans, but she and I decided that the calculated risk of getting on a plane for a few hours to spend a week essentially under my parents' care (the arrangement was for me to stay with them while doing the research) was reasonable to take. Yes, you made me pay for it by giving me more chills and fever while I was somewhere over Utah, but I was armed this time with enough antipyretics to kill a buffalo. So I'm still glad I went. Recovering in Panhandle, Texas, is essentially no different from recovering in Seattle. And Mom's chicken soup beats any I could make.


• Being lucky enough to have scheduled my return flight between that arctic front's passage over Seattle and its subsequent arrival in Panhandle. For a few days before the anticipated snowy cold snap, we were concerned that I might get stuck in Texas for the holiday, leaving D on his own for Thanksgiving. But I'm home now, thanks to a little mercy from the travel gods, and we will have turkey together tomorrow. Given the last month's health ridiculousness, we will not be throwing the usual fete we love to put on nor will we be traveling to share the holiday's bounty with the numerous folks from out of town who have invited us. But we are glad that I'm on the mend (for real this time, we hope) and look forward to the long weekend, if only just to rest.

So. Here's to a happy Thanksgiving. May what remains of 2010 offer much to be grateful for. (I wouldn't mind, though, if the things to be happy about were packaged with fewer associated challenges ...)

Sincerely,
C. Troubadour

In which I am a bad patient

This whole recovery thing is not what I'd anticipated.

Don't get me wrong -- I know I had surgery, which means not trying to do more than my body can handle. Even if all that that entails is sleeping A LOT. (Seriously, I had no idea I could crash all day and then still sleep a full night without waking up in the middle of it.) But I'm off the prescription pain meds as of today, which means I have a clear head for the first time in 48 hours (yay!) even if I'm still stuck in bed.

It also means the gears are turning.

They should, if anything, be turning on Chapter 4 of the thesis. (Forgot to mention somewhere in the last two weeks -- I turned in a revision of Chapter 2 and a new Chapter 3 to my advisor!) If recovery continues as expected (and it should), I should be cleared for a research trip I'd had in the works long before the health mess ever happened. That's scheduled for next week, so I'm looking guiltily at my files, which I need to back up and organize so I can make the most of my time while I'm up to my elbows in old photos and supplementary documents. Actually finishing the Chapter 4 draft would be good too.

But the kitty is pawing at the bedroom door, which is not conducive to any sort of concentration, and the ibuprofen is only so effective, and I've been distracted by more pressing thoughts since I got my brain back.

It's been an isolating year.

Seattle, I've been told, is a friendly place but a difficult one in which to make friends -- as in those who will make room for you in their established social circle. This cultural oddity even has a name: the Seattle Freeze. Seriously, a name? How's that for intimidating. I know I haven't tried my hardest in the last year to reach out to people, but I have tried, despite all the other stuff I've written about here (2010, you've been difficult). I've gone to get-togethers hosted by D's work colleagues; tried to start conversations there with the wives and girlfriends; suggested and pursued follow-up lunch dates, coffee dates, dinners. Much response?

* Crickets chirping *

I'm still looking and asking, because it's not healthy to be so isolated. I've even gone so far as considering sites like Meetup.com (where there are actual references made to the Seattle Freeze). But a lot of what's offered isn't quite my style -- dance parties on a boat in themed costume? Sure, but I do better in smaller settings. Then how about speed friending? Um, that's kind of an oxymoron.

How about just a meal and some good conversation?

I know, these are things I shouldn't be worrying about before I can walk around the house without feeling exhausted. But being stuck in bed gives you a lot of time to think. And I'm thinking my list of local friends could use some rejuvenation.

So, dear bloggy friends (how I wish you were geographically nearer). How do you make opportunities for new friendships where you live -- and encourage them to grow?

The last thing I remember

... is the room beginning to spin.

It was kind of cool, the pinwheeling, marbleizing filter that had suddenly fallen over my eyes as I lay on the operating table. I wanted to remove the oxygen mask to tell the anesthesiologist what I was seeing, but before I could reach for it, I was out.

*

And then someone was saying my name, and I was propped up in some bed with a lot of blankets but I was still cold and there was no way in hell I was opening my eyes because -- well, there was just no way in hell. "We're going to move you to a recliner, okay?" the voice said, bright and sonsy. "Just swing your legs over the edge and we'll help you stand."

Amazingly, my body complied. (Apparently, I'm very good at following directions even while semi-conscious.) Teeth chattering, limbs shaking, eyes still mostly closed -- why the recliner? I wanted to ask; let me stay in bed, please. But I couldn't muster a word. It didn't matter, though, because I was out again before I hit the chair.

*

At some point, the urologist came to talk to me. "We got the stone," she said. "It was impacted."

"Great," I said. And then I remembered why I was there to begin with.

The suspected kidney stone from early September never passed. And after weeks of waiting, hurting, and bleeding, it was time to figure out if the stone was the problem or if something else was going on. So I met with a urologist -- not the one who first found the stone but another recommended to me after my third trip to the ER. She scheduled the imaging studies for yesterday -- x-rays, with contrast injected into the urinary tract -- to see what there was to see. If there was indeed a stone, it could be taken out at the same time, while I was under.

"How's your pain" -- suddenly, that other sonsy voice was speaking again -- "on a scale of one to ten?"

"Two?" I ventured. My bigger concern was my ability to think or move (or were they really just the same thing?) -- both still muddied and slow and exhausting, like trying to levitate from a bed of quicksand.

"Good. I need you to drink something -- can I get you apple juice?"

My brain cleared for a moment. Apple juice equals sugar. "Don't think I can have it -- prediabetic," I said, eyes still closed.

"Water, then," the voice said. "And how about some crackers?"

"Can't," I said, fighting harder against the quicksand. "Carbs."

"I don't want the pain meds to make you nauseated," the voice insisted. "I'll bring you just a little to nibble on."

"Okay," I said, too tired to argue or try to explain anymore.

*

They're eye-opening, these moments of limitation. I'm used to being able to handle my own basic needs. When I can't, I fight hard to do it anyway -- for weeks, I've gone without more than over-the-counter pain relief because I needed to be able to function. To drive a car, to take care of household chores, to engage with other people just to feel connected to the outside world. And to monitor my health care in a system with a lot of cracks in it. I can't do that effectively on stronger meds, though, apparently, I still try.

I'm clearer today, but only just. I made the mistake of letting the pain meds wear off at one point yesterday, hoping to get my brain and body back, but it was too much. So here I am, typing five words a minute, reaching for clarity that feels just beyond my grasp.

I think I'm okay with that. Fragmented as this memory will be when I return to it in a few days or weeks, it will be here. To remind me that the limitations I feel are relative. Three days ago, I was complaining about not wanting to work out. Today, it's not a question of want at all. I'm just glad to be able to get down the stairs on these jelly-filled legs to brew some coffee. And come right back up to bed.

Warning: rant ahead, or a peek into the mind of a food-anxious freak

What follows is an account of one day in my battle with disordered eating. I have fought this problem since before I was old enough to drive a car. It is one of the reasons I finally sought professional counseling through a dietitian this summer, though I didn't know it at the time.

In the months since my work began with the dietitian, I've made many gains. But under the right (wrong?) circumstances -- such as the recent weeks of stress -- backsliding happens. I'm writing about that for the first time here, now, because it's better than keeping silent.

I should have paid attention to the sinking feeling this morning.

It's the kind you get when you haven't eaten in a few hours and your blood sugar dips. Your stomach is growly and your head gets thick and it is all you can do to remember where you were supposed to go next -- much less what you were supposed to do once you got there -- on that list of errands you'd set for yourself.

It was another early morning. And you didn't count on things taking so long. Take a snack, your brain was saying as you headed for the car, wishing you could just stay home. But you were tired and you didn't want to have to have that snack. In the fuzzy logic -- or plain mule-headedness -- of on-the-way-out-the-door thought, you told yourself a doctor's appointment, a haircut, and an in-and-out trip to the grocery store should not take more than three hours. You'll be home right on time for your next meal,* you said. Screw the snack. It's extra calories you don't need. You've lost a little weight in the last month -- don't you want to keep things the way they are?

So you get through your appointment. When you get to the salon -- the bargain-basement walk-in one that also happened to put out a coupon that you needed to use this week if you wanted the additional savings -- you find two other people ahead of you in line. Okay, no problem. You flip through the look books since you haven't had a trim in six months -- better find a picture of what you're supposed to look like so whoever on the rotating staff is assigned to you will do the job right.

And you wait.

And you wait.

And you wait some more. No reason things are slow except that there are only two people working. By the time the woman with the scissors is ready for you, you're regretting that snack you told your brain to forget. The stylist does a good job, a thorough one. So thorough you're wondering if she's cutting each hair individually. And this is just a trim? The morning you thought you'd still have, after finishing these errands, slowly begins to slide out of reach. But, oh good, the stylist is finally done.

This, if you weren't going to take that snack, is where you should have gone home right away instead of trying to stick things out.

After leaving the salon, you head over to the grocery store. What did you need? It takes effort to remember, even though it's just two items. One of them -- salad greens -- wouldn't even be necessary if the greens you bought last Thursday, with an expiration date of November 10th, hadn't already decomposed by the 7th. But you need those greens. What the hell else are you supposed to fill up on if bread and crackers and cereal and all the rest of the food you've ever loved can only be eaten in portions that would make a mouse cry?**

At last, you do get home. You make that salad -- a quarter of an apple, an ounce of goat cheese, not quite a tablespoon of olive oil and balsamic vinegar, tossed with the greens -- and slap some turkey with mustard on low-carb bread. It's a good lunch, a filling one. But you've eaten the same damn lunch for five days straight*** because you've been on autopilot with everything else going on. And now you want what you know you can't have: anything with more than 15 grams of carbs per serving. In any quantity you like.

You wait out the cravings. You're supposed to get on with the rest of the day anyway -- so the morning's gone, and you haven't showered yet, and the workout that you've been hating lately but that you cling to because it means your body still functions and your weight is still under your control needs to be done. But then the phone rings. And you're so lonely that you will totally blow another two hours talking when you know you'll be mad at yourself for shoving off more of the afternoon. Your resistance is waning.

When you hang up, you head for the kitchen. You need fuel for the workout, or that sinking feeling will get you halfway through. So you allow yourself some carbs.

But you've got no willpower left. Between the sugar lows and the lost morning and the loneliness and the sheer sense of defiance you have against all that the universe has thrown at you this year and the last with no rhyme or reason, you've HAD it. Before you can stop yourself, you've inhaled enough from the pantry to horrify your (former) endocrinologist and alarm your dietitian, the latter of whom you should call and 'fess up to right now so she can help you.

And I will.

Tomorrow.

* Eating meals at regular intervals is helpful in maintaining optimal blood-sugar levels and preventing binges.

** Obviously, this is a bit hyperbolic, but when your brain has no fuel, it doesn't process thought very logically or reasonably.

*** Creating variety, even only slightly, in what you eat can be helpful in preventing boredom, which can otherwise trigger binges.

Foggy

My writing brain is sluggish tonight. Yesterday morning started early for me; I had to beat traffic going downtown to have some labs drawn. And even though I slept in today, I'm dragging now. Thank goodness for the end to Daylight Savings Time. The day we "fall back" is one of my most favorite in the year.

When I got to the doctor's office, things were pretty quiet, unlike Wednesday afternoon, when I was there for follow-up with the new internist. The lab techs were just getting started with their preparations for the day -- filling syringes with flu vaccine, restocking vials for blood -- and I didn't have to wait to be called in. The woman with my lab orders waved me over right away and started tying a tourniquet around my arm.

"You fasting?" she asked.

I nodded. I hadn't been sure if the tests required it, but it seemed better to err on the side of caution than to have to reschedule the draw -- one of the tests could only be done first thing in the morning.

I glanced at the labels the woman had printed out for each vial of blood and noticed the number was remarkably short for what I'd seen on the day of my follow-up appointment. (The tech who had originally printed them that afternoon had advised me to wait, given the morning-only test, and have all the blood taken at the same time to save me an extra needle stick.) So -- "We're doing cortisol, anti-TPO, vitamin B-12, and vitamin D today?" I asked, just to be sure.

"Hmm? No, no, I've just got lipids and a hemoglobin A1c," the woman said. "Wait, what's your name again?" She fumbled around with her order sheet for a moment as I gave her my information. "Oh yes, I remember! The other girl said you were going to come back today to get everything done and she taped your other labels to the fridge -- "

We both turned to look at the refrigerator, whose doors were bare.

"Shoot," the woman said, untying the tourniquet. "Wait right here."

I've learned not to be surprised when snafus like this occur. Even as recently as Wednesday, there were some near-mistakes that happened -- the physician ordered the wrong test and only realized it when I asked her why she'd chosen it over an alternative that was purportedly more accurate; then the lab tech handling a urine test gave me the wrong label for the specimen cup and only realized it when I pointed out that it was for the second of two urine tests my doctor had ordered, which could only be done while I was symptomatic (I wasn't that day).

Is it just me, or does it seem like I'm having to double-check what shouldn't be mine to check in the first place?

The woman taking my blood Friday morning eventually found the labels she needed -- in a garbage can. Lucky for me; apparently, once those labels are printed, the request records leave the lab computer and go to a completely different facility where specimens are received (that way, the folks handling that step in the process know exactly what to look for). I don't know whether we would have ended up having to call the receiving facility to figure out what testing needed to be done or if anyone was even at said facility at that time of day. Either way, it wasn't going to be a simple fix.

So. I'm grateful that everything worked out in the end. I just hope the incidence of error drops in future visits. For the next set of tests, scheduled for Wednesday of the coming week, I'll be sedated -- and there's no way I can look out for myself like that!

Two-faced

Halloween was a low-key affair this year. Last week, we again attended the annual pumpkin carving party one of D's friends likes to host, but we didn't go in with a plan as we did the first time. Just a gourd of a ghoulish hue and a vague idea of what we might put on it. Here's the end result:


A pair of eyes apiece -- the ones on the right are mine (adapted from a template) and the others belong to D (carved freehand).



I'm amused that the creepy gaze I thought I was creating ended up looking more concerned than anything else. I guess having another face emerging from the side of one's head would be a good reason ...

Halloween night in question was busy, and not just because we got about 200 trick-or-treaters (fairly standard in our neighborhood). We had a last-minute guest, one of our friends from Portland, who was supposed to be on vacation in Venice but had had his passport turned down the day before at the Portland airport. Too beaten up, the gate agents told him. His only option, if he still wanted to make the trip, was to get a new document issued from the nearest emergency processing center -- which was in Seattle.

"I'm going to be fairly rotten company," he warned me ahead of time. Which was completely understandable. But I paused before telling him that I might not be much fun either. Even though we've known each other for more than a decade, I still hesitated to say anything about what's been going on in the last few weeks. On the outside, there are no obvious signs that mark me -- perhaps I look more tired than usual and my clothes are a little looser, but no scars, no broken bones. Still, I've had my resources tapped repeatedly, dealing with unpredictable pain, diverting whatever energy I have into finding a doctor who will listen, waiting for a diagnostic plan to take shape.

As I hinted here, these aren't things I like to tell people in real life, not even my family, because pain, both physical and emotional, is so intimate. To admit to someone that you hurt is to take a risk -- that the other person will respond insensitively, that he or she will downplay your experience, that you will feel worse for having said something in the first place. So I've learned not to talk about pain out loud if I can get away with it; I do it in this space instead.

But with someone I've known so long, it also feels dishonest to pretend all is well. And I'd been run down enough in the last few weeks that the act of pretending was going to be too much in person, especially because the physical pain is so unpredictable; it can flare up at any time. So I told my friend in brief that I wasn't in the best shape. The result was an awkward few seconds on the phone -- he acknowledged what I'd said but didn't seem to know what else to offer. Then someone came to his door and he said he had to go.

So I'm still turning one face to the outside world and letting the other exist here. I wish there were a way to integrate them more. But for now, this is the best I can do.