The lady is 68, but she looks 80. As an old professor of mine would say, she's already gotten a lot of her living done. She had a(nother) heart attack that resulted in cardiac arrest. The following code was long, but ultimately successful, if you call getting spontaneous heart motion successful. That was ten days ago. She hasn't waked up since. Her brain function is so weak that she doesn't trigger any respirations on her own - the ventilator does all the work. Because of her poor heart function, her kidneys are failing. Her liver wasn’t working so well because of the cirrhosis, and now it doesn’t work at all. Her EEG is awful: severe encephalopathy, otherwise known as there are a few neurons firing, but not in any order. At this point, one can statistically say that if she hasn't waked up, she's not going to. Besides, her heart can barely beat at all. She is slowly dying.
But her son, who has been inebriated whenever anyone has had contact with him, by phone or on the few occasions he's come into the hospital, is convinced she's faking her coma to get out of paying her taxes. Any attempt to tell him otherwise has met with near violence.
Ultimately, what's left of that heart will give out, and no one will be able to restart it. We stood around imagining what kind of reaction Crazy Son will have, and succeeded in scaring ourselves. Call me a coward, but I'm hoping against hope that I will be out of the building when that happens.
I've decided that Mother's Day is weird for me.
For the last five years, it's a day of odd relief. Not that I don't miss my Mom, I do. Sometimes more than I can stand. But I always hated Mother's Day. She lived in terror of being abandoned, and she'd start pressing about what I was going to do before any significant day like birthdays or Mother's Day until her expectation could never be fulfilled. Nothing I did would be enough, except perhaps the year I was 12 and announced that I was cooking dinner. Cornish game hens, and I did a good job. She was surprised then. The bar of expectation was set higher every year after that. The pressure became awful.
On the first Mother's Day without her, three months after her last birthday, I had no obligation. (I totally blew it on the present for that birthday, by the way, a breathlessly soft teal green infinity scarf that at the time of her disappointment I offered to take off her hands. I wear it every winter and tell myself it was hers.) No crisis. No judgment. I missed her. But I was appallingly relieved.
My son is singularly inattentive to holidays; I have wistfully learned to expect nothing from him regarding special dates. I swore that I'd never do what Mom did, and perhaps I went too far the other way and didn't impress him that these things do have meaning to people. Er, mothers.( Read more...Collapse )
This is not exactly big, but I'm grinning.
I posted a fan fiction to fanfiction.net, called "Encounter at Harrod's, Of All Places". Not that great an accomplishment. I mean, it's not even a totally original story. But less than four hours later, I get notification that I've been flagged as a Favorite Author, and "Encounter" is a Favorite Story. By two different people.
And I'm grinning like I got an Olympic medal.
So it's that kind of day.
Cephas Picker is 62. He has a number of significant health problems that he pays little to no attention, but there was one that was a problem that should have been solved years ago. As far as the initial issue was concerned, the problem was solved. He had a craniotomy in 1999 to remove a meningioma. That surgery was simple and recovery was routine. No biggie.
Until he developed an obsessive disorder that led him to pick at the scalp incision. This is psychiatric disorder in the same category as people who pull on their eyebrows or pull out their hair. A couple weeks ago, he fainted on one of the few occasions he left his home, and some well-meaning person called EMS (he wasn’t pleased).
He fainted because of the infection related to the picking obsession. The area that he worried at with his fingers became infected and the corruption spread into his bloodstream. We are taught not to lose our composure in front of patients. No one has succeeded with this guy. He was all we could talk about in the doctor’s lounge. How could such a problem be allowed to go on for years?( Read more...Collapse )
My young friends who work IT for a large corporation told me that a common interview question is “What sort of a kitchen appliance would you be?”.
I laughed. “Clearly dreamed up by someone who doesn’t cook.”
“The quality of a chef isn’t decided by her appliances. In fact, there are major chefs who use very few. Machinery does not make an award-winning meal.”
“Anyway, which would you be?” asked the husband of the team.
“A chef’s knife.”
“That’s not an appliance.”
“Reference my last statement.”
“Why a chef’s knife?” she said.
“A good chef’s knife is never bought cheaply. It’s properly forged with a well-balanced handle that must fit the hand of the chef. You don’t choose the first one in the store. Some are custom-made.
“It’s a formidable-looking tool, but it’s as versatile as the skill of its user. It can handle heavy cutting or subtle slicing. The more skilled the cook, the more useful the knife – although I wouldn’t try to bone a chicken with one. It doesn’t do absolutely everything, but then, neither do I.
“Furthermore, no matter how skilled the chef, the knife still commands respect. Use it wrong, you will bleed.”
I shrugged. “If your metaphor is a workplace that is under the utter control of one so-called chef, then I’m the chef’s knife.”
“Well,” she said. “That would be considered the wrong answer.”
“It’s a blender,” he said. “You have to say you’re someone who brings everyone together.”
“And removes their identity to make a pulverized mass.”
“I don’t work in that kind of environment,” I said. “One person may be the top dog, and the buck stops there, so to speak, and that person’s me. But every member of my team has a skilled job that he or she knows well and problem-solves independently. Not a feudal system. A lot of people don’t realize that. I won’t put up with such a system.”
They shared a rueful glance. “Good thing you don’t work there,” she said.
“There’s a reason I don’t.” I grinned.
“Wish I didn’t,” she muttered.
“Hey,” I said. “You’re extensively trained and essential to whatever those Blenders there do. You can be a chef’s knife. I’d recommend it. Command the respect.”
They looked at me blankly, clearly wondering how they’d dare do such a thing. I wondered the same. Would I have been that brave at their age?
Sometimes, you really do get to be a goddess.
Called to see a man on Monday, on the “Wellness” unit, which is the name for the unit for people undergoing substance withdrawal. He’d been drinking for 50 years, drying out for brief periods before starting up again.
“That means he started when he was six,” I said.
“So he says,” was the answer.
I decided that exploring that particular parenting issue was not a productive pursuit at the moment. But, ew.
He’d gone through detox three weeks ago, and started drinking as soon as he got out. He landed back in detox a week later, and was now apparently dried out. But he started to get weird again before the weekend. Thinking that for some reason, he’d resumed alcohol withdrawal symptoms a week after he was out of the danger zone, the “Wellness” staff resumed the CIWA (alcohol withdrawal) protocol, but he only got worse.
He was tremulous, with a wide intention tremor that was spectacular. He was hallucinating.
“There are court cats,” he said, pointing behind me.
“Yeah. Cats in ball gowns.” This part was lucky. Usually the hallucinations in this case are hideous visions of snakes and bugs and demons. He lucked out.
But the biggest “tell” was his eyes. Even if he tried to stare straight ahead, his eyes jittered and danced, and when he tried to look to the side, or watch someone move across the room, his eyes juttered in their sockets so violently I expected to hear a knocking sound. (I didn’t. he was hallucinating, not me.)
This wasn’t alcohol withdrawal. This was Wernicke’s syndrome.
Next, I tried instead to establish whether he was oriented. He knew his name. Every question after that produced answers that devolved into word salad and fantasy.
“Tell me where you are.”
“This is a place where they open and close and move and don’t have licorice whips.”
“What year is it?”
“19, 19, 19, two thousand barnacles.”
I point to the sitter who’s been with him all afternoon. “Have you ever seen her before?”
He looks at her in surprise. “No.”
I told the Hospitalist, “You’ve got Wernicke-Korsakoff on your hands, here, and it’s the worst I’ve ever seen.” In fact, it’s the first full-blown case I’ve ever seen. Wernicke’s has all the symptoms this poor man had, but when they can’t remember something for more than two minutes, there’s a nastier problem. A permanent one. I’ve caught a couple of Wernicke cases before the dementia set in that graduated them to Wernicke-Korsakoff, but this guy had been at this for four or five days, and he was well on his way to complete mental breakdown. That worried me. The longer this goes untreated, the more permanent the damage.
“So we put him back on the CIWA protocol?”
“That’s for alcohol withdrawal. He’s not withdrawing. W-K is an acute vitamin deficiency. It’s a malnutrition syndrome. The last thing he needs is more benzodiazepines.”
“Vitamin deficiency?” said a nurse.
“Thiamine. B1. Drunks don’t eat right. And detoxing drunks in alcohol withdrawal don’t eat at all.”
As a matter of fact, W-K isn’t the sole property of drunks, although it’s the reason drunks of old wound up in insane asylums, drooling. Anyone with an acute malnutrition situation is at risk for this. The last case I’d dealt with was a young woman with hyperemesis gravidarum (that’s morning sickness with a vengeance). Poor thing hadn’t been able to keep more than saltines down, if those, for four weeks.
“I’m sure he got a banana bag,” said the hospitalist. That’s an IV with added B1, B6 and folic acid that we give alcoholics as a matter of course.
“That’s nice, but he needs to be flooded with the stuff. A bag gives him 100 mg of thiamine. We’re going to do 1500 mg a day.” And hope it makes a difference.
Hospitalist stared at me and then shrugged. “Well, it won’t hurt him,” he said.
No, it wouldn’t. Thiamine doesn’t build up in the system. You take too much, it gets filtered out by the kidneys into now-expensive urine.
I wrote the orders, warned everyone that sedating him won’t help and went on to the next patient, pretty skeptical that I would make much of a difference.
The next day, I ran into Hospitalist in the doctor’s lounge. “You are NOT gonna believe that guy!” he exclaimed.
“Uh oh. Is he all right?”
“He’s amazing! It’s like it never happened! I didn’t think you’d do it.”
All of a sudden I felt like Henry Higgins.
So I go to the Wellness Unit. And no, he wasn’t completely back to normal. I could still detect some tremor and memory glitches. But he was coherent. He could hold a glass and drink from it without splashing. The court cats were gone. And he was oriented.
Now I felt like a goddess.
I saved a guy from permanent brain damage with nothing more than massive doses of vitamin B1.
I don’t have a good reason for going off on this tangent, but then, tangents never seem to provide me reasons for existing. It really started to gel as I watched a pair of eagle parents work to raise their chicks. Hours of sitting on the eggs in any weather, and then more hours of hunting and feeding two ravenous little babies. Four weeks since hatching and the parents are looking exhausted. It’s one heck of an instinct that drives these two to work against their own best interests to keep these eaglets fed. It’s kinda nuts.
It’s a part of “Nature” that makes no sense except as an abstract.
Every creature is equipped with drives for survival: the procurement of nutrition and hydration, adequate rest, a fight-or-flight response system. Without these, the organism is subject to impaired function or death. An animal that encounters a situation that puts any of these at risk will take action at once to remedy the situation. Absolute biologic practicality. Concrete as it gets.
It’s essential to the perpetuation of a species that each generation produce the next. That’s an abstract, the ideology that for some reason, the planet has some sort of need for more of what you are. This abstract applies to every living thing on the planet, and countless organisms put themselves through horrible trials to satisfy that abstract. Overall, I’m pretty sure that humans are really the only species who appreciate this imperative to procreation as an intellectual concept as well as some sort of neuro-hormonal drive. Admittedly, I come to that conclusion mostly because I have no ability to discuss the presence of abstract thinking with the other organisms nearby. My dogs, my cat, the fish in the backyard pond, the cherry tree above it and the spring peepers in the tree are not entering into that conversation with me.
I simply marvel that the process isn’t easier.
Outside of the abstract concept that the Species Must Go On, procreation provides little to no actual benefit to an organism. As a matter of fact, it’s highly detrimental to a lot of individuals. Plants grow, bud, flower, and produce seeds, and some die immediately after. Some insects also die as soon as they lay eggs, leaving their defenseless young to form, hatch and grow up on their own with no assistance from their forebears. Same with creatures like salmon, that struggle through epic journeys to return from the ocean to the streams they hatched in, there to spawn and then stage massive societal death. How dramatic and counterintuitive is that?
Mammals don’t do a whole lot better. Pregnancy is a hazardous pursuit across species, even for humans. In civilized societies, childbed mortality has dropped dramatically, but it doesn’t take a much smaller degree of societal development for pregnancy to become a risky business indeed. An expectant mother can miscarry and bleed dangerously. (Believe me, when they tell you that a miscarriage causes bleeding, it’s not an understatement. I never had a miscarriage that didn’t make me nastily hypovolemic and sick.) Delivery has a panorama of risks starting with placenta previa, and then eclampsia and moving through breech births, uterine exhaustion, tears, infection and lots of other fun things. Even without the mortality, pregnancy taxes a body in ways that are simply irrational, whether it’s the leeching of calcium from Mom’s bones to build the baby’s (old wive’s tale: a woman loses a tooth per baby, not a myth), or morning sickness, stretch marks, gastric reflux, sciatica, or whatever else. Inspection of anyone’s family tree back as little as 100 years ago shows marriages producing multiple stillbirths, lost pregnancies and so forth, and men collecting wives as their women die in the pursuit of procreation.
Any animal presented with any of these risks from any other cause would indulge in a fight-or-flight response.
Humans should know to do the same. I mean, really, what rational woman would volunteer for such a mission? “Here, sign up to ruin your body and put yourself at risk from all sorts of temporary or permanent damage – including death – from a parasite that will take over your body for the better part of a year, only to further tax your abilities for years after, causing loss of sleep, tons of work, endless worry, and costing you thousands of dollars you may never actually have. Depending on the society you live in, you will have no choice of profession other than this, and if there is a profession you can participate in, there will be several years in there during which you will have to perform an outrageous juggling act that won’t be likely to provide you much professional advancement.” Um, no. And yet, for some reason, we are hardwired to be more than motivated to do this. We yearn for children. We go on and on about how wonderful parenthood is, when rational analysis of the practice shows very little benefit, physical or otherwise, outside of this social and emotional abstract. Women hang their self-esteem on their ability to produce the next generation, and infertile women are labeled less-than-women by themselves and society at large. It makes no sense on a practical basis. And why, oh why, has no one evolved an easier/safer process?
Males aren’t immune to the risks of procreation, either. Male salmon die along with the females. Countless species have their males putting themselves in danger from each other simply for the right to mate with the females, who may or may not accept the victors of those conflicts. Theoretically, the mating-rights battles aren’t supposed to be battles to the death, but still, combatants can be mortally wounded.
Some males will exhaust themselves seriously during mating season. My Beloved grew up on a sheep ranch. He describes putting the rams in with batches of ewes and watching them drive themselves to mate with any female who stood still long enough. They didn’t stop to eat, drink or rest, but kept at it till they were staggering with fatigue, glassy-eyed and panting, barely able to stand, let alone mount the next ewe, but not stopping until they couldn’t smell ewes nearby. One assumes that this practice conferred some pleasure on the rams – it’s hard to imagine a hormonal drive strong enough to push a creature to continue through agony. But even so, it makes no sense. Exactly what is the benefit to the male organism that does all this? None that isn’t abstract.
We watch human males go through all sorts of gyrations to attract sexual partners for no truly beneficial reason. Besides 10 seconds (I’m being generous, I know) of glory, what does he get out of sex? Bragging rights? Abstract. An heir to the throne? Definitely a societal abstract. For a man who is truly able to appreciate an abstract, the deepening of a love bond with a chosen life partner? None, I mean NONE of this is practical. And yet, manhood is measured by the presence, size and proficiency of a body part that has absolutely no practical use to its owner except as a waste conduit. It doesn’t provide nutrition or anything else except 5 seconds (being more realistic) of a nice feeling. And the abstract benefit of offspring, small organisms that are dependent for years, taking the fruits of the adults’ labors for no other reason than to benefit The Future. It’s a weird form of societal slavery in which a combination of future generations and some sort of anonymous imperative steals your time and labor without recompense except with an abstract.
And as a ram will kill himself to get as much sex as possible, human males will go to ridiculous lengths for the same. They will pit themselves against each other, put themselves in physical danger. They will spend untold amounts of money. They will risk their livelihoods (and that of the offspring they have) in order to pursue sex in pastures set as out-of-bounds to them by (abstract) mores of their society, or to pursue sex under circumstances that would not/could not produce the progeny the whole ridiculous system was set up for. I mean, geez, how many millions of dollars did Bill O’Reilly just throw away simply to be able to sexually assault a bunch of women who weren’t his wife? Would he blow as much past and future money to get food? (Money – another abstract.) Men will commit all sorts of crimes, from rape to murder, just to ejaculate. And exactly what is the practical benefit for them? There isn’t one.
I don’t really want to explore the detriment of sexually transmitted diseases.
Even the satisfaction of other basic needs can wind up being distorted by the pursuit of sex. Shelter isn’t just a house, it’s the fanciest house obtainable to impress potential sexual partners, quite often without the intended production of another generation. Transportation (not a biological imperative, but a practical one anyway) isn’t just a vehicle, it’s as impressive a vehicle as obtainable that serves not only as a chick magnet but to put off possible competition. Women aren’t any different, really. For example, clothing is obviously far more than a protection against the elements, and in this first-world society, the target isn’t only a future spouse. Women have their own fondness for 10 seconds of glory, even (especially) without the end result of progeny. I’m still not sure that this is all simply because it feels good.
This drive that informs all adult behavior even into parts of adult life that have little or nothing to do with Future Generations keeps going no matter what the circumstances, even when progeny are not the goal or even a possibility. It’s like the broom in the Sorceror’s Apprentice. It has no “off” switch. The other primal drives have endpoints. A resting body wakens. An eating organism stops when satiated. This primal drive? Endless. It all seems hugely out of proportion to the needs of The Future. How is it that one organ system, a system that really contributes nothing to the established well-being of the body in general, hijacks so much of the organism’s function? Especially for humans, with our prolonged lifespans that extend past the years for producing and raising the next generation, years that would be just as well filled by pursuing other abstracts that would satisfy our vaunted big brains. Brains be damned, we hit 90 and all we want to do is, er, procreate. Just ask my Dad.
It makes no sense.
So we were chatting and all of a sudden he transitioned from his normal speech with occasional word-finding troubles to pure word salad.
“What did you say, Dad?”
“Flurrinasal better bell-bottom sinny sinny biggle.”
I held up a pen. “What’s this?”
“That’s digerrigar blombat.”
I pointed at his watch. “What’s this?”
I hollered for Beloved, who was just draining the pasta for dinner. And in five minutes, we were on the way to the hospital in a driving rainstorm. We hit the ER at the 29-minute mark. We decided that the hospital I used to work at was the place to go, even if administration didn’t like me. (I gave them plenty of reason to do so, but in my defense, they gave me more reason to give them reason. Or something.) They had the stroke program I knew was as it should be. Of course they did. I’d set it up 12 years ago.
The security guard recognized me and had him back in a bed in moments. The stroke protocol system rolled smoothly along just as it ought to, and my old partner showed up less than an hour after his symptoms had started, the Pharmacist had the tPA dose waiting for her and he got the bolus 50 minutes after we hit the door. Not bad at all.
And we waited for his speech to clear. It didn’t.
Then he started to bleed. The venipuncture site just gushed. Pressure dressing. A skin tear from five days ago opened up like it was brand new. Another pressure dressing. And then his cheek started to swell right over the cheekbone. What the hell?
Then I remembered that he’d fallen two weeks ago and wound up lying on that side of his face. But he never developed a bruise or anything at the time. Apparently, he should have. Later we would figure out that another large hematoma had popped up on his right hip, where he’d fallen. His cheek continued to swell and darken and we looked at each other in consternation. Not a place to get a pressure dressing. Hard place to put an ice pack, which he didn’t tolerate anyway. We talked about getting Plastic Surgery to come in in the morning.
We got him to the ICU and got him settled. I left at 10:00 PM. At 10:45 they called. He’d started sundowning and was basically uncontrollable, repeatedly trying to crawl out of bed and hitting at people who tried to keep him from hurting himself. A patient has to keep quiet after tPA, there’s too much bleeding risk and if he falls, there’s hell to pay. And there was hell keeping him quiet.
Beloved talked me out of going to him, insisting that he go himself. I had to work at 5:00 AM, and he insisted I needed to sleep. God, he’s wonderful.
They had a rough night, but of course, once the sun came up, Dad calmed down and was back to his usual cheerful self. His speech is much clearer today and he did well with Therapies and the doctors. The hematoma on his face has shrunk some, but now he has a beautiful black eye. He leaves the ICU for the floor tomorrow. Beloved has gone to get some sleep and then he’ll come back and stay the night again.
The nurses were full of praise for how good Beloved was. “I’m no dummy,” I said. “I married a Neuro Nurse.” And he’s wonderful.
The sun is setting and so far, Dad’s calm, although he’s started with some increased confusion. Pray for a better night.
We did The Boy's high school graduation yesterday, and Dad did really well. I didn't, I teared up like an emotional Mom. So sue me.
The Boy managed to graduate with Honors, which is a huge reward after all the struggles we went through convincing him that even in Honors courses, teachers expect homework to be turned in. But he did it. He Walked in with the Honors group in red graduation robes (everyone else wore blue) and wearing his Honors medal and he looked great!
The trip down could have been worse, but it could have been better. It’s a 12-hour drive, and he did pretty well for the first 9 hours. Then he fell asleep, which I probably shouldn’t have let him do. The last three hours were full of agitation.
“Where am I?”
“How do we get home?”
(Reading the road signs) “I don’t know what these towns are. Where are we?”
“Pull over and ask someone how we get out of this mess.”
I’d review that we were going to my house, and why, and that the Guys and the dogs were waiting for us, and in 10 minutes, we’d do it all over. And over.
He’s adjusted to our house relatively well. I’m poised and ready to get him back home (and what a fun trip that will be) if he disconnects, but we may be able to stay more than a week. Maybe.
Yesterday, he couldn't remember how to tie a tie.
Happy Mother's Day.