Narcissism and Slavery

As the festival of Passover approaches, it’s a tradition among some of us, Jews and non-Jews alike, to start thinking about the Passover story as an allegorical reference to how we limit ourselves, and how we can use our inner resources to liberate ourselves.  We think about our Inner Pharaoh, and what we need to do to get free of him.

The Hebrew word for Egypt is “Mitzrayim.”  The word can be broken down into its roots: “Mi” = “from,” “tzr” or “tzar”=narrow place, tight squeeze, trouble, “yim”=masculine plural ending.  So you could say that our own personal Mitzrayim is the narrow, tight places in which we find ourselves.  Our challenge during the spring season of new growth and opening is to do just that: to split the Red Sea, to walk through scary tight places in order to remember who we are, and to grow past our narrow-minded presuppositions, to give birth to our newly liberated selves.

The other day at the nursing home my mother commanded (not asked–commanded) me to appear before her, at her house, at seven PM.  She refused to give me any details, just “be there.”  So I showed up at 7:30, since I had something to do prior and she had not asked me if that was a convenient time.  Did it give me pleasure to know that she would be annoyed?  Perhaps, yet I also know that annoying her will eventually come back to haunt me.  Sometimes it’s worth it.

I got there, and she is sitting in Dad’s recliner, which instantly puts me on guard.  There is this thing in Jewish culture where a person’s chair is part of their personal sacred space, and intentionally sitting in someone else’s place is considered an act of disrespect.  So I am on guard anyway, and this just confirms that I better stay there.

As I perched on the arm of the couch, not wanting to sit in HER place (and besides, it gives me the creeps), she pronounced clearly and with authority:  “I am NOT asking your permission.”  

“OK,” I said, waiting for the other shoe to drop.

Then she tells me in great detail of her plans to bring Dad home from the nursing home, how she and I will care for him with the help of whatever aides she can find; that she’s located a couple of them and they only charge $14 an hour, and besides, we would only need them for showering….on and on.  Apparently she has not taken into consideration that it takes two young strong people to get him from the bed to the wheelchair, to the toilet, to diaper and dress him…and he’s been discharged from Physical Therapy because he’s not made progress….and his meals are now put through a blender so that he doesn’t choke, which had been one of my big concerns even before the nursing home.

And She Who Must Be Obeyed is NOT asking my permission.  That means I don’t even have to bother voicing my concerns, because they’ve already been summarily dismissed.

I decide that I don’t have to have a “dog in that fight,” as they say here in the mountains.  I keep my mouth shut.  Poor Dad will be the one who suffers, and I hate that, but since “my permission” has not been asked, I won’t ask a lot of permission to be out of the country when I need to be.

And I’ll need to be, because that scenario is so excruciatingly painful to me that I will have to give myself a lot of space, knowing that injuring myself in order to try to further Mom’s follies is not going to help Dad, in the long run.

A few days later, I am told that “we” are taking Dad to the dentist.  The aides at the nursing home will help us get him in the car.  Who will get him out?  Oh, they have a wheelchair at the dentist.  She already checked that out, Stupid.  

I don’t like this.  I’m just getting over an episode of seriously-bad-back caused by catching Dad as he was on his way to the pavement, after taking him to another appointment.  Mom had, in her trademark style, strode around to the driver’s seat, leaving me to somehow get Dad into the back seat.  He collapsed, and I was holding him up calling for help, when one of the familiar Viet Nam Veteran street people came and helped me get him into the car.  I gave him all the cash I had, and I wish there had been more.  But it was too late for my back.

So I told her my back won’t take it, and she sneers at me and says that hers will.

There is a county transport service that has wheelchair accessible vans.  I told this to my mother, who immediately denied it.  Then she called about it, and wonder of wonders!  Of course it was her idea now; but at least.

“You will be there at 12:30 to meet the van.  You will ride in the van with Dad to the dentist.  His appointment is at one.  My appointment is at two.  So you have to ride in the van with Dad.  DON’T BE LATE!!!”

OK.  I will be there at 12:30, and I will go into the appointment, because Dad has been hallucinating lately and I worry about the dentist’s chair and all the noises, and his trouble swallowing, and the fact that he will not be able to hold the little saliva sucker thing that you now have to hold yourself.

Isn’t it funny how it really is the straw that breaks the camel’s back?  Here’s mine (my latest, anyway):

Friday afternoon, my mother shows up at my door with my mail.  She knows I don’t want her picking up my mail (we don’t have mail delivery here, so we have to go to the post office for it), but she had some excuse this time.

After an uncomfortable moment standing at the door, I decide to show her dinner in progress.  I always cook them a kosher meal for Friday Nights, and I bring it wherever they happen to be.  Nowadays I’m bringing it to the nursing home.  So I thought I would show her the kosher chicken rolling around in the kosher rotisserie, the pans of veggies, the potatoes…..oh, I do it all the time!

“See, Mommy, see what I did?  It’s for YOU, Mommy!  I picked these flowers for YOU!  I cooked this food for YOU!  Aren’t you happy with me now?  Won’t this make you love me and stop saying those horrible things to me?”  Says the little girl Laura, tears brimming but not falling, for that would make her laugh: “You need to grow a thicker skin.”

My kitchen is very tiny.  Very tiny indeed.  In fact, with my mother in it, I found I suddenly could not breathe.

“Let’s move into a bigger space.  I’m feeling claustrophobic,” I said.

Her little malevolent eyes glitter.

“Claustrophobic, eh?  What DON’T you have?  I think you’re a hypochondriac.

“Hypochondriac?” I repeat, shocked.

“Yes, hypochondriac.” She says emphatically.

I see her to the door, slam it, and collapse in a heap of raging tears.  As soon as her car leaves the driveway I start screaming.  I beg G-d’s forgiveness as I curse my mother, bringing down all of Hell’s fires on her head, into her belly, wishing her as painful a death as she engineered for her own mother…..and then I stop suddenly, realizing what has happened, that I have absorbed the poison from the wicked Queen’s apple, and if I continue in this manner I will, G-d forbid, become my own hateful mother.  My own personal Pharaoh.

So I have been praying for some enlightenment, some clarity, some “how-to” that will get me through this piece of time surrounding my father’s death.  My very own Mitzrayim: stuck in the narrows, whichever way I turn.  Face-to-face with Pharaoh, a smirk and a sneer and a twisting of the guts.

Here is some really good advice on learning to open one’s mouth from The Invisible Scar, a blog dedicated to healing for Adult Children of Narcisists (ACON).

But I am not ready to deal with the backlash that always comes with opening my mouth.  I am mortally afraid that if my mother escalates (a certainty) or lays hands on me (a distinct possibility), that I might “lose it” and do something violent, G-d forbid.

So I am keeping my mouth tightly closed, which I know is part of the Narcissist’s Weapon Arsenal.  I don’t want to emulate her, I don’t want to BE her–and I know that’s a danger here.  But right now I can’t deal with another knife wound.  Figuratively, that is.

Tomorrow, at the one o’clock meeting (DON’T BE LATE), my dad’s fate will be decided: does he stay in the nursing home until he dies, or do we bring him home to die, however long that takes ( he estimates two years, and I believe him).  Although I have been told I do not have a voice in this decision, I damn well do, and I will use it.  I plan to make my case very clearly that there is no way that he could possibly get the care he needs at home.

Feeding, changing his diaper and his bed three or four times a day, dressing him, getting him showered, all without any assistance from him, because he is so debilitated……these things cannot be done by an angry 87 year old harpy, and aside from feeding him, my arthritic body barely allows me to hold his head up to drink from a cup.

My voice says NO.  We CANNOT bring Dad home.  I WILL NOT see his last days sullied by that screaming harpy cursing him for being an old, debilitated man.  I will make that clear, in an unemotional, measured way: that is MY way, MY voice, because my voice has been crushed since I came out of the incubator at one month of age.

I did make contact with a regional Veterans’ Administration representative–my Dad is a WWII combat veteran–who is doing his best to get funding to pay for either nursing home or home care.  She, my mother, had been telling me with that “you stupid idiot, you should know better” tone of voice, that the VA would never give them money.   Well, guess what: they will be getting around $2000/month in Veterans’ Benefits–“For Dad and me,” she emphasized, as if I would want a single cent from them!  And of course she takes credit for the VA angle.  But at least it will take the financial incentive to take him home off–otherwise she would have to “spend down” her own money before Medicaid would pick up the nursing home tab.

Speaking of money, before Dad had his last fall, the one that landed him in the nursing home, I had been caring for him two days a week, plus making dinner for them (my own money, and let me tell you, kosher meat is not cheap) on Friday nights.  The county Social Services worker told my mom that there was money available to pay me for my work as a caregiver.  My mother turned it down on the grounds that a child should not be paid for taking care of a parent.  Thank G-d I have money to live on now, but I am furiously saving for the day that that source of funds dries up, when I turn 65, in 4 1/2 years.  That money would have come in right handy, to stash away for the desperate times that will follow the cessation of my private disability funds.

It is a terrible thing to say, but I am looking forward to the day that I am free from this elephant sitting on my heart.  I know what that will mean.  He is not yet ready to go; he needs to rectify some issues inside himself.  I don’t want to rush that.  But one thing I have learned in my chaotic life is patience.  I once heard that the best way to victory over an abusive parent is to outlive them.  I don’t know if I will outlive my mother, but in a way my death preceding hers would also be a victory.  I just don’t want to see her sneering face on the “other side.”

And since I have a feeling that that would be a very effective form of Hell, I had better be careful not to “become my enemy.”

Somehow I must do the work necessary to face down my Inner Pharaoh and in doing so, lose the fear that has kept me in slavery for 60 1/2 years.

The Letters After My Name

Laura P. Schulman, MD, MA, FAAP.  What do these letters mean, of themselves, and what do they mean to me?  Why do I use them, here on Bipolar For Life?  What, if anything, do they have to do with bipolar-ness?  And most importantly, why do I insist upon using them when the professional qualifications they symbolize are now meaningless?

MD: Medical Doctor.  A passion since childhood, hard-won.  I put myself through college (oh yes, another set of letters: BA, Bachelor of Arts) by holding down three jobs while taking a full course load.  I know, I know, hypomania.  But it was fun, and I would have graduated with honors except that the required Honors Seminar conflicted with one of my jobs.  Oh well.

The MD turned into a combined degree program in Medicine and Medical Anthropology, six years.  Graduated with a perfect grade point average, 5.0.  Number One in my class (actually shared with my then-husband, who also had a 5.0), inducted into the Alpha Omega Alpha Medical Honor Society.

My first year in practice as a Pediatric Emergency Physician, I was inducted as a Fellow of the American Association of Pediatrics, and added FAAP to the collection.

All that stuff, including the wisdom garnered while cocktail waitressing as an undergraduate:  I used it until that very bad day, April 4, 2000, when I locked my office door for the last time, drove home, and went into a catatonic depression that resulted in my permanent disability.

All those letters, lost.

OK, yes, I did earn them, every one of them.  And it could be argued that in so doing, I earned the right to keep them after my name, forever.  No one can ever take them from me.

On the other hand, I feel lost when I look at them.  It’s as if–no, it isn’t as if–it’s the reality, cold and hard, that I am no longer who I once was.  I no longer go to the ER or the office every day.  I no longer practice Pediatrics, or anything else.  I live moment to moment.  My energy goes into keeping my mind in a reasonably healthy trajectory, and it takes every once of energy I have just to keep living from one moment to the next.

For a long time I used the letters after my name as a reminder of what I have achieved in this life.  But now I feel that they have become a burden.  I look at them and cringe.  This is not what I wanted for a life.  This is not what I worked 20 hours a day during my undergraduate years, who knows how much during my Medical and Graduate School years, 120 hours a week during internship and residency–I did not work all those hours to be sitting around like a bump on a log just trying to keep my shit together so I don’t start screaming and scare the dog.

I look at those letters, and I start to cry.  I think about the people who read this blog, or my comments, and think I am a practicing physician with oodles of money, knowledge, and perhaps power.  And I think I am misleading them.  In fact, I know that’s the case sometimes, from comments I’ve received.

Those letters weigh upon my soul.  They sit on me like an elephant.

It’s not that I don’t want them anymore.  I earned them with my sweat, blood, and tears, dammit.  They’re mine.

It’s just that right now I’m feeling the grief of my lost life, and I don’t want them staring me in the face every time I look at my blog or my email signature.

So I think you will see the letters after my name disappear.  Not today; I don’t have the energy for it.  But soon.  Maybe tomorrow.

To My Readers

Dearest Readers, how can I ever hope to express my gratitude for the love and support you have given me during these hard times?  Truly, I don’t know what I would do without you.  Your words of comfort and encouragement have soothed my soul.  The stories of your own experiences with your aged parents have encouraged and strengthened me.

May you all be blessed with healing according to your needs, peace of mind, and good friends–whether “in the flesh” or here, in our wonderful Mental Health Blogger community (and everybody else too)!

Much love,

Laura

 

And Here Goes The Other One…What Will I Do?

As my regular readers know, life with my mom has always been far from pleasant.

And now….Dementia Case #2.

I had suspected it, even before I left Jerusalem in 2011 (January 11, 2011, to be exact) to come to the US and help with my dad.  Fears out of proportion, throwing screaming fits in public and not just in private, arguing with the carpenter about whether or not she had paid his bill (she hadn’t).  He even came to me and asked if I had noticed anything wrong with my mom.  He’s been working for us for years, and never saw anything like that.

Interesting how dementia brings out a person’s true character traits.  Take my dad: soft, sweet, gentle, kind.  Very occasionally grumpy or moody, but who isn’t?

My mom, on the other hand, is selfish, angry, suspicious, and nasty.  And she lies.  In fact, she likes to say, “a little white lie won’t hurt.”

The hell it won’t!

But one or two of you might know her personally, and you will say, “Oh, but she is just the sweetest person!  How can you say such things about her?  It must be YOUR misperception.”

The hell I say!

That’s the way people with Narcissistic Personality Disorder operate.  They bask in public accolades, while conducting a Reign of Terror at home.  But the abused ones are in a pickle, because if we try to get help from anyone who knows her, they will shout, “How can you say such a thing about your lovely mother, who is such a gift to the community, such an angel, has dried so many tears and started so many non-profit charities!?”

So in general we just shut up and take it, and marry someone equally dysfunctional.

That’s the way I grew up.  And my dad was terrified of her and hopelessly in love with her, both at once.

Think “Mommie Dearest.”

No, she never dragged me out of bed to scrub the bathroom floor, but plenty went on, and I won’t elaborate here, because today I got the confirmation of a growing suspicion: she’s got dementia.

I’ve been too caught up in the emotional tempest surrounding Dad’s plight to really pay attention to her acting-out.  I’ve been mightily pissed off because she threw a bunch of pottery items that my dad made (he’s a potter) behind the refrigerator.  Right.  And she somehow disposed of a beautiful porcelain vase that Dad and I collaborated on back in my painter days.  It just “disappeared.”  And like the little cups that ended up smashed behind the refrigerator, every inquiry about my vase gets an “I don’t know” with averted eyes and a little smirk.

She’s been on a gaslighting campaign regarding my memory, accusing me of forgetting things that she never told me, such as important appointments.  Gaslighting, if you don’t already know, is when someone tries to make you think you’re crazy by setting up situations that don’t really exist.  It’s a power trip, or it can be used as a coverup for someone’s own mistakes.

Last year I went to the trouble of having a complete cognitive workup–lasted two days and cost me $1200.  And it turns out that I do have one very specific hole in my memory: reconstruction of long and detailed stories–which is distressing for someone whose job used to be collecting and reconstructing long and detailed stories, as a physician.  But my long, medium, and short-term memories are perfect.  So it ain’t me, babe, as someone once wrote in a song.

So this whole business of Dad being in a nursing home has brought out some interesting (heh) and instructive situations.  On a couple of occasions she has asked me to bring something from the house, and when I bought it, she would scold me for bringing the wrong thing, citing my “terrible memory.”

Today, in fact, she called me from the nursing home, asking me to bring Dad’s slippers and a couple of packages of pull-up diapers.  When I reached their house, though, she was already home, having lunch.  The slippers were sitting on a chair.  I picked them up to put them in my backpack and she screamed with her mouth full, “No, not that!  Those are his Pads.”  “Pads” are the brand name of the slippers.

“Didn’t you put these out for me to take?  Did you mean a different pair of slippers?”

“You don’t know what you’re doing.  Go take your shower.”  The building I live in does not have a bathroom, in the usual sense of the word, and I was in fact planning to take a shower at their house before going to the nursing home.  So, cursing under my breath, I did.

I hoped that by the time I finished my toilette that she would be in a more reasonable mood, but no luck.  As soon as I landed downstairs she began screaming at me about my terrible memory, and shoved a bag of stuff in my general direction.  It contained a couple of packets of diapers, with the already mentioned slippers on top.

“Wait a minute, Mom,” I said, trying to control my temper and not doing a very good job.  “These are the same slippers that you said were the wrong ones.  These are the ones that were sitting on the chair, and I picked them up, and you said they weren’t the right ones!”

“No I didn’t!  I told you to get the Depends (diapers).  You don’t know what you’re talking about.  You can’t remember anything!”

At that point I put my coat on, gathered up my stuff and the package, and sailed out the door cursing, not so much under my breath, and not caring whether she heard or not.

When the blood stopped pounding in my ears, I realized that my suspicion is dead-on: she’s sliding into dementia.

Now what am I gonna do?

My dad is safe where he is, but she is a loose cannon and could do anything.  She’s already made some disastrous financial decisions that I am powerless to reverse, because at this point it would be very difficult to prove her incompetent.  That may change very quickly.  But what am I going to do in the meantime, having to interact with her on a daily basis because of my dad, having her living in a place that is now completely inappropriate for her, and having her seething anger aimed in my direction?    Granted, part of the anger is due to the grieving process for my dad.  But that does not excuse her leveling it at me.

I can’t go to the Social Services people, because they all know her in her “public face” and none of them would believe me if I tried to tell them what’s going on.  And of course if they approached her about it, she would tell them all about her mentally ill daughter with the “terrible memory.”  She even has a story about how my memory got so terrible: it was the Transcranial Magnetic Stimulation treatments that have saved my life over the years.  That’s her explanation for why I can’t remember anything.  And of course the Social Services people would shake their heads and cluck their tongues, because they KNOW her and they know she’s a competent person, a kind, sweet angel.

So what am I going to do?

My Head Feels It Will Blow Up

I think it has something to do with my dad being a prisoner in a nursing home.  He looks so helpless there.  And he’s developed a belief that the nursing home is run by Nazis.

When my dad was a corporal in the US Army in World War II, one of his jobs was to go into villages that the Nazis had taken over–this was in the Alsace–and make sure that it was actually the Nazis and not somebody else.  Then he would radio his outfit, and they would rain artillery fire on the village and blow it up.

Dad knew that the Nazis did not kill or run out all the people whose village they took over.  They simply moved into their houses, ate their food, raped their daughters, and held that position for the advancing front.  Dad knew that when he called in fire on those villages, he was calling in fire on the innocent people that the Nazis were using as human shields.

Long before there was a acronym for Post Traumatic Stress Disorder, Dad had it.  He spent most nights fighting hand-to-hand, even though he denies that he ever did that in the war.  Often my mother had to go sleep in the guest room to avoid getting unwittingly assaulted.

She vehemently denies that he has PTSD–a service-related condition that would qualify him for lots of important VA benefits.  If he doesn’t, then why the kicking and punching, why the paranoia, why the things that remain half-said, the conversations begun and ended in a shudder……why are there Nazis in the nursing home?

Tonight he waved me in to him and whispered conspiratorially: “Your mother may not believe this, and heck, you may not believe this either, but they are meeting tonight in the square.”

“What square, Dad?”

“The town square.  The square of THIS town.”

“Who’s meeting in the square tonight?”

“The ones we fought against in the war, the ones that wanted–US–GONE.  We won that one, but they’re back.  You be careful out there.”

I nodded.   “I’ll be careful, Dad.  You be careful too.”

He closes his eyes, shudders.  I hear no more from him tonight.  A few words of small talk, a few observations about Noga the Lhasa Apso, who is a welcome visitor.  Tonight Dad “doesn’t think she likes him.  The only reason she comes is that I bring her.”

I stay two hours, then they put Dad to bed.  He is looking very black in the face, bitter.  He falls asleep, but I wake him to kiss the top of his bald head just like always when I say goodbye.

Tonight he doesn’t say “I love you.”

In Praise of Invertebrates

No one has ever called me “spineless,” yet there have been times when I’ve sorely envied those creatures without one:

Give praise to the invertebrates, for they shall inherit the Earth.

I don’t know who said that.  Thought I did, but looked up the source and it wasn’t where I thought it would be.  But never mind. For the past, oh, month or so, give or take, I have been limping around on one or another of my limbs.  My knee locked up; my hip hurt; and now my back has eclipsed the rest. My back has been, for me, a symbol of the level of support I am getting from those close to me.  And while some may argue that what’s physical is physical, and that the mental/emotional/psychosocial arenas cannot cross over purely physical lines to cause or worsen structural damage, I disagree.

My point of view lines up with that of the “biopsychosocial model” on which I was nursed and weaned by my Very Special Medical School, the University of Illinois at Champaign Nirvana Urbana, smack in the middle of Corn Country, Illinois, USA.  The biopsychosocial model, as it indicates, teaches that our health and wellbeing are not compartmentalized, but a living organism that is affected by everything in our environment, inside and outside. There is certainly a genetic component to my spinal maladies: my dad started having awful back problems in his early thirties, just as I did.  So I guess I have him to thank for that, along with a lot of other inherited traits, most of them good.

My adventures with Degenerative Disk Disease (DDD), which is a progressive disintegration of the intervertebral disks, started in 1987, in the Big Yellow Truck that carried our little family away from Champaign Nirvana, into the uncharted territory of Rochester, NY, which is even colder than it sounds, being just across the lake from Ontario. I should define terms here, in case there are people reading this who have the good fortune not to know them.  An intervertebral disk is an ingenious structure composed of a thick outer wall of tough yet supple ligament, filled with a gel.  It is in the shape of a hockey puck, and alternates with the vertebrae, insulating them from shock and serving as the means for our spines to be flexible.  Think of gymnasts, or contortionists, or Tango dancers and you’ll get the picture.  Speaking of pictures: Here is an X-ray of a normal lower back.  Note the clean lines and clearly defined spaces between the vertebrae, which look like boxes with little things sticking out of them. Here is a nice comparative image of a normal lower back, top, and its unfortunate cousin on the bottom.  Mine looks like that one, only worse. lumbar_degxray_vertical   All sorts of treatments and non-treatments exist for this extremely painful and often debilitating condition.  I have experienced quite a few of them. When we were driving from Champaign Nirvana in the Big Yellow Truck (or “Big Lellow Truck,” as my son called it, being two at the time and in awe of the Ryder Rental), I noticed that I couldn’t find a comfortable way to sit.  When I was driving, a hot river of molten pain flowed down my right leg into the accelerator.  When I was riding shotgun, the only way I could sit even mildly-to-moderately comfortably was cross-legged, bolt upright.  No sleep on that trip.

When we arrived in Rah-cha-cha, there was far too much to be done to pay attention to a mere case of low back pain, so I forged ahead with helping to unload the van, unpack, set up, and immediately start my internship in Pediatrics. By then I had developed a matching pain in my neck, such that I had to build a set of pillows molded around my neck so that I couldn’t move–or else I would wake up suddenly paralyzed with pain. But I had an internship to start, and my ex had a post-doctoral fellowship to start, so I soldiered on and started my residency.

As is the nature of things, before one starts anything significant, one has to sign all the papers first.  That was a good thing, in the case of the residency, for it gave me something I had been lacking and would be needing shortly: insurance. At that point in my internship/residency program, we were fully staffed, so “call” duty was every third night.  That meant that you came in at your regular time, 5 am, then worked until 5 pm sign-out rounds.  You met with the lucky creatures who were going home, and conferred with them about their patients, whose care you would be assuming until 8 am sign-in rounds the following day.  Then you would continue your work-day till 5 pm, when you “signed out” your patients for the night, went home, and fell on your back in the bed, staring at the ceiling and feebly trying to repel your husband and child, who are trying to greet you after your long absence.

As luck would have it, my first night on call was Night One of my internship.  It was the debut appearance of the infamous “black cloud” that would follow me throughout my medical career.  My neck had been in spasm all day, but I did my best to ignore it and soldiered on.  Sign-out rounds came and went, and I was on my own with my resident.  It was just the two of us to cover all of Pediatrics, Labor and Delivery (the baby part), Newborn Nursery…and admissions from the Emergency Department, which seemed to be a very busy place that night.

My neck felt like it was trying to rip itself off my body and fly away on its own.  I was wishing it would. We admitted a sick little girl with a fever of 104 F (40 C), to the toddler ward for diagnosis and treatment.  Part of the diagnostic work-up involves the collection and subsequent examination of every kind of fluid there is in the body (gas, oil, antifreeze, brake fluid…just kidding).  You have to collect things in a sterile a manner as possible, so as not to introduce germs from the outside of the body into the fluid samples.

Long story short, we needed to get a sterile urine sample from this little girl, and that involved a catheter, and cleaning the “outer parts,” and someone with experience to do that part, and anyone at all to do the all-important Holding The Patient Down part.  I shudder.  I was once Held Down for a medical procedure when I was 5, and I still remember it.

At last we had the hapless little girl spread-eagled and ready for the 30-second procedure.  My job was to keep her in that position, so that 30 seconds would remain 30 seconds and not, say, 20 minutes, which is what might happen if we messed up the first try and had a furiously fighting toddler on our hands. So I got a good grip on the little chubby thighs, and prayed that my superior would get the job done chick-chock, which is Hebrew for “right now.”

She missed.

The outraged little victim jerked her leg away from me, and looking me straight in the eye, kicked me a good one right in the center of my forehead. POP. That was the annular ligament of C5-6 you heard popping, there.  In layman’s terms, the tough outer covering of the disk between the 5th and 6th vertebra in your neck, of which there are seven, gave way and all the gelatin from the center of the disc poured out like fire, compressing the nerves that emanated from my spinal cord at that level.

I was paralyzed with pain.

But I would not give in.

This was my first  on-call night of my internship, dammit, and besides, where would we get a replacement for me at 2 am?  I have always said that the reason more people don’t die during their residencies is that the program does not allow time to attend one’s own funeral.  So I soldiered on, until sign-in rounds, where the Chief Resident noticed that I was in agony and sent me to the Emergency Room.

There I was examined by a medical student, an intern, a resident, the Chief Neurosurgery Resident, and finally, the neurosurgeon himself, who looked at the X-rays and agreed with all the others that I had an acute rupture of C5-6.  They sent me home to rest for a week, with a prescription for Tylenol with Codeine.  I rested, felt absolutely no better, and went back to work.

Another week, and another on-call night, and I truly felt like my head was going to just fall off and roll around on the floor, because my neck could no longer bear its weight.

Another morning in the ER for me.  This time the neurosurgeon just happened to be in the building.  He stopped by and saw me. “What, are you here again?” angrily joking.  “What’s the problem this time?”

I sheepishly explained that I couldn’t move because of the pain in my neck.  I got a terse lecture regarding the subjective nature of pain, that it was “only pain,” and that I really should suck it up and go back to work.  But my hair was all wet from my tears, so in obvious disgust he ordered a CT scan of my neck.  MRIs did not exist yet. He looked at the scan himself, and his attitude flipped 180 degrees.

“I’ve never seen such a huge rupture in someone your age.  The nucleus (gel center) is sitting completely outside of the disc space!  We will schedule surgery.  Until then, you will wear this spiffy hard cervical collar and don’t take it off.” Surgery was a week from then.

I spent the time arranging for child care (my ex was not good at that), and begging for insurance coverage.  My insurance, you see, did not kick in until I had worked a full week in the program.  Somehow, in some office, someone was compassionate, and I got my insurance.  I was kind of eagerly anticipating surgery, hoping that it would get rid of the awful pain that had somehow become my entire life. To be continued…….