Thursday, March 30, 2017

To the Woman I Can't Remember

So this morning, I'm sitting in grand rounds (a weekly, department-wide lecture series we have to keep us learning), listening to this speaker on trauma, women, and addiction. And she brings up a slide on symptoms of PTSD providers don't always think to look for, and of course that includes pelvic pain and chronic GI symptoms.

Listen, I am a psychiatrist. One who particularly focuses on trauma. I've been in mental health for a decade, and my interest in trauma precedes that by at least five years. I'm well aware of this connection and frankly rolled my eyes a bit that the speaker brought it up as something we don't think about (but, in all fairness, the talk was also aimed at obstetricians). But in that moment, looking at that slide, I suddenly was not the Assistant Professor in Psychiatry, and instead was connected to my sorrowful, worn down intern self from many years ago.

Because of course, I was not always the wizened mental health provider. Twelve years ago I was a bedraggled intern in a terribly abusive situation in a malignant OB/GYN program. It was a Thursday, like today, and I had clinic in the morning and academics in the afternoon, which included the conference where we discussed surgical cases for the upcoming week. On my schedule that morning was a woman coming in for a pre-operative visit. I can't quite remember if her surgery was scheduled for the next day or the following Monday, but it was soon. The patient before her didn't show, so I took a moment to look at her chart.

I will tell you that I would not recognize this woman today. She could walk into my office tomorrow and I wouldn't make the connection. I cannot remember her face, or her name, although I definitely remember our interaction and conversation, and how I felt. However, for some reason I have two very distinct images that still stick with me. Strangely, I still vividly remember her ultrasound. She was having a laparoscopic cystectomy, so I looked at the pictures, and...well, there it was. Not a terribly small cyst, but definitely not large, maybe 3cm, oblong, thin walled, full of translucent fluid. I looked at this thing for a while thinking, this is a physiologic cyst. Like, something that happens sometimes around ovulation. Next month it'll probably be gone. Huh. Why were we cutting into her? Well, okay, she had chronic pelvic pain, so maybe they were worried this was an endometroma? Or something not benign? I remember staring at the screen thinking, why aren't we just watching this?

The other picture still in my head is a snapshot of her medical record. Something didn't feel quite like it fit, so I flipped over to see if I could find some other piece of history, and lo and behold, she had a long string of notes from GI detailing her longstanding symptoms and ultimate diagnosis of irritable bowel.

This raised a large red flag for me.

So I go in to see her, and she's a delightful woman close to my own age. She looks tired and uncomfortable, but was well engaged and appropriately anxious about surgery. She asked thoughtful questions and we went over my checklist and her medical history and I inquired about the GI symptoms ("I manage") and got a more detailed timeline of her pelvic pain. Both started pretty concurrently.

Now, let's also step back for a minute and appreciate that, in all fairness, I was secretly already a psychiatrist, I just didn't know it yet. This manifested in my GYN days as me getting in repeated trouble for (among other things) asking questions that generated more work. Do you feel safe in your relationships? Do you feel like sometimes you have issues around food or eating? Has anyone ever forced or coerced you into doing something sexually you didn't want to do? In the buttoned up region where I lived, women would often say, no, no, of course not. But, two weeks later they would end up back on my schedule to be evaluated for a "yeast infection" that inevitably was an excuse to double back and discuss those difficult issues. So you can imagine where I went with this woman. "Sometimes we see this cluster of symptoms - pelvic pain, sleep issues, stomach trouble - in women who've had traumatic things happen to them, particularly if they've been sexually assaulted. Has that ever happened to you?" And you can imagine that of course it had, shortly before these symptoms developed. "Have you ever seen a psychiatrist or a therapist for this?" Well, you know, once, right after it happened, but, you know "I manage."

Oh, dear girl. I know you were managing. You managed well. I'm just so sorry that you had to.

I thanked her for sharing her story with me. I asked if she was okay, having done so. She nodded and half-chuckled in that anxious way and said, "you know, no one else has ever asked me about that."

And then I went on to the next patient, sat through grand rounds, grabbed some lunch, with her story gnawing at me. And eventually I'm sitting on the floor of the conference room in my surgical greens, eating cafeteria nachos, listening to the discussion of the benign gyn cases coming up in the next seven days. We come to her chart, and her ultrasound is staring down from the projection screen, looking even more like a plain old luteal cyst. One of the attendings makes a comment to that effect, and the case attending sort of nods and then shifts the discussion to surgical technique and which resident is going to be doing what with which trochar, etc. I was so uncomfortable. It was stuffy in the conference room. I was on the floor. I was tired, and though I didn't know it yet, I was close to having had enough of the situation, and it was less than a month until I would leave the program. I was running on fumes, both physically and emotionally. I knew pretty much anything I said or did those days was inevitably going to be the wrong thing. So when the question was posed to me about her fitness for surgery, I might not have been as thoughtful about my answer as I would be today. Did everything go okay during her pre-op check? Yeah, medically she's clear. it seem relevant to anyone that she was gang raped three years ago?

The room was silent but thick with discomfort. People were looking at me. I babbled a little. I mean, that was a few months before the pain started, and all of her GI symptoms manifested. She hasn't really had any treatment for that. We know these things can be connected. This doesn't look like a cyst of any particular import in terms of her pain. Do we, I mean, should we maybe have her see psych first? Should we maybe postpone the surgery?

Someone asked where I'd found that in the chart. I, well, I didn't. I asked at this morning's visit. I saw one of the male residents roll his eyes. I reiterated that I was worried we were going to cut into her and cause adhesions and give her a reason to have more pelvic pain. What should we do? Should we wait?

I was still hopeful enough at that point that my elders would lead me, you know? I had just enough of that idealistic spark left that I thought maybe I could save her - and indeed all of us - from a procedure that wasn't addressing the real cause, or if it was indicated, they would teach me why this was still a good idea. From the floor, and from my station in the room, I felt a little like Oliver Twist asking for more gruel. Please, sir, could I have some more acknowledgment and collaboration and learning? Just a drop? I would've accepted pretty much any reasonable argument - that the cyst was oddly shaped and may be causing intermittent torsion, that I should think of this as an exploratory procedure to look for endometriosis, whatever. This procedure may well have indeed been indicated, I just wanted to know why. But instead, one of the senior residents simply asked, wasn't I interested in learning how to do surgery?

I truly don't remember if my answer - "Not by mutilating healthy tissue, I'm not." - ever actually left my mouth. What I do remember was slumping back against the wall, back into invisibility, as the conference continued without me from that point on. I was checked out, deflated. The hospital nachos sat like a lead ball in my stomach and tears prickled at my blinking lids. I wanted to go home. I wanted out of this place, out of this life. At that point, however, I felt like I had absolutely no power to do anything else at all but keep my head down and ride the current. I felt like I had no rudder, no oars, I was just beholden to the forces around me. And unfortunately, that day, I felt like her canoe was also at their mercy, and I could do nothing to help.

I don't remember the outcome of the surgery, in terms of her pain (I remember discussing the shape of the cyst and that it was, indeed, benign, and that they didn't see any endometriosis). It is entirely likely that she felt better and life improved. That is certainly the course my canoe took (...eventually). But clearly, a piece of her has stuck with me, such that 12 years later, in a different state, a different specialty, a different life, I wished I could know how she was doing. And I would say to her, I'm sorry. I wish I could've offered you more. I wish I would've had the energy to do something other than slump back onto the floor, like maybe refer you to a competent therapist. I wish I would've had a better sense of the resources back then. My concerns about the way the trauma and the pain interacted were truly less about the surgery itself and much more about the attitudes with which that juxtaposition was viewed (or, as it were, not). And I'm sorry that was and is the prevailing culture in women's health - not because it's my fault, but in a way that it makes my heart hurt for all of us. I hate that medicine is still to a large degree ignorant and avoidant and victim-blaming.

But, brave woman, know that you and your story are still with me. Know that our fifteen minute conversation changed the course of my career, and the way that I practice today. Know that I'm fighting the good fight as best I can. I've tried to become that competent therapist. I've tried to become a better resource and, indeed, a better survivor myself. I hope that healing found you in ways physical, emotional, and spiritual. And I hope that medicine continues to get a clue, and soon. We're working on it.

Saturday, September 03, 2016

Riding off into the sunset

Y'all. I've GOT to start writing on this blog more often than when people die. Although apparently I skipped the entire year when my dad died. Jesus.

I've had two this time. Two hits so fast I barely had time to get an non-purple/memorial manicure between the "purple was his favorite color" ones. My godson...that hit hard. It was shocking. He was 23, for God's sake. Who expects to die on their way home from work at 23? I was numb, I was sad, I was angry. It didn't make sense, because when his other godmother called me to tell me about it, I was bracing for news of a whole different death. One I thought I had made my peace with in some ways. And just when I was starting to emerge from the sodden, mired, foggy trudging of my godson's sudden exit, that one hit. And it hit me like a damn freight train. I was utterly unprepared for the magnitude of my grief on this one.

Because back in 2013, I was having a really bad day. My dad had died, and some days later I went to the funeral home to pick up all the stuff - you know, prayer cards, paperwork, etc. It had been delayed because the funeral director I was working with had lost his grandfather. In his arms. So when we met we processed that a bit. And somehow, at the end of all this what I decided would help me feel better was a visit to the Harley dealership. I knew I was in the market for a new bike, but I was just going to browse this time. Just sit on a few, see how they felt. Just the used ones, because seriously, who buys a new Harley?

Well, you know of course I ended up buying a damn brand new 2013 Softail Slim that day.

Of course the next day, when the paperwork finally went through, it was snowing (February in NC, my friends. Riding weather Friday, snow on Saturday). So we agreed to do the trade the following weekend, when I had to call roadside assistance to jump start the Honda three times and finally rode it to Raleigh in rain so hard I can't even tell you. I have never been so drenched in my entire life. Like, I was leaving puddles in the dealership. And then the bike wasn't ready. What?! So I spent an hour and a half drifting around, waiting, meeting some of the people who would end up becoming incredibly important to me over the next few months. Not that I knew that at the time.

So there I am, dripping all over Motorclothes, and this....guy pops up seemingly out of nowhere and says, "So you bought the Slim?" This random guy I swear I'd never seen in my entire life, in his long sleeved flannel HD shirt and his glasses and his ridiculous smile, and although maybe 12% of me was startled the other 88% was like, "Oh...there you are." We chatted a bit and someone called me away and I was like...hmm.

So the finance guy invites me to ride with them on their weekly day off journey, and I keep going back to the dealership for the social stuff, and finally I have a day that sort of lines up, so I give in. I meet my boys (not that they were yet) at the Dunkin Donuts (honestly, I'm still shocked I was brave enough to do this; that was NOT in my comfort zone) and they introduce me to a bunch of old retired veterans with names like Pops and Rabbit and Quarter Mile, and then this loud ass Road King rolls up, and here's that guy again. And within five minutes, he's charming and making my anxious ass laugh and as we all saddle up he helps me fix my stupid chaps that don't actually fit right and then he pulls in line next to me and I'm going to be completely frank with you all right here - I was done. Hook, line, sinker. I don't know what it was, but I was in.

"This guy's cute." I later told my new friend Amy, the only other regular young blonde girl and new rider amidst the grizzled retirees that had been riding longer than either of us had been alive.

"He rides like an asshole" she said.

(This is accurate.)

And he was cocky, and stubborn, and sometimes a complete jackass. I'd see more of this over the coming years, but you know, it was just part of the package, and even then I could see that package held a really good heart. We talked at the dealership, we did a few more rides together. We became Facebook friends, we exchanged numbers. He was ex-Army, I learned, fairly recently divorced. Living with some family as he hadn't been in NC long. Had been in sales nearly as long as I'd been out of diapers. Kind of warned me he came with some baggage. He had great stories and seemed to genuinely like me, and so we started that infernal tango that two people who've been hurt do in their desire to be less hurty together while fearing more pain. And like two weeks in, he wasn't feeling great, and he kept asking advice without divulging the information I needed to give that advice, and then...then he turned yellow.

I noticed it at, of all things, a Ladies of Harley pancake breakfast, but I already knew enough to keep my mouth shut and wait, and a couple of days later I got a text saying he was headed to the ER, but it was nothing. I happened to be at that same hospital because a friend of ours was having surgery that day, and was like, you know I know what jaundice looks like, and what it means, and I'll meet you downstairs. And as would happen over and over, he protested loudly but kept me there.

And as I'm guessing you've already figured wasn't nothing.

Pancreatic cancer is a really horrible not nothing.

I knew that absolutely zero people would blame me for turning around and running right then and there. Including him. Maybe he'd have preferred it at the time, actually. But it didn't feel like the right path, and so, okay. I was in it for whatever came along.

And it was such a hard road. It was hard for me to navigate my place, which was complicated by all those other specters that came along for the ride (not the least of which was the big guy in the black hood. Can you put that scythe down for a sec, brother?). But I did my best, and so did he. Chemo was miserable, radiation was a hundred times worse. We stole our moments when we could. Sometimes that meant, since I was working a community-based job by then, me stopping by his work with a white mocha for a few moments of conversation. Once it meant an argument by a taco truck. Often it meant a lot of colluding and dreaming and deep conversations over text. When he was too sick to venture out, he'd tell me "We'll meet in our dreams tonight. Wear something purple." We planned big trips we knew we probably wouldn't take, I brought him along virtually on the rides he was too sick for now. We talked about death, and life, and fear, and food. We always kept adding to our "places to eat" list. And every now and then the stars would align, and we'd manage to actually eat a meal together, or meet for coffee and laugh together and wax philosophic in the same physical space. And that time together was precious, every second of it.

He struggled a lot with the "shoulds." He refused to let us declare ourselves as anything official, repeatedly saying he was too sick to be the kind of man he needed to be to be a boyfriend. I told him that was utter and complete bullshit, and he knew it, and I wanted him for exactly who he was, but he wouldn't give in. I later realized some of the other factors at play, but I stayed fast. Fine, don't be my boyfriend. I called him my "whatever." And so we were, some days more whatever than others. We were a funny team, seemingly very mismatched - he was a very religious, gun-toting, right wing, fiery, impulsive soul who saw everything strictly in black and white; I was, of course, an overtly spiritual flaming liberal who was constantly reassessing her vantage point and discussing all the shades of grey (way more than 50), although as he would frequently remind me, we were a solid match on the stubborn scale. I remember one afternoon we planned to meet at the mall, and had trouble finding each other, and so got into this whole, angry, "you're making this more complicated than you need to!" "Are you kidding me? YOU're the one making this so complicated!" "Forget it, let's just forget this." "Seriously, knock it off. Just shut up and stop moving." But we connected, and begrudgingly hugged each other, and shopped for stupid things, and ended up at the swanky furniture store pretending we were shopping for our beach house and perfecting our back stories if the saleslady asked (she didn't, sadly). At one point I was admiring this weird, stylized, nonsensically expensive periodic table blanket they had on the wall, and was like, we could get this! And he looks at me, all worried, and is like, " we have to?" I assured him, we did not. Well, maybe just for my sunporch.

But often we balanced each other well. The perfect example of this was a day we managed to get a ride in together. He was taking me around, showing me some local things, when the nausea hit, and all we could do was wait it out. So as it passed, we laid in the cool, shaded grass next to a pond, soaking in the dappled sun and watching the ducks. And we talked and talked, about deep, soul-wrenching things, and about light, funny things, and I couldn't resist the urge to lean over and kiss the whatever right out of him but for the fact that I was pretty sure he would vomit on me if I did. So there we sat, drinking in the day and the company, befriending passing people and laughing about life, until he could get back on the bike. He apologized to me for that afternoon, because we hadn't done what we set out to do, and so obviously he let me down. I reminded him that we had accomplished exactly what I set out to do, and that it had been one of the most perfect afternoons I'd had in a long time.

The absolute worst of it, though, was a weekend at the shore we planned for real. Like, in real life, not just in our purple-clad dreams. At the last second, it didn't happen. Of course I was disappointed, but I get over that stuff. I was a master of adjusting our course at that point. I was angry, too, although not for what he thought. That, however, revealed that however disappointed and angry he thought I was, this albeit-fictional level of acrimony was no match for the enmity he was leveling at himself. That piece broke my heart, and I told him so.

And we tried, we both really tried to make some of the relationship-y things happen, even if so many things got in the way. We said our "I love you"s in code and euphemism, in "I appreciate you" and "I'm here for you, always." When we were packing up their place for a move, and we were home without the rest of his family, we talked about how nice it might be to actually come home together and do the silly little things of daily life, like cook a meal and do the laundry and doze off in front of the TV. After an amazing row about new years eve dinner, because he was angry that he couldn't manage a Big Night Out Extravaganza and was convinced that's all that would count, we ended up having an incredibly lovely dinner at an Italian place near his house at 4:30pm. I was oddly a regular there (because that was nowhere near my house), and when our other reservation fell through as he was leaving work (and I was driving in, and he was ready to scrap it and I was all, hang on, this is what I do best), they totally accommodated us and didn't even charge us a corkage fee for the bottle of (really good, strangely enough) non-alcoholic champagne I'd managed to scrounge up on the way there, because chemo but also NYE. It was perfect and I wouldn't trade that evening for anything, even a Big Night Out Extravaganza.

We even did perhaps the most relationship-y thing of all when he spectacularly dumped me once in a fit of "I don't want this to be my life." I was wounded and angry and in an uncharacteristic display of self-care, I ran away to the coast for a weekend. I walked the beach and shot pictures and journaled and drank a lot of coffee and came home steadfast in my "I did everything I could, and I'm done." And maybe that was the beginning of the end, but as it turned out, neither of us was actually done.

So on we went, him fighting for his life and then well, maybe not anymore. His initial post-treatment scans were, amazingly, clear. So were his one year. We were hopeful, although the aftereffects of the surgery and radiation were not good. He continued to slowly lose weight periodically, to feel weak, to go farther into his shell. We argued endlessly about finding different doctors and trying different things, but he rejected my advice most of the time (and, infuriatingly, every so often listened when it came from someone else). And his push-pull on me became more and more just pushing me away.

I knew, from that jaundiced pancake morning on, that this was not going to be an easy road. I was completely prepared to put all of the work in up front, knowing that the possibility existed I was going to get no return on that investment because he was going to die. Or maybe I would get it back, and we would figure out where those two people on a brisk morning at a Dunkin Donuts would've wound up if they hadn't been sidetracked to Cancerville. What I was not especially prepared for, however, was to struggle with an increasingly unilateral relationship indefinitely. And it wasn't fair to him for me to make him continue to put that much energy into fighting me on it, to be completely honest. So I did what I thought was best, finally, and I stepped back, telling him so. He'd reach out periodically after that, and after some discussion of how hurtful it was for me to have been cut out of his life, we found a new equilibrium. We were okay, good, even. I moved to Chicago, and it was too much, I think, to see me off, but later we made plans for when I came back to visit. Plans that may not have happened, but they won't.

When I first heard he was in the ICU, I sat back and I said, do I need to do something, here? I decided I didn't. I was certain he knew how much I loved him. I couldn't think of anything left that I'd regret not saying while he was still with us. It was going to be sad, but we were in a good place and if he needed to go, I wished him safe passage. Then he was home, and back, and in, and out, and for a month I watched his sister's Facebook page for any indication. And then, then I got a text from a friend, and he was gone. And suddenly I was heartbroken and just devastated in a way I had not seen coming.

Knowing that now, would I have done anything differently? Probably not. I wonder sometimes (fine, I've wondered a lot) about his experience of all of this. I know there was a piece in there about burdening me. I worry that in his desire not to drag me down with him he just contracted and sank further. He knew I would perpetually keep trying to be his life jacket. I also know a lot of what happened wasn't about me at all, and in several ways wasn't even about him. It was all so complicated. So if that last message I sent him had said "I need you to know that I love you so, so much, and I always will" instead of "Feeling any better?", that could've been too much. And no matter where we were in our whatever-ness, I was always, always the perpetual optimist about his prognosis, even when inwardly I wasn't feeling so sure that was true. Even if he knew he was headed on home, I don't know what it would've been like to have me admit his defeat, you know? The last thing I ever would've wanted to do was cause him any pain, any grief.

But I really did love him so, so much.

Tuesday, January 27, 2015

Picture It: Hawaii, 1977

It's funny how you never know where things will lead.

Back in early 1977, my parents - aged 34 and 44 - booked a trip to Hawaii. Because it was my dad's first trip, they went with a tour group. Elsewhere in Illinois, two 20 year old best friends were eagerly awaiting the same trip, dutifully going to the travel agent every month to pay their installments and dreaming about a vacation full of sun and sand and fabulousness. When my parents first met these two young ladies, they figured they were "spoiled brats," as they would later recount it, whose parents had sent them to the Islands for their high school graduation.

(Let's ignore how, two decades later, my parents took my best friend and me to Hawaii when we graduated high school, shall we?)

As it turned out, though, those two gals, Bev and Tres, were really pretty awesome, and for whatever reasons, the somewhat mismatched foursome really clicked. And in the days before texting and Facebook and instant access, they still managed not to drift apart when the magic of the mana wore off and real life returned. Later the following year, Tres had a daughter, and a few weeks later, so did my mom.

That's me on the left. Seriously. How cute were we? See those red strings? Someone tied balloons around us.

Selina and I, and later her sister Erin, grew up together, more or less as cousins. Carl and Tres and the girls were a constant as the years went by, and we created memories together too numerous to count - drinking "kiddie cocktails" on the big squishy mat in my basement, hiding in the loft of the barn in their expansive backyard, and perhaps the one we reference most often of all, going to the Gnome Festival to get our yearly tassels for our gnome hats.

I know, I know. The cuteness never stops around here.

Time would pass and we would drift a bit and then reconnect. Weddings, birth, death, things changed, and they stayed constant. In some brilliant twist by the Universe, my uncle Carl got transferred to North Carolina about two months before the Match sent me here as well, and we ended up living just a few miles apart. My actual mother quickly started referring to them as my "Southern Parents," and frankly, there is no more truth than could've been added to that statement. They were the best southern comfort I could've possibly come to. We made even more wonderful memories. They had me over for holidays and random Tuesday nights. My aunt freaked out when she discovered I had never seen A Christmas Story and made its viewing into a major event. She helped me pack up my apartment more times than I want to remember (why DID I move so much when I first got here?). Carl installed my washer/dryer over and over and over again. They cooked things and built things and took me on adventures.

And then, a few years back, my aunt found out there was an invader in her body - The Big C. She grumbled and grumped a bit, but the truth was she was the bravest, most organized, totally on-top-of-it cancer patient one could hope to be, through the breast surgery, chemo, and radiation. The family rallied, of course, and I was the local voice of the girls when they couldn't be here (although the times they WERE here were way better. There's a great picture of Erin and me, sitting in the hospital on the day of surgery, knitting our little fingers off, smiling our anxious grins, and just so glad to be together at such a stressful time). I interpreted the surgeons and summoned the Nurse Navigator and in the end, this turned out to be tremendous practice for when, just as all that was finishing up, my mother got sick. Carl and Tres and the girls were a huge support for me through all that went down, and I can't imagine how I ever would've gotten through it without them. Ultimately, they decided to move back to the Windy City, and although I teased Tres about abandoning me, I was glad to see their nuclear family back together again. Tres would still send me epic text messages that were too long for the iPhone to display except in their own window. She would still end every conversation with "Alright! Okay! Bye bye!" And then, last year, she called me, and I knew from the tone of her voice at "hello" that the cancer was back. We cried. And she was going to fight.

She did just that, going in full-force despite having sworn up and down that last time was The Last Time. She cheerfully updated me, and fortunately, my cousin Erin (now a physician's assistant) would follow up behind her and give me the real medical lowdown. I kept saying I was coming up to Chicago. I kept meaning to go up to Chicago. Life here was chaos, but when wasn't it? No, really, I was coming soon. And then.....sometime in December, this nagging in the base of my soul got louder and louder, and I booked a flight for mid-January. I knew the facts of what wasn't going well, but my heart was hearing something else. Kate. Seriously. Get a move on. And then, last Friday, less than a week before I was supposed to fly out there, my cousin Selina sent me a text. "Hey I want to call but I'll lose it. We are putting my mom on hospice tonight."

Oh God. Go, the voice commanded.

"Do I need to come sooner?" I asked her. YES, was the resounding response.

"We'll decide first thing in the morning." She said.

You two are being idiots. Get off your ass and start packing. (The voice may have had some less-printable things to say as well.)

I sat, and I cried, and as I texted with all of them, we agreed sooner seemed better for the whole lot of us. My plane tickets were ridiculous to switch, so the next day, after my Saturday office hours, I jumped in the car and headed north.

I got there Sunday, just in time for my little niece's first birthday celebration. We laughed. We took too many pictures. The kiddo was like, "Why is all this cake in front of me?" We didn't have birthday candles, so we stole a taper out of the Advent ring and she had one giant candle that was almost bigger than her cake.

"I'm dying." My aunt told me.

"I know." I replied.

Things were way worse than I had anticipated, though.

For the next few days, we sat. We tended to her and to each other. Selina and her family live right across the alley, but Erin and her husband and I all moved in. Carl slept on the couch next to the hospital bed. We sent people on outings, practiced the best self care we could, and we leaned on each other when the moments were rough. We talked about the inevitable. First openly with Tres, then in hushed whispers as she started to fade. "I want to go home," she told us. She rested in the hospital bed in the living room, and life went on around her. We made meals, we told stories, we laughed loudly, we cooed at the baby. We leapt to her side when summoned in one way or another. We held her hand and we lotioned her skin. She was consumed with this horrible, intractable itching that was just impossible to control, which we first blamed on a horrible drug rash (which was indeed part of the issue). We threw everything we could think of at it, including this ridiculous homemade calamine lotion I brewed up that I kept joking with her was a mud bath spa treatment. It all seemed to help, at least a little, until it didn't. Erin and I wracked our medical minds until we finally came upon a combination of meds that gave her some relief. It finally dawned on me, like a light bulb that made an audible pop, that her liver wasn't breaking down what it needed to, and that was producing a good portion of the itching that we couldn't control with antihistamines and steroids. So we altered the cocktail. We all took our turns going toe to toe with the hospice people a few times, but in the end, there were a few there that did an amazing job. She stopped being able to swallow or speak on Thursday morning. We kept vigil Thursday night, monitoring her comfort, but she finally seemed restful.

Friday, the hospice team leader and the nurse we knew came out. They talked with us, they assessed her.  They were sweet and wonderful. The nurse asked me when I planned to leave, and I told her that I had originally intended to leave that day and we were still debating that. She leaned in close and said, "If you can, you should stay. She needs you. They need you. You need this." And so, that was the end of that discussion (the voice, who had been actively arguing with me again, was pleased). She also told me that I was the one who could tell her it was okay to let go. And so I did. I stroked her hand and I whispered in her ear to tell her, as I had been for the past few days, that she was so loved. That we would be okay together, because of what she had brought us. That we would always have each other because of her. That what she had come here to do, she had accomplished, and if she was ready to let go, it was okay. That she could move on and care for us in this new realm. And I meant all of it from the very bottom of my heart.

I don't know if it made a difference. I don't know what anyone else had to say to her. I strongly suspect she knew all of it anyway. But she seemed peaceful. We pulled out the old photo albums, and we laughed and exclaimed and cajoled each other over the old pictures for hours and hours. We girls drank kiddie cocktails. We didn't keep vigil that night, because we felt like things were under control. Maybe not ours, but she was comfortable.

I was already awake when Carl called at 4:47am on Saturday, the 24th, the two year anniversary of my dad's death. "Do you want to come downstairs?" was all he said. I told him I was on my way. And though I didn't know what exactly was waiting for me, I didn't feel panicked. I didn't feel scared. I felt, in fact, sort of light. Her breathing was shallow and erratic when I got to her bedside, and it wasn't much longer until it stilled completely. Some day I'll write about the actual experience of her death for me, but suffice it to say that peacefully, and surrounded by love, she moved into whatever comes next. We cried, and we held each other, and we told stories. A different nurse came, and pronounced her, and asked us to tell her more stories while she gently bathed the body and dressed her in what we thought would make her happy (Snoopy pants and a mock turtleneck. My aunt was a lover of all things Snoopy). She stayed with us until the funeral home came to take her worldly shell, and with it, her last selfless gift - she donated her body to the Anatomical Gift Association, destined to be a cadaver to teach the budding medical minds of Chicago.

My aunt is going to med school, y'all. I couldn't be prouder.

In the end, the week was an amazing experience. Sad, yes. Undoubtedly. God, I already miss her. I drove back this weekend, which was rough. I'm pretty sure I cried straight from the Northside to Indianapolis. I stayed overnight in Ohio with other (genetic) family, who also mean a great deal to me and cared for me well. My friend wisely convinced me Sunday as I struggled through the trip back that going into work yesterday was a bad idea, and so I stayed home and I slept through most of it. Today, I wandered, irritable and disorganized, through my hectic day full of demanding people. Blissfully, my coworkers also convinced me to take some bereavement leave, which admittedly won't even amount to a complete day off (long story), but I think will give me time to sit and feel and process. I have to say, though...this week is one I wouldn't trade for absolutely anything. That time we had together, being in the true meaning of family, was such an incredible gift. I truly struggle to remember a time when I felt so loved. And the fact that I could be there, be part of something like that, not The One Responsible For Everything, The One Who Holds Everyone Else Together, but someone with a role and also with feelings and grief and joy and love and able to be all of those things in a safe place. That, that was priceless. To be able to acknowledge how significant every single one of those people is to me, to have them hold me when I needed to cry and to be able to return the favor, that is something I could never repay. That, that is family.

I love you, Tres. I love everything you brought into my life and everything you will bring me from this point on (because I know you haven't stopped moving, and in fact, I suspect you're even a little faster now, which I didn't think was actually possible). I am so honored to be part of your legacy. And I am SO FLIPPING GLAD you and Bev picked THAT tour. Not that you had much of a choice, I suspect - the intersection of our lives was planned long before any of us could've thought it so. Enjoy your new freedom. I'll see you when I see you, and I promise to take care of the rest of the clan, and - you know how hard this is for me - to let them take care of me.

Alright! Okay! Bye bye!

Saturday, January 03, 2015

My Annual Blog Post

No, hopefully not. I didn't actually realize it'd already been so long. Where the hell did 2014 go?

Well, it's a new year (happy 2015!!). I decided today would be a day to clean the heck out of my house, finally. It's so gross - I spent September and October cramming for the Integrative Medicine boards, and when I got back in November I promptly came down with mono, and then because both my functional T cells were busy I then got the flu as well right before Thanksgiving. I am actually still trying to drag myself up from all that, and was already being treated for adrenal fatigue before that happened, and blah blah blah. Maybe I shouldn't have fired my housekeepers...

However, I had possibly the worst night's sleep I had in a while last night, and so I went to the coffee shop this morning, where I had a very very wonderful surprise meeting with my Gay Boyfriend. He lives out of town and so when he pops up for these unannounced whirlwind stints, it is always a lovely, lovely discovery. We were chatting this morning about recent events, and he looked at me very pointedly (we're cut of the same sensitive cloth), and said, "I don't like your energy in this new year."

He's not wrong.

So it seemed like the thing to do, frankly, before the very literal act of cleaning the house, was to examine the metaphoric place I'm in about cleaning out my life. I've been working very, very hard this year at further examining my inner world. I have a fair amount of external stability (relatively speaking, of course; there's still plenty of external chaos. This is still my life we're talking about), so the journey has become much more inward. And it strikes me today that now is the time I'm starting to transition from examination to action. So I thought I'd spend a few minutes writing about what that means. I guess we'll see what comes out.

I have too much stuff. That's the first thing that strikes me. This is true both in the metaphoric and literal sense. I have way too much crap in my house that needs to move to a new home, and I have far too much of other people's emotional and energetic stuff I'm carrying that also needs to go. Releasing that is probably harder than letting go of any of the physical clutter, and it needs to be done.

I have so much difficulty prioritizing myself. Both what I want and what I need. In truth, I have a very hard time knowing what either of those things are. GB and I were also talking this morning about my difficulties with not taking on other people's issues when I know that I can help but it isn't the right thing for me. He made some very sage statements about the time we invest, and how we need to move towards things that will bring a better return instead of being black holes of our time and energy. The things that complicate this for me are (at least) two-fold. One, because of the path of my journey so far, I am very very adept at taking whatever is offered and making the best of it, instead of figuring out what it is that I want or need and moving towards it. The other, of course, is that I need to feel like I'm worthy of saying "Yeah, I would get more benefit from something different than what is offered, and that's okay." Of holding out for something else - something better, at least in terms of fit - instead of taking what crumbs are offered because I feel like nothing else will likely ever come along. The truth of the matter is, though, I most certainly am worthy of what suits me, and beyond that, I deserve it. It's just true, no matter what the mean girl in my head says.

I also have a serious passion for experiencing the new and unknown. That's been on the back burner a lot in the past few years. And it doesn't have to be big, "let's travel the globe!" adventures (although how cool would that be?!). It can be small, fiscally responsible ones. My cousin has made a resolution that, instead of starting a new diet this year, she is going to start working through all the recipes she's been hoarding and has never made. I like this idea, and I am going to resolve to try 52 recipes I've never made before. I am also going to try to get out with my camera more. And while I'm saying "no" more to people who are testing my boundaries in unhealthy ways, saying "yes" more often to new experiences. Not that that's scary or anything (useful! Healthy! And also, scary).

The other thing I really want to do this year is work hard at reconnecting my soul and my body. I'm still unsure of the particulars of that, but I suspect it will include a lot of self-compassion, mindfulness, still quiet listening, moving, stretching (again, literal and figurative), and being. Full-throttle living doesn't need to be reckless, it just needs to be open.

Well, that seems like a pretty good start. Now to work on that "less examination, more implementation" thing. Perhaps I'll start with the laundry...

Sunday, February 09, 2014

Good Morning, Sunshine.

So I woke up this morning, and the first tendrils of daylight were creeping across the inky sky. I could've stayed in my oceanfront room and watched the return of the light, but it just isn't the same as being actually on the beach. So I dragged my butt out of my warm bed (it was a rough, restless night) and down to the sand in the 30 degree weather. I bundled and climbed up to perch on the lifeguard tower (technically not allowed. Oopsie). And the sunrise did not disappoint.

I am now back at the local coffee chain (can we get some of these where I work, please?) trying to do a bit more journaling and drinking too much coffee (but it's so GOOD). They even have a gluten-free breakfast sandwich. How cool is that? It's been a good weekend. I did a lot of writing and shot a bunch of pictures and actually did gain some insights this weekend, I think. Yesterday I walked the beach shooting and then wandered down the boardwalk and the little shops by my hotel. I wandered into this shop that looked like the usual jewelry and beachside tchotchkies but also turned out to be full of new age-y things. There I found this ring, as well as a delightful indulgence of my woo-woo side.

The ring is Labradorite, which is supposed to be good for insight and offer protection.The owner also gave me some intuitive advice on a conflict in my life of late. I've been trying to get more in touch with my less concrete, more spiritual side lately. I had a tarot reading a couple of weeks ago, which didn't tell me anything I didn't know but certainly helped catalyze some things. I have been looking into learning to do some energy work (my friend teaches Reiki) and would like to get a meditation practice going for real. I've been reading about being a Highly Sensitive Person and I've picked up a little more Jungian stuff. God and I have always been on good terms, but sometimes I take that for granted. I think I often neglect my more spiritual/mystical side, which I also suspect is a fairly big piece of who I am.

Saturday, February 08, 2014

Happy 2014

I truly have no idea why it's been well over a year since I've blogged. So much has happened. Maybe it's the fact that SO MUCH HAS HAPPENED. I think it's felt overwhelming to try to detail what's been going on in my life.

I won't try to give you the full list, because there just isn't enough room on the server. But my dad died in January of last year. I bought a new car just before that. That car was totalled a couple of weeks ago (along with the integrity of my left eighth-or-so rib), and I now have a Subaru, which is what I intended to buy in the first place. I traded the underpowered Honda in for a freaking awesome Harley-Davidson. I dropped that bike, but fortunately she was fixable. I fell tremendously in love, which has turned out to be quite complicated and problematic. I was deeply and terribly hurt by a whole different man, who, well, we're working on repairing that, and making reasonable progress. I have a whole new motorcycle-related family, thanks to the somewhat impulsive purchase of the Harley. My biological family rallied a bit. I've acquired important new friends who feel like family. My Village is going strong. I have a new job...actually, that job turned into a different new job. The new job is not committing fraud like the old job, and this pleases me. Plus I like being a real ACTT doctor, it turns out. The private practice has been...oh, wait, I don't think you knew about the private practice. I joined a private practice as well and that's been in much flux, at my hand. I moved my mom into a different retirement community. I lost sixty pounds (well, 75, but I've gained some of it back over the past couple of months). Olivia is no longer a kitten but a full-grown and hilarious cat. Lucky tends to go by Lou these days (his middle name, of course), and is such a delight. He's by far my best snuggler. Maggie is still the Grande Dame of the house and will be TWELVE next month.

Strangely, as I reflect on this time of love and loss, of tremendous tumult and change and upheaval, it's the past two months that feel like they've been the hardest. I have no explanation for this, except that maybe I forgot how hard things were previously. And, I'm exhausted. But things are leveling out. I'm taking more time to focus on my own needs (which you know I can never identify). I truly feel like I can't see the issue even though it's there in front of me. Which is a weird and unpleasant feeling.

I'm currently writing this from a coffee shop at the beach, by the way. I had lunch with my old officemate earlier this week, who (perhaps inadvertently) suggested I needed to get the hell out of Dodge for a minute. I'd been saying that for months, but something about her suggesting it jarred me loose. So here I am, on my first solo vacation ever. I didn't even bring the dog. I have an oceanfront hotel room for the weekend and my laptop and my journal and my camera, and my phone (to keep me connected to the ones I love). I can't imagine what else I could need. Oh - coffee. Check. I'm hoping to get in some serious reflection and gain a little perspective on my life right now. Here's hoping.

Let's do this.

Friday, November 23, 2012

Ushering in the Christmas season

It was a tough day.

But then, I was trying to put together my Christmas cards online. I was searching for the perfect photo for the last slot on the card and Lucky did THIS.

My good boy...