Monday, April 24, 2017

At the Bottom of the Box

My dear Boys and Girls knew my favorite flowers
How am I doing?

I've been asked that question dozens of times in the past two weeks, and it fills my heart every time someone looks at me with concern and checks my well-being. I always answer truthfully, and depending on how deeply you want me to answer I will tell you just the first few or all of the following--

I'm better every day. I'm figuring out my new physical boundaries. I'm sitting more, and moving slowly and pacing activities. I know now that if I try to do too much on one day that I will spend the next day feeling terrible.

What I probably won't tell you is that the hardest thing I've had to deal with hasn't been physical. In fact, I don't know exactly how to categorize this tough thing. Is it mental? Psychological? Spiritual?

What is fear?

My recovery from this episode has been a reverse Pandora's box, filled with wonderful people and encouragement. It has been love and hope and messages and cards, hugs and cookies baked with dark chocolate. It has been flowers whose scent follows me through the house and reminds me how very many people are pulling for me. But every once in a while at the bottom of the box I suddenly sense a cold tremor that all of that goodness can't quite squelch.

Sometimes it's mental, when I don't know how to respond to what my body is telling me. I know all the classic symptoms of a heart attack (chest pain, sweating, nausea, feeling of doom) but as I was told over and over again when I was having none of these symptoms but was by every clinical measure having a heart attack, women's heart attacks present differently. So when my heart unexpectedly beats hard and fast, and no amount of calm thoughts or steady breathing stops the disruption, should I be heading for the emergency room?

Sometimes it's psychological, when a chance remark by one of my medical caretakers that "Yeah, you really had a lot of embolisms" gives me information I didn't have before and even though nothing has changed, suddenly I'm aware of how close to the cliff I had been standing and fear washes over me.

Sometimes it's spiritual, when my deeply-held belief that God is in control of my life seems to be buried under appointments and prescriptions.

A dear friend was at her husband's side in the emergency room when, with no prior indication of heart problems, he was found to be having a heart attack. I had sat with her after his multiple-bypass surgery, and took a meal when they got home. So I asked her--am I crazy?

She looked at me sadly.

"We were in the emergency room several times after the surgery," she said. "You just don't know."

And that's where the fear originates, I think. You just don't know this body, this schedule, this life.

How am I doing? I'm doing very well, better every day, and I expect to be looking back years from now and marveling at how modern medicine (science!) helped a fearfully and wonderfully made body cope with a glitch in the works.

But it can be scary.

Wednesday, April 19, 2017

The Surest Sign of Spring

A couple of weeks ago, when all things healthwise were topsy-turvy in my world, I got a text from Boy#4.

"Are you having surgery?" he asked my cell phone. "J. texted me saying that he'd heard that (and asking if you were OK), so I just wanted to see who has the better information."

To see why this is significant, you should know that my son lives out of state, as does his friend, J. I love living in a small town partly because everyone looks out for everyone else, but once in a while the news accuracy is just a hair off plumb.

I was able to reassure Four that he had the better information, that I was not having surgery, but was being treated with high doses of blood thinners and TLC.

"OK, I assumed that was the case. Learning your mom is having surgery via text from your friend would probably be worse than hearing about it from her blog."


Well, Four, if you get a text from J. that I was seen hobbling down Main Street and that I didn't seem to be walking well--polio, maybe?--be assured that I was just welcoming spring.

You can keep your robins, your crocuses, even your groundhog. In my world, the surest sign that spring has sprung is the pedicure that ends winter toes. From October to April I am frugal and be-socked (or be-pantyhosed, as I confessed here recently). I shine up my own toes and rub in my own foot softeners because no one is seeing those bare feet except me. But when tax season ends, I skedaddle over to my favorite pedicurist and she pampers me with an orange-scented leg-and-foot massage that makes me practically drool into the hot whirlpool at my feet then finishes with nail polish in a color I would never buy for myself.

Yesterday, though, I hadn't planned ahead and didn't bring my own post-pedi footwear, so all of Small Town saw me shuffling down the block in the fashionable spa-issued slippers. My gait may have indicated a serious health setback, so I'm just clearing up any confusion here:

I'm fine, Four, and my toes are looking sharp.

It's spring.

Thursday, April 13, 2017

This Is What Happened: Part 4

I am thankful for the woman who brought me this chicken ceasar parmesan on pita. It was wonderful, and so was she.

(Feel free to backtrack and read Part 1, Part 2, and Part 3 of this story. Really. They're more exciting than today's entry, and do not lead with pictures of hospital food.)

Well, believe it or not, we are closing in on the final episode of this chapter in my life. I know! Who knew so many words could be used to say "Welcome to my new life!" (That, to summarize, is essentially what my New Best Friend the Hematologist told me when I met him this week. Blood thinners forever, and grapefruit no more than once a week, and while you're here, how about let's draw eight vials of blood? EIGHT!)

But this whole experience has been enormously educational. Here's what I have learned:

I have learned that I am surrounded by the very best, very finest, very dearest family and friends anyone could have. I realized in the 10 minutes that I thought I was going to die that I have not told these dear family and friends nearly often enough that I cherish them, and that I have lived the most blessed life because of them.

I have learned that being in the hospital is the next best thing to being an exotic dancer, because hoooo-boy, does everyone just have to go about their business while you are inadequately covered.

And I have learned so much about how to pray for a person who might find herself (or himself) in a similarly precarious situation.

I hope I have been clear in this space that I am a praying person, and I deeply believe in this spiritual practice. I know to the very marrow of my bones that dozens, maybe hundreds, of people (including many, many of you) have been praying for me in the past few weeks, and I am weeping as I consider the magnitude of this gift. Because I know these are the things you've been asking as you lifted me up to the Divine:

That the right people be put in my path. I cannot express completely how this played out, because it was inexpressible. Every single person I met, from the moment my initial EKG was read until this very minute, has been the right person at the right time, doing and saying the right things. There was the medical assistant who drove me to the hospital and asked me to tell her exactly what the Boys are doing these days. I saw you, Esther, and I saw what you were doing, and I loved you for it. There were the emergency room nurses who brought warmed blankets, and Dr. V., who diagnosed me. There were the firefighter/EMTs who went to school with the Boys and lifted me into the ambulance, then talked to me about Costa Rica and upcoming weddings. The nurses in the cardiac ICU--Jessica, Steve, Kensie, Kayla--who joked with me and told me enough but not too much. Even the food service aide who brought my lunch and was just so delighted that I was able to have a regular diet was magnificent. Every single person was encouraging and competent and cheerful.

That I would not be afraid. I knew I was in a perilous state for at least 10 hours, and I'm not even counting the days before when I was probably at risk of sudden death. Do you know how much of that time I was afraid? Ten minutes. I remember it vividly: I was on my back in the emergency room, my blood pressure had been going up for two hours and the doctor had just given me the news that a heart attack was confirmed. I looked at Husband, who was sitting in the chair next to the bed, and I thought "I don't think I'm going to make it out of this, and I am so very sad for the years I will not have with this man, and with my Boys and Lovely Girls." But then I thought of the woman who had that very morning brought me a refrigerator magnet her mother had made. "No Fear With God" the magnet says, and even though I had accepted the gift off-handedly, I remembered the fiery furnace and the witnesses who said "We know God can deliver us out of this, but even if He doesn't, He's still God." And from that moment there were times when I was concerned, times when I was shaky, times when I was confused, but no more times when I gut-wrenchingly afraid.

That I would know how much I am loved. Oh, people. Again with the tears over here, because you cannot imagine. You simply cannot imagine how I have been touched by the messages, the cards, the flowers, the concern. I know you have been praying that I would feel that support, because I do.

I'm only glad that I am here and can tell that you are the very best, the very dearest, the very finest. I love you, I cherish you, and I have lived the most blessed life because you are in it.

Monday, April 10, 2017

This Is What Happened: Part 3

(If you haven't read Part 1 and Part 2 of this Story That Never Ends, I encourage you to go back and do that first. There is a through-line that will help you make sense of the following flogged-beyond-recognition analogy.)

I certainly didn't set out to confuse and frighten you, my lovely peeps, especially the ones who made me cry with your hugs at church yesterday. But as I look back on the past two entries, I can see why some of you were waiting for the next installment to be picked up by Boy#1, who is my designated blog poster if I am ever too feeble to talk about my personal medical history on the internet. (Oops, One! Did I forget to tell you that?)

But I probably should have added a spoiler alert when I ended the last post by being pushed into the ambulance. The spoiler is this: Hi, everyone! Waving from over here! At home!

The truth is that an initial diagnosis of a heart attack that is changed to a diagnosis of pulmonary embolisms is a tire-screeching veer into a treatment path that is quite different from the original treatment path. Heart attacks require tremendous activity; blood clots in the lung require the exact opposite.

When they closed the doors on the ambulance I was expecting to arrive at Big City Hospital and be rushed to the heart cath lab, maybe to be followed up by a visit from a surgeon who would explain surgical options and lifestyle changes. Instead, I was met by a team of nurses who let me do my own antiseptic wipe-down then hooked me up to monitors. I already had been jabbed in the stomach with a dose of blood thinner before we left Small Town, and there was nothing more to be done.

Let me see if I can explain this using a tortured analogy, which is my favorite way to explain things:

Either a heart attack or a pulmonary embolism has the potential to kill a person. The typical heart attack, though, is like a bomb exploding. It hurts, it knocks you off your feet, it damages things that may or may not be able to be fixed later.

A pulmonary embolism, on the other hand, is like one of those unexploded World War II landmines you read about being found under beds in London. (And a side note: I'm a terrible housekeeper, but how terrible a housekeeper must the owner of that flat be? VE Day was in 1945--you haven't cleaned under the bed in SEVENTY-TWO YEARS? Seriously?)

Anyway, that unexploded mine might never explode. It might stay there undetected for decades more. But something--deterioration, humidity, the knowledge that we're living in Trump's America--might cause that bomb to re-activate, and when that happens it's best to scurry off to the air raid shelters, because a PE can take. you. down. It stretches, yawns, then enters the blood stream to cut off circulation to the brain (a stroke) or the heart (a heart attack).

I don't know how long blood clots had been forming in my lungs. I'm guessing they'd been there for a while. Looking back on the spring Husband and I realize how many times I said "Man, I am so tired," and I found I no longer could walk up the 77 steps of Small College without panting, but I thought those were just normal signs of aging. It wasn't until the strain of breathing overtaxed my heart and sent me to the emergency room that I realized I had a landmine under the bed.

So what does one do to defuse a landmine that is still dangerous? Very little, as it turns out. One checks for collateral damage (and a 2D echocardiogram showed that in spite of the heart attack symptoms, my ticker is strong and undamaged, thank You, God). The shots of blood thinner in the stomach transition to a lifelong regimen of oral medicine, and a referral is made to a hematologist. A night in the cardiac ICU and another night in a ward bed end with discharge orders to "take it easy."

And now we wait. We wait for the wonderful, astounding creation that is the human body to absorb the clots, or to isolate them up scars that are stable and cannot enter the blood stream. That waiting could take several months.

The cliffhanger stages of this story are over. I have a couple more chapters to write about things that happened along the way, and I'll be meeting my new best friend (the hematologist) tomorrow to see if we can flesh out the orders to "take it easy."

In the meantime, though, it's been kind of nice to have permission to take a nap any old time I feel like it.

"Gosh, I'd love to vacuum, but I really need to take it easy."

The landmine is still there, but I'm a terrible housekeeper--the odds are excellent it's going to stay undisturbed for another 72 years.

(Wait! Don't leave! I have a few more things to say, so please come back tomorrow.)

Friday, April 7, 2017

This Is What Happened: Part 2

No, this isn't the same photo as yesterday. 
(If you haven't read Part 1 of this saga, you might want to do that first. Otherwise today's installment might not make sense.)

I wasn't entirely sure I trusted the emergency room doctor when I met him. I mean, this was no Doug Ross. Dr. V. was rumpled, and needed a shave, and I wasn't sure his level of urgency was the same as my own. (He did not once bark out the word "Stat!," which was both concerning and disappointing.)

But that doesn't mean he wasn't paying attention. You may have noticed a clue to the theme of today's post yesterday in the paragraph wherein I talked about giving my medical history over and over. If you noticed it, bravo, and I want you for my doctor because I certainly wasn't paying attention while I was saying it.

Dr. V. was.

He heard me mention that I'd had a superficial blood clot in my leg several years ago. It was so insignificant in the grand scheme of the day (BLOOD PRESSURE EMERGENCY) that I glossed over it, but after Dr. V. had let me know that my symptoms had won me an ambulance ride to the Big City for a heart cath, he came back to it.

"The ambulance can't be here immediately so I want you to have a CAT scan to make sure you don't have any clots in your lungs."

"And that," I thought to myself, "is why insurance costs are so high. Unnecessary and expensive medical procedures."

I didn't say it, of course, because as the senior medical staff in the room he also could have ordered the removal of my left pinkie and I probably would have agreed. So the lovely radiology technician wheeled me down to the coldest room south of Siberia, injected iodine into the crook of my elbow, and scanned my lungs. (Side note: If I were Queen of the World I would not promise tax breaks or more vacation time as the best things that could happen to my subjects. No, I would hand out those heated hospital blankets to everyone in the queendom. They are...I have no words for the wonderfulness that they are. I have mentioned often that they make the pains of childbirth worthwhile, and I will now amend that to include the pains of a heart attack.)

And speaking of pain, I had none. No sharp pain in my chest, no dull radiating pain into my jaw, no lower back pain because women experience heart attack pains differently than men do. No pain, except maybe (and the quiet, genteel doctor was thrilled to hear this description) "you know, that kind of pressure when your bra is too tight? Like you want to take a deep breath but it's kind of difficult?"

Husband was still keeping track of the blood pressure numbers while I gave him a list of people to call to cancel obligations and appointments. At one point he looked up at me: "I think when this is over we probably need to talk about your schedule." Point taken.

Finally the ambulance arrived and they strapped me onto the transport gurney. Just as we moved toward the door Dr. V. came hurrying back from radiology. He lowered his voice to let the ambulance attendants know, but I overheard the diagnosis.

"She has bilateral pulmonary embolisms."

And that's when I said "Well, CRAP."

If you have just been told you have bilateral pulmonary embolisms, please do not Google bilateral pulmonary embolisms because the information will discourage you from buying green bananas. I knew this because my father had pulmonary embolisms following his heart bypass, and my brother had pulmonary embolisms following a long airplane trip. I had Googled the term many times in the past, and it's horrifying.

So there I was, being loaded into the ambulance for a trip to the Big City, having just heard that while I had thought I was not having a good day I was actually having a really bad day, and my ruined pantyhose were in the wastebasket of the emergency room so my bare feet were uncomfortably stuck into my leather shoes, and the ambulance driver told me they weren't going to use lights or siren so really, what was the fun of an ambulance ride?

Well, CRAP.

(To be continued.)

Thursday, April 6, 2017

This Is What Happened: Part 1

Here are two of the things I thought as I lay flat on my back in the emergency room Monday afternoon:

I really should have cleaned out the refrigerator. I'm going to be so embarrassed when my compassionate friends come in to do that for Husband.

This is the absolute worst time of the year to die. 

I'm not sure what this post is going to be like. Over the past couple of days I've written it in my head several times. A couple of times it was funny, although more often than that it was quivering and shell-shocked. I suspect that today's installment will be the latter, but because I can't seem to tell this tale with minimal words, I'm sure to take more than one post to tell this story and I'll get to the funny parts before I'm done. Just maybe not today.

It's a story that began Monday as I was walking the few hundred feet from the parking lot to Husband's office. It was my morning to be his intern (as the lawyer down the hall teases me) and I knew there would be a stack of tax returns waiting for me to sort. I'd had a cold a couple of weeks ago and ever since then I seemed to be uncharacteristically short of breath when I walked up a flight of stairs, but suddenly I realized I was not going to make it from the car to the elevator without leaning against the alley wall to catch my breath.

"Well, this is not normal," I thought, and when I reached the office I called my doctor before I separated and stamped and filed tax returns. That pesky cold must have given me pneumonia.

A few hours later, though, the doctor listened to my lungs, and they were clear. His technician came in to set up an EKG, and ten seconds later, the word was back: The doctor wants you to go immediately to the emergency room. You appear to be having a heart attack.


I'm sure there are other ways of getting one's attention than this. Maybe "Madam, a velociraptor seems to be gnawing on your foot." Or "Did you realize that you are giving birth to a giraffe?" In my case, though, "You appear to be having a heart attack" were by far the most attention-focusing eight words in the English language.

They were pounding through my head as the doctor's assistant drove me the ten blocks or so to the local hospital. They were ringing in my ears as I called Husband, in tears, to ask him to meet me there. They were pulsing in my mind as I encouraged the ER nurse to tear holes in my pantyhose to attach diodes to my ankles, and admitted to her that I am the final woman in the Western hemisphere to wear pantyhose "and I always wear tights in the winter and bare legs in the summer, but right now it's too hot for tights and too cold for bare legs and...." I could not stop babbling about my pantyhose, and still the babble could not drown out the reality of YOU APPEAR TO BE HAVING A HEART ATTACK.

By now Husband had arrived and was watching the monitors. In the doctor's office my blood pressure had been shockingly high for me, a person who has taken great pride in her historically low numbers. (I'm out of shape everywhere else, but by golly, my diastolic and systolic are always stellar.)

"What was it in Dr. D's office?" he asked. 168/88, I told him. "Okay, you're still under that."

On the left side an efficient and calm nurse was taking my history. On the right an aide was sliding a large-bore access point into the crook of my elbow. I unclipped my Fitbit and handed it to Husband to stash with my purse and clothes.

And over and over I told the same story. A cold a couple of weeks ago. Undeserved good health all my life. Knee surgery in 1984. Four mostly-uneventful childbirths. A superficial blood clot in my lower right leg in 2008. Worked in the yard for three hours two days before. Shortness of breath. Shortness of breath. Shortness of breath.

I told the nurse, the student nurse, the ER doctor, while blood was being drawn and Husband watched the monitor readings go more and more dangerously high. He did not tell me the numbers but I could read on his face that they were not good.

They hit their peak when the doctor came back with the blood test results: My troponin levels were elevated. I had just graduated from "You appear to be having a heart attack" to "You are having a heart attack." Alarms sounded as my blood pressure hit (Husband told me later) 198/110.

And that's the moment I thought about my refrigerator, but the troponin was lying.

My word counter is telling me I'm going on way too long. I'll pick it this up tomorrow.