I saw Dr. B today for the last time: He says I'm fine, and don't need to take antibiotics anymore. In fact, the ones I've been taking for the last three months were only precautionary -- just in case my brain abscess was caused by tuberculosis, which is still a possibility. He thinks that it was probably nocardia, though he wouldn't rule out TB completely -- in short, it's still a mystery, partly because there was no evidence that my immune system was compromised. But he doesn't need to see me again unless something new flares up.
I can live with being a mystery.
Showing posts with label brain. Show all posts
Showing posts with label brain. Show all posts
Friday, October 2, 2009
Friday, September 11, 2009
Why I Am a Socialist
Today is a solemn anniversary for the country, but it's also an anniversary for me -- one that brings a mixture of emotions. A year ago this morning, I woke up with a headache and a curious gap in my eyesight. Several hours later, I was in the Stanford Hospital emergency room -- not a place you ever want to be -- and beginning a series of tests. The essential details of my experience are here, here, here, and here.
A year later, I'm about as back to normal as one ever gets from an experience like that. I still gulp a handful of pills (two antibiotics and a B6 tablet to counteract their side effects) every morning, just to be on the safe side. But I'm as active as I ever was (which is not very), don't tire as easily as I did a couple of months ago, and my eyesight has only a slight glitch in it. (Hard to describe. It's kind of like a little wrinkle in the peripheral vision. When I'm driving -- and yes, I drive carefully -- I have to keep scanning leftward because oncoming traffic sometimes disappears into the wrinkle.)
We still don't know what caused the abscess in my brain. It may have been tuberculosis (though I once doubted it) or nocardia. Whatever it was, the treatments -- the round-the-clock IVs, followed by the daily trip to outpatient infusion, followed by the pills -- seem to have worked. Well, one would hope three weeks in hospital, followed by two months in a nursing home, followed by nine months of medication would do something.
But the good thing is that all of this -- tens of thousands of dollars of surgery, doctor visits, MRIs, CTs, endoscopies, broncoscopies, nursing care, rehab therapy, IVs and infusions and pills -- was covered by my insurance: Medicare and an AARP supplemental policy. I'm a happy senior citizen, one who knows that he has benefited from a government program. I'm also aware that I have been paying for it for years through payroll deduction, and am still paying for it in smallish (by comparison with private insurance) monthly premiums.
Oh, sure, I have some gripes about Medicare, but they're minor ones. (For one thing, I could have had my round-the-clock infusions at home instead of having to stay in the nursing home, but Medicare doesn't pay for home treatment -- even though, given the cost of meals and other institutional overhead, it would probably save them some money.) The point is, it works -- and works well.
Which is why I'm so ardent about health care reform and so intolerably annoyed by the sound and fury that has been generated by the attempts to bring it about. Everyone deserves the kind of care and attention I have gotten for the past year, and anyone who says otherwise is a damn fool.
A year later, I'm about as back to normal as one ever gets from an experience like that. I still gulp a handful of pills (two antibiotics and a B6 tablet to counteract their side effects) every morning, just to be on the safe side. But I'm as active as I ever was (which is not very), don't tire as easily as I did a couple of months ago, and my eyesight has only a slight glitch in it. (Hard to describe. It's kind of like a little wrinkle in the peripheral vision. When I'm driving -- and yes, I drive carefully -- I have to keep scanning leftward because oncoming traffic sometimes disappears into the wrinkle.)
We still don't know what caused the abscess in my brain. It may have been tuberculosis (though I once doubted it) or nocardia. Whatever it was, the treatments -- the round-the-clock IVs, followed by the daily trip to outpatient infusion, followed by the pills -- seem to have worked. Well, one would hope three weeks in hospital, followed by two months in a nursing home, followed by nine months of medication would do something.
But the good thing is that all of this -- tens of thousands of dollars of surgery, doctor visits, MRIs, CTs, endoscopies, broncoscopies, nursing care, rehab therapy, IVs and infusions and pills -- was covered by my insurance: Medicare and an AARP supplemental policy. I'm a happy senior citizen, one who knows that he has benefited from a government program. I'm also aware that I have been paying for it for years through payroll deduction, and am still paying for it in smallish (by comparison with private insurance) monthly premiums.
Oh, sure, I have some gripes about Medicare, but they're minor ones. (For one thing, I could have had my round-the-clock infusions at home instead of having to stay in the nursing home, but Medicare doesn't pay for home treatment -- even though, given the cost of meals and other institutional overhead, it would probably save them some money.) The point is, it works -- and works well.
Which is why I'm so ardent about health care reform and so intolerably annoyed by the sound and fury that has been generated by the attempts to bring it about. Everyone deserves the kind of care and attention I have gotten for the past year, and anyone who says otherwise is a damn fool.
Wednesday, March 4, 2009
No Mo' Nocardia?
I learned a new word today: nocardia. It may have caused my brain abscess -- which according to last week's MRI has pretty much gone except for some swelling. So Dr. B. has decided to take me off the daily infusion -- woohoo! no more PICC line! -- and cut back on some of the antibiotics. I'll no longer have to schlep to Stanford every day, or wake up at 6 a.m. to take clindamycin. Life is good.
Wednesday, February 4, 2009
Another Groundhog Day: The End of Six Months of Winter?
I saw Dr. B. today, and he's pleased with my progress. Wants another month of IV treatment though, which will bring me up to six months of antibiotics. He also switched me off of Flagyl, a particularly potent and bitter pill that I had to take every six hours. (I have to set the alarm clock to wake me at six a.m., though there's something like a guilty pleasure involved in shutting off an alarm clock and rolling over to go back to sleep.) One of the side effects of Flagyl (or its generic, which has one of those methawackadoodle names) is a tingly-numb-burning sensation in the fingers and toes. It's mostly a nuisance, although Dr. B. says it could turn into permanent nerve damage, which is why I'm now taking clindamycin instead.
The next checkup is March 4, and I have to have a CT and an MRI before that. But there's light at the end of my tunnel vision.
The next checkup is March 4, and I have to have a CT and an MRI before that. But there's light at the end of my tunnel vision.
Thursday, January 22, 2009
"There is a pain so utter..."
There is a pain—so utter—
It swallows substance up—
Then covers the Abyss with Trance—
So Memory can step
Around—across—upon it—
As one within a Swoon—
Goes safely—where an open eye—
Would drop Him—Bone by Bone.
Emily Dickinson, who never (so far as we know) gave birth, was still acquainted with time's anodyne, the erasure of the experience of pain most often associated with the recovery from childbirth. But there are other kinds of pain that time trances over as well. In my hospital stay, I never suffered much physical pain -- on the familiar 1-to-10 scale that doctors and nurses use, I don't think I ever got much past a 6. (My roommate, however, who came back from intestinal surgery howling in agony as the anesthetic wore off and before the morphine drip could be installed, responded to the 1-to-10 question, "It's a 12, goddammit!")
In my case, it was more the psychological pain, the disorientation, the hallucinations, that grew most acute as the fever spiked. Those I have mostly forgotten, but every now and then one of them resurfaces.
One night in the hospital, I awoke to find a strange, pale animal, something like a naked rat, in bed with me. As I reached in panic for the intercom to summon the nurse, the thing lunged for the call button.
It was my own hand.
It swallows substance up—
Then covers the Abyss with Trance—
So Memory can step
Around—across—upon it—
As one within a Swoon—
Goes safely—where an open eye—
Would drop Him—Bone by Bone.
Emily Dickinson, who never (so far as we know) gave birth, was still acquainted with time's anodyne, the erasure of the experience of pain most often associated with the recovery from childbirth. But there are other kinds of pain that time trances over as well. In my hospital stay, I never suffered much physical pain -- on the familiar 1-to-10 scale that doctors and nurses use, I don't think I ever got much past a 6. (My roommate, however, who came back from intestinal surgery howling in agony as the anesthetic wore off and before the morphine drip could be installed, responded to the 1-to-10 question, "It's a 12, goddammit!")
In my case, it was more the psychological pain, the disorientation, the hallucinations, that grew most acute as the fever spiked. Those I have mostly forgotten, but every now and then one of them resurfaces.
One night in the hospital, I awoke to find a strange, pale animal, something like a naked rat, in bed with me. As I reached in panic for the intercom to summon the nurse, the thing lunged for the call button.
It was my own hand.
Friday, January 2, 2009
Going Green
I'm not much of an environmentalist, I'm afraid. Oh, I insist on fluorescent bulbs, but I sometimes forget and throw paper or bottles into the trash instead of the recycling bin, and I can never remember what I'm supposed to do with the little dead batteries from the remote. But my stay in a couple of medical institutions shocked me. Every day, I watch several yards of plastic tubing and three or four little syringes tossed into the waste bin after my infusion. Not to mention the disposable gloves that the nurses pull on and toss after each procedure, even the ones that take only a few seconds.
I know there are perfectly good reasons for all this waste, but in a big hospital like Stanford it must be prodigious. What happens to all that stuff? Is it dumped? Incinerated? Or somehow purged of its previous uses and recycled? None of those alternatives is particularly attractive. And the energy costs of running all that equipment must be astronomical. (Is there a fresher word than "astronomical"? Cosmic? Galactic?)
In an age when we're all being urged to turn down our thermostats and recycle and drive less, it seems like the hospitals are exempt. Maybe that's how it should be -- I certainly don't want to get my meds through an IV line somebody else has used before me -- but I wonder how conscientious hospital management is being encouraged to be.
I know there are perfectly good reasons for all this waste, but in a big hospital like Stanford it must be prodigious. What happens to all that stuff? Is it dumped? Incinerated? Or somehow purged of its previous uses and recycled? None of those alternatives is particularly attractive. And the energy costs of running all that equipment must be astronomical. (Is there a fresher word than "astronomical"? Cosmic? Galactic?)
In an age when we're all being urged to turn down our thermostats and recycle and drive less, it seems like the hospitals are exempt. Maybe that's how it should be -- I certainly don't want to get my meds through an IV line somebody else has used before me -- but I wonder how conscientious hospital management is being encouraged to be.
Monday, December 29, 2008
That's a Load off My Mind
I saw Dr. B this morning, and the lesion has shrunk by half! Even he was surprised at the improvement. He wants me to continue the IV therapy and the pills, but for the first time he seemed almost ... happy. (He's not a very demonstrative type.)
My sight, I know, has improved slightly. Now it's almost like there's less of a blind spot than a sort of wrinkle in what my left eye sees. I told my daughter, as she was driving me back from the appointment, that I'm almost ready to try driving -- around the block. Neighbors beware!
Oh, and I got a haircut, my first in maybe five or six months. I had it shorn back to the No. 2 buzz cut that I had before. The only fault is that it makes the hole in my head -- a depression in the scalp about the size of a dime -- more visible. But he jests at scars who never felt a wound, right?
My sight, I know, has improved slightly. Now it's almost like there's less of a blind spot than a sort of wrinkle in what my left eye sees. I told my daughter, as she was driving me back from the appointment, that I'm almost ready to try driving -- around the block. Neighbors beware!
Oh, and I got a haircut, my first in maybe five or six months. I had it shorn back to the No. 2 buzz cut that I had before. The only fault is that it makes the hole in my head -- a depression in the scalp about the size of a dime -- more visible. But he jests at scars who never felt a wound, right?
Friday, December 26, 2008
Climbing the Phone Tree
I got my first bill from my medical adventure the other day: $1,083.74 for office visits and lab tests at the clinic I went to on the day I discovered I was sick. Medicare had declined to pay any of it.
It was a mistake fairly easily corrected. Medicare had me listed as having "other insurance" as the primary payer. It seems that Medicare updates its records once a year, in October. So unless you make a point of telling them what's going on, if you change insurers after their update day, they won't know about it until next October. In my case, I had paid-up insurance from my former employer through the end of October 2007 -- after the Medicare update. At the end of October, that policy ceased, and Medicare became my primary carrier. (I also have a Medicare supplemental policy.) But Medicare didn't know about it, so all of my medical bills from October 2007 to October 2008 were denied.
This good news out of all this medical mishegoss is that it was relatively easily cleared up. Conservatives are always arguing against government programs because of the "bureaucracy." But my experience with Medicare is that their bureaucracy is more efficient and responsive and more pleasant to deal with than that of the big private insurance companies. Maybe it's because the big private insurance companies can pick and choose whom they insure, while Medicare has to deal with anyone over 65, some of whom must require careful and clear explanations. As I know from my experience in the nursing home, anyone who works with the elderly needs the patience of a saint.
This is, of course, another argument for a single-payer national insurance system -- the only kind of health reform that I think will work. It took me three phone calls to clear it all up -- one to the clinic to find out why the charges weren't paid, one to Medicare to ask why they weren't listed as the primary insurer and to be assured that the mistake was corrected, and another to the clinic to ask them to resubmit. One phone call should have been sufficient.
And don't get me started on voice-recognition phone trees:
ROBOVOICE: You said "enrollment."
ME: No, I didn't! I said "claims."
ROBOVOICE: Please choose from one of the following options....
It was a mistake fairly easily corrected. Medicare had me listed as having "other insurance" as the primary payer. It seems that Medicare updates its records once a year, in October. So unless you make a point of telling them what's going on, if you change insurers after their update day, they won't know about it until next October. In my case, I had paid-up insurance from my former employer through the end of October 2007 -- after the Medicare update. At the end of October, that policy ceased, and Medicare became my primary carrier. (I also have a Medicare supplemental policy.) But Medicare didn't know about it, so all of my medical bills from October 2007 to October 2008 were denied.
This good news out of all this medical mishegoss is that it was relatively easily cleared up. Conservatives are always arguing against government programs because of the "bureaucracy." But my experience with Medicare is that their bureaucracy is more efficient and responsive and more pleasant to deal with than that of the big private insurance companies. Maybe it's because the big private insurance companies can pick and choose whom they insure, while Medicare has to deal with anyone over 65, some of whom must require careful and clear explanations. As I know from my experience in the nursing home, anyone who works with the elderly needs the patience of a saint.
This is, of course, another argument for a single-payer national insurance system -- the only kind of health reform that I think will work. It took me three phone calls to clear it all up -- one to the clinic to find out why the charges weren't paid, one to Medicare to ask why they weren't listed as the primary insurer and to be assured that the mistake was corrected, and another to the clinic to ask them to resubmit. One phone call should have been sufficient.
And don't get me started on voice-recognition phone trees:
ROBOVOICE: You said "enrollment."
ME: No, I didn't! I said "claims."
ROBOVOICE: Please choose from one of the following options....
Sunday, December 21, 2008
Product Placement
Household hint for today: If you've got a cast or some sort of surgical dressing that needs to be waterproofed whenever you bathe, wrap it in Glad Press'n Seal. It sticks to itself and to the skin, and doesn't need as much tape to hold it in place.
I learned this tip from a nurse at the Ambulatory Treatment Infusion Center (acronymically called, of course, "the attic") when I was describing how hard it was to wrap a plastic bag around my left arm with my right hand in order to cover my PICC line. They had given me one of those plastic sleeve thingies that are usually used to cover casts, but it also covered my left hand, meaning I couldn't use it to wash with.
So I got a roll of Press'n Seal (why they can't call it, more correctly, "Press 'n' Seal" I don't know) and sure enough, it does the trick.
What a strange little world of expediencies I have found myself in.
I learned this tip from a nurse at the Ambulatory Treatment Infusion Center (acronymically called, of course, "the attic") when I was describing how hard it was to wrap a plastic bag around my left arm with my right hand in order to cover my PICC line. They had given me one of those plastic sleeve thingies that are usually used to cover casts, but it also covered my left hand, meaning I couldn't use it to wash with.
So I got a roll of Press'n Seal (why they can't call it, more correctly, "Press 'n' Seal" I don't know) and sure enough, it does the trick.
What a strange little world of expediencies I have found myself in.
Wednesday, December 17, 2008
An Eye for an Eye
I went to see an ophthalmologist, Dr. L., today. I aced the eye chart, even with my wonky left eye, but there's still a problem with my vision. Dr. L. says it may never go away. When I said, oh, maybe the brain will find a work-around -- something others have said to me -- she said, Probably not. "The brain isn't really all that flexible. And the lesion has deprived part of it of oxygen." In other words, I've got a dead spot in my brain.
Oddly enough, her candor appeals to me. I'm a little tired of the choruses of "Climb Every Mountain," "You'll Never Walk Alone" and "Cockeyed Optimist" that people keep singing at me. A little honest resignation to reality never hurt anyone.
Oddly enough, her candor appeals to me. I'm a little tired of the choruses of "Climb Every Mountain," "You'll Never Walk Alone" and "Cockeyed Optimist" that people keep singing at me. A little honest resignation to reality never hurt anyone.
Sunday, December 14, 2008
Nothing But the Tooth
Why don't hospitals and clinics have dentists on staff? Why is dentistry different from other specialties that deal with the human body? Why don't dentists get the training that M.D.s get? Why do medical plans not cover dentistry? (Especially Medicare. You'd think nobody needed help paying for dentistry more than its recipients.)
All these questions occurred to me as I was lying on a bed in the hallway at the Stanford E.R., waiting for the diagnosis of what had made me go partially blind. (Literally in the hallway. Stanford's E.R. is so crowded that it has put beds in the hall, especially for patients who don't need modesty curtains. They're even labeled: Hall 1, Hall 2, etc.) My neighboring patients included a woman with no family, no job (hence, no insurance), and a variety of serious and unpleasant illnesses; a diabetic man who had neglected the injury to his foot he received on the job and was now threatened with amputation because it had turned gangrenous; and a grizzled biker type who was there because he wanted a pain-killer for -- he said -- a really bad toothache. The young resident who saw him winced at the state of the man's teeth.
"How long has it been since you saw a dentist?"
"I dunno. A while I guess."
"You need to see one."
(with utter lack of conviction) "OK."
He got the meds and left.
We're constantly told how important dental health is. How infected teeth can spread infection to the rest of the body. In my case, in which the source of an infection was crucial, I was repeatedly quizzed about my teeth. (I am pleased to report that there was a chorus of admiration when a team of doctors and med students examined my "dentition" one day. I must tell my fine young dentist, Dr. W., to whom I once commented, "I have fillings older than you." He has since replaced them. Expensively.)
So why isn't dentistry an integral part of the medical picture? I guess if I Googled enough I'd get an answer, something to do with the histories of the separate professions, rivalries and jealousies and economic advantages. But in a time of reform, when everything is being examined with a view to making it new, when "holistic" is a byword, shouldn't this odd, arbitrary division between dentistry and medicine be re-examined?
All these questions occurred to me as I was lying on a bed in the hallway at the Stanford E.R., waiting for the diagnosis of what had made me go partially blind. (Literally in the hallway. Stanford's E.R. is so crowded that it has put beds in the hall, especially for patients who don't need modesty curtains. They're even labeled: Hall 1, Hall 2, etc.) My neighboring patients included a woman with no family, no job (hence, no insurance), and a variety of serious and unpleasant illnesses; a diabetic man who had neglected the injury to his foot he received on the job and was now threatened with amputation because it had turned gangrenous; and a grizzled biker type who was there because he wanted a pain-killer for -- he said -- a really bad toothache. The young resident who saw him winced at the state of the man's teeth.
"How long has it been since you saw a dentist?"
"I dunno. A while I guess."
"You need to see one."
(with utter lack of conviction) "OK."
He got the meds and left.
We're constantly told how important dental health is. How infected teeth can spread infection to the rest of the body. In my case, in which the source of an infection was crucial, I was repeatedly quizzed about my teeth. (I am pleased to report that there was a chorus of admiration when a team of doctors and med students examined my "dentition" one day. I must tell my fine young dentist, Dr. W., to whom I once commented, "I have fillings older than you." He has since replaced them. Expensively.)
So why isn't dentistry an integral part of the medical picture? I guess if I Googled enough I'd get an answer, something to do with the histories of the separate professions, rivalries and jealousies and economic advantages. But in a time of reform, when everything is being examined with a view to making it new, when "holistic" is a byword, shouldn't this odd, arbitrary division between dentistry and medicine be re-examined?
Thursday, December 11, 2008
What You See Is What You Get
I mentioned earlier that I had been having trouble getting my shirts on right-side-front and my shoes on the correct feet. I don't anymore. As before I got sick, I can just look at a pair of shoes and tell which goes on the left foot and which the right.
What amazes me is how a simple, everyday task could have become so arduous. Because even though I could see the shoes perfectly clearly -- i.e., no cloudiness or blurring or double vision -- I couldn't see the difference between them. I would have to feel for the arch inside -- and even then, I sometimes failed to match the shoe to the correct foot.
My problem, it seems, was one of pattern recognition -- something that the brain does to help us see. I could "see" the shoes, but I didn't "get" them, if you know what I mean.
The first time I recognized this phenomenon was when I was in the hospital. Lying in bed, unable to read or make sense of what I saw on TV, my mind wandered everywhere, but especially to my home. And I realized to my horror that I couldn't visualize it. I even tried to map out a floor plan in my head, but it was as if my imagination couldn't hold anything as complex as a rectangle.
When I first arrived at the nursing facility, one of the therapists had me play the kids' game Connect Four -- the one in which you drop checkers into slots so they line up. Get four in a row -- vertically, horizontally, or diagonally -- and you've won. But I couldn't make sense of the game. I especially couldn't see the diagonal pattern. It was revelatory, but also depressing.
The first thing I mastered was the clock on the wall. I could see the hands perfectly clearly, but I couldn't make them tell time for me. Gradually, however, the ability returned. And the first time I saw a calendar I was baffled. I had "forgotten" the familiar pattern of the calendar -- left to right, starting with Sunday. I would scan across to Saturday and then have no idea which way to go, until I "remembered" that I had to look at the leftmost date on the next line. On the other hand, things that involved some kind of muscle memory rather than visual techniques, such as tying my shoes, never went away.
I still have a gap in my vision. I notice it most when I'm reading, a process that involves scanning lines from left to right. When your eye reaches the end of one line, it darts back to the left-hand margin and begins the next. But sometimes, when I'm reading particularly wide text, as on some Web sites, the gap in my vision puts in a fake "margin" to which my eye goes. I have to force my eye beyond this imaginary margin to the real one.
The thing is, through all these experiences, I remained perfectly lucid and verbal -- or at least I think I did. Which only made them more frightening. The brain is a scary organ.
What amazes me is how a simple, everyday task could have become so arduous. Because even though I could see the shoes perfectly clearly -- i.e., no cloudiness or blurring or double vision -- I couldn't see the difference between them. I would have to feel for the arch inside -- and even then, I sometimes failed to match the shoe to the correct foot.
My problem, it seems, was one of pattern recognition -- something that the brain does to help us see. I could "see" the shoes, but I didn't "get" them, if you know what I mean.
The first time I recognized this phenomenon was when I was in the hospital. Lying in bed, unable to read or make sense of what I saw on TV, my mind wandered everywhere, but especially to my home. And I realized to my horror that I couldn't visualize it. I even tried to map out a floor plan in my head, but it was as if my imagination couldn't hold anything as complex as a rectangle.
When I first arrived at the nursing facility, one of the therapists had me play the kids' game Connect Four -- the one in which you drop checkers into slots so they line up. Get four in a row -- vertically, horizontally, or diagonally -- and you've won. But I couldn't make sense of the game. I especially couldn't see the diagonal pattern. It was revelatory, but also depressing.
The first thing I mastered was the clock on the wall. I could see the hands perfectly clearly, but I couldn't make them tell time for me. Gradually, however, the ability returned. And the first time I saw a calendar I was baffled. I had "forgotten" the familiar pattern of the calendar -- left to right, starting with Sunday. I would scan across to Saturday and then have no idea which way to go, until I "remembered" that I had to look at the leftmost date on the next line. On the other hand, things that involved some kind of muscle memory rather than visual techniques, such as tying my shoes, never went away.
I still have a gap in my vision. I notice it most when I'm reading, a process that involves scanning lines from left to right. When your eye reaches the end of one line, it darts back to the left-hand margin and begins the next. But sometimes, when I'm reading particularly wide text, as on some Web sites, the gap in my vision puts in a fake "margin" to which my eye goes. I have to force my eye beyond this imaginary margin to the real one.
The thing is, through all these experiences, I remained perfectly lucid and verbal -- or at least I think I did. Which only made them more frightening. The brain is a scary organ.
Wednesday, December 10, 2008
Abscess Makes the Heart Grow Fonder
Home! Of course, I hadn't been here long before the garbage disposal jammed and the sink backed up. I took it on myself, in a bit of hubris, to repair things and only made them worse -- I tightened an O-coupling too much and wrecked it. So I had to call the plumber and pay for my hubris.
After three months away, things have changed around the house. That is, nothing is where I left it. Which for a mild (?) obsessive-compulsive like me is disturbing. Nevertheless, after my first outpatient IV session today, I vow to come home and rest.
After three months away, things have changed around the house. That is, nothing is where I left it. Which for a mild (?) obsessive-compulsive like me is disturbing. Nevertheless, after my first outpatient IV session today, I vow to come home and rest.
Sunday, December 7, 2008
Second Childhood
Hospitals and nursing facilities are grown-up places, where things like prudishness and modesty have to be left behind. I overheard two nurses laughing about the persnickety patient who requested that no men, not even aides or orderlies, be allowed to enter her room. Of course, nurses have seen and handled things that would have most of us fleeing or throwing up. There aren't many professions that get more respect from me than nursing does.
Still, it bothers me to hear a 90-year-old man say things like "I need to go potty" or "I have to wee-wee." And the nursing staff encourages it. Instead of "urinate" and "defecate," they say "pee-pee" and "poop" or even something I hadn't heard since third grade: "No. 1" and "No. 2." (No one uses the most familiar four-letter Anglo-Saxonisms.)
At first I thought this was an example of the infantilization that some critics decry in our culture. But then I lightened up. These twee euphemisms are the ones that almost every parent uses so often during the toilet-training years that it shouldn't be surprising when they become second-nature to us.
But something in me still thinks that being sick -- or just very, very old, as most of my roommates have been -- should be treated with frankness, not cutesiness.
Still, it bothers me to hear a 90-year-old man say things like "I need to go potty" or "I have to wee-wee." And the nursing staff encourages it. Instead of "urinate" and "defecate," they say "pee-pee" and "poop" or even something I hadn't heard since third grade: "No. 1" and "No. 2." (No one uses the most familiar four-letter Anglo-Saxonisms.)
At first I thought this was an example of the infantilization that some critics decry in our culture. But then I lightened up. These twee euphemisms are the ones that almost every parent uses so often during the toilet-training years that it shouldn't be surprising when they become second-nature to us.
But something in me still thinks that being sick -- or just very, very old, as most of my roommates have been -- should be treated with frankness, not cutesiness.
Saturday, December 6, 2008
More on TB
Nicholas Kristof has a scary-informative column about tuberculosis today.
And I may have to modify my previous assertion that I don't have TB. When I said that to Dr. B. yesterday, he said not to be so sure. My history of respiratory problems could have its source in the bacillus. Well, damn. And as Kristof's column says, there's not a lot of new research on TB, partly because it's a disease of the poor, who don't tend to fund research. So I am scrupulously gulping my antibiotics -- literally bitter pills.
And I may have to modify my previous assertion that I don't have TB. When I said that to Dr. B. yesterday, he said not to be so sure. My history of respiratory problems could have its source in the bacillus. Well, damn. And as Kristof's column says, there's not a lot of new research on TB, partly because it's a disease of the poor, who don't tend to fund research. So I am scrupulously gulping my antibiotics -- literally bitter pills.
Friday, December 5, 2008
Liberation Day
The groundhog saw the shadows and liked what he saw, so my winter in the nursing facility is nearing its end. As soon as the two bureaucracies -- hospital and facility -- can iron out the details, I'll be back home, probably by Tuesday. The catch is that for the duration, i.e., as long as the lesion still shows up on the MRI, I'll have to go in every day (Sundays and holidays too) for about an hour of intravenous antibiotic. But hey, I won't be stuck in wheelchair central anymore, waked up every morning for a change of IV bags.
Thursday, December 4, 2008
Groundhog Day
Tomorrow is my version of Groundhog Day. Not that it's going to repeat over and over, although that pretty much describes my current institutionalized life. I mean that Dr. B. is going to come out of his office and look at the shadow of my brain lesions on the MRI and say whether I have six more months of IV therapy. (I could be here till June.)
A devout friend writes that he has me in his prayers. This old agnostic is almost willing to believe that they're working.
A devout friend writes that he has me in his prayers. This old agnostic is almost willing to believe that they're working.
Tuesday, December 2, 2008
TB or Not TB
If this were an episode of "House,"the cranky, pill-popping doctor would long ago have diagnosed my brain abscess as caused by an ingrown toenail. Dr. House often finds the solution to his mystery cases in the family medical histories of his patients. But in my case the family medical history only complicated things.
In the age of prosperity and antibiotics, tuberculosis is a disease of people who live in cardboard boxes under bridges. (At least in countries without, ahem, a national health insurance program.) But as anyone who knows Romantic poets, Victorian novels or grand opera is aware, it used to be more widespread.
My mother had tuberculosis when I was 3 or 4. She spent a year in a sanitarium and had part of a lung removed, yet she lived to be 75. (She might have lived longer -- her sister lived till she was 90 -- if she hadn't given in to depression and essentially starved herself to death, refusing to eat. Which is why I'm no foe of antidepressants.) Moreover, her father, who lived with us until I was 8 or 9, also had TB. So whenever I have to fill out one of those medical history questionnaires the doctor give you, I mention this exposure.
TB is not all that contagious, I think. None of my mother's six siblings contracted it, nor did my father. But I've had a history of upper-respiratory crud -- from sinusitis to pneumonia (twice) to an empyema, so doctors are quick to send me to X-ray.
Which is good, except that this time they decided that TB was a prime suspect, even though the usual pinprick skin test was negative, and they sent me to lock-up: a private room in the contagious ward, accessed by a kind of airlock and only by people wearing face masks. I spent three days there producing sputum samples -- coughing (even though I didn't have much to cough) into a little plastic cup full of weird-smelling chemicals.
I don't have TB, and I suppose I should be grateful for their thoroughness in making sure of the fact. But for a time there I wondered if instead of being Bette Davis in Dark Victory -- alerted to the onset of death from a brain tumor by losing her eyesight -- I was going to be Greta Garbo in Camille. Fortunately, I'm neither.
In the age of prosperity and antibiotics, tuberculosis is a disease of people who live in cardboard boxes under bridges. (At least in countries without, ahem, a national health insurance program.) But as anyone who knows Romantic poets, Victorian novels or grand opera is aware, it used to be more widespread.
My mother had tuberculosis when I was 3 or 4. She spent a year in a sanitarium and had part of a lung removed, yet she lived to be 75. (She might have lived longer -- her sister lived till she was 90 -- if she hadn't given in to depression and essentially starved herself to death, refusing to eat. Which is why I'm no foe of antidepressants.) Moreover, her father, who lived with us until I was 8 or 9, also had TB. So whenever I have to fill out one of those medical history questionnaires the doctor give you, I mention this exposure.
TB is not all that contagious, I think. None of my mother's six siblings contracted it, nor did my father. But I've had a history of upper-respiratory crud -- from sinusitis to pneumonia (twice) to an empyema, so doctors are quick to send me to X-ray.
Which is good, except that this time they decided that TB was a prime suspect, even though the usual pinprick skin test was negative, and they sent me to lock-up: a private room in the contagious ward, accessed by a kind of airlock and only by people wearing face masks. I spent three days there producing sputum samples -- coughing (even though I didn't have much to cough) into a little plastic cup full of weird-smelling chemicals.
I don't have TB, and I suppose I should be grateful for their thoroughness in making sure of the fact. But for a time there I wondered if instead of being Bette Davis in Dark Victory -- alerted to the onset of death from a brain tumor by losing her eyesight -- I was going to be Greta Garbo in Camille. Fortunately, I'm neither.
Sunday, November 30, 2008
What's in a Name?
A nurse I hadn't seen before was hanging my IV bag the other day when I noticed her name tag.
"Is your name Arsenic?"
"Ar-say-nich," she said softly, a little wearily, as if answering the question was a burden she had borne for a long time. She was Croatian, she said, and the "c" was pronounced "ch."
Even so, it's an unsettling name for a nurse. You couldn't get away with a Nurse Arsenic in fiction. It would be like calling a surgeon Jack Ripper.
The word "arsenic," I learn from Wikipedia, is from the Greek, meaning "masculine" or "potent," which is how, I suspect, it became a Croatian surname. The Greeks got the word from the Persian, where it meant "yellow orpiment" -- a pigment. (Artists used to get arsenic poisoning from their paints.)
I suspect that Miss Arsenic, if she stays in the United States, will change her name, just as countless Vietnamese named Phuc have decided to do.
I don't mention all of this to make fun. No doubt there's a language somewhere in which "Matthews" means "foreskin" or monkey dung."
"Is your name Arsenic?"
"Ar-say-nich," she said softly, a little wearily, as if answering the question was a burden she had borne for a long time. She was Croatian, she said, and the "c" was pronounced "ch."
Even so, it's an unsettling name for a nurse. You couldn't get away with a Nurse Arsenic in fiction. It would be like calling a surgeon Jack Ripper.
The word "arsenic," I learn from Wikipedia, is from the Greek, meaning "masculine" or "potent," which is how, I suspect, it became a Croatian surname. The Greeks got the word from the Persian, where it meant "yellow orpiment" -- a pigment. (Artists used to get arsenic poisoning from their paints.)
I suspect that Miss Arsenic, if she stays in the United States, will change her name, just as countless Vietnamese named Phuc have decided to do.
I don't mention all of this to make fun. No doubt there's a language somewhere in which "Matthews" means "foreskin" or monkey dung."
Saturday, November 29, 2008
It's All in My Head
I can't imagine driving a car. That fierce and constant calculus of velocity, distance, and direction, which the ordinary brain does more deftly than any computer, is beyond me.
But on the other hand, just a few weeks ago I thought I'd never be able to read again. When I woke up that morning and the clock said 26 and Julian Barnes had become Ian Barnes, it wasn't that there was a blot or a blur in front of the 7 or the Jul-. It was as if my brain was telling me they weren't there. Later, lying on a gurney in a hallway at Stanford Hospital, I would watch people going by in a hall that crossed the one I was in. They would walk in from the right and then at a certain point simply vanish, as in some cheesy movie special effect. And other people would appear from the left out of sheer nothingness.
My brain was simply incapable of processing some of the information it was receiving. But it was doing the best it could. I think Julian became Ian because my brain knew Ian was a proper name. But Barnes didn't become Nes, because it knew that to be a nonsensical name.
Things got worse over the next few days, which I spent in a very nice private room in the ground floor isolation ward while they made sure I didn't have tuberculosis (another story for another day). It had a big window opening onto an enclosed garden. But I couldn't make sense of what was outside, couldn't distinguish trees from walls, shrubs from flowers; it was a mass of green with dots of colors that I toook to be blossoms. Later, I moved to a third-floor ward in which occasionally you could hear the hum of an engine starting up. It was the Medevac helicopter, which landed on the roof nearby. Visitors told me that from my window they could see the chopper taking off. But I never brought it into view. Maybe my brain thought it wasn't worth seeing.
As for reading, I developed a kind of dyslexia: Words refused to shape themselves into coherent syllables. Letters swapped places. The name "MERYL" was written on a dry-erase board on the wall -- presumably the name of a supervising nurse, not the actress. But my brain kept rearranging and substituting the letters. "Meryl" became "Merlyn" became "Merry." Was it simply trying out variations to see what worked?
Nor was watching TV any better. Profoundly bored, I wound up listening to a classical music station when I wasn't sleeping. But classical music on the radio is "easy listening" for office workers: classical Muzak. After several days of Baroque jangle I gave up. I don't care if I never hear Vivaldi again.
Finally, a few days after I left the hospital for the rehab facility, an occupational therapist put a book in front of me and asked me to try to read it. Maybe several weeks of ennui had persuaded my brain that this was a good thing to do, because the words took shape and stayed in place.
They say that when one part of the brain is injured, the other parts try to compensate, to work around the crippled part, to form new neural pathways or something. I believe it now. I haven't regained my sight completely. Occasionally someone will speak to me on my left and I'll have to search for the speaker. I look at cartoons on the Internet and don't get the joke -- the new pathway in my brain hasn't developed a sense of humor, perhaps.
Most embarrassing, I seem to have lost the easy automatic approach to familiar tasks: I put my shoes on the wrong feet. I have to be careful pulling a polo shirt over my head lest it go on inside-out or wrong-side front. I've been known to make several attempts at this before succeeding. Yet there are tasks -- like tying my shoelaces -- that are as automatic as they've been since I learned them many decades ago.
Some day, a long while from now, maybe I'll try driving. But I can't think about that now.
But on the other hand, just a few weeks ago I thought I'd never be able to read again. When I woke up that morning and the clock said 26 and Julian Barnes had become Ian Barnes, it wasn't that there was a blot or a blur in front of the 7 or the Jul-. It was as if my brain was telling me they weren't there. Later, lying on a gurney in a hallway at Stanford Hospital, I would watch people going by in a hall that crossed the one I was in. They would walk in from the right and then at a certain point simply vanish, as in some cheesy movie special effect. And other people would appear from the left out of sheer nothingness.
My brain was simply incapable of processing some of the information it was receiving. But it was doing the best it could. I think Julian became Ian because my brain knew Ian was a proper name. But Barnes didn't become Nes, because it knew that to be a nonsensical name.
Things got worse over the next few days, which I spent in a very nice private room in the ground floor isolation ward while they made sure I didn't have tuberculosis (another story for another day). It had a big window opening onto an enclosed garden. But I couldn't make sense of what was outside, couldn't distinguish trees from walls, shrubs from flowers; it was a mass of green with dots of colors that I toook to be blossoms. Later, I moved to a third-floor ward in which occasionally you could hear the hum of an engine starting up. It was the Medevac helicopter, which landed on the roof nearby. Visitors told me that from my window they could see the chopper taking off. But I never brought it into view. Maybe my brain thought it wasn't worth seeing.
As for reading, I developed a kind of dyslexia: Words refused to shape themselves into coherent syllables. Letters swapped places. The name "MERYL" was written on a dry-erase board on the wall -- presumably the name of a supervising nurse, not the actress. But my brain kept rearranging and substituting the letters. "Meryl" became "Merlyn" became "Merry." Was it simply trying out variations to see what worked?
Nor was watching TV any better. Profoundly bored, I wound up listening to a classical music station when I wasn't sleeping. But classical music on the radio is "easy listening" for office workers: classical Muzak. After several days of Baroque jangle I gave up. I don't care if I never hear Vivaldi again.
Finally, a few days after I left the hospital for the rehab facility, an occupational therapist put a book in front of me and asked me to try to read it. Maybe several weeks of ennui had persuaded my brain that this was a good thing to do, because the words took shape and stayed in place.
They say that when one part of the brain is injured, the other parts try to compensate, to work around the crippled part, to form new neural pathways or something. I believe it now. I haven't regained my sight completely. Occasionally someone will speak to me on my left and I'll have to search for the speaker. I look at cartoons on the Internet and don't get the joke -- the new pathway in my brain hasn't developed a sense of humor, perhaps.
Most embarrassing, I seem to have lost the easy automatic approach to familiar tasks: I put my shoes on the wrong feet. I have to be careful pulling a polo shirt over my head lest it go on inside-out or wrong-side front. I've been known to make several attempts at this before succeeding. Yet there are tasks -- like tying my shoelaces -- that are as automatic as they've been since I learned them many decades ago.
Some day, a long while from now, maybe I'll try driving. But I can't think about that now.
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