Unravelling

She sat at my kitchen table with her foot resting on the chair and her knee pulled up to her chin.  Her blond hair perfectly placed in a messy bun, juxtaposed against my un-purposed messy morning hair.  We planned a coffee date for first thing in the morning, after she dropped her kids off at daycare.  We picked my house because the baby likes to sleep late.  She had a lunch date with another friend later that day: she was trying to fit in as many visits as she could.

“What can I get you to drink?” I asked as I instinctively placed a mug under the coffee maker. “Coffee?”
“No thanks, just water,” She replied. “I’m changing the way I eat.  No coffee, nothing processed.  I want to make my body as strong as I can.  I’m getting ready to fight this.”
I wasn’t sure if she wanted to talk about it.  I said I was going to take her lead.

We met the year before at Taekwondo.  Her oldest son was in my youngest son’s class.  For weeks we would sit and talk about the superficial realities of life: Work, kids, husbands, weather… Slowly, our friendship developed and we would occasionally meet up outside of the gym.  I’m always happy to make new friends.

“So, when did this all start?”
“Remember back in February, when I had pneumonia?”

She was gone for weeks from Taekwondo, I remembered.  She came back and it seemed to take ages for her to fully recover.  When the snow started to melt, I ran into her in the neighborhood, walking with her husband and two boys – it was the first time I had ever met her younger son, who wasn’t more than three.  We vowed to have a playdate with the kids once the weather was a little nicer.

“The chest pain never went away, so they did an x-ray and they found two spots.  I had a biopsy.  Then I had a CT scan.  Then they wanted a PET scan.”
I listened intently, trying not to ask too many questions.

A few months ago we all went out together for a friend’s birthday party.  Our friend was turning 33.  Just like me… and just like her.  We joked that 33 would be the best year; it had to definitely be better than 32! And we toasted to that, them with their wine glasses and me with my diet pepsi (since I was pregnant and all).  We vowed to have more get-togethers after that – but we didn’t

“They found a few spots in my hip bones and in my leg bones.  I’m going for my first appointment with the oncologist on Wednesday.”

Wednesday was my birthday.  There would be not be another toast to 33 on my birthday.  No this time.

“I’m going to tell her that I don’t want timelines and I don’t want numbers.  I’m going to beat this.  I know I will!”

I painted a reassuring smile on my face and placed my hand over hers.
“Of course.”

I waited until she left to feel the sadness and the heartache – for her and for me.

I don’t think I could ever be so strong if I was diagnosed with Stage 4 Lung Cancer.

 

Tempered Expectations

Every year I dread the arrival of my birthday. It is such an anti-climactic day and for years it always felt like something was missing. 

Maybe it’s because when I was a kid, my birthday was a big and special day – and now there is nothing special about it. 

Maybe it’s because my husband is not the kind of guy who celebrates anything, my special occasions included. 

Maybe it’s because I have this idea that everyone around me has more exciting birthday experiences than I do.

Maybe I’m just getting old. 

Whatever it is, I always feel like it could be more. 

Today was different, though. I had no expectations. In fact, I expected that it would be nothing special and nothing more than any other day. And because of this tempered expectation, I was not disappointed when there were no big hugs and kisses and home-made cards from my kids. I was happy to spend the morning getting some exercise and getting to know a new friend. We had a nice family dinner at my favourite restaurant,  and I was pleasantly surprised when my husband gave me a birthday card with some thoughtful words written on it.  The only birthday gift I got today was a free birthday drink from Starbucks. 

It wasn’t exciting and it wasn’t spectacular, but I wasn’t disappointed – and that’s better than most birthdays. 

Start From What You Know

b0446333f9307d0fc1fb22570b6c6885Over a year ago, when A. was diagnosed with autism and I took a month off work, I bought a puzzle because it “spoke” to me.  It was my goal to finish the puzzle that month.  Unfortunately, it didn’t happen: The puzzle was more challenging than I anticipated and I just didn’t have enough time. I stored the partly completed puzzle under my bed and worked on it when I had time.  A few months ago, though, the kids had some friends over and they were playing hide and seek – and under my bed was a perfect hiding place.  The puzzle was ruined.  I packed it up, preserving the assembled parts as best as I could and stashed it away.
A few weeks ago I decided to re-start the puzzle.  I started by counting pieces and I was disappointed to realize that I was missing 10 pieces.  I counted again.  Still missing 10 pieces.  How could I possibly think they would all be there?  I was saddened, as the message of the puzzle spoke to me and there was something inside of me that felt a sense of disappointment that this puzzle would never be completed and eventually hanging on a wall in my house.  I remembered buying it at a local bookstore, so I set out for a walk with baby El to see if they still carried it… but they didn’t.  I eventually found it on their website, on clearance for $10, so I snatched it up.  That small part of my inner being felt satisfied.

The puzzle arrived yesterday and I was eager to start working on it.  I began sorting the pieces and I immediately remembered how challenging the puzzle is.  I felt disheartened thinking about all the work I had done before that was now wasted:  There was the actual assembly of large chunks of puzzle, but there was also the immense work of sorting pieces.  There are only 2 colours: black and off-white, so sorting came in the form of the size of print.  Hours of sorting – gone.

With the new puzzle, I knew there was only one place to start – placing everything out in the open.  I proceeded to filter out the edge pieces… the only pieces that have a definite position in the puzzle, and the only pieces that are almost predominantly black.  And so, I put all the sadness of what I had done and lost previously behind me and I started again.  I started with what I knew to be true and I will only work forward from there.

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The “No Time” Life

Everyday I come up with some great thoughts and ideas that I want to blog about.  Everyday, however, I never find time to sit down at my computer to write them out.  Right now I have borrowed some time: baby El is awake but content in her swing.  A is at school.  E is distracting our Nanny.  I am sitting at the kitchen table drinking cold coffee, awkwardly holing my breast pump in place with my forearms as I type this post  (I’m still waiting for my pumping bra to arrive from Amazon).  I am lamenting the fact that today was A’s year end party at school and I missed it … because it it totally escaped my mind after I read the notice sent home last week.  I am not looking forward to explaining my absence to a sullen little boy when he gets off the bus in about an hour from now.

Yesterday I eagerly sat down on the bed, ready for my marathon afternoon of nursing El to get her to sleep, and I placed my computer within reach – hoping that maybe I could blog about one of the many thoughts that have been floating around in my head.  Unfortunately, El wasn’t going to cooperate.  After an hour of struggling to get her to sleep, I decided to wrap her up in the carrier and take her for a walk.  While on my walk I came up with a great idea: I could make a voice memo of my blog ideas and then transcribe them another time. So that’s what I did!  I walked and I recorded some great blog ideas.

But this morning, with my borrowed time to blog, I didn’t feel like listening or transcribing any of my ideas from yesterday.  I felt this overwhelming sense of sadness and disappointment; like the emotions that go along with the posts was missing and I was just transcribing some sort of task.  My sadness was extended because I didn’t want to listen to or write down my thoughts from yesterday (really, for the past week or so that have been neglected).  Instead, I decided to write about these feelings of disappointment.

My lack of blogging is just one place that I have been feeling disappointment.  For weeks now I have been trying to find time to add some breast pumping sessions to my day with the hopes of increasing my milk supply.  I want to do this slowly in anticipation of my return to work in 3 months, and also to counteract the likelihood that my supply will decrease when I have my IUD inserted in a few weeks.  Alas – that hasn’t been happening reliably.  Let’s also not forget about my unfortunate omission of A’s celebration today.  And then there is the complete lack of time (and energy) to get back into an exercise regime.  The weight loss has slowed and it’s time to kick it up a little, but there is no time.  My only form of exercise comes as leisurely strolls around my community with a fussy baby strapped to my chest. Oh, and there is also a serious lack of quality time that I spend with my other two kids… I feel like an epic failure.

I know that;s not the case; but it doesn’t stop me from feeling that way.  I want my life to go back to having some reliable structure and from, even if that structure is different than what it used to be.  Like most, I am a creature of habit and I thrive on routine and schedule.  This daily routine of “no/poor sleep – nurse fussy baby all day – maybe eat – maybe drink coffee – maybe shower – maybe do something I want to do” is really starting to eat away at my will.  I’m not sure what to do to change things up…

I Almost Forgot

“You cannot protect yourself from sadness without protecting yourself from happiness.”
~Johnathan Safran Foer

I almost forgot that this day, November 27, used to be meaningful to me.  On this day, I guess 6 years ago now, I met the person who became one of my closest friends for a short time.  Last year I was sort of “celebrating” this milestone.  But up until I re-read the post from this day last year, I ha forgotten the importance of this date.

I admired her so much.  She embodied everything I thought I wanted to have in a role model and a friend.  She embodied everything I thought I wanted to be.  We became good friends for a short while, but then she pulled away.  I was hurt so badly.  Sometimes I still miss her, but most times I wish I could just stop thinking about her.  I catch myself wondering if there is still a “what if?” But then I bring myself back to reality.

I let myself be happy for a brief time by taking risks, living authentically, and being vulnerable.  Unfortunately, this happiness didn’t last and the loss of that friendship caused me a great amount of sadness.  The question then becomes, what that brief moment of happiness worth the sadness?  It is really hard to know for sure.

Taking One Day At A Time

“The only Courage that matters is the kind that gets you from one moment to the next.”
~Mignon McLaughlin

From The Old Blog, November 24, 2014:

I can only take my life one day at a time.  Getting through today is enough work and enough of a struggle. I lose confidence in my ability to survive when I imagine doing it all over again tomorrow.  Regardless, every time tomorrow comes, I get out of bed and survive once more.

It is a relief to know that having only enough courage for one day is all that matters.  I’ll worry about tomorrow’s courage tomorrow because likely in that next moment, I will find the courage I need to keep going.

That’s all I need, and that makes it a little easier to survive.

I really felt a string sense of peace with what I wrote last year on this day.  It was not *completely* about struggle, it was not about making good or bad decisions, it wasn’t about a friend I seemed to be over fixated on.  Rather, it was about me – the raw me – the true me.  While some days are better than others, I still days that feel like this post:  can’t imagine making it past this one day that I am living.  What is of ultimate importance, however, is that I just make it through the day I am living.  Tomorrow is another day.

It’s Always Okay

“‘It’s Okay’ is a cosmic truth.”
~Richard Bach

If there is one thing that I have learned from this November project that has taken me back over the last few years of difficulty, it is that this quote is truer than ever.

Perhaps it’s easy to say that when nothing absolutely “tragic” has happened.  However, despite the difficulty of this previous year, I am doing okay.  And, last year at this time, after a rather difficult year before that, I still said I was doing okay.

It’s all relative, I believe (and, isn’t that another somewhat famous quotation?).  So far in my life it seems like, even though nothing is ever perfect or what I would like it to be, everything is always “okay.”

And, that’s the truth.

  Something To Treasure

“If you are not happy, you had better stop worrying about it and see what treasures you can pluck from your own brand of unhappiness.”
~Robertson Davies

I had a difficult week at work.  I was tired from waking up early every day, putting in long hours at a mentally challenging job.  I had some patient cases that challenged me beyond my limits and made me feel like I’m not smart enough to be doing what I’m doing.  And worse, I felt like I will never be smart enough or capable enough to do this job I’ve picked for myself.  Saturday was no better, when I still had to get out of bed, put on my blue scrubs, and cart myself to work and do it all over again for another day.

The day started out with a difficult case: a woman who was sick and only getting worse.  The baby inside of her also showing signs of not thriving well.  The decision was made to deliver her baby and we wheeled her into the operating room.  A 27 week baby that looked more like a 24 week baby that was difficult to deliver… a lifeless baby that I handed to the nurse… a baby that needed CPR before being intubated and whisked away to the NICU.  And the a tattered uterus to put back together.

IMG_6458I left the OR feeling more tired and deflated.  The feeling of the baby’s brittle bones between my fingers and his heavy doll-like head bobbing in my hands was etched in my mind.  I walked back into the delivery room waiting for the next disaster but instead found a large bouquet of flowers on the desk… and it was for me.  A rare and unbelievable gift from my husband – something to keep me going for the day.  The card simply said, “Have a great day, Beautiful.”

And therein are my treasures: A loving husband, who might not always seem to “get me,” but he loves me nonetheless.  Two healthy children who will never know the difficulties of the baby I had just delivered.  Another growing child inside of me – one that I came by rather easily.  A job that I love, despite how much it exhausts me.  And, all the opportunity and ability that anyone in the world could wish for.

 

My Backstory

“We are all special cases.”
~Albert Camus

From The Old Blog, November 21, 2014

We all have a story that makes us who we are.  I would argue that these stories are not always fun to tell or easy to accept.  It is these stories, however, that make us “special.”  My story is far from great, but I know it could have been worse.  I am the grown up child of a messy divorce, and this simple fact has made the “special case” that I am today:

My parents were newly divorced and were too busy hating each other and making each other miserable to really realize what they were doing to their children.  They provided the necessities and we never wanted for anything physical – we were clothed and fed, we went to school and we did well.  Emotionally, they gave us nothing.  I never felt special or like I mattered to my parents.  My accomplishments always seemed to fall on deaf ears and land in front of blind eyes.  I was a 12 year old girl with nothing to motivate me and no one to encourage me.
~From The Old Blog

Some days I go back to being that 12 year old girl, and I get angry at myself every time I do it.  I am embarrassed that this so heavily defines who I am and how I interact with people.  I fear that I will never be able to escape from that 12 year old me.  And, that right there is the problem: I should not want to escape from her.  Rather, I should want to open up my arms to her and give her that which she never had.  I should be the one to support her, motivate her, cheer her along, giver her advice, and be her best friend.  That is exactly what she has spent the last 20 years trying to find.  Now I can be that for her, I just need to believe it.

We all have stories that make us special cases but many of us are too afraid to go back and read those stories.  Those stories are what make up who we are and we need to understand them to really understand ourselves.  Going back to the beginning can also tell us how far we’ve come and, hopefully, allow us to realize how much we can help ourselves.

I an not a special case because I am the grown up child of divorced parents.  I am a special case because of what I have become as a result:
I am sensitive, kind, and loving.
I work hard, seek perfection, and achieve my goals.
I put others before myself and passionately give everything I can.
I am a loving mom, a sincere wife, and a good friend.

I am all of those things, even if I don’t always believe it… even if other people don’t always believe it.

The Story of Ms. Jones

“Life isn’t fair.
It’s just fairer than death,
That’s all.”
~William Goldman

We were about to round on Ms. Jones (not her real name).  I admitted her the other night after she fell and was found in her bathroom by the aides at her assisted living complex.  She was lucky: she didn’t break any bones despite the grapefruit sized hematoma that was forming over her left hip.  I learned from the emergency room chart that she was a relatively healthy 95 year old lady with a history only significant for hypertension and atrial fibrillation.  I tried to go talk to her and do a physical exam, but she was grumpy and drowsy and wouldn’t cooperate (in her defence, it was maybe 3am and the emergency physician had just given her some dilaudid).  I filled out all her admission paperwork and scanned her home medication list.  I opted to continue her medications for hypertension and her aspirin, but since her hemoglobin had dropped during her stay in the emergency room from 108 to 86, I thought it prudent to hold her anticoagulant (blood thinner).

When we walked into the room that morning, I was pleasantly surprised to see a well groomed, alert, and very proper English woman sitting up in bed and eating her breakfast.
“Good Morning Ms. Jones,” my staff said.  “We are your team of doctors and we are here to see how you are doing.”
“Well, if you want to know about my pain, it is okay.  But if you want to know how I’m doing, well I’m rather upset that the nurses won’t give me any hot water for my tea.”

It turns out there was a communication error and the nursing team believed that Ms. Jones was on a thickened fluid diet to minimize the risk of lung aspiration.  As this diet is quite common in our patients, we continued to explain to Ms. Jones the rational behind why she wasn’t allowed to drink her tea.
“Well, that just ridiculous!  I was just drinking tea the other day and I certainly didn’t choke on it.  I don’t see why it is any different today.”
We offered to place Ms. Jones on an “at risk diet” if she insisted on drinking her tea.
“Well doctors, I am 93 years old.  What do I have left in my life if I don’t take risks?”

She had a point, I guess.  We proceeded with our rounds, ordered the necessary tests and continued on with the day.  We thought about re-starting Ms. Jones’ anticoagulation, but her hemoglobin was down to 80, so we held off and sent her for a CT scan instead.  The results came in later that day and there were no identified areas of internal bleeding.  We decided we were going to restart the medication the next day.

When we rounded the next day, we visited Ms. Jones again.  She was happily eating her breakfast and drinking her tea.  She complained that she had been feeling increasingly weak over the past month and attributed her fall to that weakness.  She commented that it was just part of getting old.  Regardless, we asked for a physiotherapist to help Ms. Jones with her mobility and assess if she needed any aids.  As planned, I wrote an order in the chart to re-start the anticoagulation.  It was all ready to go, but we all suddenly felt uncertain: She had only been off of it for 3 days.  Why not wait one more day and make sure her hemoglobin remains stable?  It is a delicate balance trying to decide how to manage these medications for a person with atrial fibrillation who is also at a high risk of bleeding.  Without the medications, there is a chance that the heart can throw off blood clots that can cause a stroke.  With the medications, however, it becomes difficult to control andy sources of bleeding.
Later that afternoon, I passed by Ms. Jones walking with the physiotherapist and a walker down the halls of the unit.  She smiled at me, and I smiled back.

The next day was Friday and we started rounds in the same way we always do.  Our team was a little smaller, so we divided up the work and moved a little faster so that everything would get done.  We got to Ms. Jones’ chart.  The physiotherapist was convinced that she would safely mobilize with a walker.  Her hemoglobin had been stable over the past 36 hours, and from all other aspects, it seemed like she was ready to go home.  We walked into her room to tell her the good news.  However, Ms. Jones was not sitting up in her bed eating her breakfast.  Instead, she was laying with her head cocked to her left side, her right leg flexed and rotated to the left, and her right arm motionless by her side.  We said hi to her but all she did was moan.
“Ms. Jones, are you alright this morning?”
She just moaned again, this time louder and more persistently.  I went to her left side and looked at her.  She wanted to say something, but all she could do was moan.  She reached for the ID badge dangling from my neck and looked at it.  Then she looked at me.  And she moaned again.  My staff had already left the room and was on the phone with a radiologist requesting a STAT CT scan.  But we didn’t really need it to know that Ms. Jones had a stroke, likely sometime overnight.

By the time Ms. Jones’ sons had arrived at the hospital, the results of her CT scan were back: Large right MCA territory infarct.
We explained to her sons what this meant and that given her age and the size of the stoke, she likely had a poor prognosis.  We explained the options for her further care and it didn’t take long for them to both agree that their mother would not be happy living the way she was now.  The felt that if their mother could talk to them, she would say that it was her time to go.

And just like that, we consulted palliative care for Ms. Jones.  We discontinued all her therapeutic medications, and ordered all our comfort care measures.  She was moved to a private room.  And ever since that day, there has been a constant bedside companion from her family present.  I know this because I visit Ms. Jones multiple times a day.  She knows who I am and she smiles at me when I tell her that I’ve been thinking about her.  Every day she looks more and more like it might be her last day.  But every morning her name is still on my list.  So I go back to visit her again.

It was the day we were going to send her home, and instead it became the day that determined her death.  It isn’t fair.
Ms. Jones was such a fun. happy, feisty little English lady who probably had a few more good years ahed of her.  But our medical care failed her and now she is dying.  Life isn’t fair.
Every day she slips further and further away.  She spends less time awake and I spend more time talking with her family members.  They tell me stories about their mom and it makes them happy.  Then they turn at look at their dying mother asleep in her death bed, and their voices stop.  I let them cry and I place my hand on their shoulder for just the right amount of time.  Death is not fair.

I decided to share last year’s blog post in it’s entirety.  The remains poignant and I still think of Ms. Jones, to this day.