Vascular Surgery

WARNING:  NOT FOR THE FAINT OF HEART!

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Vascular Surgery

There’s a good reason women make the best surgeons, she thought.

Quick, deft hands, single-pointed concentration, focus.

She thought of the women jet engine mechanics she had met in the Air Force.

Not that she had been in the Air Force; but in the course of her duties as a civilian surgeon under contract, she had met them. Now, reining in her reverie, she was intent on the task at hand.

Drat this light, she thought. She really needed a more direct light source, but one has to work with what one has at hand.

Slowly, painstakingly, she drew the outlines with a surgical marker: carotid triangle; carotid vein; carotid artery. This, the artery, was what she wanted.

She steadied the syringe she had readied with an oh-so-fine 27-gauge needle.

2% lidocaine with epinephrine should be enough analgesia for comfort, and enough epinephrine to ensure a relatively bloodless field. She couldn’t help chuckling: bloodless indeed.

Squinting in the insufficient light, she injected the layers: first the skin, then the loose fascia of the neck; lastly, the layer surrounding the vessels of the neck, careful to avoid direct injection into the wall of the vessel, which might cause a spasm.

Now it was time to cut. She picked up the number 11 scalpel and steadied her hand. Carefully, carefully she opened the delicate skin of the neck, noting with satisfaction that the epinephrine had done its job. There was no need for the tiny hemostats she had ready in case of superficial bleeders.

The next layer, the loose fascia, pulsated bluish, overlying the great vessels of the neck. These she would blunt dissect with the larger curved hemostats.

She injected a bit more of the anesthetic, just to be sure. No need to cause discomfort, which might result in unwanted movement.

At last the artery was exposed. She marveled at its pulsations, at the tiny arteries that nourished the big one itself, and the minuscule veins that issued from it, carrying its waste into the larger system of veins, to be cleansed by the liver and kidneys downstream.

Holding her breath, she slid the first hemostat, jaws open, under the artery. Clamp. The vessel, trapped in the jaws of the hemostat, stopped pulsing abruptly. There was no going back now.

Now the second hemostat, exactly one and a half centimeters below the first: clamp. She raised the surgical scissors, poised for the definitive cut between the clamps.

Tilting her head to see better in the mirror, she cursed the dim light in that bathroom again.

And then, the definitive cut!

In a single motion, she swiftly removed the two clamps and was instantly drenched in red liquid. A scream of agony split the night as she sat bolt upright in the bed, heart pounding, drenched in sweat, clutching the sodden bedclothes as she struggled, locked in the arms of the Angel of Death like biblical Jacob.

Frantically clutching her throat, she rushed to the bathroom, the very same bathroom, and strained toward the mirror in the same dim light.

Nothing.

Her throat, graceful and bluish white as ever, shone back at her from the reflection. Sucking in a deep gulp of air, letting it out in a sigh that brought the dog running, she splashed water on her face and neck, toweling off the sweat.

“It’s OK, buddy,” she whispered to her whining canine companion. “Just another nightmare.”

The dog smiled anxiously, wagged his tail tentatively, and licked her calf. She reached down and patted his faithful head.

“Good thing I have you, she murmured. Stripping off her sweat-soaked nightgown, she rinsed off in the shower before throwing on a fresh one. She sank into the recliner with a book: sleep would not visit again, not tonight.

 

Sleep, Precious Sleep

Yesterday morning my phone rang way too early.  It was a friend who probably though I get up at a normal time for a human being; but I don’t.

You see, my meds last twelve hours, and I have to sleep them off if I want to be functional the next day.

More than that.

If I don’t get the right amount of sleep, I turn manic.  Pretty simple, eh?  Meds>sleep>functional.  Not enough sleep (even with meds)>manic.

I needed to get up earlier than usual today, because there is a lot to do in preparation for Passover, and I needed a full day in which to do it.  This can usually be engineered by taking my night-time meds early.

So I did.

But nothing happened.  I didn’t get sleepy.  Instead I started feeling wired.

Uh-oh.

I thought, maybe I actually forgot to take my meds.  I looked in my pill box: tonight’s meds gone.  So I did take them, after all.

So I did what my shrink tells me to do under those circumstances: I took an extra Seroquel.  That usually knocks me down.

But not last night.  May as well have taken a sugar pill.

I took another, and a milligram of Ativan to keep it company.

Nothing.

By the way, in case you’re wondering, I left an hour between doses, sufficient to feel the effects of the drugs.

I was getting very concerned by this time.

So I took yet another Seroquel, an Ativan, and another Ambien (those are in my usual bedtime hammer cocktail).

Not one fucking bit of “sleepy” coming my way.

So I got out of bed, where I had been passing the time by watching Betty Boop flicks on Youtube, and began doing my Passover chores, since it was clear that I was going to have a short and shit day.  I got everything ready for cooking, chopped mountains of veggies, did all my prep work so all I would have to do is throw the brisket in the slow-cooker, throw the veggies on top, and not worry about it.

Finally the sledge-hammer anti-mania drugs took effect (oh for a few milligrams of Haldol, for quick knock-down) and I managed to get in bed before the blessed drugged sleep overcame me.

I still had to wake up earlier than usual this morning, to call the clinic and cancel my 11 am appointment for ER follow-up with my primary care doc.  I woke to my alarm, made the call, and lay back down to go back to sleep for a couple hours, since I’d already done my prep work and had the time for a longer sleep.

Nothing.

Not gonna happen.

So I got up, feeling cross and speedy, and made my oat matzah (gluten free), singed the meat, sauteed the veggies, made a sauce, threw it all in the slow cooker and sat down to write this.

I really want a beer, but now they’re assur, forbidden, because of being made with yeast.  Anything leavened is forbidden for one week.  Damn.  Oh well, maybe I’ll get up and clean.

 

Get Me The Hell Out Of Egypt

No, not Eretz Mitzra’im, which is the Land of Egypt.

Had I been there, I most likely would have been thrown out in one of the many exiles of my people who came there seeking asylum from the Spanish and Portuguese, long about 1492.  All but a handful of Hebrews have been ejected from that land.

But.

In Genesis 15:13-14, it is said:

And He said to Abram, “Know with certainty that your offspring shall be aliens in a land not their own–and they will serve them, and they will oppress them–four hundred years.  But also the nation that they will serve, I shall judge, and afterwards they will leave with great wealth.  (Emphasis mine)

There was, in fact, a cordial relationship between the Hebrews and the Mitzrim (Egyptians).   They traded together, and the Mitzrim gladly allowed the Hebrews to come to Mitzra’im in times of famine in the land of Canaan, where the Hebrews dwelt (now called the Land of Israel), to buy food and water.

For the Nile waters the land of Mitzra’im, but the Land of Canaan is dependent upon seasonal rains for sustenance.

Years and generations passed, and Jacob, whose Godly name was Yisrael (Israel), had twelve sons and a daughter.  His favorite son Yosef (Joseph) angered his brothers, who sold him to a Midianite caravan, who sold him to an Ishmaelite caravan, who sold him to Poti-Fera (Potiphar), who was the Egyptian Chief over the Pharaoh’s butchers.  (Gen. 37:27, 37:36, 39:1)

Yosef did well there, and was promoted to be the supervisor of all Potiphar’s household.  But bad luck for him:

After all these things, his master’s wife cast her eyes upon Yosef and she said, “Lie with me.”  But he adamantly refused…” (39:7-8)

And she kept after him.  One day she actually grabbed hold of his garment and tried to pull him to her, but he escaped and fled, leaving his garment in her hand.  She screamed “Rape!” and Yosef, who was found outside the house with nothing on, was cast into prison.

You can see from this unfortunate turn of events that even when we are doing our best and thinking things are going well, even the greatest among us may have characteristics that unwittingly trip us up and lead to a fall.

Yosef is called Ha’Tzaddik, The Righteous One, because everything he did was in honor of G-d, and he was able to overcome the most natural of urges–the sex drive–even when freely offered by Potiphar’s Wife, who was said to be the most beautiful in the land.

But it is said that Yosef had one flaw: he was beautiful and he knew it.   He would spend time putting on makeup (as was normal for Egyptian men at the time) and gazing at himself in a mirror of burnished bronze.  Thus, all the women in Mitzra’im longed to be with Yosef.  Indeed, why should Eshet Poti-fera (Potiphar’s Wife) not have him?

Yosef had told her that he was free to partake of anything in his master’s household, with the exception of Potiphar’s Wife! (39:9)

But woe to him, he was thrown into prison; but Yosef had G-d’s favor, and even this turned into a good thing, although not for a while.

Yosef found favor in the jailor’s eyes, and he was made supervisor over the prison (even though he was a prisoner himself) (39:21).  There happened to be two other prisoners there, courtiers of the King of Egypt (for in this verse he is not named).  They were the royal baker and the royal cup-bearer, and they had each displeased the King.

One morning Yosef found them distressed, for they had both had disturbing dreams. (40:6)  Yosef correctly interpreted those dreams, and the outcome was that one servant was reinstated, while the other was beheaded.  Yosef asked the reinstated one to put in a word for him with Pharaoh, for that was his boss, but the man forgot, and Yosef was stuck in prison for two more years.

Nothing happens in vain, and everything is G-d’s plan.

Pharaoh had a disturbing dream, and called all of his wise men, magicians, and necromancers to try to interpret it, but none could.  This jogged the afore-mentioned servant’s memory, and he recalled Yosef, and told Pharaoh, who commanded that Yosef be brought before him.  Yosef was given a bath and a shave and new clothes (41:14), and brought before Pharaoh.

Pharaoh told him his dream (41:17-25) and Yosef correctly interpreted it for him (go and read the dream for yourselves–it’s worth it!); and Pharaoh mad Yosef his viceroy over all the land.

Because of the content of the dream, Yaacov (Jacob, Israel), who is Yosef’s father, remember, brought his whole family, who now numbered 70 souls, down to the land of Goshen which is in the northern part of Egypt, a fertile grassy land perfect for grazing flocks, for the Hebrews have always been shepherds.

There was a time of peace, and Yisrael (Jacob) died, and then Yosef died, and the Hebrews grew to be a large and prosperous nation in Goshen.  But:

A new king arose over Egypt, who did not know of Yosef.  He said to his people, “Behold! the people, the Children of Israel, are more numerous and stronger than we.  Come, let us outsmart it lest it become numerous and it may be that if a war will occur, it, too, may join our enemies, and wage war against us and go up from the land. (Exodus 1:8-10)

 

Nationwide Recall of Antidepressant Issued

Nationwide Recall of Antidepressant Issued.

via Nationwide Recall of Antidepressant Issued.

 

Heads up, Effexor XR users.  Pfizer has recalled lot numbers V130142 and V130140, and Greenstone lot number V130014, because they may contain a heart medicine that could potentially be life threatening.  In case you can’t access the above linked article without a password, I will quote the relevant passage from the Medscape article here:

A voluntary nationwide recall of 3 different lots of the antidepressant venlafaxine (Effexor, Pfizer Inc) has been issued by the drug’s manufacturer owing to possible contamination with a heart drug and subsequent potentially fatal consequences.

As a precaution, Pfizer Inc is recalling 1 lot of 30-count Effexor XR (venlafaxine HCI) 150 mg extended-release capsules, 1 lot of 90-count Effexor XR (venlafaxine HCl) 150 mg extended-release capsules, and 1 lot of 90-count Greenstone LLC-branded venlafaxine HCl 150 mg extended-release capsules.

According to Pfizer, the action is being taken because 1 bottle of Effexor XR contained a single capsule of dofetilide (Tikosyn, Pfizer Inc) 0.25 mg, an antiarrhythimic medication used to treat atrial fibrillation/atrial flutter and maintain normal sinus rhythm.

Pfizer says the probability that other bottles of Effexor XR have been similarly contaminated is low but that it has issued the recall as a precaution.

This recall involves Pfizer lot numbers V130142 and V130140, which both expire in October 2015, and Greenstone lot number V130014, which expires in August 2015.

“Although Pfizer has not received any other such reports, these 3 lots are being voluntarily recalled as a precaution because they were packaged on the same line,” the company said in a release.

“The use of Tikosyn by an Effexor XR/Venlafaxine HCl patient, where the contraindications and drug-drug interactions with Tikosyn have not been considered by the prescribing physician, could cause serious adverse health consequences that could be fatal,” the company notes.

I hope no one is taking these lots of Effexor XR/Venlafaxine HCl, but if you are, stop taking it immediately and call your prescribing provider.

Tongue In Cheek

Guess what I did yesterday?  I had a life-threatening attack of Angioedema.  My tongue swelled to the point where I couldn’t talk.  The left side of my tongue was severely effected, the right side less so.  I could still breathe through my nose, thankfully.

It came on rather suddenly, as I was sitting on my deck watching a comely young man hauling fish after fish out of the river, taking the hook out, and holding it up in the direction of the East.  He then put the fish back into the river.  Imagine the experience of the fish!

And as I was watching this curious fish ritual, I became aware that my tongue hurt.  I looked at it in the mirror and it just looked a little swollen, and thickly coated.  I use oral inhaled steroids for asthma, and thrush is always a concern.

But I know how to handle thrush, so I went for my baggie of medical grade myrrh resin that I bought at Manny’s homeopathic pharmacy on Yaffo Street in Jerusalem.  I picked a nice clear chunk and lodged it between teeth and gum, and went about my business.

But it quickly became apparent that this was not thrush.  The left side of my tongue was jammed against the roof of my mouth.  The right side was starting to swell too.

I pondered what to do.

Would you believe, one of the things I was pondering was that this was the death ordained for me on Rosh Ha’Shanah, the Jewish New Year where everyone’s fate is decided, who shall live and who shall die, and if you are condemned to die then there are different ways to die, and one of them is by strangling.  Maybe this was it, and I should just sit down in my recliner and let the decree take me away.

Then I thought, who will take care of Noga if I die somewhat suddenly?

I went to the medicine cupboard and got out the Benedryl, and took the proper 50 milligrams.  Then I got Noga’s Predisone (she has allergies) and took a couple of the 5 mg tablets.  I silently (since I could no longer produce understandable speech sounds) cursed that I did not have any epinephrine.  I used to keep a whole emergency formulary at home, but now I don’t even have a prescription pad, even though I still hold my license.

Should I call 911?  Well, if I definitely wanted to die, then yes.  First of all, I wouldn’t be able to talk to the dispatcher except in grunts, and she would probably think I was a prank caller and hang up on me.

Even if I managed to give her my address, the Keystone Cops that they call the EMS here would never find it.  It’s not on any map, being a mile and a half down an “unimproved” road and up a dirt driveway that looks like it goes to nowhere in particular.   Giving directions in my present state was definitely not a possibility.

Not only that, but the last several times that Dad has fallen and needed emergency medical services to put him on a backboard and take him the the skunkworks they call a hospital here, the EMS has not showed up any sooner than 30 minutes after being called, even when he was unconscious. Calling the EMS was a quick ticket to the next life.

So I hopped in my car and drove the 15 minutes to the hospital.  I remembered to say Shma Yisrael, the prayer we Jews are supposed to say before we die, and asked the Creator if s/he would please spare other people when I passed out from lack of oxygen and ran off the road.  I was pretty sure that I got a positive answer.  That made me feel better, because if I was destined to die along the road I really didn’t want to take anyone with me, although it also occurred to me that they, too, might be destined to die right now and I would simply be the agent of their death by sudden impact, which is the equivalent of the punishment of stoning.

Miraculously, I made it to the hospital, parked in the wrong lot, amazed myself by navigating the path to the Emergency Room, and walked to the Registration cubicle.  The young clerk was sitting there chatting with her friends.  I approached and put out my tongue, hoping that she would see that I was walking wounded and get me inside quick.  She gestured for me to take a seat.  I did no such thing, but made urgent guttural sounds, like some sort of primate.  This time she said, “OK, I’ve called the nurse.  She’ll be here soon.”  I felt sort of better.  At least when I passed out, someone qualified would find me.

The nurse appeared right quick, and I put out my tongue for her.  She exclaimed and whisked me away to a monitored room.  The air conditioning ate through my fleece jacket, fleece vest, and two layers of silk turtlenecks.  This thing had made me really cold.  So she holds up this thin hospital gown and says cheerfully, “Everything off, now, and put this on.”

I pantomimed freezing, hugging myself and jumping up and down a bit, to make it clear I was not about to abandon my layers of warm clothing for a barely-there schmatta.  She turned the thermostat up,  the air went off, and she brought me some warm blankets.  Monitors of all kinds were applied, and a wave of panic washed over me.  Trapped.  Tied down.  Wanna run, but probably would die, and I had decided not to die this time.

An aide came in and sat down at the computer and asked me a question.  “Uuuh!”  I answered.  This reiterated several times before she got the clue that I could not talk.

A pair of nurses appeared, carrying the tools of the Intravenous Line trade.  Panic attack.  I have a disease that has destroyed my veins, making them very fragile.  They often bleed for no reason at all.  Last time I was hospitalized I went through seven IVs in one day.

But they got it on the first try, even though one of them had to hold the vein down to keep it from rolling.  I’ve done that.  Works pretty well.

The doctor brisked through the door, asking questions as she came.  Must be busy, I thought.  She’s in hyperdrive.

I tried to talk and that told her what she wanted to know.  She asked me a series of intelligent questions to which one could nod or shake one’s head.  She rose in my esteem.

Medicines went into the IV.  A respiratory therapist came and gave me a breathing treatment to prevent spasms of the bronchial tubes.

The doctor popped in from time to time, and when the medicines started working and I could speak after a fashion, we of course started exchanging war stories.  Doctors are incorrigible when it comes to war stories.  I am certain that if there were two physicians and one of them was on their death bed, the two of them would be talking about this or that horrendous case, and trying to one-up each other, just for the fun of it.

Little by little my tongue went down, but the left side was being a bit stubborn.

The doctor came in and announced that they were going to admit me for overnight observation.

I secretly thought that was a good idea, but there were several factors that argued against it.  One was that my little Noga was home all by herself and would not have enough water or food to keep her in good shape.  Another is that I take exotic medicines that hospitals usually don’t have, and I must have them.  Third, although I am something of a heretic and no good at all at certain things, I am still an observant Jew and I cannot eat anything from that hospital.  The joy of being hospitalized in Israel is that the hospital food is kosher and served in accordance with Jewish law.

But this hospital is Baptist, and Baptists love their pork.  Three times a day, pork.  It’s amazing.  But I wouldn’t even be able to eat green beans here, because they are seasoned with pork fat, and the mashed potatoes are served with utensils that have also served pork.  In summary, the place is non-Kosher and I would not be able to eat anything there.

So we negotiated that I would stay 6 hours in the ER for observation.  That was all right with me.

It was a very boring 6 hours, since I had no reading material, and the medicines they gave me made me too wired to sleep.  So I amused myself by trying to count the slats in a Venetian blind that covered a window in the room.

Seven o’clock arrived and so did “change of shift.”  I was impressed how smoothly the nurses navigated the change.  Usually change of shift means you don’t have a nurse while they are in “Report,” and you could lie there and die in the meantime.  I soon discovered that the reason the change happened so swiftly is that they had pretty much dispensed with Report, because my new nurse didn’t know anything about me.  That was too bad because she had no idea how desperate my case was when I came in, and said I “didn’t look so bad.”  I thanked her.

Likewise the doctor, whom I happen to know both from my old doctoring days, and because she has taken care of my dad during his last two hospitalizations.  She was very hassled, and rightly so, since she had to run from room to room taking histories and doing physicals.  And I came to understand that there were many cases more serious than mine.  I should say so; it is an Emergency Room.

She of course had not seen my tongue in its supersized phase, but the first doctor had briefed her on my case, and suddenly the 6 hour observation turned into an 8 hour observation, and she said she would not let me go even then if my tongue had not returned entirely to normal dimensions.

She roared out of the room, and I really hoped she was using the waterless hand cleanser units that lined the walls in the ER, because she sure did not stop to wash her hands before exiting my room.  I am a stickler about washing hands, especially in places where sick people come on purpose.

At that moment I realized I have a Tikun Klalli booklet in my wallet.  I always have a Tikun Klalli on me.  The Tikun Klalli is a set of 10 Psalms selected by Rebbi Nachman of Breslev, and is said to be the Universal Cure.  So I got it out and settled down to read the introduction, which I had never read before.  I didn’t actually read the Tikun itself, because once you start it you shouldn’t stop, and there was a big risk of interruption, of course, where I was.

The time flew past as I crawled through the easy yet esoteric Hebrew of the Introduction.  Often the Introduction of Kabbalistic books is the key to understanding the book itself.  So it was gratifying to be using my time in a productive way.  And my tongue went entirely back to normal, except for a huge blood blister on the bottom of my tongue where it had been stuck on my teeth.

The doctor flew in, looked at my tongue, asked me how I felt, and announced that she would indeed let me go, and only had to do the requisite paperwork.  I would have jumped up and down if I wasn’t attached to so many monitoring gadgets.  It was now after one o’clock in the morning.  I was sorely feeling the absence of my evening meds.

So what had provoked this gruesome tongue-swelling?  The consensus was that my blood pressure med was the culprit.  Seems that any blood pressure med ending in -pril, such as Captopril, Ramapril (which is what I was taking) and others, have a small but present chance of causing angioedema.

At last I was released and drove home.  Noga turned herself inside out with joy.  I was pretty happy myself.

But.  I was filled with apprehension: what if it came back?  I made a plan.  If it came back, that meant that I was destined to die.  I would somehow get plenty of my sleep meds down, so I might be able to pass out pretty quick and not feel the minute or two of choking before lack of oxygen shut down the brainwaves.  I took a large syringe full of insulin (my dad’s) and prepared it to inject, just in case I couldn’t get the sleepers down.  I found a manilla folder and wrote a note explaining what had happened, saying goodbye to all, how to find my will, what to do with Noga.  And between every line I wrote DO NOT RESUSCITATE.  I took a black marker and wrote it on my chest.  It’s still there: DNR.  That’s what I want.

I filled three large bowls with water for Noga in case it took a long time to find me.  I put her bag of food on the floor where she could get it.

Then I went to bed, choking down all my usual pills plus an extra clonazepam to ensure sleep.

And as you can see, I also woke up.

I Am Alien

 

alien woman head

The first thing I remember, after they left me, was waking up in a box.  The sides of the box were clear, and I could see, through the half-dark, two white shapes gliding on padded feet to and fro, with stiff white headdresses. 

Scratchy wrappings smelling of something that made my eyes water bound me tight and I grew very afraid. Then I found that I could wriggle one hand free, and soothe myself by sucking the largest one of the digits.  This took away some of the fear.

After the half-light memories, I remember no more until much time had passed.

They had told me that I would not remember them, when they dropped my astral body into this receptacle, this mobile vessel that the natives here call “human.”  But I do have faint recollections of my real people, mostly in the form of feelings of kinship, and an understanding that surpasses words.

Although my memories of what happened after I left the box have been erased, I have seen a home movie of my first steps at the age of nine months post-emergence.  The movie shows a small native female running away down a sidewalk, falling, picking herself up, and running further away, until the large native identified as “my mother” runs and picks up the small one, carries it back to the starting point, and sets it down; whereupon the small female commences running away again.  The natives surrounding the movie camera are heard “laughing.”  The small female was me: trying, as soon as I attained locomotion, to run home.

Several years later they took me to a building full of native children, and a large female overseer gave each one a paper covered with shapes, and color sticks, and commanded all to fill the shapes with color.  I saw no point in this meaningless exercise and turned the paper over, so that I could draw a picture of my real parents.  The overseer objected strongly to this, and made me stand in a corner; this was a relief, as that way I did not have to participate in their ridiculous activities.  From then on I learned the ways of achieving the corner, and did spend most of my time there, dreaming of home.

At night I sat by my window for hours, pleading with my parents to come and get me, explaining to them that they had left me on the wrong planet for too long.  I heard them from afar:  Not yet, not yet.  Your job is not finished.  Not yet.

My native “parents” did not know what to do with me, since I refused to associate with the native children, whose language was simple and crude, whose games ridiculous, and who, at the age of six, could read nothing more complicated than “Dick and Jane.”  By that time I had read a good deal of my parents’ library:  Herman Hesse, Gunter Grass, Franz Kafka, which was my favorite, especially Metamorphosis.  This was by far the best thing about this world: books, because they took me away, for a time.

The animals were a relief from loneliness. They have great wisdom and do not require speech to explain their thoughts and wishes, which are many and subtle.  The natives have terrible misconceptions regarding the animals: they think that because the animals cannot speak as they do, that they must be an inferior race.  This is wrong.

In my readings I discovered that there are special doctors for people whose minds work differently from those of the rest of the natives.  In these times they are called “Psychiatrists,” but in earlier times they were called “Alienists,” because those who do not conform to the norms of this world are considered “strange,” or “alien.”  I also learned that beings originating from other planets, like myself, are called “Aliens” as well, because we are strangers in this world.

Upon a time, there were great houses called “Alien Asylums,” where Aliens were sent for safety.  I thought, perhaps, that in an Alien Asylum I might find some one like myself, from my own planet.  I wanted to learn all I could about these places, and to see if there was one nearby.  So I got out the great book called “Encyclopedia” and looked up “Alien Asylum,” and was shocked at what I found there.

The Aliens were tortured in a ghastly fashion, with straitjackets and cold sheet wrappings and electric shocks.  I decided that I would not go there; in fact I decided to try to mimic the natives so that they would not know that I am an Alien.

I did so by spending all of my time at my studies, or in reading famous books, or in working with the animals, so that they could see that I was a very good native.

Many years passed in this fashion, but then something—I do not know what–happened that damaged my gyroscope, and I found myself one moment flying toward the sky and my home planet, and the next moment crashing to the ground.  I was unable to right this malfunction, and soon it became known to the natives, who carried me against my will to an Alien Asylum.

Fortunately the Asylum was not like the ones in the Encyclopedia.

In fact, it reminded me markedly of my first days at school, where I was given the papers with shapes and the color sticks, and told to color inside the lines, if I wanted to get out.  I refused to participate in this absurd activity, and they gave a bad report of me to the Alienist.  He ordered them to make me swallow pills, many pills every day, that made me feel weak and dizzy.  But then I was no longer expected to color either inside or outside of lines.

When they released me from the Asylum, the Alienist sent me to be “Tested.”  A kind native woman asked me many questions and gave me puzzles to solve.  I solved many puzzles, until there were no more left.  Then she asked me to look at pictures of native faces, and tell her what the people in the pictures were feeling.  This I could not do, because I am not a native and I do not use their modes of communication.

After we finished all the tests, I returned to the Alienist for his report on their outcome.  He told me that I had Asperger Syndrome and Bipolar Disorder.  He explained to me what those things mean; but it was nothing that I did not already know.

I am Alien.

Alien spaceship

Food for thought…

Laura P. Schulman, MD, MA:

From 22 going on 33, via Kat at Looking for the Missing Me…..this is Brilliant!

Originally posted on 22 going on 33:

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Overwhelmed With Weird

I think I need my head examined.

Since today kept getting more and more bizarre, I just had to chill out with a movie.  A movie that my psychologist suggested that I watch with my son, way back when he was (WAS!!!) dating a woman with Borderline Personality Disorder, who called him every thirty seconds and texted him in between calls, and became irate when he didn’t return her texts while he was in meetings.  My bone-chilling fear was that she would manage to get pregnant…….but thank G-d she did not, and at last he developed, through hard work, the strength to finally leave her.

The movie, of course, is Fatal Attraction.

My skin is still crawling.

I must be having a masochistic spell, or I certainly wouldn’t have pulled that one out of the hat.  Or maybe I just needed to see something weirder than my real life, these days.

Dad is doing much better now that he’s home from the nursing home.  Mom is busy working on that, though, by encouraging him to stand up by himself in the bathroom (that’s when he falls down–when he’s standing up, because he can’t feel his legs, and the tile floor is always hard).  ‘Round and ’round and ’round she goes, and where she stops, nobody knows.

I’m glad Dad is better.  We get to spend more quality time together.  After I gave him his lunch today, we had tea.  He wanted a really strong tea, so he chose Irish Breakfast, and I had Earl Grey.  As we shared our tea, conversation floated naturally from one topic to another.  Then, on his way to the cookie jar, he fell asleep in his wheelchair, and I let him nap in peace.

My mother came in from shopping with her usual flourish, braying for the cat and waking Dad, which is hard to do.  I waited until everything was settled down, and gathered my things to go.

As I was getting ready to leave, and before I had a chance to put my raincoat on, she slapped me on the arm…hard.

 Memories of stinging childhood slaps.

“Don’t hit me!” I yelled.

“Why not?  I can hit you if I want to.  You’re my child!” Smirked Mrs. Social Worker Guardian-Ad-Litem.

“Parents who hit their children get reported to Social Services.  Remember?”  My mouth said it, but my mind was numb.

“Oh.  Yes,” she said blankly.

So I go home and watch Fatal Attraction.

What a jerk.

I. Am. On. The. Wrong.  Planet.  Phone home.

Which Disaster Will You Be Having Today, Ma’am?

It’s hard to know where to start.

When I last posted, I believe my dad was already in the nursing home, ostensibly for rehabilitation after a fall.  Medicare pays for 100 days of rehab, and then if long-term care is needed, one’s own funds have to be used until gone, and then Medicaid kicks in.  But then you are pretty broke, both the patient and the spouse, because the nursing home costs $6000 per month more or less, and that doesn’t include a lot of necessary things.  So for most normal people, it doesn’t take long to run through the savings/retirement account at that rate.

But it does include the basic care an invalided person needs, like feeding and diapering, showering, and a variety of entertainments for those who are able to take them in.

Well.  Dad’s 100 days were up, and Mom, who used to work at the very nursing home he was in, went to look at the room on the long-term care wing where he was to go.  I didn’t see the room, but apparently it was dark, tiny, and horrible, and Mom freaked out, and she was talking about it in front of Dad so HE freaked out even though he didn’t really understand what it was all about, and he started crying and in his broken language, begging to “go home to his house.”  So I freaked out too.

So Mom decided to bring him home, and I went along with that because Dad’s pleas were heartbreaking.

But.  I had tickets to Israel for the two weeks surrounding the festival of Purim, and Mom wanted to bring Dad home before I came back.  I didn’t like that idea, but when Mom gets a bee in her bonnet about something, it will happen regardless of any extenuating circumstances.

But.  I refused to cancel my trip on account of her poor judgement, so I put Noga in the boarding kennel and went off to Raleigh to spend a few days with my son before hopping a Delta flight (free with miles) to New York, and from there to Israel on Turkish Airways.

Time with my nearly-29-year-old baby boy was wonderful as always.  We never run out of things to talk about.

I arranged with my hotel to keep my car in their garage at $5 per day, cheaper even than the airport’s long-term-parking where you have to drag your luggage to a shuttle stop, then hope the shuttle appears before your flight leaves.  Then, when I returned, I would stay the night at the hotel and drive back to West Bumfuck (as my gay boyfriend in Jerusalem calls it).

My flight was at 7 am.  The night before, I called the front desk and asked them to arrange a cab for me at 5:30–the airport is a 20 minute drive, and since it was a domestic flight I only had to be there an hour before.

The desk person told me they don’t do that (calling cabs), but that there are tons of cabs hanging around at that hour because of all the guests leaving for flights.  But did I want a wake-up call?  I did.  At four am, please.  It takes me a long time to get ready in the morning.

Four am, both my phone alarm and the room telephone go off, and I levitate, thrashing for the light, the phone, whatever I could get my hands on first, sending everything on the bedside table flying: water bottle, glasses, asthma inhaler, cell phone, telephone, lamp.  Fuck.

I felt around and got hold of the lamp.  It still worked.  Then I collected the rest of my belongings, calmed down, and went for the shower.

I got down to the lobby with my bags at about twenty after five.  There was a cab waiting outside.  I rushed to the desk and asked them to reserve that one for me; but at that very moment a couple jumped in and off it went.  So I asked the clerk to please call another one, which she did.  I finished checking out and sat down to wait for the taxi.

An elderly yet fit couple came down, checked out, and sat down to wait for a cab.  Their flight was three-quarters of an hour after mine.

The cab showed up forty-five minutes late.  We all rushed out.  They had a lot of luggage; it took several tries to get it all arranged so that the back hatch would close.  By now it was well after six.  There was hardly any traffic; I entreated my driver to go faster, but he just bumped along.  It wasn’t his flight, after all.

In short, I arrived at the check-in exactly five minutes late.  Would they hold the flight?  No.

But I could go on the next flight, which got into JFK at 1:30 pm.  Great: that was exactly the time my Turkish Airways flight took off.  I called Turkish Airways.  It took a while to get someone who spoke English on the line.  Wouldn’t you think they would have English speaking customer service people in their New York office?

Anyway.

There is only one Turkish Airways flight to Istanbul (the only place T.A. flies from JFK) per day.  I could take the same flight out the following day: for an additional $444.

I considered it briefly.

Then it became clear that this pattern of obstacles was trying to tell me something.  But which thing was it?  Was it a test, to see how many obstacles I could overcome in order to merit to be in the Holy Land for Purim?  Or was it a sign that I’d better turn back, let go, let all my plans (and considerable money) slide?

I chose the latter.

So I took another cab back to my hotel (another $45 fare!), collected my car, drove the five hours back to get Miss Noga, who was of course thrilled to see me (and I her), and drove back up the mountain to beautiful West Bumfuck.  I fell into bed at 7 pm and slept until 10 the next morning.

I figured I’d better go up to the house (remember, I live in an outbuilding on the property) and see what was going on.

Mom was sitting at the table having her breakfast.  Dad was sitting at the table in his wheelchair, staring at the slices of cheese on toast, pawing at them with his nearly useless hands while Mom ate her food and mildly scolded him for playing with his food.

She had only just brought him home, it turned out.  She brought him home in her car, having forgotten that there is a county van service that would transport him safely in his wheelchair, for free.  The very same one we used last week to take him to the dentist.

I fed him his cheese, but the toast was too much for him: it stuck in his throat.  He can’t eat solid foods anymore.  It has to be mashed up or put through the blender.  And his hands have forgotten how to get his fork/spoon/hands to his mouth.  If no one feeds him, he doesn’t eat.

Then the home hospice nurse came and did an intake.  They have someone coming to the house a few times a week, and they provide a wide range of services that I am grateful for.

Mom has arranged for three hours a day of private nursing assistance.  The guy came today and got Dad out of bed, which was a good thing because Mom was unable to get him out of bed by herself.  TYS, TYS, not funny.

The bed of course was soaked in urine, since my dad is incontinent.  So he wanted to get up, naturally, but couldn’t because he is mostly immobile, and Mom is 87 although she has not so far awakened to that fact.  So they had to wait for the nursing assistant to arrive, to get Dad out of bed and showered and dressed.

I showed up there at noon, having slept till 11 am (am I stressed or something?!).  Mom had made Dad a sardine sandwich–his favorite!–that he had not had in 103 days, the time he was in the hospital and nursing home.  So Mom was very excited about the sardine sandwich.  Dad was asleep in his wheelchair, drooling on his front.

She sets this delicious sandwich down in front of him, with all sorts of expressions of anticipated delight.  He stares at it blankly.  I ask him if he wants a bite.  He nods, so I pick up the sandwich and bring it to his mouth, which remains closed.

“Do you want a bite of sardine sandwich, Dad?”

Nods.

“Then you have to open your mouth.”

He does, I slip the sandwich in, and he takes a bite.  I watch out for my fingers.  He is known to have a ferocious bite.

We manage another bite, and then his throat rebels.  I wait anxiously for him to get it swallowed.  I guess that’s the end of the sardine sandwich experiment.

But Dad reaches over, in a rare moment of coordination, and takes the top piece of bread off the sandwich: he uses his spoon to carefully butter the bread with apple sauce, then drops it on the plate.

Mom mashes up the remaining sardines and takes the bread away.  I feed Dad the sardines.  When they’re gone, he spies a bit of onion on the plate and points to it.  I feed it to him.  There are little specks of sardine here and there on his plate; he points to them, and I gather them up on the tip of the fork and put them into his mouth.

Then he has an attack of acute chest pain.  This has been happening more and more often.  In my opinion he’s having cardiac angina–when the heart muscle doesn’t get enough oxygen, it complains loudly with pain.  My mother has convinced herself it’s indigestion.  Well, whatever.  I try to convince her to give him a nitroglycerine tablet when he complains of chest pain, but she looks off into the distance, which I know means “I won’t.”  She says she will give him an antacid.

And now she’s decided that he doesn’t need his pain medication for his destroyed spine and shoulder, because “he just sleeps all day.”  I remind her that maybe sleeping all day might be better than being in agony all day.  Quality of life and all that.  Besides, he sleeps all days anyway.

She briefly brightens up at “quality of life,” being a social worker and all, but then starts complaining again that the medicine “dopes him up.”  So I don’t doubt she will withhold his pain meds.  If she does, I will speak with the hospice nurse and see what good it’ll do.

So here I am, back in my own little hornet’s nest in West Bumfuck, waiting to see what will be.  I know what will be; it’s a matter of when.

 

Bunny Boiling Close Call

If you aren’t yet familiar with it, “Bunny Boiling” is a term referencing a scene in the movie Fatal Attraction.  The movie stars Glenn Close as a person who is supposed to have Borderline Personality Disorder.  (I don’t agree with that assessment, but that’s the consensus.)

There’s a scene in the movie where Close’s character, Alex, in retaliation for a perceived slight from the object of her affection (Michael Douglas), takes his family’s pet rabbit and boils it on the stove.  No, I haven’t watched this scene.  I would freak out or throw up or something, so I leave it to others to write about it.  I learned about the term on the excellent site Out of the Fog, which provides support and resources for people in relationships, whether chosen or unchosen, with people with Personality Disorders.

What it boils down to (sorry, bad pun) is that the disordered person, for whatever reason/non-reason, takes something that is precious to the person they want to hurt, and breaks/destroys/kills it.  It’s not a pretty thing.

And that’s one of the reasons I don’t think “Bunny Boiling” is a feature of Borderline Personality Disorder.  In my experience, Borderlines rarely if ever take out their anguish on other people in planned, complex ways.  Borderlines turn their pain in on themselves, via self-harm that may either be physical such as cutting/overdosing, or in exposing themselves to danger, usually subconsciously.  Some Borderlines have rage attacks and level their explosive anger at people they love, and some hit or throw things.

But they are usually contrite and filled with self-loathing after these spontaneous outbursts, and that’s when self-harm becomes a risk.

Please note: The characterizations of Personality Disorders you will see here are a combination of my own clinical experiences, cross-checked with the Diagnostic and Statistical Manual V.

Contrast that with Narcissistic Personality Disorder, where the person does not feel disordered at all.  Rather, s/he expects the world to put her on a pedestal and worship her.  If she thinks she is not getting enough adulation, she will attempt to emotionally cow everyone in her inner circle, using an arsenal of weapons such as intimidation, gaslighting, temper tantrums, physical and/or emotional abuse, and disregard of boundaries.  She is not above stealing from her own family, and she is not above….Bunny Boiling.  Outside the family, she is all smiles and sunshine, usually a pillar of the community, craving (and getting) admiration and accolades at work and in the community.  The family is powerless to gain support from the community, because if they try to get help no one believes them, because the disordered person is SUCH an angel, anyone who speaks against her must be the devil incarnate.

I’ve noticed some overlap here with Antisocial Personality Disorder.  Both Narcissists and Antisocials tend to have no remorse for the sometimes heinous deeds they do.  They will willingly steal, and feel that it’s merely what they deserve to have, after all.  They both use others for their own designs. They lack empathy.  Neither type has any problem with destroying things belonging to other people, although they do it for different reasons.

Narcissists will destroy things belonging to loved ones because they feel they are not getting the attention or adulation they deserve; therefore they will steal/break/destroy/kill something of special value to the loved one or family.

Antisocials don’t need a motive.  They do destructive acts because they enjoy it.  I have had some horrific experiences with Antisocials, and have observed them torturing animals and getting sexual pleasure from it.  I’ve had Antisocial children in my pediatrics practice as young as five or six, who purposely set the house on fire or set the family cat on fire, etc.  Therapy did not help.  It’s tragic and terrifying to see this developing over time in a youngster.  I know that some of you who are reading this will be angered by my characterization of Antisocial Personality Disorder, and accuse me of demonizing it, but what I am describing is from my direct experience, so I can’t soft-pedal it.

I have written a lot about my mother and my anguish at trying to escape her abuse, only to get sucked back in.  I’ve been doing a lot of work on myself around this, and I am starting to see the way the roles have played out over my lifetime.  My mother is the Disordered One who has absolutely no remorse about tormenting me, kicking the dog, breaking precious fragile one-of-a-kind handmade objects, and saying shockingly denigrating things about my father in front of selected other people.

I am the scapegoat, the one she takes her anger and frustration out on, and then is furious that I don’t adore her the way she envisioned being adored by her child.  For my part, I desperately seek ways to appease her and make her love me, or at least accept me, or at least stop treating me like a contemptuous piece of shit.

My father is the “Winged Monkey,” a term taken from the Wizard of Oz.  The Wicked Witch of the (East or West, can’t remember) had a band of Winged Monkeys that she sent to retrieve Dorothy and crew when they escaped.  In a Personality Disordered family/relationship, a Winged Monkey is the person who, after the scapegoat has fled, goes to her and explains that Mom really didn’t mean to say what she said, she was tired, she was aggravated about something at work, she had her period.

And the scapegoat, not wanting to believe that Mom is such a mean person, capitulates and returns to the abusive situation, hoping that this time will be different, and resorting time and again to appeasement behaviors to try to make Mom proud, so that THIS time she’ll be as nice to me as she is to everyone else.  And since this is just another cycle-of-abuse situation, there is often a “honeymoon” period where everything is lovely, because Mom really didn’t want me to leave–she just wanted to throw me out.

I’ve tried all kinds of strategies to get away from my mother.  I’ve been in therapy since 1984.  I’ve utilized the Geographic Solution, even moving to the other side of the world to get as far away from her as I could.  Hell, if they offered a one-way trip to Mars I’d jump at the chance.

There I was, on the other side of the planet, enjoying myself immensely, assuaging my guilt for enjoying life by calling Mom on Sundays and Thursdays.  Then the Winged Monkey struck again.

He didn’t mean to do it.  He just got awful sick, and they are awful old, and I couldn’t just let them flounder.  Could I?  So I packed up my stuff and came back to the States after four glorious years abroad, and moved into the barn.  No bathroom, no kitchen, but it’s a roof and it has heat, and I’m damned well not going to live in the house with THEM.

Except now, as of about a month ago, it’s not THEM who live in the “real house,” because my Winged Monkey has moved into the nursing home, and it looks to be for the rest of his life.  It is a tragedy.

Last Tuesday I was visiting him, as I do every day, and I brought along Noga, as I do every day.  She has become the unofficial Therapy Dog at the nursing home.  When we finally get to my dad’s room, after greeting all the residents and staff along the way, she cuddles up to him in his bed,

Noga, the Angel Puppy

Noga, the Angel Puppy

and he buries his hand in her silky fur.  Sometimes he cries.  If nobody stops her, she will lick his ears till he convulses with laughter.  She is his angel.

Last Tuesday Mom was looking distracted and a bit agitated.  She asked me if she could take Noga for a walk in the park that adjoins the nursing home.  I didn’t see any harm in that, and I thought it might be therapeutic for Mom, as it was a beautiful day for a walk.  I handed over Noga’s leash, and turned my attention to Dad, who was having a rough day as well.

Half an hour later, Mom came striding into the room with Noga gunny-sacked under her arm.  Her hair (Noga’s) was a mess and her harness hung around her neck.  I took her–she was shaking and grabbed onto me with her claws, terrified–and I noticed that the part of the harness that was hanging from her neck was a part that normally goes over her leg.  The harness had been completely off, and hastily thrown on–not put back on properly.

“What happened?” I asked Mom, keeping my voice even.

“I don’t know, she got out of her harness,” says Mom, avoiding eye contact.

“Did she get scared and pull back?  Did she see a rabbit or something?”  I was hopeful there would be some rational explanation.

“No, she just got out of her harness,” Mom repeated.

I got a chill in the pit of my stomach.

First it was a group of four little shot glasses my dad had made, that he and I used to use every afternoon.  They disappeared, and I found them behind the refrigerator after much grilling.  Two of them are still whole, but the fridge is huge.  I’ll have to wait for someone to help me, but for now they’re safe.

Next it was a really beautiful porcelain vase that my dad and I collaborated on–he threw the vase, and I painted it.  It disappeared from its place on the shelf, and all the other pieces of pottery have been rearranged to fill the gap.  She “doesn’t know” what happened to that either, and she’s not budging on this one.  I think she sold it.

And now, I can only be grateful that whatever occurred to induce her to bring Noga back to me intact–whether it was a moment of remorse, or fear, or whether Noga simply would not leave her–she brought my Angel Puppy back to me.

Although I don’t fool myself that there will be no more “Bunny Boilings,” I will do my best to keep Noga safe, and not to let my own pattern of appeasement deliver her over to….her.

 

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