Blogroll

When I'm not here, you may find me wandering the pages below. (If I'm a regular visitor to your site and I've left your link off or mislinked to you, please let me know! And likewise, if you've blogrolled me, please check that my link is updated: thisroamanticlife.blogspot.com. The extra (a) makes all the difference!)

Archives

For posts sorted by date or label, see the links below.

For posts on frequently referenced topics, click the buttons to the right.

To search this blog, type in the field at the top left of the page and hit enter.

Body: in sickness and in health

I won't lie; this body and I have had our issues with each other for many years. Body image -- sure. Physical and mental overextension -- comes with being a Type A kind of girl. I still struggle with these things, so they show up from time to time in my writing.

More recently, illness, pure but not simple, has added itself to the mix in a multi-system sort of way. And the challenges in figuring out exactly what's gone wrong are many. As problems have revealed themselves in the last few years, beginning with reactive hypoglycemia in late 2008, I've documented them here, partly to gain a little clarity on managing complex conditions but mostly to give voice to vulnerabilities I feel but don't normally share with anyone face to face. Better out than in, they say, right? (Oh yes, humor is one way I deal.)

The links below cover the different angles I've examined (and from which I've been examined) within that experience.

Travel: neither here nor there

When the person you're married to lives two time zones away, you log a fair number of frequent flier miles. And if you blog about commuter relationships, you log quite a few posts en route too.

Since we're no longer in separate places, I blog less often from airports. But we do travel -- together now! -- which is much more fun to write about. So in addition to thoughts on our years of commuting, the links below cover the places we've been as a pair and, in some cases, the adventures that have happened on the way.

Writing: the long and short of it

Why do I do it? Good question. Maybe it's not so much that I like to write but that I have to write, even when the words refuse to stick to the page. Believe me, I've tried doing other things like majoring in biochemistry (freshman fall, many semesters ago). Within a year, I'd switched to English with a concentration in creative writing and wasn't looking back.

After graduating, I taught English for a few years and then worked as an editor, which I still do freelance. In 2007, I applied and got into an MFA program at a place I like to call Little U. on the Prairie. I finished my degree in 2011 and have been balancing tutoring and writing on my own ever since.

The following links cover the writing I've done about writing: process, content, obstacles, you name it. It's not always pretty. But some part of me loves it, even when it's hard. And this is the result.

Heart: family and friends

I'd have a hard time explaining who I am without being able to talk about the family I grew up in as well as the people I've met beyond its bounds. But even with such context, it's not easy! In the simplest terms, I'm a first-generation Asian-American who has spent most of this life caught between cultures. That, of course, doesn't even begin to describe what I mean to, but there's my first stab at the heart of it all.

That's what this group of posts is reserved for -- heart. The essential parts of my life whose influences I carry with me, for better or worse. The links below cover what I've written as I've learned how these forces work within me, for me, against me, in spite of me. They anchor me even as they change me, and they keep life interesting.

Recommended reading

What do I do when there's too much on my mind and my words won't stick to the page? I escape into someone else's thoughts. Below is a collection of books and articles that have been sources of information, inspiration, and occasional insight for my own work.
Showing posts with label Doctors. Show all posts
Showing posts with label Doctors. Show all posts

Friday, June 21, 2013

New standards in multitasking?

On the days O. wakes up early from his afternoon nap, I'm not inclined to give up my plans completely -- nap time, when I'm not pumping or running errands, is for exercise and/or doing a little something exclusively for my own pleasure in order to maintain my sanity. How to build that into baby-entertaining? Witness this four-point intervention:


1. That knitting project you see in the foreground? I've been working on it while pumping in the middle of the night. Turns out it's also doable while ...

2. Ellipticizing. Sure, I'm not using the handlebars (you can see the yarn draped over the left-hand one), but my arms are getting plenty of toning at other times of day from hefting ...

3. O., who is holding my ball of yarn (and also pulling it apart), while I talk to him -- they say you know you're exercising at an appropriate intensity if you can still hold a conversation. I can't say my chit-chat is scintillating, but I'm pretty sure he is fascinated by the movement of the machine, which is a great device for ...

4. Getting O. to turn his head to the left. We had his 4-month check-up last week, where it was determined that all's well -- he's grown another 3 inches since his 2-month visit! We are now, however, supposed to work on evening out the asymmetrical flatness to the back of his head. He favors lying with his head turned to the right, hence the pediatrician's recommendation that we interest O. in all things on the opposite side.

I think I'm going to call this a decent compromise for all parties involved. Or at the very least, something I can look back at and laugh about someday.

Thursday, April 4, 2013

Tongue-tied

Friday, March 29th, 10:55 a.m.

Today is D.'s first day back at work after his month of paternity leave, and it's just the two of us, O. and me, in the bunker of our bedroom. A pile of clean laundry sits on the unmade bed and random receipts and invoices from the last few weeks, most of them for medical care, are stacked on the floor and the ottoman to the nursing chair I don't use for nursing. Instead, I sit there solely to pump these days, every two hours. O., asleep in his rocking seat just within arm's reach, is snoring to the rhythm of the pump motor as I type.

Saturday, March 30th, 8:20 a.m.

I could write this as if it were one continuous post, but the reality is that I can only put down words every so many hours, when O. doesn't happen to need feeding while I'm pumping. I've rigged a hands-free flange holder from a strapless bra that always threatened to slip down whenever I wore it -- there was little for it to grip. It's serving its new purpose with much better success. Even when I'm holding O. in my lap, his powerful little legs kicking in protest when I take the bottle away to burp him, the bra does not yield when his foot swipes the collection containers dangling by his toes. Brings new meaning to the mother of invention indeed.

10:20 a.m.

We determined, after seeing a lactation consultant and an occupational therapist who specializes in infant feeding problems, that O. was born with a tongue tie. The ligament under his tongue was too tight and couldn't allow him to nurse properly, even though he made a remarkable effort for the first three weeks of his life. I had no idea he was struggling -- I just knew he was chewing me to pieces, but I thought it was normal. Breastfeeding is supposed to be painful at first, the on-call pediatrician who saw O. for jaundice said when he was three days old. I accepted that -- I'd planned to breastfeed unless there were extraordinary circumstances preventing it in hopes that O. would be better protected against developing the kinds of food allergies I have. I assumed the blistering would eventually toughen me up. As it was, O. was gaining weight at twice the average rate once we got through the initial postpartum weight loss every baby experiences.

4:15 p.m.

But then O. hit his first growth spurt and couldn't get the milk he needed, despite all the clamping and gnawing he'd been doing to compensate. Once we discovered the tongue tie, it was clear we had to get it clipped -- he was making himself gag too often when he tried to pull his tongue back and he couldn't stick it out far enough to form a proper latch. So we took him to yet another person who could do the procedure. It's a quick one, but I could not watch. The last I saw of O., drunk on the sugar water he'd been given before the frenotomy, was his tiny body swaddled in a hospital-issue blanket, his large, dark eyes gazing up at the nurse who would hold him down. And then the nurse practitioner who performed the clip was pressing gauze into his mouth and dancing from foot to foot with him in her arms while his face turned pink with his silent scream.

6:20 p.m.

We are 10 days from that afternoon and O.'s attempts to nurse are no better, at least from a nutritive standpoint. He no longer leaves me bloody, but he can't get a satisfactory latch, even though we both try so hard. We are now being sent to a group of occupational/physical therapists at Seattle Children's Hospital -- it seems there are more issues with O.'s mouth that we won't be able to address until he has an oral motor evaluation. The residual sensitivity he appears to have -- namely, that hyperactive gag -- is preventing him from being able to suck effectively.

Sunday, March 31st, 5:30 a.m.

It is hard not to be consumed by the quest for answers and assistance. It feels as if for as long as I've been stuck in this seat to pump -- the entire month, as of today -- I've been making appointments for O. and looking for recommendations on the most effective ways to increase milk supply. As he began to have more trouble nursing, I stopped producing as much milk because he wasn't extracting it well. Now we're playing catch-up. D. has a spreadsheet going for the data -- volumes, time elapsed between pumping sessions, time of day. Yes, we're geeks. But if charting will tell us whether we're actually gaining anything, then I can decide whether the hours I'm investing are worth what I'm losing in sleep and, more importantly, time with O.

8:30 a.m.

Of course, O. doesn't understand this when all he wants is to snuggle on my chest, flanges be damned. It's my heartbeat he wants against his cheek, to lull him to sleep when he's tired and to be comforted in his alert moments. Try as I have, I can't find a way to hold him in that position, so we are stuck at best at arms' length, which for both of us is an enormous disappointment. O. knits his little brows, throwing fists in all directions in search of something, anything, to pacify himself.

10:30 a.m.

"Talk to him," D. suggests. But I'm a mediocre conversationalist with the non-verbal set. I feel ridiculous narrating what I'm doing -- really, I'm not doing anything, just waiting passively for the pump to finish its business -- so that's out. And I sense O. is smart enough to know I can do better. D., an extrovert through and through, just has to stick his ever expressive face in front of O. to fascinate him; chit-chat is a bonus.

12:30 p.m.

So I practice my Cantonese on him. Very basic things, as my own retained vocabulary from childhood is scant: the words for parts of his body or a narration of what he's looking at. I follow with the English equivalent. Nothing like doubling the time from one sentence to another when you don't know what to say to replace the language of touch.

Monday, April 1st, 3:55 a.m.

Does he really recognize my voice from his time in utero? I wonder. For D.'s month off, I've had to spend so much time tied to the pump that D. has been O.'s primary caregiver. Bottle-feeding, changing, playing, walking him around the living room in the middle of the night -- it's no wonder I've had trouble finding a connection to this intense little soul now that I'm all he has during the weekday. For the last two weeks, when my face has been in front of his, he's stared past me into my hair. I tell myself it's because he's attracted to high-contrast things, but I worry he's forgotten who I am.

9:10 p.m.

It's also amazing the difference a day makes. Today was our second on our own with this pumping schedule, and for most of it, O. made eye contact with me. And he smiled.

Tuesday, April 2nd, 8:05 p.m.

We've been given exercises to do with O. to help loosen the muscles of his mouth and increase the range of motion of his tongue. He hated having our fingers in and around his mouth right after the frenotomy -- no surprise -- but I've figured out how to make that more, shall we say, palatable. I wait until he's looking at me and then do one of the lip stretches with my fingers on myself while making an interesting noise, such as clicking my tongue, in rhythm with the left-right motions -- we have to push and pull the upper and lower lips sideways. Then I do the same on him. He thinks it's a great game as long as I stay on the outside of his mouth -- he opens it almost as if to laugh and makes cooing sounds. He still doesn't like my touching his gums or tongue, though. He used to welcome having a finger to suck on for comfort, but now he grabs our hands and forcibly pulls them away when we go for the exercise where we have to press on his tongue to encourage him to form it into a trough (it'll help him maintain suction at the breast). I did manage to get him to take my finger briefly when he was sleepy today, just for pacification. It's as if regaining his trust is part of his therapy too.

Thursday, April 4th, 4:15 a.m.

Tomorrow we'll have made it through a work week. I've measured the hours until D. returns each day by pumping intervals -- five, on average, before I can have his help again with O. I consider it a victory if I can feed myself and accomplish one other task in between sessions if O. is asleep: folding laundry, paying bills, anything that can be done not seated in front of my laptop, which is where the pump is set up. I baked bread yesterday. Two beautiful, springy-centered, golden-crusted, gluten-free loaves. I'd mixed the dry ingredients Monday afternoon and was never able to get enough time until 48 hours later to add the wet and then put it all in the oven. But I anticipated that. And I even mixed two extra rations of dry ingredients and bagged them for next time.

9:15 a.m.

I've realized after these simultaneously long and short days -- long when you can never get more than three hours' sleep because of pumping demands, short because there is never enough time in between to finish tasks that you used to count on being able to complete in one attempt -- that a to-do list is laughably moot. So I've renamed it the Wish List. I jot down what I'd like to get done on it and impose no time limits. It gives me the sense that those things still matter, that it is okay to prioritize the time for them, even if it means an entire day's scattered free minutes have to be used to get one wish fulfilled. The bread was worth it. It also keeps me from forgetting the little things that would otherwise nag at me every time I'm reminded of them while I'm attached to the pump or have my hands full with O. (sometimes both). Move ottoman was one of today's wishes, the one that came with the nursing chair. I've wanted to get it out of our bedroom for the entire month as it's not usable at the moment. (Never lean back while pumping unless you really do want to cry about spilled milk.)

7:25 p.m.

I won't say I've accepted all this as the new normal yet. But we're surviving it until the next turn in the road. We'll see the occupational/physical therapy group in just under a week, and then, who knows. At least we've proved to ourselves that some form of life as we once knew it can continue -- only in discrete chunks. O. is worth it. I just can't wait until the pump is no longer between him and me.



*

This post happened to coincide with a prompt from Mama Kat's weekly Writer's Workshop. Check out more stories and essays by clicking the button below.

Mama’s Losin’ It

Sunday, March 10, 2013

At four weeks

... you are feisty and fierce in your demands, little owl. You've kept us on our toes since mere days after you were born, with jaundice that required in-home nursing care. You finally learned how to latch to the breast but then refused to nurse two weeks later for reasons we can't explain. That mild fever you had the same day? A change in the musculature of your mouth? We're at a loss. Thankfully you've gained weight on our alternative measures -- round-the-clock pumping for the bottle feedings we swore we'd only rely on until we got your nipple strike figured out. You'll latch now, but only briefly, and you draw blood sometimes before milk.

You're learning at last how to bring your fists to your mouth to comfort yourself when we are not enough, which feels like it has been every day since March arrived. Your cries break my heart even as my own impatience to find answers takes away any confidence in my ability to choose what to do next for you. Keep you alive, yes. But there are so many avenues we've gone down, trusting the guides -- pediatricians, lactation consultants -- who were supposed to help but only compounded our problems.

I've jotted down parts of the story of your arrival -- also complicated and fraught with decisions I wish we hadn't had to make, but there we were and here you are. I remind myself that you are still safe and whole. Even as we continue to find ourselves against these hurdles no one ever talked about or prepared us for. (And why would they have, given how unusual your circumstances seem to be? No sense scaring expectant parents further.) Every time I go to write about you, thinking we've finally cleared the latest obstacle -- now, now we can report with some distance and relief that all is well, I tell myself -- something else catches at our heels and threatens to throw you from our grasp.

But now you're bundled skin-to-skin with me inside the fleece jacket I've zipped around us both. We huddle against each other, tear-stained but not at odds for once. And while you sleep, I can hold off on deciding what we should be doing next for you, for me, for all of us on this wild course that seems to have no end. What I would give just to remain this way, in this quiet hour holding you, and not have you wake again just yet, hungry.

Wednesday, February 6, 2013

Scenes from around the table, part 4: prodding

This is the fourth and final post in a series chronicling our last holiday season before baby arrives -- as they say, life is never the same afterward, so in the interest of capturing a few snapshots to remember this time, here are some jottings from moments that have lingered with me over a multi-destination Thanksgiving week.

Dr. Sis is already in bed with her iPhone docked and its music playing when I come out of her bathroom the night before the baby shower. Rolls of teal tissue, turquoise wrapping paper, and silver ribbon lean against one another in the corner amidst shipping boxes I have been instructed not to poke around in -- quarters in Dr. Sis's Boston condo are cozy, leaving few options for hiding gifts except covering them in plain sight. I climb under the comforter, trying not to disturb a second pile of boxes on my side of the bed.

The clutter, some hardly shower-related, spills into the living room in the form of shoes, books, cleaning supplies, grocery bags. In my own home, the mess would drive me crazy, but I respect that this is my sister's space and that she's a junior resident. That she can find time to feed herself is already a feat on her demanding schedule. Preparing to host a party? Unimaginable. And yet, that's exactly what she's been doing all evening, to my amazement. She and Marketing Sis have already wrapped a large pile of packages now nestled on an arm chair in the dining nook, waiting to be opened the following afternoon.

Through my homebody's eye, I see more than just gifts buried in the corners of this condo. It's a part of Dr. Sis's life, which I've lost the ability to inquire about without feeling like I'm intruding. She is, and has always been, someone who gets her joy from being around other people, usually in spaces not her own -- or maybe it's that she immerses herself in that which is outside her home because the world behind her own door is something she'd rather not steep in alone for too long. So things pile up and get left behind as she comes and goes, stopping to sleep but not, I imagine, to be still here. Whenever she is home, she runs Pandora or tracks from her iTunes account, the music, it seems, a buffer against too much rumination.

I want to be wrong about all of that. Except, perhaps, the part about joy -- if she really does find her happiness outside, out loud, out and about, more power to her. Just because I'm a homebody doesn't mean I think she ought to be.

On this night, I'm not sure what kind of mood she's in, but heart-to-hearts have been rare between us, so I don't expect to plunge into any heavy conversation. We have so little time and we both need sleep; it would be unwise to tread too far into those questions I'm dying to ask anyway. What is it to be where you are now, doing what you're doing? Who's in your life these days? What makes you tick? Basic things I thought I used to know about her.

I admit I haven't been forthcoming with the same information myself. When I have offered up those pieces of my life to her, though, I've never felt satisfied with them. The true answers to most of those questions are that I don't know, it's complicated, things are still a work in progress, I need more time to think. And Dr. Sis, an analyst by nature and in her line of work, delves deeper, harder, faster than I can regroup to get more detailed answers out. She has to be direct, efficient in diagnosing her patients. I don't like feeling like a patient when we start talking. Tell her this, and she'll likely respond, "Really. Well, say more about that."

It's like falling into a trap. A heart-to-heart shouldn't feel like a catch-22 -- and yet. And yet. I wonder if having a mind as sharp as hers is partly why she keeps her music running. I imagine a brain like that needs a regulator, to quiet its inclinations to examine, evaluate, spin. I know reflection has been a big part of Dr. Sis's medical training, but too much introspection can be more harmful than helpful. Writing has its similarities.

Dr. Sis is poking around on her laptop, so I scoot down under the comforter away from the light from the screen, even though I'm not quite sleepy. I expect her to drop off soon -- she's just come off studying for and taking a two-day certification exam on top of taking call over part of Thanksgiving weekend and hosting a Turkey Day dinner -- but Dr. Sis turns toward me, a thoughtful expression on her face, and begins prodding at my belly.

After Marketing Sis's unabashed interactions with her unborn nephew, this doesn't surprise me. I'm amused at the difference in each sister's approach, though. While Marketing Sis has talked to, laid an ear against, and even kissed the belly, Dr. Sis methodically examines it for landmarks. She palpates low, just as my OB has in recent weeks, looking for identifiers I can't name. "He's supposedly rotated downward," I say. Dr. Sis nods and continues to press and poke, her other hand now at the top of my abdomen as if to take the measure of her nephew's body.

"There's an appendage," she says as he squirms a little.

"How can you tell?" I ask. Even though my sister's focus is not in obstetrics, she has done a rotation in the field and delivered her share of babies. I'm awed that she can find a fetal heartbeat with just her stethoscope, fascinated that the random movements I feel under my skin make a difference between heel and head to her. The baby, not so much -- he suddenly kicks vigorously beneath my sister's fingers, as if perturbed. We look at each other, both a little startled, and laugh.

"I'm sorry," she says to the nephew. To me: "When those parts are next to each other but you can feel them moving independently, that's how you know." Dr. Sis makes a flippery motion with her two hands as our middle school swim team coach used to show us when we were learning how to execute an efficient flutter kick.

Then she lets the belly be, respecting its resident's protests. Too much, those kicks seem to say. For once, though, I don't mind the prodding.

For more from this series, please click here.

Saturday, January 5, 2013

We interrupt this series

... for a small update. One that looks to weigh about 4 pounds and seems to think an early arrival might be in his future, per yesterday's ultrasound and non-stress test (both unscheduled, but I woke up with signs that indicated a call to the OB was warranted).

Holy hydration and couch-boundedness, we are so not ready for this baby yet!

Everything to do with the baby himself looked good at the perinatologist's office -- he happily performed his little breathing exercises for us to see, wiggled and squirmed with abandon, and kept his heart rate at a thoroughly reassuring level through contractions I was apparently having fairly regularly but could not yet feel. Today -- well, I can feel them, but some of that is surely from heightened awareness.

I'm home for now with strict instructions to be a lazy slob -- the perinatologist's words, not mine! -- all weekend. Since we'll be at 35 weeks on Monday, my regular OB won't stop labor if it starts in earnest at this stage of the game as the research indicates infants of this age do better out rather than being forced to stay in. So D is running loads of laundry and helping me cook some extra meals (I season, he does the heavy pan lifting). Both tasks were in the plan for the weekend already, but now it feels extra important to make progress on each just in case ...

Time to refill my water glass and go focus on something else. We'll be back to our previously scheduled program shortly (I hope!) with part 3.

Oh and um, Dr. Sis? Marketing Sis? That shipment of baby stuff from the lovely shower you threw me in Boston -- I'd send that sooner rather than later if you can swing it. Please and thank you ...

Saturday, September 10, 2011

Scenes from a graduation, part 6: these ceremonial rites

When we get to the concert hall several hours later, no one is wearing academic regalia -- at least, not yet. The graduates will not arrive for a little while from morning exercises. But there are families milling about, some members clutching black robes striped in kelly green, the colors for those who already hold degrees in medicine. These are for the hooders, most of them parents of the graduates but some of them spouses or siblings.

The gown my mother hands my father is cardinal red.

"He insisted that it had to be this color," she says, rolling her eyes, "because he's a fellow." Red denotes not just my father's doctoral degree but his board certification in a sub-specialty, cardiology. My mother sighs. "Look at him; now he doesn't want to put it on because he knows he'll stand out."

And she's right. As the rest of the hooders begin to unfold their garments, my father hesitates, glancing self-consciously around. Perhaps he's second-guessing his insistence on the "proper" colors for his rank. There are, without question, numerous other fellows in this crowd, but they've all opted to keep the information to themselves. Each doctor will be on stage for mere minutes, half obscured by the graduates they will hood. Why the need to make such a particular visual statement? Pride, yes. But in the case of my father, it feels misdirected. While I can't know for certain what his motivations were when he ordered his robes, I suspect self-importance guided the choice more than the desire to wear his best, so to speak, out of respect for my sister.

I pity him a little, as his insecurity flickers into view. He couldn't help himself, I want to say to my mother, not sure if it's meant to excuse his hubris or condemn it. Neither seems appropriate, so once again, I pull out my camera. Even if I can't sort out the color of my thoughts, I can save the image of the moment to muse on later.

*

Rewind six months. I am elbow deep in boxes of photos and memorabilia at my parents' house, not sure what I'm there to find, but the clock on my thesis is ticking. The idea of graduation -- mine or anyone else's -- is far from my thoughts.

My mother and I have been talking since late summer about the whirlwind weeks of my parents' courtship. Four, to be precise. They'd started dating in the final month of my father's senior year of college at a Canadian university, after which he started medical school in the U.S., on a campus nine hundred miles away. My mother still had a semester to finish and hadn't planned on moving to another country.

But my parents wanted to remain a couple, she said -- the story of which I'm intrigued by, tempted to write. They'd already started talking about marriage by the end of those four weeks. So they courted by airmail for the entire four years that my father was studying to become a doctor.

In his home office, surrounded by stacks of unread medical journals and copies of call schedules, I finger the edges of a photo taken on the day of my father's medical school graduation. His school, unlike my sister's, does not have a special robe color for degree candidates, so he stands on the lawn that flanks the university chapel, in black and green like the faculty. He is alone in the picture, hands clasped in front, mortarboard as square to the top of his head as his gaze is to the camera.

"Who took the photo?" I ask.

"A classmate," my mother says. It was too expensive for her to fly down for the festivities, she explains a little sadly. "No one from his family went either -- too far to travel from Hong Kong." This latter excuse, we both know, is only half true; my father's parents rarely made much of personal achievements. These were to be expected rather than praised or celebrated, as he'd learned early on in his childhood.

We are quiet for a moment. The story that follows is familiar now to both of us: how my father left for Canada immediately after the degree ceremony, driving all night to get back for their wedding, which was to take place within days. It's misleading, then, this portrait's pomp and circumstance, its staid, unhurried pose. That someone managed to capture it -- my father was likely on his way to his already packed car when his friend offered to take the shot -- was fortuitous and may have been the only moment, however brief, in which someone else shared in his achievement the way a family might have.

It is this image that I suddenly remember in the concert hall foyer, as my father finally lets the folds of cardinal red fall open, and I wonder if he is thinking of that day some thirty years ago, footnoted so fleetingly on film. As he fumbles with the sleeves, the zipper, the hook, his face remains unreadable, his eyes focused solely on the task at hand. Because he has been raised to be this way -- practical, unsentimental -- he will not let on, even if this garment reminds him of the chapel and the lawn and the few seconds' pause before the click of the camera's shutter.

Perhaps my mother remembers the photo too as we reach automatically to help him smooth and straighten. The hood, lined in his alma mater's colors, flops and dangles like a superfluous appendage -- "Hold on! Don't walk off yet!" we tell him as we try to get it to hang at least somewhat centered down his back. When we are finished, my father examines our work and chuckles for the first time that morning, at himself. In spite of the curious looks he's beginning to draw -- "They think he's the university president," my other sister whispers -- he looks pleased.

*

My father and Almost Dr. Sis see each other for the first time that day from across the concert hall. Or maybe only he sees her. In the images we collect from that hour, my father stands against the right-hand wall leading to the stage while my sister stands on the opposite side. The room is too large to capture them both in the same frame. In my father's picture, though, he is clearly looking toward his daughter, whose own eyes are aimed at the line of deans whose hands she will soon shake.

I do not remember thinking much in this moment, though so much thought has gone before it -- my questions about what I would feel, watching my sister and father partake in this long-running ritual, the symbolic induction into an exclusive circle, both professional and familial. All I know is that I have a job, to record the moment as it unfolds. (The video capabilities of my phone are limited, but it is the best we have.) Though I won't realize it until afterward, I'm relieved to have this duty, to be able to focus on the task so that any other thoughts -- and the emotions they might carry -- do not become overwhelming.

We know they will announce my sister's name, followed by the name of her hooder, but hers has barely been broadcast when we, too excited by the first-time use of the word doctor as her official title, cannot keep ourselves from hooting like fans at a sporting event. My father's name is completely lost in the roar.

A wisp of guilt blooms within my chest -- I would have liked to capture my father's honors here too. I know then that in spite of his ego, I still care that he has missed so much in his life: not just the presence of family -- his and ours -- but the affection that comes with it, something he has been so used to living without. You are important too, I want to tell him, for each moment he ever privately doubted this -- and felt the need to compensate for it.

It takes my sister some time to cross the stage, so we are calm when she finally reaches my father, who stands with hands folded just as he did on the day of his own graduation, serious and proper. She passes her green velvet hood to him, turning to face the audience as the deans have instructed each graduate ahead of time, then bends at the knees slightly, as if curtsying, so my father can place the hood over her head from behind. Even so, he knocks her cap slightly askew. She grins as she straightens it, and -- is it possible? -- seems to look directly at us as we wave. I wonder if my father can see us too.

There is no time to find out; they must exit the stage to make room for other graduates. Quickly, my sister turns to hug my father, her enormous diploma in its cover between them. And then, to my surprise, instead of offering his usual one-handed pat on the back, my father raises both arms, almost as if opening a pair of wings. He folds them around her, pulling her close, draping her in the scarlet of his own mantle, oblivious to the leather folder poking them both in the ribs.

The moment lasts only a few seconds. But his smile, when he finally lets my sister go, is just as broad as hers.

For more from this series, please click here.

Monday, July 18, 2011

Scenes from a graduation, part 4: limits

Hello! As you may have noticed, the writing's slowed down here -- we are in the midst of a heavy rotation of back-to-back visitors. (Our friends and family know the best time to come to Seattle is in summer, when the sun is out.) We're nearly done with B&B duty, though, so please stay tuned for more!

Dinner is easier -- just family. Although this is the first time we've all been in this city together, most of us have visited my sister enough individually to have dined with her at the place she's chosen for this evening, one known for its seafood. We settle in at the table together, laid with heavy silverware and votive candles, as if we've been doing this for a lifetime.

In a way, we almost have. Fine dining -- whether it's while traveling or at my parents' house -- is what my father has come to enjoy, of very little else, in the last fifteen years, so this is what we do with him. He cites his busy hospital schedule as an excuse for his lack of hobbies. I look at Almost Dr. Sis, who'd usually rather be out -- alone or with friends -- than in on free afternoons and evenings, and know my father's limits are more a product of temperament than anything external.

I'm an admitted homebody. And maybe, just maybe, if I'd become a doctor myself, I would be, like my father, too exhausted to do more than eat. That I resemble him in many ways -- habits, aversions, quickness to anger -- has been undeniable all my life, as much as I've been dismayed as I've grown more and more aware of these similarities. On a scale of predictable to spontaneous, we both skew away from the impromptu and, as a result, miss out on the joys of surprise, happenstance, discovery. Or so I believe, when I see the tension in his small, dark eyes, which mirror my own, as a well-laid plan goes astray.

My father is also, more often than not, testy and demanding, intolerant of change or other people's differing opinions. When these tendencies are at their worst, he's able to clear the living room at home just by walking into it, each daughter conveniently finding a reason to disappear, if only because conversation among us is impossible -- too likely to invite a lecture or judgment from him, born of his need to be in control. Left alone, then, he dissolves into the couch cushions, remote in hand and laptop on his knees, lost to their steady stream of I'm not sure what for the rest of the night, save for our evening meal together. Even then, the news blares from across the room. We try to ignore it; he does not.

I see what he misses -- and what I miss -- because of who we are, and the fear that I will become him tightens around me like a straitjacket. It's irrational; I know I have a chance at a different life than he may ever have because I do see, do fear. Still, when I'm feeling frazzled or inflexible, I have to remind myself that I'm not my father's carbon copy, even as I resist and moderate the tendencies we share, perhaps more rigorously than necessary.

For more from this series, please click here.

Friday, June 24, 2011

Scenes from a graduation, part 3: projection

In the auditorium of a local hotel, finally done traveling for the day, I slip into a cushy ergonomic chair that rotates. This isn't theater seating; it's conference hall seating. An enormous projection screen dominates the front wall, and the School of Medicine's glossy logo has been carefully applied to the wooden podium beneath it (removable decals, I'm guessing). Individual ethernet jacks and power outlets, built into the console table stretching across each row, make me feel like I ought to fire up my laptop to take notes. But we -- Troubadour Mom and Dad, my youngest sister and I -- pull out cameras instead.

Of course, we're not here for a lecture. This gathering of parents, siblings, children, other relatives, and friends is like Class Day from our undergraduate commencement festivities, a smaller celebration before the next day's all-graduate ceremonies with the lawyers, the engineers, the MBAs, and so forth. Tonight, a class-chosen faculty speaker will bestow light words of wisdom, a classmate will offer humorous reflections on these last few years of training, there will be a few awards, and then we'll all disperse for heavy hors d'oeuvres. My sisters and I share the same alma mater; I wonder if they also feel a certain déjà vu as we wait for the proceedings to begin. But maybe the conference room setting is too different to them. Class Day, so many years ago, was an outdoor folding-chair affair that, in Almost Dr. Sis's case, took place in a downpour.

I have to laugh a little at myself, always seeking the structure of things, the bones of each new experience. Is it just my way of handling the unfamiliar? Perhaps -- the parallels underneath, analogous armatures, ground me. But it is also a way of remembering, better to secure the details. For our family, there will be no other sister who passes through this medical program or any other. One chance, then, to enjoy these moments for what they are.

The soon-to-be graduates process in, the men in suits, most of the women in dresses. Academic regalia is reserved for the next day. I have not yet seen Almost Dr. Sis since arriving -- does she see us? No time for her to look up, but we follow her with both eyes and camera lenses.

I don't snap any shots, though. The pictures I might get would be blurry, I realize -- the camera on my phone isn't the best for subjects in motion -- and I'm happier without the filter of a viewfinder limiting what I can see. I lean forward, watching my sister in a soft white frock, glossy like meringue, cross into her assigned row.

It turns out that she is in charge of presenting the class gift this evening. As she steps toward the podium, the screen behind her suddenly lights up -- the audiovisual crew working this event has zoomed in, and my sister's head, now ten feet tall, smiles back at us in startling digital glory.

And I can't focus on her, the small woman in the flesh at the microphone. Her slight movements -- a nod, a turn, a tilt of the chin -- become giant ones on the screen. I'm reminded for a moment of Dorothy's audience with the Wizard of Oz. Of course, my sister and her video image are identical, unlike the thundering puppet head and its master, but the projection is still a bit disturbing. So dramatically magnified, it draws the eye away from the real person below.

But isn't that the point of it? I think. To help us see better, to allow us an enhanced point of view?

Maybe. I feel like I'm losing something, though, if I ignore the woman standing right in front of me in favor of the bobbing on-screen head. I can't watch both. I try to anyway.

*

The hors d'oeuvres at the reception are, indeed, heavy. Fortunately, to save me from eating too much, there are scores of my sister's friends to be introduced to. Some I recognize from my last visit a little over a year ago. Others are mentors I've heard of only by name.

There is one woman whose face gives me a double-take. The wire-frame glasses, the slightly upturned nose, the sandy curls, front teeth that peek out below a thin upper lip with a bit of mustache, and that raspy voice with a New York accent -- she is the doppelganger of a professor who has sat on my thesis committee for two years. The woman at Little U. is the sort of person who invited my research methods class, which she also taught, over to her house for potluck on the last night of the semester, just before I moved back to Seattle.

The woman at this reception supervises a group of medical students who travel each summer to run a clinic in South America. I realize my sister introduced me to her on my last visit, at a coffee-shop planning pow-wow for one of those trips. The woman doesn't remember me -- and I don't expect her to -- but the memory of her warm hug from that first meeting comes back as I greet her now. She is effusive, pouring forth compliments about my sister, this class, how special they are to her. It's impossible for me not to remember my own professor's words from potluck night, the same sort of praise overflowing from her in uncannily similar tones.

I'm not looking for these parallels in this moment; they've somehow found me. But for once they aren't grounding. In fact, I realize, I wish not to see what I see this time because it's made me aware of the other comparisons I can't help making -- between the path I chose, to write, and the path I rejected, to become a doctor myself. At one point, that was what I truly believed I wanted to do.

The need to be present for this rite of passage, then, the importance of getting here. You wanted to see what could have been, a voice whispers in my ear, and I recoil.

Don't, I hiss back silently, guiltily. This isn't about you. I glance around the circle my family has made around my sister and the woman who continues to effervesce. Good -- they haven't noticed the extra head I've suddenly grown, or the conversation I'm having with it.

For more from this series, please click here.

Sunday, June 5, 2011

Scenes from a graduation, part 1: getting there

This is the first in a series of posts chronicling my whirlwind second half of May -- there was too much to put in a single post, and the trip generated much for me to think about, so here's the compromise: a story in parts. For the entire series, please click here.

My suitcase gapes at me from the bedroom floor and I wonder if the zipper will close. Nine days of clothing for three different cities with three different climates and three different kinds of celebration -- this is what I have to pack within the confines of a single carry-on.

My first stop on this trip is Almost Dr. Sis's graduation from medical school, which promises to be cold and rainy. Very rainy. Here in Seattle, we're used to mist and drizzle, but in the Midwestern town where she's lived for half a decade now, there are thunderheads gathering and a long sweep of heavy gray downpour following behind.

On this Friday afternoon, I've just tucked a pair of wool slacks into place -- it promises to reach the mid-40s in the evening, though we're in the latter half of spring -- when the phone rings. It's my mother. "Our connecting flight was canceled and we're driving from Chicago," she says, with irritation. "Can you look up directions for us?"

I can hear my father at the wheel in the background naming interstates. "Do I want 290? 294? Ask her which one, which way -- " His agitation rises with what I'm guessing is each passing road sign. They are on the arteries that skirt O'Hare, circling blindly.

My mother tries to address my father's question before I've even had a chance to grab my laptop from the bed. He doesn't trust her answer; they bicker. I fumble at the keyboard, calling up maps, the hair on the back of my neck beginning to stand on end. The memory of previous car trips from childhood: my mother misreading directions, their ensuing fights, my sister and me shrinking small and silent in the back seat with our younger sister, still a baby, between us. My hands work faster now as their voices escalate.

"Here," I say. They're too busy arguing to notice. "Mom. Mom." No answer. In my own home, two thousand miles away, their presence is suddenly too loud, too close. "WILL YOU BOTH SHUT UP ALREADY?"

Silence.

I wince, expecting even now, as an adult, a sharp reprimand from my father for my tone of voice, but maybe only my mother has heard me clearly -- she is the one holding the phone. I plunge ahead before either of them can say anything, offering exit numbers and mileage estimates in lieu of an apology. "It's about seven hours," I note.

"We'll make it in less time," my mother assures me. "You know how Dad drives. By the way, he wants to know which flight you're on tomorrow."

I suppress a sigh, knowing my father is worried that I'll end up in the same predicament -- except with the graduation ceremonies scheduled for Sunday morning, I'll have much less of a window to get from Chicago to my final destination. It matters. My father, a doctor himself, will be the one to place the doctoral hood on my sister, a moment that, to me, feels somehow essential to witness in person, though there will be professional photographers and videographers to capture it all. And I wonder, suddenly face to face with that truth, why it should be so. Of course I am proud of her. But it is more than just being present to let my sister know, more than sitting in the same room with her for this long-anticipated, hard-won induction into the professional circle my father has been a part of for many decades. What is it? I ask myself. And -- with even more curiosity, as I suspect it is for different reasons -- what is it that makes my presence so important to him?

There isn't time in this afternoon to muse, only to finish packing. "Can she take the red-eye tonight?" I hear my father ask.

"No, but I'll look into bus options for tomorrow afternoon, just in case," I promise.

*

On the jet bridge the next morning, I check my seat assignment: 10A, on a window. When I can, I pick seats with a view; it helps with the tendency toward motion sickness both my sister and I have inherited from my father.

As I step into my row, however, I'm greeted by a solid wall. No porthole, not even half of one like some seats get when they happen to fall between windows. Just a beige expanse of siding. I peer at 10F on the opposite side of the aisle; the oval pane there throws light back at me, ordinary as can be.

I feel, not surprisingly, closed in against this blank barricade. I check the status of my next flight on my phone; still on time. But this flight, the captain suddenly tells us over the intercom, will be delayed. Chicago's still having weather.

D has my flight information and instructions to be near his phone around the time I'm supposed to land at O'Hare, in case he has to make a quick bus ticket purchase for me online. Will I be able to make my connection? Will there be a connection to make? I turn my frown to the wall to my left. I can't see what's on the other side, can't see what's to come.

*

It is the first flight I'm taking from Seattle after finishing my thesis, and for a moment, when we finally leave the runway, I'm a little giddy. When the flight attendant announces that we may now use approved electronic devices, I will not need to wrestle my laptop from my backpack and attempt to write. The goal I've been working toward for four years is all but done; only Little U.'s approval of the document -- formatting compliance, verification of my committee's signatures endorsing the final submission -- is pending. Perhaps by Monday, I tell myself, the day my sisters and I will fly to Texas to spend the middle of the week at our parents' home.

But as I speed toward the thunderheads in Chicago, without a view and without the deadlines I've been so used to, I'm forced to sit with my new lack of purpose. It's only transient, I know. Still, I envy, just a little, my sister's waiting future. A residency at a prestigious hospital in Boston is the next step for her. What the experience will hold is certainly unknown, but it's better defined than the summer I have before me. The plans for whatever I choose to do next with my life still wait to be constructed.

The plane banks as the captain adjusts our trajectory. I turn automatically to the window I don't have and feel my stomach protest. A quick glance to the right, to the view I can steal from 10F. It's limited, but it's better than nothing.

Sunday, May 1, 2011

Things I can no longer ignore

It's funny how timing works out.

I've had my head in my thesis pretty steadily (and intensely) since February -- and in the midst of concentrating on the project with so much of my brain, I had to let a lot of other things on my radar remain, at best, peripheral. Which included some aspects of my health. Nothing debilitating: some skin irritation, nerve wonkiness in my hands and feet, intermittent GI protests. The last issue has been ongoing since the middle of 2009 (despite the work-up a year ago), and after so long, I'd practically gotten used to it.

But about two days before I turned in my thesis to my committee, things started to get noticeably worse. Fortunately, I had a follow-up appointment with my doctor (the new one) the day after my draft was due, and her advice, after hearing everything that had been going on for so long, was to consider a food sensitivity as the culprit.

"Gluten and dairy," she said -- these were the most likely suspects. So she suggested an elimination diet followed by an allergen challenge. "Just try going gluten-free for three weeks then dairy-free for three weeks," she said, "and see what happens."

What else is a girl to do with all her newly available time?

I took the news back to my dietitian, who happens to specialize in this kind of testing, and she printed up the protocols. I figured the process wouldn't be fun, but it would be short-lived. Then I looked at the instructions.

"To make this kind of testing accurate and meaningful, you'll want to do more than eliminate gluten and dairy," she told me, pointing to a greatly expanded list of foods and food additives. "Sensitivities can occur in groups. So ideally, you'll want to test all of them."

I won't reproduce the whole catalog here. But let me name a few choice items besides gluten and dairy. Corn. Soy. Eggs. Peanuts. Tomatoes. Peppers. White potatoes. Processed and/or non-organic meats. Shellfish. Strawberries. All citruses. Caffeine. Alcohol. Refined sugars and artificial sweeteners. Processed oils. The list is, even for someone who already has experience with dietary restrictions, more than daunting. And the diet has to be followed for nine weeks, four to allow the body to get rid of residual allergens, then five that cycle in -- very carefully -- each group of potential irritants, one set at a time every third day.

Let's just say this isn't how I envisioned I'd be spending most of the summer.

There is an upside: if I can get this done by mid-September, I will potentially know exactly what's making me feel less than terrific -- and, after getting rid of the little menace(s), be able to go to Hawaii feeling better.

So. After the thesis is officially finished, I'll be looking into the logistics of this new project. It wouldn't be quite so intimidating if I lived on my own and had no one else to answer to. But we've been looking forward to being more social, inviting people over for potluck, taking an extended bike trip with a few friends, visiting and being visited by family. All of that suddenly seems incompatible with the trial because it's inconvenient for the people around me. Imagine subjecting visitors to all of those restrictions when we eat at home or outside the house. Or, in the opposite vein, consider the culinary acrobatics of preparing dual meals so guests can eat "normally," hosting a potluck but not eating what your friends have prepared, going to restaurants but not ordering anything and packing my own food to consume before or after. (Seriously, what are the chances a mainstream eatery will have something, besides a naked lettuce leaf, free of refined sugar, processed oil, corn, soy, eggs ...)

And then there are those looks. The ones you get from people who don't understand your limits and, once they realize just how many there are, back away warily. I shouldn't have to apologize for my circumstances but I often feel like it's warranted -- for the relatively few restrictions I have now, which already make some people uncomfortable.

I know -- those instances are occasional and I shouldn't expect to run into them all the time, but they reduce me to a sense of profound and irrational loneliness. I can't let that prevent me from doing the testing and I can't let the testing keep me from having a life. But how?

Well, if there's anything I'll learn from this experiment, it will be some kind of answer to that question.

Sunday, December 5, 2010

Wishful thinking

I bit down on my tongue. Hard. Held my breath, fixed both eyes on a spot on the carpet by the bed, told myself don't cry. I'd managed to get from Seattle to the panhandle of Texas despite surgery, despite infection, without letting on to anyone how I was feeling. My doctor had cleared me to fly, and I needed to go home. For my research, I'd told myself -- to look firsthand at the photos and old letters from my parents' early years together, before I was born, to begin untangling their story for my thesis. That's what I'd finally realized this project was about.

Don't cry, I thought harder. Don't cry don't cry don't cry. But my mother had her arm around me.

"You've been so good," she said. "It's okay, you don't have to be strong anymore today."

Don't have to be strong? Since when did she ever use words like that? The spot on the carpet dissolved into a uniform blur and I buried my head in her shoulder, bewildered but relieved.

"You're so warm," she said after a few minutes.

I lifted my head. "It's fine," I said. I reached for a tissue and glanced toward the door, hoping my father, who usually spent the evening watching TV on the couch just outside the room, couldn't hear us. "This fever's not as bad as the first."

My mother frowned but said nothing, a hand still holding tightly to my shoulder as she surveyed the suitcase on the floor, the airline ticket stubs on the nightstand. "You've had a long day. Now you should just rest."

I pulled the robe she'd lent me closer, leaned my head against hers, and closed my eyes.

*

I remember getting sick as a kid -- flu, strep, bronchitis, the usual. All of which meant long mornings at the pediatrician's office that smelled like old vinyl seats, worn-edged board books, and that nose-wrinkling soap you found only where there were doctors. We never said it aloud, but I don't think my mother or I particularly liked that place.

My mother tended to look worried during those visits, but not because of me. My father would be irritated when he got home. While he doctored the sick every day at the hospital, giving his all to an endless string of cardiac patients, he didn't tolerate illness in his own house. Most of the time, he'd just ignore the problem, leaving my mother to handle all the nursing duties -- administering medication and fluids, keeping track of symptoms, cleaning up vomit. On occasion, he'd pop his head into the bedroom doorway to assess the situation, but he never crossed the threshold.

He did, however, expect my mother to keep the rest of the house running as usual. A hot meal ready to serve, the newspaper waiting by the couch, bills paid, phone calls made, my younger sisters bathed and fed. If things weren't as he felt they ought to be, he'd whine -- at me ("Are you still throwing up?") and at her ("How much longer before dinner? It's getting late."). My mother couldn't help growing annoyed in turn. She never said anything directly to me, but the look on her face when she was caught between my needs and his said plenty: he wouldn't cut her any slack. Couldn't I?

Hers was obviously wishful thinking, but I felt guilty all the same. So I learned to downplay how I was feeling, even if I was miserable. It was better than feeling like a nuisance, even if I wished deep down that it didn't have to be that way.

*

My body remembered this as I leaned against my mother, so many years later, in the dimly lit guestroom of my parents' new house. The mattress on the bed was old, but the comforter was brand-new to match the pillow shams my mother had sewn. "To update things," she'd said a few weeks earlier on the phone, telling me how much she couldn't wait for me to see what she'd put together. She'd wanted to work on the room sooner, but in my parents' nearly four years in Panhandle, she hadn't gotten around to it until then. It didn't matter to me -- being with her, no matter what kind of bed I slept in, was what made home feel like home. Though I did like what she'd chosen, knowing that I would be the one to curl up there.

And how I wanted to do just that. But I didn't want to move while she sat next to me, holding me close. How I'd wanted this too, in those moments when she'd been forced to choose between me and my father. Even early that evening, he'd only grunted, when my mother mentioned I'd been ill, and then complained about what had taken her so long at the grocery store, where she'd gone to get the fresh fish he'd wanted for dinner. Nothing seemed to have changed.

But my mother's arm stayed around me as I glanced toward the door, listening for sounds of the TV, long after the meal had ended. "He's gone to bed," she said. "Don't worry about him."

I dabbed at my eyes, not sure what to say. But for once, she seemed to understand how much I needed her, even more than I'd realized.

Wednesday, November 24, 2010

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

Thursday, November 11, 2010

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.

Monday, November 8, 2010

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.

Saturday, November 6, 2010

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!

Monday, November 1, 2010

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.

Monday, October 18, 2010

Square one

So, about Wednesday.

It was a small adventure, locating the clinic. The place is in an area of the city I don't normally spend much time in, so I was more than out of my element, trying to find parking, looking for the right building, attempting to understand the electronic directory, then finally giving up and guessing which floor to take the elevator to. No signs, and no one to ask.

I'd stuck all the information I'd gathered into a folder I'd recycled from -- believe it or not -- ninth-grade English class. (Last summer, as I was digging through the boxes of stuff that used to be in storage at my parents' house, I tossed the old homework assignments and kept the office supplies.) It was a little weird to feel the thickness of all that data crammed into the space that used to hold a semester's worth of journal assignments, but it was strangely appropriate too. Replace one narrative with, in essence, another even more intimate: blood counts and other analyses set in order like entries in a diary.

To my relief, I'd guessed correctly, and the elevator opened into the foyer of the office I needed. In a few minutes, I was sitting with a lap full of new paperwork.

I couldn't finish it fast enough -- a nurse took me back to a room very shortly. She indicated the examination table and the gown folded at one end, so I got undressed. Hopped up onto the paper liner, folder and forms still in my hands. I was still scribbling when the doctor came in.

"Hi," she said, as she headed for the sink to wash her hands. "I'm Dr. ________, but you can use my first name." She smiled and pulled a rolling stool up to my dangling legs. "What's brought you to our clinic today?"

I held up the paperwork. "I'm sorry; I'm not done with these -- "

"It's okay," she said, taking the forms and my folder, setting them on a chair out of reach. "Tell me what's going on."

I froze. The folder, which held my story, also seemed to have my voice in it. But the doctor was waiting, so I offered the first things I could remember: four specialists, each with their own work-ups, no comprehensive picture. "I need someone who can look at the whole, not just the parts," I said, nodding toward the chair.

She opened the file immediately, eyes widening. As she scanned the contents, I explained when my health problems had begun, trying to get a better beginning, middle, and end established for the fragmented narrative I'd started with. She nodded, taking notes, asking a question here and there to clarify. But for the most part, she listened.

When I was done, she closed her eyes, fingers to her temples, as if she was thinking hard. "This is a lot of information," she said, "and if you're willing to trust me with this, I'd like to keep it for a few days, just to synthesize all of it more thoroughly in my mind. I'm thinking several things right now, but I want to see exactly what's been done and what hasn't so we can put together some next steps."

I nodded. A doctor taking this kind of time before trying to formulate a path to a diagnosis? It was more than I'd hoped for. For the first time in months, I had the sense that I'd found someone who could help. But what kind of follow-up was she envisioning?

"Early next week," she said, eyes seeking mine with a reassuring expression. "I'll be in touch with you with a plan. We're going to get to the bottom of this."

This time, I think I can believe that.

Sunday, October 10, 2010

And then things got ugly

I've been waiting.

At first it was just waiting for an appointment with a new doctor -- an internist to start with; she comes highly recommended. She works within a well-reputed medical center I've been referred to in Seattle, one whose philosophy emphasizes continuity of care: a single system, linking all of its specialists. Everybody has access to your records, your history. No faxing things to separate people, no need to dig channels of communication. They're already in place. But you have to have a primary care physician within the organization -- he or she acts as your point person -- before you can arrange to see anyone else (like, say, an endocrinologist).

So my appointment, which I made the day before my last post, is this Wednesday.

The same day of my last post, within the hour I hit publish, my body threw a hissy fit. I'll spare you a list of the symptoms, but suffice it to say, they weren't something to ignore.

We weren't sure of the cause, but the first suspect was that kidney stone. Its initial presentation was odd, which I knew, but it turns out the urologist's report hems and haws about whether it was ever even a stone. If it was, it's up and done something unkind. If it wasn't, then something else is going on and we need to figure out what that is.

In the interim between the Friday I got sick and this Wednesday (not quite three weeks), we've done some stopgap investigating. As much as I didn't want to, we went to an ER on the first Saturday (on the advice of the nursing consult service D's company provides to its employees) to make sure nothing imminently life-threatening was happening. After that, we were advised to follow up with a urologist. Of course, the earliest appointment I could get was after the first appointment with the new internist (this is how new-patient scheduling sometimes goes). I was still feeling off, so my remaining option while waiting was to go back to my current doctors.

At some point in April, when the endocrine guy was beginning to run out of ideas, he referred me to a rheumatologist (suspecting something autoimmune). "He's a very good diagnostician," he told me. So I saw that person in June (see what I mean about new-patient scheduling?) but in the end received no new answers after one more round of tests.

Given the new symptoms from September, I figured it might be worth going back to him. Fortunately, he had an opening the Tuesday after I got sick; still no answers, but he repeated his tests.

The Thursday of that week, we left for D's brother's wedding weekend, during which my symptoms got worse. Tack on one more ER visit.

Then we came home. Symptoms even worse. Decided to forgo the ER visit against most natural instincts, sensing from our track record that we wouldn't get answers. The rheumatologist's tests came back a few days ago with nothing new either. And now, we're here.

I've got all my paperwork gathered and organized, all the records I could pull together from the last eighteen months. I've sat down and charted from scratch on a timeline all the weird things that have happened with my body since I got diagnosed with prediabetes, and then some from the time before. I've noted diet changes, weight changes, GI changes, urological changes, medicinal changes, mental changes, environmental changes. There's nothing more I can think of to add.

I wanted to wait to write about any of this, hoping I'd have better news. But here I am, waiting.

I just have to make it to Wednesday. We start fresh there.

Friday, September 24, 2010

Them's fightin' words

I knew getting a dietitian was the first step toward some important changes, but apparently it's starting a small revolution.

I think I'm firing my endocrinologist.

It's not a straightforward story, but the short version is that on my visit to said endocrinologist's office last week to follow up on that pesky kidney stone, I updated him on the diet adjustments I've been making with the help of my dietitian. And he wasn't happy -- the caloric allowances she'd laid out for me didn't jive with what he thought I should be aiming for (he was advocating a much tighter budget). Not one to sit helpless when given conflicting information, I asked him to speak with the dietitian so that we could determine where the disagreements were in their assessments of my needs. His response: "Tell her that I have a subspecialty degree in metabolic disease" -- or some such field, I can't remember his exact words -- "and if she still has questions after that, she can call me."

Huh. Did he really think she (or I) was going to accept credential-waving as an adequate reason to follow his plan?

Sensing I was getting the brush-off, I e-mailed the dietitian after I got home, explaining the discrepancies between the recommendations, and expressed my concern. She immediately got back to me, promising to contact my doctor so that we could get the diet guideline questions resolved.

Apparently, he wouldn't talk to her.

Instead, he left a message for her with his nurse -- one that wasn't far off from what he'd told me to relay, from what I've gathered. And he's still refusing to take the dietitian's calls.

Is it ego? Insecurity? A control issue? All of the above? I'm done speculating. I need a care team, one in which the various members work together. If someone's refusing to communicate, much less collaborate, there's no way this is going to work out in my best interest. So I'm removing myself from his responsibility.

This has been a long time coming -- over the last few months, this guy has said and done other things that left me feeling unsupported and unheard. It's not worth going into detail, but each incident eroded my trust in him just a little bit more. I'm glad to be able to leave his service, knowing without question that the problems with him aren't "just in my head."

But finding that next person. I can't say I've got a lot of confidence in the current remaining team members (with the exception of the dietitian) -- they communicate minimally, by faxed lab results at best. This endocrinologist was kind of the only person who at least went through the motions of examining the bigger picture (he made the referrals to other specialists, so he got their letters back interpreting the results of their tests). I need someone willing to take the time to look closely, to pursue answers.

I happened to read Big Little Wolf's commentary on the doctor-patient relationship as all this was going on, and that, among other things, has reinforced what I've known for a while: that my search isn't going to be an easy one. But I'm looking because I have to. This mess -- or message service -- masquerading as coordinated care has gone on too long.

And I will totally sic all seven pounds of my attack kitty on the next M.D. who tells me his degree is what makes his plan (or lack thereof) superior to anyone else's.

Saturday, September 4, 2010

Every kidney has a silver lining, the sequel

Yep, this little nuisance again.

You'd think I'd recognize a kidney stone after the first one, but no, this one presented itself quite differently. Referred pain? You got it (rather, I did).

So a good part of Friday found me waiting here (the hospital's walk-in imaging clinic):


Not exactly my first choice for where to spend all that time. But when the ultrasound didn't reveal anything amiss in my gallbladder (a good thing!), the GI folks had to refer me to somebody else (with a practice in the same medical facility, but an entirely separate registration/appointment process). That doctor, whom I got to see only on the luck of some other patient's cancellation, sent me back to the clinic for an x-ray, which revealed the real cause of all the trouble.

The doctor was very kind and hung around after his office had closed, just so he could interpret the x-ray for me (it was late in the day when he ordered the test, so there was no way the radiologist would have the official report to him in a timely fashion). He could have gone home and told me to wait for the results, to be delivered by phone after the long weekend, with orders to go to the ER if things got worse before then. But he didn't, and I'm thankful. Because of his kindness, I was able to go home with an answer and greater peace of mind. I'm still under orders to go to the ER if anything untoward occurs, but given the size and location of the stone, that's very unlikely.

Who knew I'd be glad to have a kidney stone instead of the alternative?

(Don't get me wrong; it still hurts. But given the choice, while alone, I'd rather deal with a problem I can treat from home as opposed to something that requires hospitalization, no matter how routine. Who would feed the kitty?)

I just hope I'm not in for a repeat of this in the future. Especially since it occurs without warning and in such misleading ways! Worst fear: that it happens while I'm on a plane. If I'd gone with D on Thursday instead of staying behind to work on my thesis, I'd have been somewhere over Texas during the nastier part of that afternoon. I suppose I should thank my writing obligations for preventing that ... ?

Posts by date

Posts by label

Air travel Airline food Allergic reactions Astoria Awards Bacteremia Bacterial overgrowth Baggage beefs Bed and breakfast Betrayal Blues Body Boston Breastfeeding British Columbia California Canada Cape Spear Clam-digging Colonoscopy Commuter marriage Cooking CT scans Delays Diagnoses Dietitians Doctor-patient relationships Doctors Eating while traveling Editing Endocrine Endoscopy ER False starts Family dynamics Feedback Food anxiety Food sensitivities Gate agent guff GI Halifax Heart Home-making House hunting Hypoglycemia In-laws Intentional happiness Iowa Journaling Kidney stones Knitting Lab tests Little U. on the Prairie Liver function tests Long Beach Making friends in new places Malabsorption Massachusetts Medical records Medication Mentorship MFA programs Miami Monterey Motivation Moving Narrative New York Newark Newfoundland Nova Scotia Olympic Peninsula Ontario Ophthalmology Oregon Oxalates Pancreatic function tests Parenting Parents Paris Pets Photography Portland Prediabetes Pregnancy Process Professors Publishing Reproductive endocrine Research Revision Rewriting Rheumatology San Francisco Scenes from a graduation series Scenes from around the table series Seattle Sisters Skiing St. John's Striped-up paisley Teaching Technological snafus Texas Thesis Toronto Travel Travel fears Traveling while sick Ultrasound Urology Vancouver Victoria Voice Washington Washington D.C. Weight When words won't stick Whidbey Island Why we write Workshops Writers on writing Writing Writing friends Writing in odd places Writing jobs Yakima
Showing posts with label Doctors. Show all posts
Showing posts with label Doctors. Show all posts

Friday, June 21, 2013

New standards in multitasking?

On the days O. wakes up early from his afternoon nap, I'm not inclined to give up my plans completely -- nap time, when I'm not pumping or running errands, is for exercise and/or doing a little something exclusively for my own pleasure in order to maintain my sanity. How to build that into baby-entertaining? Witness this four-point intervention:


1. That knitting project you see in the foreground? I've been working on it while pumping in the middle of the night. Turns out it's also doable while ...

2. Ellipticizing. Sure, I'm not using the handlebars (you can see the yarn draped over the left-hand one), but my arms are getting plenty of toning at other times of day from hefting ...

3. O., who is holding my ball of yarn (and also pulling it apart), while I talk to him -- they say you know you're exercising at an appropriate intensity if you can still hold a conversation. I can't say my chit-chat is scintillating, but I'm pretty sure he is fascinated by the movement of the machine, which is a great device for ...

4. Getting O. to turn his head to the left. We had his 4-month check-up last week, where it was determined that all's well -- he's grown another 3 inches since his 2-month visit! We are now, however, supposed to work on evening out the asymmetrical flatness to the back of his head. He favors lying with his head turned to the right, hence the pediatrician's recommendation that we interest O. in all things on the opposite side.

I think I'm going to call this a decent compromise for all parties involved. Or at the very least, something I can look back at and laugh about someday.

Thursday, April 4, 2013

Tongue-tied

Friday, March 29th, 10:55 a.m.

Today is D.'s first day back at work after his month of paternity leave, and it's just the two of us, O. and me, in the bunker of our bedroom. A pile of clean laundry sits on the unmade bed and random receipts and invoices from the last few weeks, most of them for medical care, are stacked on the floor and the ottoman to the nursing chair I don't use for nursing. Instead, I sit there solely to pump these days, every two hours. O., asleep in his rocking seat just within arm's reach, is snoring to the rhythm of the pump motor as I type.

Saturday, March 30th, 8:20 a.m.

I could write this as if it were one continuous post, but the reality is that I can only put down words every so many hours, when O. doesn't happen to need feeding while I'm pumping. I've rigged a hands-free flange holder from a strapless bra that always threatened to slip down whenever I wore it -- there was little for it to grip. It's serving its new purpose with much better success. Even when I'm holding O. in my lap, his powerful little legs kicking in protest when I take the bottle away to burp him, the bra does not yield when his foot swipes the collection containers dangling by his toes. Brings new meaning to the mother of invention indeed.

10:20 a.m.

We determined, after seeing a lactation consultant and an occupational therapist who specializes in infant feeding problems, that O. was born with a tongue tie. The ligament under his tongue was too tight and couldn't allow him to nurse properly, even though he made a remarkable effort for the first three weeks of his life. I had no idea he was struggling -- I just knew he was chewing me to pieces, but I thought it was normal. Breastfeeding is supposed to be painful at first, the on-call pediatrician who saw O. for jaundice said when he was three days old. I accepted that -- I'd planned to breastfeed unless there were extraordinary circumstances preventing it in hopes that O. would be better protected against developing the kinds of food allergies I have. I assumed the blistering would eventually toughen me up. As it was, O. was gaining weight at twice the average rate once we got through the initial postpartum weight loss every baby experiences.

4:15 p.m.

But then O. hit his first growth spurt and couldn't get the milk he needed, despite all the clamping and gnawing he'd been doing to compensate. Once we discovered the tongue tie, it was clear we had to get it clipped -- he was making himself gag too often when he tried to pull his tongue back and he couldn't stick it out far enough to form a proper latch. So we took him to yet another person who could do the procedure. It's a quick one, but I could not watch. The last I saw of O., drunk on the sugar water he'd been given before the frenotomy, was his tiny body swaddled in a hospital-issue blanket, his large, dark eyes gazing up at the nurse who would hold him down. And then the nurse practitioner who performed the clip was pressing gauze into his mouth and dancing from foot to foot with him in her arms while his face turned pink with his silent scream.

6:20 p.m.

We are 10 days from that afternoon and O.'s attempts to nurse are no better, at least from a nutritive standpoint. He no longer leaves me bloody, but he can't get a satisfactory latch, even though we both try so hard. We are now being sent to a group of occupational/physical therapists at Seattle Children's Hospital -- it seems there are more issues with O.'s mouth that we won't be able to address until he has an oral motor evaluation. The residual sensitivity he appears to have -- namely, that hyperactive gag -- is preventing him from being able to suck effectively.

Sunday, March 31st, 5:30 a.m.

It is hard not to be consumed by the quest for answers and assistance. It feels as if for as long as I've been stuck in this seat to pump -- the entire month, as of today -- I've been making appointments for O. and looking for recommendations on the most effective ways to increase milk supply. As he began to have more trouble nursing, I stopped producing as much milk because he wasn't extracting it well. Now we're playing catch-up. D. has a spreadsheet going for the data -- volumes, time elapsed between pumping sessions, time of day. Yes, we're geeks. But if charting will tell us whether we're actually gaining anything, then I can decide whether the hours I'm investing are worth what I'm losing in sleep and, more importantly, time with O.

8:30 a.m.

Of course, O. doesn't understand this when all he wants is to snuggle on my chest, flanges be damned. It's my heartbeat he wants against his cheek, to lull him to sleep when he's tired and to be comforted in his alert moments. Try as I have, I can't find a way to hold him in that position, so we are stuck at best at arms' length, which for both of us is an enormous disappointment. O. knits his little brows, throwing fists in all directions in search of something, anything, to pacify himself.

10:30 a.m.

"Talk to him," D. suggests. But I'm a mediocre conversationalist with the non-verbal set. I feel ridiculous narrating what I'm doing -- really, I'm not doing anything, just waiting passively for the pump to finish its business -- so that's out. And I sense O. is smart enough to know I can do better. D., an extrovert through and through, just has to stick his ever expressive face in front of O. to fascinate him; chit-chat is a bonus.

12:30 p.m.

So I practice my Cantonese on him. Very basic things, as my own retained vocabulary from childhood is scant: the words for parts of his body or a narration of what he's looking at. I follow with the English equivalent. Nothing like doubling the time from one sentence to another when you don't know what to say to replace the language of touch.

Monday, April 1st, 3:55 a.m.

Does he really recognize my voice from his time in utero? I wonder. For D.'s month off, I've had to spend so much time tied to the pump that D. has been O.'s primary caregiver. Bottle-feeding, changing, playing, walking him around the living room in the middle of the night -- it's no wonder I've had trouble finding a connection to this intense little soul now that I'm all he has during the weekday. For the last two weeks, when my face has been in front of his, he's stared past me into my hair. I tell myself it's because he's attracted to high-contrast things, but I worry he's forgotten who I am.

9:10 p.m.

It's also amazing the difference a day makes. Today was our second on our own with this pumping schedule, and for most of it, O. made eye contact with me. And he smiled.

Tuesday, April 2nd, 8:05 p.m.

We've been given exercises to do with O. to help loosen the muscles of his mouth and increase the range of motion of his tongue. He hated having our fingers in and around his mouth right after the frenotomy -- no surprise -- but I've figured out how to make that more, shall we say, palatable. I wait until he's looking at me and then do one of the lip stretches with my fingers on myself while making an interesting noise, such as clicking my tongue, in rhythm with the left-right motions -- we have to push and pull the upper and lower lips sideways. Then I do the same on him. He thinks it's a great game as long as I stay on the outside of his mouth -- he opens it almost as if to laugh and makes cooing sounds. He still doesn't like my touching his gums or tongue, though. He used to welcome having a finger to suck on for comfort, but now he grabs our hands and forcibly pulls them away when we go for the exercise where we have to press on his tongue to encourage him to form it into a trough (it'll help him maintain suction at the breast). I did manage to get him to take my finger briefly when he was sleepy today, just for pacification. It's as if regaining his trust is part of his therapy too.

Thursday, April 4th, 4:15 a.m.

Tomorrow we'll have made it through a work week. I've measured the hours until D. returns each day by pumping intervals -- five, on average, before I can have his help again with O. I consider it a victory if I can feed myself and accomplish one other task in between sessions if O. is asleep: folding laundry, paying bills, anything that can be done not seated in front of my laptop, which is where the pump is set up. I baked bread yesterday. Two beautiful, springy-centered, golden-crusted, gluten-free loaves. I'd mixed the dry ingredients Monday afternoon and was never able to get enough time until 48 hours later to add the wet and then put it all in the oven. But I anticipated that. And I even mixed two extra rations of dry ingredients and bagged them for next time.

9:15 a.m.

I've realized after these simultaneously long and short days -- long when you can never get more than three hours' sleep because of pumping demands, short because there is never enough time in between to finish tasks that you used to count on being able to complete in one attempt -- that a to-do list is laughably moot. So I've renamed it the Wish List. I jot down what I'd like to get done on it and impose no time limits. It gives me the sense that those things still matter, that it is okay to prioritize the time for them, even if it means an entire day's scattered free minutes have to be used to get one wish fulfilled. The bread was worth it. It also keeps me from forgetting the little things that would otherwise nag at me every time I'm reminded of them while I'm attached to the pump or have my hands full with O. (sometimes both). Move ottoman was one of today's wishes, the one that came with the nursing chair. I've wanted to get it out of our bedroom for the entire month as it's not usable at the moment. (Never lean back while pumping unless you really do want to cry about spilled milk.)

7:25 p.m.

I won't say I've accepted all this as the new normal yet. But we're surviving it until the next turn in the road. We'll see the occupational/physical therapy group in just under a week, and then, who knows. At least we've proved to ourselves that some form of life as we once knew it can continue -- only in discrete chunks. O. is worth it. I just can't wait until the pump is no longer between him and me.



*

This post happened to coincide with a prompt from Mama Kat's weekly Writer's Workshop. Check out more stories and essays by clicking the button below.

Mama’s Losin’ It

Sunday, March 10, 2013

At four weeks

... you are feisty and fierce in your demands, little owl. You've kept us on our toes since mere days after you were born, with jaundice that required in-home nursing care. You finally learned how to latch to the breast but then refused to nurse two weeks later for reasons we can't explain. That mild fever you had the same day? A change in the musculature of your mouth? We're at a loss. Thankfully you've gained weight on our alternative measures -- round-the-clock pumping for the bottle feedings we swore we'd only rely on until we got your nipple strike figured out. You'll latch now, but only briefly, and you draw blood sometimes before milk.

You're learning at last how to bring your fists to your mouth to comfort yourself when we are not enough, which feels like it has been every day since March arrived. Your cries break my heart even as my own impatience to find answers takes away any confidence in my ability to choose what to do next for you. Keep you alive, yes. But there are so many avenues we've gone down, trusting the guides -- pediatricians, lactation consultants -- who were supposed to help but only compounded our problems.

I've jotted down parts of the story of your arrival -- also complicated and fraught with decisions I wish we hadn't had to make, but there we were and here you are. I remind myself that you are still safe and whole. Even as we continue to find ourselves against these hurdles no one ever talked about or prepared us for. (And why would they have, given how unusual your circumstances seem to be? No sense scaring expectant parents further.) Every time I go to write about you, thinking we've finally cleared the latest obstacle -- now, now we can report with some distance and relief that all is well, I tell myself -- something else catches at our heels and threatens to throw you from our grasp.

But now you're bundled skin-to-skin with me inside the fleece jacket I've zipped around us both. We huddle against each other, tear-stained but not at odds for once. And while you sleep, I can hold off on deciding what we should be doing next for you, for me, for all of us on this wild course that seems to have no end. What I would give just to remain this way, in this quiet hour holding you, and not have you wake again just yet, hungry.

Wednesday, February 6, 2013

Scenes from around the table, part 4: prodding

This is the fourth and final post in a series chronicling our last holiday season before baby arrives -- as they say, life is never the same afterward, so in the interest of capturing a few snapshots to remember this time, here are some jottings from moments that have lingered with me over a multi-destination Thanksgiving week.

Dr. Sis is already in bed with her iPhone docked and its music playing when I come out of her bathroom the night before the baby shower. Rolls of teal tissue, turquoise wrapping paper, and silver ribbon lean against one another in the corner amidst shipping boxes I have been instructed not to poke around in -- quarters in Dr. Sis's Boston condo are cozy, leaving few options for hiding gifts except covering them in plain sight. I climb under the comforter, trying not to disturb a second pile of boxes on my side of the bed.

The clutter, some hardly shower-related, spills into the living room in the form of shoes, books, cleaning supplies, grocery bags. In my own home, the mess would drive me crazy, but I respect that this is my sister's space and that she's a junior resident. That she can find time to feed herself is already a feat on her demanding schedule. Preparing to host a party? Unimaginable. And yet, that's exactly what she's been doing all evening, to my amazement. She and Marketing Sis have already wrapped a large pile of packages now nestled on an arm chair in the dining nook, waiting to be opened the following afternoon.

Through my homebody's eye, I see more than just gifts buried in the corners of this condo. It's a part of Dr. Sis's life, which I've lost the ability to inquire about without feeling like I'm intruding. She is, and has always been, someone who gets her joy from being around other people, usually in spaces not her own -- or maybe it's that she immerses herself in that which is outside her home because the world behind her own door is something she'd rather not steep in alone for too long. So things pile up and get left behind as she comes and goes, stopping to sleep but not, I imagine, to be still here. Whenever she is home, she runs Pandora or tracks from her iTunes account, the music, it seems, a buffer against too much rumination.

I want to be wrong about all of that. Except, perhaps, the part about joy -- if she really does find her happiness outside, out loud, out and about, more power to her. Just because I'm a homebody doesn't mean I think she ought to be.

On this night, I'm not sure what kind of mood she's in, but heart-to-hearts have been rare between us, so I don't expect to plunge into any heavy conversation. We have so little time and we both need sleep; it would be unwise to tread too far into those questions I'm dying to ask anyway. What is it to be where you are now, doing what you're doing? Who's in your life these days? What makes you tick? Basic things I thought I used to know about her.

I admit I haven't been forthcoming with the same information myself. When I have offered up those pieces of my life to her, though, I've never felt satisfied with them. The true answers to most of those questions are that I don't know, it's complicated, things are still a work in progress, I need more time to think. And Dr. Sis, an analyst by nature and in her line of work, delves deeper, harder, faster than I can regroup to get more detailed answers out. She has to be direct, efficient in diagnosing her patients. I don't like feeling like a patient when we start talking. Tell her this, and she'll likely respond, "Really. Well, say more about that."

It's like falling into a trap. A heart-to-heart shouldn't feel like a catch-22 -- and yet. And yet. I wonder if having a mind as sharp as hers is partly why she keeps her music running. I imagine a brain like that needs a regulator, to quiet its inclinations to examine, evaluate, spin. I know reflection has been a big part of Dr. Sis's medical training, but too much introspection can be more harmful than helpful. Writing has its similarities.

Dr. Sis is poking around on her laptop, so I scoot down under the comforter away from the light from the screen, even though I'm not quite sleepy. I expect her to drop off soon -- she's just come off studying for and taking a two-day certification exam on top of taking call over part of Thanksgiving weekend and hosting a Turkey Day dinner -- but Dr. Sis turns toward me, a thoughtful expression on her face, and begins prodding at my belly.

After Marketing Sis's unabashed interactions with her unborn nephew, this doesn't surprise me. I'm amused at the difference in each sister's approach, though. While Marketing Sis has talked to, laid an ear against, and even kissed the belly, Dr. Sis methodically examines it for landmarks. She palpates low, just as my OB has in recent weeks, looking for identifiers I can't name. "He's supposedly rotated downward," I say. Dr. Sis nods and continues to press and poke, her other hand now at the top of my abdomen as if to take the measure of her nephew's body.

"There's an appendage," she says as he squirms a little.

"How can you tell?" I ask. Even though my sister's focus is not in obstetrics, she has done a rotation in the field and delivered her share of babies. I'm awed that she can find a fetal heartbeat with just her stethoscope, fascinated that the random movements I feel under my skin make a difference between heel and head to her. The baby, not so much -- he suddenly kicks vigorously beneath my sister's fingers, as if perturbed. We look at each other, both a little startled, and laugh.

"I'm sorry," she says to the nephew. To me: "When those parts are next to each other but you can feel them moving independently, that's how you know." Dr. Sis makes a flippery motion with her two hands as our middle school swim team coach used to show us when we were learning how to execute an efficient flutter kick.

Then she lets the belly be, respecting its resident's protests. Too much, those kicks seem to say. For once, though, I don't mind the prodding.

For more from this series, please click here.

Saturday, January 5, 2013

We interrupt this series

... for a small update. One that looks to weigh about 4 pounds and seems to think an early arrival might be in his future, per yesterday's ultrasound and non-stress test (both unscheduled, but I woke up with signs that indicated a call to the OB was warranted).

Holy hydration and couch-boundedness, we are so not ready for this baby yet!

Everything to do with the baby himself looked good at the perinatologist's office -- he happily performed his little breathing exercises for us to see, wiggled and squirmed with abandon, and kept his heart rate at a thoroughly reassuring level through contractions I was apparently having fairly regularly but could not yet feel. Today -- well, I can feel them, but some of that is surely from heightened awareness.

I'm home for now with strict instructions to be a lazy slob -- the perinatologist's words, not mine! -- all weekend. Since we'll be at 35 weeks on Monday, my regular OB won't stop labor if it starts in earnest at this stage of the game as the research indicates infants of this age do better out rather than being forced to stay in. So D is running loads of laundry and helping me cook some extra meals (I season, he does the heavy pan lifting). Both tasks were in the plan for the weekend already, but now it feels extra important to make progress on each just in case ...

Time to refill my water glass and go focus on something else. We'll be back to our previously scheduled program shortly (I hope!) with part 3.

Oh and um, Dr. Sis? Marketing Sis? That shipment of baby stuff from the lovely shower you threw me in Boston -- I'd send that sooner rather than later if you can swing it. Please and thank you ...

Saturday, September 10, 2011

Scenes from a graduation, part 6: these ceremonial rites

When we get to the concert hall several hours later, no one is wearing academic regalia -- at least, not yet. The graduates will not arrive for a little while from morning exercises. But there are families milling about, some members clutching black robes striped in kelly green, the colors for those who already hold degrees in medicine. These are for the hooders, most of them parents of the graduates but some of them spouses or siblings.

The gown my mother hands my father is cardinal red.

"He insisted that it had to be this color," she says, rolling her eyes, "because he's a fellow." Red denotes not just my father's doctoral degree but his board certification in a sub-specialty, cardiology. My mother sighs. "Look at him; now he doesn't want to put it on because he knows he'll stand out."

And she's right. As the rest of the hooders begin to unfold their garments, my father hesitates, glancing self-consciously around. Perhaps he's second-guessing his insistence on the "proper" colors for his rank. There are, without question, numerous other fellows in this crowd, but they've all opted to keep the information to themselves. Each doctor will be on stage for mere minutes, half obscured by the graduates they will hood. Why the need to make such a particular visual statement? Pride, yes. But in the case of my father, it feels misdirected. While I can't know for certain what his motivations were when he ordered his robes, I suspect self-importance guided the choice more than the desire to wear his best, so to speak, out of respect for my sister.

I pity him a little, as his insecurity flickers into view. He couldn't help himself, I want to say to my mother, not sure if it's meant to excuse his hubris or condemn it. Neither seems appropriate, so once again, I pull out my camera. Even if I can't sort out the color of my thoughts, I can save the image of the moment to muse on later.

*

Rewind six months. I am elbow deep in boxes of photos and memorabilia at my parents' house, not sure what I'm there to find, but the clock on my thesis is ticking. The idea of graduation -- mine or anyone else's -- is far from my thoughts.

My mother and I have been talking since late summer about the whirlwind weeks of my parents' courtship. Four, to be precise. They'd started dating in the final month of my father's senior year of college at a Canadian university, after which he started medical school in the U.S., on a campus nine hundred miles away. My mother still had a semester to finish and hadn't planned on moving to another country.

But my parents wanted to remain a couple, she said -- the story of which I'm intrigued by, tempted to write. They'd already started talking about marriage by the end of those four weeks. So they courted by airmail for the entire four years that my father was studying to become a doctor.

In his home office, surrounded by stacks of unread medical journals and copies of call schedules, I finger the edges of a photo taken on the day of my father's medical school graduation. His school, unlike my sister's, does not have a special robe color for degree candidates, so he stands on the lawn that flanks the university chapel, in black and green like the faculty. He is alone in the picture, hands clasped in front, mortarboard as square to the top of his head as his gaze is to the camera.

"Who took the photo?" I ask.

"A classmate," my mother says. It was too expensive for her to fly down for the festivities, she explains a little sadly. "No one from his family went either -- too far to travel from Hong Kong." This latter excuse, we both know, is only half true; my father's parents rarely made much of personal achievements. These were to be expected rather than praised or celebrated, as he'd learned early on in his childhood.

We are quiet for a moment. The story that follows is familiar now to both of us: how my father left for Canada immediately after the degree ceremony, driving all night to get back for their wedding, which was to take place within days. It's misleading, then, this portrait's pomp and circumstance, its staid, unhurried pose. That someone managed to capture it -- my father was likely on his way to his already packed car when his friend offered to take the shot -- was fortuitous and may have been the only moment, however brief, in which someone else shared in his achievement the way a family might have.

It is this image that I suddenly remember in the concert hall foyer, as my father finally lets the folds of cardinal red fall open, and I wonder if he is thinking of that day some thirty years ago, footnoted so fleetingly on film. As he fumbles with the sleeves, the zipper, the hook, his face remains unreadable, his eyes focused solely on the task at hand. Because he has been raised to be this way -- practical, unsentimental -- he will not let on, even if this garment reminds him of the chapel and the lawn and the few seconds' pause before the click of the camera's shutter.

Perhaps my mother remembers the photo too as we reach automatically to help him smooth and straighten. The hood, lined in his alma mater's colors, flops and dangles like a superfluous appendage -- "Hold on! Don't walk off yet!" we tell him as we try to get it to hang at least somewhat centered down his back. When we are finished, my father examines our work and chuckles for the first time that morning, at himself. In spite of the curious looks he's beginning to draw -- "They think he's the university president," my other sister whispers -- he looks pleased.

*

My father and Almost Dr. Sis see each other for the first time that day from across the concert hall. Or maybe only he sees her. In the images we collect from that hour, my father stands against the right-hand wall leading to the stage while my sister stands on the opposite side. The room is too large to capture them both in the same frame. In my father's picture, though, he is clearly looking toward his daughter, whose own eyes are aimed at the line of deans whose hands she will soon shake.

I do not remember thinking much in this moment, though so much thought has gone before it -- my questions about what I would feel, watching my sister and father partake in this long-running ritual, the symbolic induction into an exclusive circle, both professional and familial. All I know is that I have a job, to record the moment as it unfolds. (The video capabilities of my phone are limited, but it is the best we have.) Though I won't realize it until afterward, I'm relieved to have this duty, to be able to focus on the task so that any other thoughts -- and the emotions they might carry -- do not become overwhelming.

We know they will announce my sister's name, followed by the name of her hooder, but hers has barely been broadcast when we, too excited by the first-time use of the word doctor as her official title, cannot keep ourselves from hooting like fans at a sporting event. My father's name is completely lost in the roar.

A wisp of guilt blooms within my chest -- I would have liked to capture my father's honors here too. I know then that in spite of his ego, I still care that he has missed so much in his life: not just the presence of family -- his and ours -- but the affection that comes with it, something he has been so used to living without. You are important too, I want to tell him, for each moment he ever privately doubted this -- and felt the need to compensate for it.

It takes my sister some time to cross the stage, so we are calm when she finally reaches my father, who stands with hands folded just as he did on the day of his own graduation, serious and proper. She passes her green velvet hood to him, turning to face the audience as the deans have instructed each graduate ahead of time, then bends at the knees slightly, as if curtsying, so my father can place the hood over her head from behind. Even so, he knocks her cap slightly askew. She grins as she straightens it, and -- is it possible? -- seems to look directly at us as we wave. I wonder if my father can see us too.

There is no time to find out; they must exit the stage to make room for other graduates. Quickly, my sister turns to hug my father, her enormous diploma in its cover between them. And then, to my surprise, instead of offering his usual one-handed pat on the back, my father raises both arms, almost as if opening a pair of wings. He folds them around her, pulling her close, draping her in the scarlet of his own mantle, oblivious to the leather folder poking them both in the ribs.

The moment lasts only a few seconds. But his smile, when he finally lets my sister go, is just as broad as hers.

For more from this series, please click here.

Monday, July 18, 2011

Scenes from a graduation, part 4: limits

Hello! As you may have noticed, the writing's slowed down here -- we are in the midst of a heavy rotation of back-to-back visitors. (Our friends and family know the best time to come to Seattle is in summer, when the sun is out.) We're nearly done with B&B duty, though, so please stay tuned for more!

Dinner is easier -- just family. Although this is the first time we've all been in this city together, most of us have visited my sister enough individually to have dined with her at the place she's chosen for this evening, one known for its seafood. We settle in at the table together, laid with heavy silverware and votive candles, as if we've been doing this for a lifetime.

In a way, we almost have. Fine dining -- whether it's while traveling or at my parents' house -- is what my father has come to enjoy, of very little else, in the last fifteen years, so this is what we do with him. He cites his busy hospital schedule as an excuse for his lack of hobbies. I look at Almost Dr. Sis, who'd usually rather be out -- alone or with friends -- than in on free afternoons and evenings, and know my father's limits are more a product of temperament than anything external.

I'm an admitted homebody. And maybe, just maybe, if I'd become a doctor myself, I would be, like my father, too exhausted to do more than eat. That I resemble him in many ways -- habits, aversions, quickness to anger -- has been undeniable all my life, as much as I've been dismayed as I've grown more and more aware of these similarities. On a scale of predictable to spontaneous, we both skew away from the impromptu and, as a result, miss out on the joys of surprise, happenstance, discovery. Or so I believe, when I see the tension in his small, dark eyes, which mirror my own, as a well-laid plan goes astray.

My father is also, more often than not, testy and demanding, intolerant of change or other people's differing opinions. When these tendencies are at their worst, he's able to clear the living room at home just by walking into it, each daughter conveniently finding a reason to disappear, if only because conversation among us is impossible -- too likely to invite a lecture or judgment from him, born of his need to be in control. Left alone, then, he dissolves into the couch cushions, remote in hand and laptop on his knees, lost to their steady stream of I'm not sure what for the rest of the night, save for our evening meal together. Even then, the news blares from across the room. We try to ignore it; he does not.

I see what he misses -- and what I miss -- because of who we are, and the fear that I will become him tightens around me like a straitjacket. It's irrational; I know I have a chance at a different life than he may ever have because I do see, do fear. Still, when I'm feeling frazzled or inflexible, I have to remind myself that I'm not my father's carbon copy, even as I resist and moderate the tendencies we share, perhaps more rigorously than necessary.

For more from this series, please click here.

Friday, June 24, 2011

Scenes from a graduation, part 3: projection

In the auditorium of a local hotel, finally done traveling for the day, I slip into a cushy ergonomic chair that rotates. This isn't theater seating; it's conference hall seating. An enormous projection screen dominates the front wall, and the School of Medicine's glossy logo has been carefully applied to the wooden podium beneath it (removable decals, I'm guessing). Individual ethernet jacks and power outlets, built into the console table stretching across each row, make me feel like I ought to fire up my laptop to take notes. But we -- Troubadour Mom and Dad, my youngest sister and I -- pull out cameras instead.

Of course, we're not here for a lecture. This gathering of parents, siblings, children, other relatives, and friends is like Class Day from our undergraduate commencement festivities, a smaller celebration before the next day's all-graduate ceremonies with the lawyers, the engineers, the MBAs, and so forth. Tonight, a class-chosen faculty speaker will bestow light words of wisdom, a classmate will offer humorous reflections on these last few years of training, there will be a few awards, and then we'll all disperse for heavy hors d'oeuvres. My sisters and I share the same alma mater; I wonder if they also feel a certain déjà vu as we wait for the proceedings to begin. But maybe the conference room setting is too different to them. Class Day, so many years ago, was an outdoor folding-chair affair that, in Almost Dr. Sis's case, took place in a downpour.

I have to laugh a little at myself, always seeking the structure of things, the bones of each new experience. Is it just my way of handling the unfamiliar? Perhaps -- the parallels underneath, analogous armatures, ground me. But it is also a way of remembering, better to secure the details. For our family, there will be no other sister who passes through this medical program or any other. One chance, then, to enjoy these moments for what they are.

The soon-to-be graduates process in, the men in suits, most of the women in dresses. Academic regalia is reserved for the next day. I have not yet seen Almost Dr. Sis since arriving -- does she see us? No time for her to look up, but we follow her with both eyes and camera lenses.

I don't snap any shots, though. The pictures I might get would be blurry, I realize -- the camera on my phone isn't the best for subjects in motion -- and I'm happier without the filter of a viewfinder limiting what I can see. I lean forward, watching my sister in a soft white frock, glossy like meringue, cross into her assigned row.

It turns out that she is in charge of presenting the class gift this evening. As she steps toward the podium, the screen behind her suddenly lights up -- the audiovisual crew working this event has zoomed in, and my sister's head, now ten feet tall, smiles back at us in startling digital glory.

And I can't focus on her, the small woman in the flesh at the microphone. Her slight movements -- a nod, a turn, a tilt of the chin -- become giant ones on the screen. I'm reminded for a moment of Dorothy's audience with the Wizard of Oz. Of course, my sister and her video image are identical, unlike the thundering puppet head and its master, but the projection is still a bit disturbing. So dramatically magnified, it draws the eye away from the real person below.

But isn't that the point of it? I think. To help us see better, to allow us an enhanced point of view?

Maybe. I feel like I'm losing something, though, if I ignore the woman standing right in front of me in favor of the bobbing on-screen head. I can't watch both. I try to anyway.

*

The hors d'oeuvres at the reception are, indeed, heavy. Fortunately, to save me from eating too much, there are scores of my sister's friends to be introduced to. Some I recognize from my last visit a little over a year ago. Others are mentors I've heard of only by name.

There is one woman whose face gives me a double-take. The wire-frame glasses, the slightly upturned nose, the sandy curls, front teeth that peek out below a thin upper lip with a bit of mustache, and that raspy voice with a New York accent -- she is the doppelganger of a professor who has sat on my thesis committee for two years. The woman at Little U. is the sort of person who invited my research methods class, which she also taught, over to her house for potluck on the last night of the semester, just before I moved back to Seattle.

The woman at this reception supervises a group of medical students who travel each summer to run a clinic in South America. I realize my sister introduced me to her on my last visit, at a coffee-shop planning pow-wow for one of those trips. The woman doesn't remember me -- and I don't expect her to -- but the memory of her warm hug from that first meeting comes back as I greet her now. She is effusive, pouring forth compliments about my sister, this class, how special they are to her. It's impossible for me not to remember my own professor's words from potluck night, the same sort of praise overflowing from her in uncannily similar tones.

I'm not looking for these parallels in this moment; they've somehow found me. But for once they aren't grounding. In fact, I realize, I wish not to see what I see this time because it's made me aware of the other comparisons I can't help making -- between the path I chose, to write, and the path I rejected, to become a doctor myself. At one point, that was what I truly believed I wanted to do.

The need to be present for this rite of passage, then, the importance of getting here. You wanted to see what could have been, a voice whispers in my ear, and I recoil.

Don't, I hiss back silently, guiltily. This isn't about you. I glance around the circle my family has made around my sister and the woman who continues to effervesce. Good -- they haven't noticed the extra head I've suddenly grown, or the conversation I'm having with it.

For more from this series, please click here.

Sunday, June 5, 2011

Scenes from a graduation, part 1: getting there

This is the first in a series of posts chronicling my whirlwind second half of May -- there was too much to put in a single post, and the trip generated much for me to think about, so here's the compromise: a story in parts. For the entire series, please click here.

My suitcase gapes at me from the bedroom floor and I wonder if the zipper will close. Nine days of clothing for three different cities with three different climates and three different kinds of celebration -- this is what I have to pack within the confines of a single carry-on.

My first stop on this trip is Almost Dr. Sis's graduation from medical school, which promises to be cold and rainy. Very rainy. Here in Seattle, we're used to mist and drizzle, but in the Midwestern town where she's lived for half a decade now, there are thunderheads gathering and a long sweep of heavy gray downpour following behind.

On this Friday afternoon, I've just tucked a pair of wool slacks into place -- it promises to reach the mid-40s in the evening, though we're in the latter half of spring -- when the phone rings. It's my mother. "Our connecting flight was canceled and we're driving from Chicago," she says, with irritation. "Can you look up directions for us?"

I can hear my father at the wheel in the background naming interstates. "Do I want 290? 294? Ask her which one, which way -- " His agitation rises with what I'm guessing is each passing road sign. They are on the arteries that skirt O'Hare, circling blindly.

My mother tries to address my father's question before I've even had a chance to grab my laptop from the bed. He doesn't trust her answer; they bicker. I fumble at the keyboard, calling up maps, the hair on the back of my neck beginning to stand on end. The memory of previous car trips from childhood: my mother misreading directions, their ensuing fights, my sister and me shrinking small and silent in the back seat with our younger sister, still a baby, between us. My hands work faster now as their voices escalate.

"Here," I say. They're too busy arguing to notice. "Mom. Mom." No answer. In my own home, two thousand miles away, their presence is suddenly too loud, too close. "WILL YOU BOTH SHUT UP ALREADY?"

Silence.

I wince, expecting even now, as an adult, a sharp reprimand from my father for my tone of voice, but maybe only my mother has heard me clearly -- she is the one holding the phone. I plunge ahead before either of them can say anything, offering exit numbers and mileage estimates in lieu of an apology. "It's about seven hours," I note.

"We'll make it in less time," my mother assures me. "You know how Dad drives. By the way, he wants to know which flight you're on tomorrow."

I suppress a sigh, knowing my father is worried that I'll end up in the same predicament -- except with the graduation ceremonies scheduled for Sunday morning, I'll have much less of a window to get from Chicago to my final destination. It matters. My father, a doctor himself, will be the one to place the doctoral hood on my sister, a moment that, to me, feels somehow essential to witness in person, though there will be professional photographers and videographers to capture it all. And I wonder, suddenly face to face with that truth, why it should be so. Of course I am proud of her. But it is more than just being present to let my sister know, more than sitting in the same room with her for this long-anticipated, hard-won induction into the professional circle my father has been a part of for many decades. What is it? I ask myself. And -- with even more curiosity, as I suspect it is for different reasons -- what is it that makes my presence so important to him?

There isn't time in this afternoon to muse, only to finish packing. "Can she take the red-eye tonight?" I hear my father ask.

"No, but I'll look into bus options for tomorrow afternoon, just in case," I promise.

*

On the jet bridge the next morning, I check my seat assignment: 10A, on a window. When I can, I pick seats with a view; it helps with the tendency toward motion sickness both my sister and I have inherited from my father.

As I step into my row, however, I'm greeted by a solid wall. No porthole, not even half of one like some seats get when they happen to fall between windows. Just a beige expanse of siding. I peer at 10F on the opposite side of the aisle; the oval pane there throws light back at me, ordinary as can be.

I feel, not surprisingly, closed in against this blank barricade. I check the status of my next flight on my phone; still on time. But this flight, the captain suddenly tells us over the intercom, will be delayed. Chicago's still having weather.

D has my flight information and instructions to be near his phone around the time I'm supposed to land at O'Hare, in case he has to make a quick bus ticket purchase for me online. Will I be able to make my connection? Will there be a connection to make? I turn my frown to the wall to my left. I can't see what's on the other side, can't see what's to come.

*

It is the first flight I'm taking from Seattle after finishing my thesis, and for a moment, when we finally leave the runway, I'm a little giddy. When the flight attendant announces that we may now use approved electronic devices, I will not need to wrestle my laptop from my backpack and attempt to write. The goal I've been working toward for four years is all but done; only Little U.'s approval of the document -- formatting compliance, verification of my committee's signatures endorsing the final submission -- is pending. Perhaps by Monday, I tell myself, the day my sisters and I will fly to Texas to spend the middle of the week at our parents' home.

But as I speed toward the thunderheads in Chicago, without a view and without the deadlines I've been so used to, I'm forced to sit with my new lack of purpose. It's only transient, I know. Still, I envy, just a little, my sister's waiting future. A residency at a prestigious hospital in Boston is the next step for her. What the experience will hold is certainly unknown, but it's better defined than the summer I have before me. The plans for whatever I choose to do next with my life still wait to be constructed.

The plane banks as the captain adjusts our trajectory. I turn automatically to the window I don't have and feel my stomach protest. A quick glance to the right, to the view I can steal from 10F. It's limited, but it's better than nothing.

Sunday, May 1, 2011

Things I can no longer ignore

It's funny how timing works out.

I've had my head in my thesis pretty steadily (and intensely) since February -- and in the midst of concentrating on the project with so much of my brain, I had to let a lot of other things on my radar remain, at best, peripheral. Which included some aspects of my health. Nothing debilitating: some skin irritation, nerve wonkiness in my hands and feet, intermittent GI protests. The last issue has been ongoing since the middle of 2009 (despite the work-up a year ago), and after so long, I'd practically gotten used to it.

But about two days before I turned in my thesis to my committee, things started to get noticeably worse. Fortunately, I had a follow-up appointment with my doctor (the new one) the day after my draft was due, and her advice, after hearing everything that had been going on for so long, was to consider a food sensitivity as the culprit.

"Gluten and dairy," she said -- these were the most likely suspects. So she suggested an elimination diet followed by an allergen challenge. "Just try going gluten-free for three weeks then dairy-free for three weeks," she said, "and see what happens."

What else is a girl to do with all her newly available time?

I took the news back to my dietitian, who happens to specialize in this kind of testing, and she printed up the protocols. I figured the process wouldn't be fun, but it would be short-lived. Then I looked at the instructions.

"To make this kind of testing accurate and meaningful, you'll want to do more than eliminate gluten and dairy," she told me, pointing to a greatly expanded list of foods and food additives. "Sensitivities can occur in groups. So ideally, you'll want to test all of them."

I won't reproduce the whole catalog here. But let me name a few choice items besides gluten and dairy. Corn. Soy. Eggs. Peanuts. Tomatoes. Peppers. White potatoes. Processed and/or non-organic meats. Shellfish. Strawberries. All citruses. Caffeine. Alcohol. Refined sugars and artificial sweeteners. Processed oils. The list is, even for someone who already has experience with dietary restrictions, more than daunting. And the diet has to be followed for nine weeks, four to allow the body to get rid of residual allergens, then five that cycle in -- very carefully -- each group of potential irritants, one set at a time every third day.

Let's just say this isn't how I envisioned I'd be spending most of the summer.

There is an upside: if I can get this done by mid-September, I will potentially know exactly what's making me feel less than terrific -- and, after getting rid of the little menace(s), be able to go to Hawaii feeling better.

So. After the thesis is officially finished, I'll be looking into the logistics of this new project. It wouldn't be quite so intimidating if I lived on my own and had no one else to answer to. But we've been looking forward to being more social, inviting people over for potluck, taking an extended bike trip with a few friends, visiting and being visited by family. All of that suddenly seems incompatible with the trial because it's inconvenient for the people around me. Imagine subjecting visitors to all of those restrictions when we eat at home or outside the house. Or, in the opposite vein, consider the culinary acrobatics of preparing dual meals so guests can eat "normally," hosting a potluck but not eating what your friends have prepared, going to restaurants but not ordering anything and packing my own food to consume before or after. (Seriously, what are the chances a mainstream eatery will have something, besides a naked lettuce leaf, free of refined sugar, processed oil, corn, soy, eggs ...)

And then there are those looks. The ones you get from people who don't understand your limits and, once they realize just how many there are, back away warily. I shouldn't have to apologize for my circumstances but I often feel like it's warranted -- for the relatively few restrictions I have now, which already make some people uncomfortable.

I know -- those instances are occasional and I shouldn't expect to run into them all the time, but they reduce me to a sense of profound and irrational loneliness. I can't let that prevent me from doing the testing and I can't let the testing keep me from having a life. But how?

Well, if there's anything I'll learn from this experiment, it will be some kind of answer to that question.

Sunday, December 5, 2010

Wishful thinking

I bit down on my tongue. Hard. Held my breath, fixed both eyes on a spot on the carpet by the bed, told myself don't cry. I'd managed to get from Seattle to the panhandle of Texas despite surgery, despite infection, without letting on to anyone how I was feeling. My doctor had cleared me to fly, and I needed to go home. For my research, I'd told myself -- to look firsthand at the photos and old letters from my parents' early years together, before I was born, to begin untangling their story for my thesis. That's what I'd finally realized this project was about.

Don't cry, I thought harder. Don't cry don't cry don't cry. But my mother had her arm around me.

"You've been so good," she said. "It's okay, you don't have to be strong anymore today."

Don't have to be strong? Since when did she ever use words like that? The spot on the carpet dissolved into a uniform blur and I buried my head in her shoulder, bewildered but relieved.

"You're so warm," she said after a few minutes.

I lifted my head. "It's fine," I said. I reached for a tissue and glanced toward the door, hoping my father, who usually spent the evening watching TV on the couch just outside the room, couldn't hear us. "This fever's not as bad as the first."

My mother frowned but said nothing, a hand still holding tightly to my shoulder as she surveyed the suitcase on the floor, the airline ticket stubs on the nightstand. "You've had a long day. Now you should just rest."

I pulled the robe she'd lent me closer, leaned my head against hers, and closed my eyes.

*

I remember getting sick as a kid -- flu, strep, bronchitis, the usual. All of which meant long mornings at the pediatrician's office that smelled like old vinyl seats, worn-edged board books, and that nose-wrinkling soap you found only where there were doctors. We never said it aloud, but I don't think my mother or I particularly liked that place.

My mother tended to look worried during those visits, but not because of me. My father would be irritated when he got home. While he doctored the sick every day at the hospital, giving his all to an endless string of cardiac patients, he didn't tolerate illness in his own house. Most of the time, he'd just ignore the problem, leaving my mother to handle all the nursing duties -- administering medication and fluids, keeping track of symptoms, cleaning up vomit. On occasion, he'd pop his head into the bedroom doorway to assess the situation, but he never crossed the threshold.

He did, however, expect my mother to keep the rest of the house running as usual. A hot meal ready to serve, the newspaper waiting by the couch, bills paid, phone calls made, my younger sisters bathed and fed. If things weren't as he felt they ought to be, he'd whine -- at me ("Are you still throwing up?") and at her ("How much longer before dinner? It's getting late."). My mother couldn't help growing annoyed in turn. She never said anything directly to me, but the look on her face when she was caught between my needs and his said plenty: he wouldn't cut her any slack. Couldn't I?

Hers was obviously wishful thinking, but I felt guilty all the same. So I learned to downplay how I was feeling, even if I was miserable. It was better than feeling like a nuisance, even if I wished deep down that it didn't have to be that way.

*

My body remembered this as I leaned against my mother, so many years later, in the dimly lit guestroom of my parents' new house. The mattress on the bed was old, but the comforter was brand-new to match the pillow shams my mother had sewn. "To update things," she'd said a few weeks earlier on the phone, telling me how much she couldn't wait for me to see what she'd put together. She'd wanted to work on the room sooner, but in my parents' nearly four years in Panhandle, she hadn't gotten around to it until then. It didn't matter to me -- being with her, no matter what kind of bed I slept in, was what made home feel like home. Though I did like what she'd chosen, knowing that I would be the one to curl up there.

And how I wanted to do just that. But I didn't want to move while she sat next to me, holding me close. How I'd wanted this too, in those moments when she'd been forced to choose between me and my father. Even early that evening, he'd only grunted, when my mother mentioned I'd been ill, and then complained about what had taken her so long at the grocery store, where she'd gone to get the fresh fish he'd wanted for dinner. Nothing seemed to have changed.

But my mother's arm stayed around me as I glanced toward the door, listening for sounds of the TV, long after the meal had ended. "He's gone to bed," she said. "Don't worry about him."

I dabbed at my eyes, not sure what to say. But for once, she seemed to understand how much I needed her, even more than I'd realized.

Wednesday, November 24, 2010

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

Thursday, November 11, 2010

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.

Monday, November 8, 2010

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.

Saturday, November 6, 2010

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!

Monday, November 1, 2010

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.

Monday, October 18, 2010

Square one

So, about Wednesday.

It was a small adventure, locating the clinic. The place is in an area of the city I don't normally spend much time in, so I was more than out of my element, trying to find parking, looking for the right building, attempting to understand the electronic directory, then finally giving up and guessing which floor to take the elevator to. No signs, and no one to ask.

I'd stuck all the information I'd gathered into a folder I'd recycled from -- believe it or not -- ninth-grade English class. (Last summer, as I was digging through the boxes of stuff that used to be in storage at my parents' house, I tossed the old homework assignments and kept the office supplies.) It was a little weird to feel the thickness of all that data crammed into the space that used to hold a semester's worth of journal assignments, but it was strangely appropriate too. Replace one narrative with, in essence, another even more intimate: blood counts and other analyses set in order like entries in a diary.

To my relief, I'd guessed correctly, and the elevator opened into the foyer of the office I needed. In a few minutes, I was sitting with a lap full of new paperwork.

I couldn't finish it fast enough -- a nurse took me back to a room very shortly. She indicated the examination table and the gown folded at one end, so I got undressed. Hopped up onto the paper liner, folder and forms still in my hands. I was still scribbling when the doctor came in.

"Hi," she said, as she headed for the sink to wash her hands. "I'm Dr. ________, but you can use my first name." She smiled and pulled a rolling stool up to my dangling legs. "What's brought you to our clinic today?"

I held up the paperwork. "I'm sorry; I'm not done with these -- "

"It's okay," she said, taking the forms and my folder, setting them on a chair out of reach. "Tell me what's going on."

I froze. The folder, which held my story, also seemed to have my voice in it. But the doctor was waiting, so I offered the first things I could remember: four specialists, each with their own work-ups, no comprehensive picture. "I need someone who can look at the whole, not just the parts," I said, nodding toward the chair.

She opened the file immediately, eyes widening. As she scanned the contents, I explained when my health problems had begun, trying to get a better beginning, middle, and end established for the fragmented narrative I'd started with. She nodded, taking notes, asking a question here and there to clarify. But for the most part, she listened.

When I was done, she closed her eyes, fingers to her temples, as if she was thinking hard. "This is a lot of information," she said, "and if you're willing to trust me with this, I'd like to keep it for a few days, just to synthesize all of it more thoroughly in my mind. I'm thinking several things right now, but I want to see exactly what's been done and what hasn't so we can put together some next steps."

I nodded. A doctor taking this kind of time before trying to formulate a path to a diagnosis? It was more than I'd hoped for. For the first time in months, I had the sense that I'd found someone who could help. But what kind of follow-up was she envisioning?

"Early next week," she said, eyes seeking mine with a reassuring expression. "I'll be in touch with you with a plan. We're going to get to the bottom of this."

This time, I think I can believe that.

Sunday, October 10, 2010

And then things got ugly

I've been waiting.

At first it was just waiting for an appointment with a new doctor -- an internist to start with; she comes highly recommended. She works within a well-reputed medical center I've been referred to in Seattle, one whose philosophy emphasizes continuity of care: a single system, linking all of its specialists. Everybody has access to your records, your history. No faxing things to separate people, no need to dig channels of communication. They're already in place. But you have to have a primary care physician within the organization -- he or she acts as your point person -- before you can arrange to see anyone else (like, say, an endocrinologist).

So my appointment, which I made the day before my last post, is this Wednesday.

The same day of my last post, within the hour I hit publish, my body threw a hissy fit. I'll spare you a list of the symptoms, but suffice it to say, they weren't something to ignore.

We weren't sure of the cause, but the first suspect was that kidney stone. Its initial presentation was odd, which I knew, but it turns out the urologist's report hems and haws about whether it was ever even a stone. If it was, it's up and done something unkind. If it wasn't, then something else is going on and we need to figure out what that is.

In the interim between the Friday I got sick and this Wednesday (not quite three weeks), we've done some stopgap investigating. As much as I didn't want to, we went to an ER on the first Saturday (on the advice of the nursing consult service D's company provides to its employees) to make sure nothing imminently life-threatening was happening. After that, we were advised to follow up with a urologist. Of course, the earliest appointment I could get was after the first appointment with the new internist (this is how new-patient scheduling sometimes goes). I was still feeling off, so my remaining option while waiting was to go back to my current doctors.

At some point in April, when the endocrine guy was beginning to run out of ideas, he referred me to a rheumatologist (suspecting something autoimmune). "He's a very good diagnostician," he told me. So I saw that person in June (see what I mean about new-patient scheduling?) but in the end received no new answers after one more round of tests.

Given the new symptoms from September, I figured it might be worth going back to him. Fortunately, he had an opening the Tuesday after I got sick; still no answers, but he repeated his tests.

The Thursday of that week, we left for D's brother's wedding weekend, during which my symptoms got worse. Tack on one more ER visit.

Then we came home. Symptoms even worse. Decided to forgo the ER visit against most natural instincts, sensing from our track record that we wouldn't get answers. The rheumatologist's tests came back a few days ago with nothing new either. And now, we're here.

I've got all my paperwork gathered and organized, all the records I could pull together from the last eighteen months. I've sat down and charted from scratch on a timeline all the weird things that have happened with my body since I got diagnosed with prediabetes, and then some from the time before. I've noted diet changes, weight changes, GI changes, urological changes, medicinal changes, mental changes, environmental changes. There's nothing more I can think of to add.

I wanted to wait to write about any of this, hoping I'd have better news. But here I am, waiting.

I just have to make it to Wednesday. We start fresh there.

Friday, September 24, 2010

Them's fightin' words

I knew getting a dietitian was the first step toward some important changes, but apparently it's starting a small revolution.

I think I'm firing my endocrinologist.

It's not a straightforward story, but the short version is that on my visit to said endocrinologist's office last week to follow up on that pesky kidney stone, I updated him on the diet adjustments I've been making with the help of my dietitian. And he wasn't happy -- the caloric allowances she'd laid out for me didn't jive with what he thought I should be aiming for (he was advocating a much tighter budget). Not one to sit helpless when given conflicting information, I asked him to speak with the dietitian so that we could determine where the disagreements were in their assessments of my needs. His response: "Tell her that I have a subspecialty degree in metabolic disease" -- or some such field, I can't remember his exact words -- "and if she still has questions after that, she can call me."

Huh. Did he really think she (or I) was going to accept credential-waving as an adequate reason to follow his plan?

Sensing I was getting the brush-off, I e-mailed the dietitian after I got home, explaining the discrepancies between the recommendations, and expressed my concern. She immediately got back to me, promising to contact my doctor so that we could get the diet guideline questions resolved.

Apparently, he wouldn't talk to her.

Instead, he left a message for her with his nurse -- one that wasn't far off from what he'd told me to relay, from what I've gathered. And he's still refusing to take the dietitian's calls.

Is it ego? Insecurity? A control issue? All of the above? I'm done speculating. I need a care team, one in which the various members work together. If someone's refusing to communicate, much less collaborate, there's no way this is going to work out in my best interest. So I'm removing myself from his responsibility.

This has been a long time coming -- over the last few months, this guy has said and done other things that left me feeling unsupported and unheard. It's not worth going into detail, but each incident eroded my trust in him just a little bit more. I'm glad to be able to leave his service, knowing without question that the problems with him aren't "just in my head."

But finding that next person. I can't say I've got a lot of confidence in the current remaining team members (with the exception of the dietitian) -- they communicate minimally, by faxed lab results at best. This endocrinologist was kind of the only person who at least went through the motions of examining the bigger picture (he made the referrals to other specialists, so he got their letters back interpreting the results of their tests). I need someone willing to take the time to look closely, to pursue answers.

I happened to read Big Little Wolf's commentary on the doctor-patient relationship as all this was going on, and that, among other things, has reinforced what I've known for a while: that my search isn't going to be an easy one. But I'm looking because I have to. This mess -- or message service -- masquerading as coordinated care has gone on too long.

And I will totally sic all seven pounds of my attack kitty on the next M.D. who tells me his degree is what makes his plan (or lack thereof) superior to anyone else's.

Saturday, September 4, 2010

Every kidney has a silver lining, the sequel

Yep, this little nuisance again.

You'd think I'd recognize a kidney stone after the first one, but no, this one presented itself quite differently. Referred pain? You got it (rather, I did).

So a good part of Friday found me waiting here (the hospital's walk-in imaging clinic):


Not exactly my first choice for where to spend all that time. But when the ultrasound didn't reveal anything amiss in my gallbladder (a good thing!), the GI folks had to refer me to somebody else (with a practice in the same medical facility, but an entirely separate registration/appointment process). That doctor, whom I got to see only on the luck of some other patient's cancellation, sent me back to the clinic for an x-ray, which revealed the real cause of all the trouble.

The doctor was very kind and hung around after his office had closed, just so he could interpret the x-ray for me (it was late in the day when he ordered the test, so there was no way the radiologist would have the official report to him in a timely fashion). He could have gone home and told me to wait for the results, to be delivered by phone after the long weekend, with orders to go to the ER if things got worse before then. But he didn't, and I'm thankful. Because of his kindness, I was able to go home with an answer and greater peace of mind. I'm still under orders to go to the ER if anything untoward occurs, but given the size and location of the stone, that's very unlikely.

Who knew I'd be glad to have a kidney stone instead of the alternative?

(Don't get me wrong; it still hurts. But given the choice, while alone, I'd rather deal with a problem I can treat from home as opposed to something that requires hospitalization, no matter how routine. Who would feed the kitty?)

I just hope I'm not in for a repeat of this in the future. Especially since it occurs without warning and in such misleading ways! Worst fear: that it happens while I'm on a plane. If I'd gone with D on Thursday instead of staying behind to work on my thesis, I'd have been somewhere over Texas during the nastier part of that afternoon. I suppose I should thank my writing obligations for preventing that ... ?