Poor Puppy

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I only count four Kong toys.  She must be sleeping on the fifth!  On her Serta mattress.  She works hard, and loves her Kongs!  Tomorrow I must trim her nails again.  She dropped her Kong today while we were playing, and in true Malligator (Malinois) fashion, she used me as a sort of hinge, grabbing hold of my leg with her claws so she could use me as a springboard.  Another gash, not too bad this time.  I didn’t have to say a word.  She knew she had injured me (again).  I just picked up the Kong, put her back on the leash, and brought her straight home at a smart heel.  Damn Malligators.  They are great at what they do, but you have to expect to get Mallinated every once in a while.  I love my girl, and she loves me.  And now to bed, for me too (no Serta mattress for me, though.  Just the back seat of my van.)

New Black Box Warnings: FDA

I have a hell of a toothache.  A couple of months ago I broke a tooth, and went to a franchise-type dentist who took emergency cases.  One of the down sides of being a professional vagrant is I don’t have a regular dentist. 

For a little over $1000 I walked out with a new crown and instructions to call if I had any problems.

I did have a problem, before I even left the office.

I felt that I should have had a root canal before the crown went on.  I know my teeth.  They are ornery, pesky things.  They operate in strict accordance with Murphy’s Law:  anything that can go wrong, will go wrong. 

The dentist assured me that the nerve looked fine, and he hated to mess up a basically healthy tooth.

A couple days later, the thing started hurting like a sonovabitch.  I called the dentist, who immediately assumed I was a drug seeker and blew me off, saying that it might take a few weeks to settle down.

It hasn’t.  In fact, it’s getting worse.  Now I have to look for a dentist who will…but wait, it’s Labor Day Weekend!  No dentist till next week, when I have to run up to Michigan to get some warrantee work done on the old brand new RV.  Maybe I’ll find a dentist there, with a lot of luck.

So, in order to buy some time and have at least a few hours out of misery, I took two of my hoarded tramadol tabs.  Now I have maybe 20 left.

Then I opened my email, to find a bulletin regarding a new FDA policy, intended to protect ourselves from ourselves:  black box warnings on both opioids and benzodiazepines, warning that they must not…Black Box MUST NOT…be taken together, because of the potential of respiratory depression leading to death.

A Black Box warning is the strongest labeling there is.  This means that in a time when even being prescribed pain medicine is becoming a remote possibility, those of us who take benzos for anxiety disorders and/or movement disorders, seizure disorders, or insomnia, will have an even more difficult time obtaining effective pain management.  Doctors who prescribe both meds at the same time will open themselves up for censure and lawsuits.  Pharmacists are being given increasing power to simply refuse to fill prescriptions.  They don’t have to, and if the FDA issues black box warnings, they are fully within their rights to refuse to fill prescription A if the patient is known to be taking prescription B.  In fact, if they do fill it and the patient has an adverse effect, the pharmacist is liable, can lose their license, and can be sued.

This is of direct concern to me.  My neurosychiatrist, who unfortunately has retired due to failed back surgery, hammered out a drug cocktail during the course of our 12 year clinical relationship, that effectively treats my bipolar, PTSD, and social phobia.  It includes 3 types of benzos.  All at once.

It also helps with the muscle spasms that cripple me day and night.

Now I fear that when my prescriptions run low, I won’t be able to find anyone to prescribe these lifesaving medicines because they are “too much.”

Worse, the degeneration of my spine is getting to a critical point.  One of the bones in my neck is rotating in such a way that it is pressing against my spinal cord.  I’m going to need surgery soon.  Major surgery, to fuse three of my cervical vertebrae and lift them up off the nerves they’re pressing on.

I won’t describe the surgery, because it makes me sick even to think about it.  I’ll just say that it involves lots of chopping up bone and remodeling.  Very, very painful stuff.

So…in today’s anti-pain med climate, what’ll it be?  Black Box Warning ahead!  Do I get to continue my benzo regimen so I can maintain a semblance of normalcy, and not be a hypervigilant mess, or do I get a modicum of pain relief after having this spinal carpentry fest?  Do I have any say in this matter?

Last time I had spine surgery, I got sent home with zero pain meds.  None.  And that was in 1987!

Why on earth did this happen?

Because I happened to joke to the pre-op nurse who was taking down my then very short med list (one med!) that I took Xanax for the three days before my periods, and that I was addicted to not having PMS.  She wrote down that I was addicted to Xanax!  It was recorded in my chart that I had admitted to being a drug addict.  So when I called the hospital to ask for some kind of postoperative pain relief, the neurosurgery intern scolded me about being a drug addict seeking drugs.  No pain meds.  And that was a relatively minor procedure, compared to the one I’m facing.

I really don’t know what to do.  Sometimes I wish I’d just die in my sleep, so I wouldn’t have to face this surgery and the prospect of being helpless, in agony, without the possibility of comfort.

Already This Morning

I woke up with a shart.

Not exactly woke up with, but soon after.

…In the middle of the first cup of coffee I’ve had in days.

Lying in bed, dallying with my 35 year old, much loved, many times broken and repaired porcelain coffee cup, made special for me by my dear departed daddy-o, sipping strong Cafe Bustelo made in my simple Melita single cup red plastic drip cone.  Very strong.

It began the way most farts begin.  But it didn’t stop there.

Fortunate that I had my favorite lounge pants on, and that they are black, and that I have a handy clothes pole in my rig where they now hang, dripping dry after a wash-out in the bathroom sink.

I am disappointed.  This morning bulges with plans unfulfilled.  It was to be the second in a series of unparalleled good days. 

Yesterday, I wasted about two weeks worth of energy that I didn’t have, but took a mortgage on my future and went ahead with something wasteful in every way.

I have held off writing about this whole balagan (Hebrew for “wretched mess”) with the cardiologist, simply because it’s too boring to think about, and certainly too boring to write about.  I’m feeling sleepy.

B’kitsur (in short): I have been experiencing episodes of inflammation in my veins, on and off for a year.  Since I must have the torn cartilage in my left wrist surgically repaired, it is now relevant to discover whether this vein issue presents any additional surgical risk.  I was sent to a cardiologist who supposedly specializes in veins, to find out.

This cardiologist did not seem at all interested in my veins or anything else.  Oh yes: he is interested in tests.  Every kind of test that is high tech and expensive, he is interested in.  I believe he might be a little bit interested in money, too.

Last week I endured three kinds of cardiac echo tests, performed by a male technologist whose pinky finger seemed to be using my bare left nipple as a place marker as he worked the echo probe on my heart; at least I hope that is what he was doing.  It hugely triggered my rape survivor PTSD, and I dissociated, leaving him alone with my left nipple.

The next part of the balagan was a stress echo, where they do a regular echocardiogram, then hook you up to a 12-lead EKG (they hook you up real good: instead of merely slapping the sticky EKG leads on, they first scrub you down with alcohol and then sandpaper your skin without asking first whether it’s OK or whether you have any skin conditions, then they stick the leads on your abraded skin without looking to see whether you’re already bleeding) and put you on a treadmill.  You take two or three steps at a normal pace, then suddenly and without warning, they turn up both the pace and the angle, so that you have to trot to keep up; and suddenly your legs feel like they’re going to fall right off and you tell them that; so instead of simply slowing the treadmill down, they stop it suddenly, so you DO fall down.  Then they drag you bodily onto the echo table and do the “post exercise” scan, which of course is invalid because your heart rate didn’t reach the target 85% of maximum.  Shit, I could have told them that.

Now, you must understand that this represents all of what I hate in modern medicine.  Not all.  That comes later.  Most.

Thing One:  This test should have been scuttled.  Medicare should never have been billed for an inadequate exam.  It’s like billing for a blood test where the quantity was not sufficient to test.  And yet it was billed.  Is this fraud, or merely bad practice?  I’m thinking.

Thing two:  When I saw the cardiologist in follow-up for this inadequate test, he never really questioned why I was unable to exercise, even though I have been complaining and complaining and complaining of exercise intolerance to anyone and EVERYONE, including himself. 

Instead of talking this through with me, he went ahead and ordered a NUCLEAR stress test.  NUCLEAR!

How effing much are they billing Medicare for that one?  Cheeziz K. Reist** on a bicycle, I can’t even imagine.  4K?  At least.  With whipped cream and a cherry on top.  No nuts, thank you, they get in my teeth.

The nuclear balagan began yesterday afternoon, following the first decent morning I’ve had in weeks.  The heat has killed my already overheated constitution.  My weight is plummeting, since anything heavier than clear liquids leads to hours of belly pain and retching.

So it stands to reason that on the first morning that I pop out of bed at 0630 feeling rested and ready to engage with the world, I must fast, because fast I must if I am to get this nuclear test behind me.

So I fritter the day away drinking sugary liquids so I won’t get any more hypoglycemic than I already am.  I check my pup into an air conditioned kennel at the vet for the afternoon, and check myself into the diagnostic cardiology lab again.

I am relieved to find that the tech with the heat-seeking pinky has been replaced with a robot who scores very high on the Spectrum, but behaves well and doesn’t give me any shit about using the special tape I brought to secure the IV: special tape that does not rip my skin off.  He gets the IV in on the first try, painlessly, in my only good vein.  I love him.

I’m injected with Technetium 99, the radioactive isotope that the gamma camera will read, to make pictures of my heart at rest.  I’m given my first Chinese Water Torture huge cup of water to gulp, which expands my circulating blood volume.  They want to get the isotope into my heart muscle and cardiac vessels.

The gamma camera scanner is claustrophobic and cold.  I dissociate.

Next thing is the injection through the IV of some stuff that dilates all of my blood vessels very suddenly.  It’s a good thing I’m lying down already, since my blood pressure plummets from 130/85 to 90/60, which is officially the territory of circulatory shock.  It felt very weird.  I decided not to dissociate for a bit, knowing that I could at any time.  I kind of dug feeling how it felt, the weirdness of it all.  I stayed present for it.

Now they wanted me to eat a high fat snack, to help open up my circulation and get things running.  Fortunately I had just such a thing in my backpack.  They did have snacks there, but all of them contained gluten.  That’s why I always bring my own food, anywhere and everywhere.  You can never tell.

After another giant cup of water and two radioactive trips to the bathroom, I went back into the scanner, this time with leads on.  The EKG would coordinate the camera to pick up on the various phases of contraction and relaxation of my heart. Cool.

So that’s done.  Very nice.  Except for the couple of PVC’s (Premature Ventricular Contractions) that I had, which are nonspecific and most likely benign, I am sure that this will be a normal study.

And I think I remember signing a “Medicare balance billing” agreement, which means that anything Medicare doesn’t pay for, I get to pay for. 

Worse, this whole balagan has snowballed from: why does this person have recurrent vein inflammation? into a whole high tech cardiac workup.

Medicine has got itself into a very sad situation. 

I’m crushed to see my formerly noble profession sink so low.

I remember babbling to the tech who did the vasodilating torture test (they swapped him out for the robot for this part), about how any doctor who knew her salt could do everything she needed with a stethoscope, an otoscope, ophthalmoscope, tuning fork, some straight pins, and a few basic lab tests, five working senses, and a working sixth sense.  Your basic Black Bag.

He said yeah, I know, right?  That’s what they do in the third world.

I’m like, yeah, right?  What are you gonna do when the grid goes down?

Meanwhile back at the low tech ranch, I’ve been forcing myself to stay inside my body when I’m out walking The Doggess.  It’s been worthwhile.

I notice that while I do get out of breath, the limiting factor is that after a few minutes both my thighs and my calves start to feel like wood.  If I don’t slow down or stop for a few minutes, my legs just absolutely stop me.  I just can’t go no further.  Nothing doing.

And so [n.b., one is never to begin a sentence with “and so”], what is your diagnosis, Doctor?  (Physician, heal thyself…if you can tell me who said that, you get a prize!) 

Hie thee to the medical literature.  Ah, there ’tis!  What ill manner of bodily curse is’t?  Fie, Doctor!  Take it off me now!  What, cans’t?  Nay.

It is: Neural claudication.

“Claudication” happens when, for one reason or another, arteries experience spasms in response to increased oxygen demands, such as exercise or digestion.  When this affects the heart, we use the term angina.  When speaking of arteries downstream from the heart, such as the legs or abdominal arteries, we say claudication.

The most common cause of claudication is atherosclerosis, and the most common cause of atherosclerosis is smoking.  Second most common, diabetes. I don’t smoke and I’m not diabetic.

Move down one notch on the algorithm.

Next cause: neurogenic.  Degenerative Disc Disease, long-standing.  Yup, got that. Description.  Yup, got that.  What to do about it: um, let’s see.  Whole spine decompression and fixation?  Hmmm, let me think about that for a while.

In the meantime, I have my explanation for the most recent annoying symptom on the list: my right thigh goes into a cramp when driving in traffic, or anytime I can’t use the cruise control.  Claudication!  And it didn’t cost Medicare a thing!

Dammit, is there a doctor in the house?!

Getting back to the shart thing:

Last evening, having completed all of the cardiac testing I intend to have in this life, I collected my ebullient pup from the vet and returned to my tiny-but-it’s-got-a-plugin camping spot.  Had a few larfs with a kindred soul at the far end of the campground, went to bed with high hopes for today. Woke up feeling pretty good, made coffee and a gluten free muffin…whoops, the Crohn’s monster swooped in and snatched another day.  Oh well, let it go, let it go, let it go.  What’s the hurry?  Where’s the fire?

In my guts, is where the fire is.

**Dear R. Crumb, thank you for bringing Cheeses K. Reist into the world.  Cheeziz is his great-grand-nephew, seven times removed.

How Stigma Compromises My Medical Care

I don’t know what to do.

I can bet that most of you will say, “Just be yourself, Laura.  Fuck ’em if they can’t relate to you as the awesome human being you are.”

Well, yeah.  I appreciate that.

However.

I have this service dog, see, and she’s neither little nor cute.  Well, she’s cute to me, but a 75 pound Belgian Malinois is automatically not cute to most people, especially the uptight assholes that tend to go into “the medical field” these days.  Even my therapist does not think she’s cute.  Even when Atina climbed into her lap and gave her kisses, because she could see that the dear lady was clearly in distress, it did not help.  My poor therapist could do nothing except beg me to get the monster off of her, which I did, and Atina reluctantly obeyed but was still of the opinion that the lady needed her attention.

On the flip side, if Atina perceives that someone is potentially a threat to me, she stations herself sideways in front of me, giving the unsafe party the hard-eye, which is dog language for “come over here and make my day.”

This is why I have a Service Dog:

I have a perfect storm of Asperger Syndrome, PTSD, and Bipolar illness.  My judgement about people is shot to hell.  I lost it on April 22, 1970, the very first Earth Day, when I was drugged, dragged into a dark basement, and brutally robbed of my virginity.  That, and the prolonged months and years of running from one frying pan into another fire, robbed me of my ability to read people’s intentions.  I think it’s because I simply dissociate every time I have to interact with other people.  So now that I’m on the far side of sixty and no longer give a shit, I’ve stopped making myself do painful things, and aside from the inconveniences of not having friends, family, or a partner when I have a medical emergency, I feel much better.

Have you noticed that sometimes your fridge, washing machine, microwave, computer, and automobile all crash at the same time?  So now you have to get a ride to the Big Box store, to the bank to get quarters for the laundromat, and a ride back and forth to the laundromat, to the convenience store for ice until the new fridge comes, and while you’re on the phone with Tech Support your phone is giving your ear a second degree burn and probably giving you brain cancer as well….

This is what I call a Wear Cycle.  When everything wears out at once.  It generally falls out when you’re between jobs, or just before those gift-giving occasions, or your wedding.

So as some of you are aware, I am in the throes of a Wear Cycle of the most annoying sort.  My body is falling apart.  I thought it just needed a tune-up and maybe a brake job, but it turns out to be the transmission, the universal joints, the head gasket; and every time they fix one thing, another one turns up bad.

The result is a seemingly endless procession of doctors, PAs, Nurse Practitioners, lab techs, snotty Front Office People, sadistic MRI techs who put me in Positions Of Stress for upwards of twenty minutes while further damaging my hearing with the various hammerings and clangings of that infernal magnetic tube, being told that I need surgery for this, surgery for that, and they all worry about my blood pressure.  Surely not!

You must understand that my relationship with The Medical Field is a mine field.  The minute I leave my van in the parking lot of the doctors’ building, the hospital, the lab, I dissociate.  I am terrified.

But you’re a doctor, you say.  How could you not be comfortable in this oh-so-familiar milieu?

That’s just it.  I’m all too familiar with it.  I know exactly what goes on behind the scenes, and it disgusted me while I was in it, and it terrifies me now.

Because I am…one of those patients.

You know, the aging female with so many complaints it throws your schedule off, and she’s slight dotty, and might be amusing if you weren’t running so far behind, and of course–of course, she has to be a doctor, at least she says she is, and she does know the lingo…and she has Medicare and doesn’t seem to have a job, so she must be disabled, but for what?  She’s not saying, and if you ask, she’ll say something vague.

I know this, because I’ve been on their side of the white coat.

So imagine what the reaction would be if they walked into the exam room and there I was with my Service Wolf Dog.

The entire visit would revolve around whether the person who Works In The Medical Field was comfortable with the Doggess, and whether she thought they were Safe.

And of course she would pick up on my instant dissociation because I dissociate whenever I run into One Of Those People, because of the abuse I suffered when I was working In The Medical Field, and the abuse I have suffered as a patient dependent upon these people’s power.

And the shame of being disabled, which is, according to the ancient tenets of The Medical Field, weak; and even worse, crazy.

I just rediscovered a former mentor who was hugely influential to me when I was a medical student.  She was my supervisor in the Public Health Clinic.  We became good friends, and she helped me crystallize my medical practice world view, which is based on compassion and empowerment of the patient to take charge of her own health and well-being.

It turns out that this amazing woman had a terrible crisis, which lead to a suicide attempt.

Rather than supporting her and helping her to rebuild her life, the medical establishment brought criminal charges against her for lowering the esteem of the medical profession in the eyes of the public.

They drove her out of the profession.  It didn’t matter to them that this heinous act might push her over that very precipice she had dragged herself back from.

It didn’t matter that they were persecuting one of the finest physicians on the face of the earth, for the crime of being human.

All that mattered was that she had “failed” to complete her suicide.  If she had died, she would have been another tragic physician suicide; but since she managed to survive, she was pronounced a disgrace to the profession.

Fortunately she is a strong and resourceful woman.  She cleaned houses in order to feed her children.  She struggled her way back onto her feet, and reinvented herself.  Blessed be.

So I know very well what the result would be, even if the Doggess didn’t bite the Assistant (you hardly ever get to see The Doctor anymore):  “Did you get a load of that lady with the dog?  What a crock!”

Yes, fuck ’em.  They’ve no right, legally or otherwise, to prevent me from having my dog with me.  She’s Durable Medical Equipment, just like a wheelchair.

The only thing is…being mentally ill automatically discredits anything I say.  I’ve tried it both ways.  And unfortunately, whenever I’m honest and disclose that I have DSM diagnoses, I get my case dismissed.  No contest.  No service.  Goodbye, and put some ice on that.  It will feel better in seven to ten days.  No need for follow-up.

In awful contrast, when I have withheld my diagnoses, it’s all sympathy and MRIs.

Hell, I even got a few tramadol tablets for my torn shoulder, when I begged the doctor because my left wrist is in a brace awaiting surgery and my right shoulder is so painful that I can’t even get out of bed without fainting if I forget and try to push myself up with my right arm.  (How do I get out of bed?  By wriggling on my tummy until my feet touch the floor.)

You think she would have given me that prescription for thirty, no refills, if she knew that I’m bipolar?

Nope.  Bipolar people are categorically drug seekers.  Even though I asked for tramadol and not Percocet.  Drug seeker, no way.

I’m stuck.

I’m terrified of those places, and I need my dog.  But the presence of my dog would set off such alarms in the mind of The Medical Field Person that my actual medical issues would be eclipsed by Prejudice.  Stigma.

If I showed up in an electric wheelchair, they would be all ears.

But a crazy person with a dog?

Two is too many

It seems that I have been putting off writing this post until I can’t anymore.

The reason I have procrastinated so long is…well, there are two reasons: fear, and pain.

I came to Flagstaff several weeks ago in search of a hand surgeon.  I took a nasty fall over a log, as some of you might remember, and after waiting a suitable number of days to make sure it wasn’t just sprained, sought care at an orthopedic urgent care facility. 

There I met a young, arrogant, and completely disagreeable orthopedist, who humiliated me in numerous ways until his assistant hipped him to the fact that he and I share a first name, to wit: “Doctor.”  Then he became all cozy and collegial, remarking on the skill of the last hand surgeon’s handiwork, as we gazed at my Xray together.  I was musing how overexposed the film was.  He was burbling away.  I had dissociated long since and have no idea what he said after that.

But I picked up the hand surgeon’s card on my way out, and spied the spine surgeon’s as well.

The chirpy receptionist volunteered to make me some appointments if I needed them, right there on the spot, so I took her up on it.

Let’s see, hand surgeon, since that came first.  And my poor arthritic shoulders were killing me, especially after the recent acrobatic stunts.  I’d have an appointment with the non-interventionist arthritis doctor, please. 

And then there is my spine, bane of my existence since 1985.  A couple of lumbar discs ruptured back then.  In 1987, emergency surgery for a ruptured disc in my neck.  Oh, and that rupture occurred on the first night of my internship.  I drew call my first night, of course.  “Black Cloud.” 

Over the three years of my residency I would go on to rupture at least five discs.  The spine surgeons threatened me with putting metal rods on both sides of my spine.  I demurred, and opted for a custom molded hard plastic exoskeleton type of thing that extended from armpits to groin, to be worn 23 3/4 hours per day.  Fifteen minutes to shower, then back into the Plastic Maiden.

In the intervening 30 years, my spine has had its moments of freedom from having to drag me into its consciousness.  Curiously enough, my best years were when I had horses and rode daily.  The gentle rocking motion kept my spine well oiled, and the occasional eruption of a bucking episode provided any needed adjustments.

Then I got Rolfed by the former Captain of the Venezuelan Olympic Women’s Luge Team.  She was gigantic.  She was good.  It was excruciating.

My back didn’t dare go out if it meant going back to Alejandra.

After I returned from Israel to be with my father in his last years, my neck began to bother me enough so that I went to see a Physiatrist.

For those who are unfamiliar, a Physiatrist is an M.D. or D.O. who is trained in evaluating and treating musculoskeletal disorders non-surgically, with things like hydrotherapy and massage.  Sound good?

Actually, I did not choose this person specifically because she would be the most likely to send me to a Turkish Bath; it was simply a matter of Cut vs. Not-Cut.

Dr. Not-Cut did not send me to the Turkish Bath, nor even to Physical Therapy, but packed me off to her partner who does one thing exclusively: epidural injections.

Now, while I’ve had many a needle inserted into my spine at the lumbar region, I have never permitted such an intrusion into my neck, for the simple reason that it’s easy enough to prick a blood vessel by mistake, which can be problematic in the lumbar, but catastrophic in the cervical, because there is simply no room for anything like a blood clot in the spinal canal of the neck.

I went for it, purely because I couldn’t look down to tie my shoes for the pain.  My head felt like it was going to fall off at any moment, and at times I felt like beheading myself just to get it over with.

The procedure was terrifying.  It was painful.  It didn’t work.

Fast forward through several medication trials and much condescension on the part of Dr. Non, and at last I had an appointment with her Nurse Practitioner, who wisely prescribed a muscle relaxant, voila.  And a special hardshell collar to keep my head from falling off.  A wise and practical woman…And she even snuck me a small Rx for some tramadol, miracle!

And until the tumble over the log incident, that’s been keeping my neck pain down to a barely noticeable hum. 

Post-log-jam, things started kicking notches up the Pain Scale until I was hovering in the 8 range and started using my beastly hard surgical collar again.  This thing provides a tiny bit of traction, and it gets rid of the feeling that my head is falling off, but it digs cruelly into my flesh and is no fun.

I did not wear the collar to my appointment with the Instant Ortho Clinic. 

Two things you must never do, if you go to any kind of emergency services place:  do not wear a cervical collar, and never never never reveal that you have a mental illness; otherwise you will be instantaneously branded as a drug seeker, and no one will ever listen to you or even notice the bone sticking out of your leg at a crazy angle. 

And there is a third one, I have discovered, to my dismay:

Don’t be elderly.  You won’t count.

Time passes, and I get my turn with the Arizona Spine Specialist Dude, very highly Ivy League Specialty Boarded And Fellowshipped, all very nice to know.  Confidence.

He seemed like a nice chap for a surgeon.  Asked me why I was there, seemed to listen, actually examined me and discovered, dismal dismal discovery…I have lost virtually all muscle strength in my left arm.  I have no reflexes at all in my right arm, and abnormal ones in my left.  This must be why it takes me two hands to get my coffee cup up to my face.

It is no longer an issue of mere pain management.  It is an issue of preserving what function remains to me.

I need surgery.

The MRI could have looked worse.  It also could have looked better.  What is clear, is that the degenerative disease is crunching my spine like Pac Man.

I have had two appointments with the Spine Surgery People.  The first was with the actual surgeon, whom I liked, who treated me respectfully and did a good job of hitting the diagnostic nail on its head.

The second appointment was with the Physician’s Assistant.  I have no confidence in Physician’s Assistants, for the simple reason that in my opinion, there is some difference between the education of, for instance, my new Spine Surgeon, who had (after his Bachelor’s Degree) 4 years of medical school, 5 years of residency, 3 years of spine fellowship, and assorted certificates; whereas, a Physician’s Assistant has a grand total of 26 months of post-college training: the equivalent of a Master’s Degree, very nice, but not enough to develop much clinical experience.

So, with some trepidation, I met with the PA to go over my MRI results.  How could a person with so little training interpret advanced imaging and recommend treatment?

I was relieved to find out that she is, in fact, operating as the surgeon’s assistant and not as an independent entity, as so often happens today.

She had been thoroughly briefed by the surgeon on the MRI results, conveyed them to me, and explained the recommended treatment: spinal fusion at two levels.  She explained how this was done, and showed me an example of the titanium plate that would be installed, to stabilize things.

Any questions?

Uh, well, yes…what would happen if I opted to do nothing?

Well, of course, your disease would progress and those nerves would continue to lose function….

Oh.  Yes.  Definitely.  I see.

Any questions?  She gives me the crisp smile that is the equivalent of shooting one’s cuffs to glance at one’s watch.

Not at this moment, I tell her, but I’m sure I will have.

All right then, just call and let me know what you want to do.

We rise, shake collegial hands…

Several days later I realize I remember absolutely nothing about the visit.  Except the part about Surgery, and Fusing Vertebrae, and Possible Side Effects Including Quadriplegia…shit.

I called and left a message for the PA.  Two days later, she returned my call.

Yes, what was it?  Very snappish.  It’s five o’clock, poor thing must be hungry and tired…shit, there I go again making excuses for other people’s bad behavior. 

It’s that I have some questions about the surgery.

–I explained that in the office.  We place a tube down your windpipe, pull your windpipe and food tube to one side, and…(what is going on here?  She has my chart in front of her.  Why is she using the sixth grade description garbage?)

Yes, thank you, you did explain that part.  What I want to know is where, exactly, you place the titanium plate.

Exasperated sigh.  Again, with feeling:

–I told you, we move your windpipe and food tube…

Cheezes K. Reist, woman.  I want to know whether the plate is placed LATERALLY or IN THE MIDLINE???

–Midline.

Good.  How long will I be in the rehabilitation hospital postop?

–That depends on you.  She drops the phone.  Oh sorry.

How long until I am able to drive?

–That depends entirely on you.

What does that mean, exactly, please?

–That means however long you are on pain medication.  Could be two weeks, could be six weeks, depends on you.  Each patient is different.

Ah, now I have some useful information: they give you pain medicine postop!  What a good idea.

It really was like pulling teeth.  Look, if someone is going to do violent things to my neck bones, I want to know the details.  All of them.  Not the sixth grade version: for better or worse, I am a physician, and I need DETAILS.

So now I am spooked, very spooked, by the fact that the surgeon’s right hand woman is sidestepping badly.  It’s bad enough that I have to make a decision of this magnitude, without this person giving me the power trip.

I know I need the surgery.  I’ve investigated the surgeon and he comes up kosher. 

But what about this other person on his team, who seems to have enough power vested in her that she could cause me to suffer?

It happens that there is a branch of the Mayo Clinic in Phoenix, several hours from here.  I think I’ll mosey over there and see what it’s like.  I don’t believe there will be huge changes in my condition in the near term…I hope.  Maybe they have some other, brighter ideas.

And then…there is the first appointment with the Hand Surgeon to look forward to, in a week or so.  Something is very wrong with my wrist, because of the fall.  Very wrong. 

I wish I could get someone to order the MRI of my wrist BEFORE I see the Hand Surgeon, to save time.  I think I’ll call his office tomorrow and ask.  Can’t hurt.

I have waves of feelings of futility.  What is all this for?  The wrist, yes, that’s an injury and must be repaired, if possible.  But what about the spine?  I watched my father’s spine degenerate until finally he was literally a helpless bag of bones.

I must ask this surgeon, whose opinion I respect: what am I looking forward to?  How long will it be until another unstable section of my spine needs to be fused, and another, and another?  How much of this can the body endure?  Am I really buying time with this?  What sort of quality time?  How long till the wheelchair and the nursing home?  I need to know.  I will make another appointment.

Malignant Narcissistic Abuse – Understanding the Enemy’s Devices

NOTE: This is a reblog of a reblog.

In order to understand what my comments here are about, please click on the original link, which you will find at the bottom of these paragraphs, read the original author’s post, then make sure to look at the meme collection. It had my mouth hanging open, it is so affirming of my own lived experience of being an ACoN (Adult Child of a Narcissist).

One thing in the meme collection that I must take issue with is the statement that taking on narcissistic traits, if one grows up in such a home, is voluntary. It is not. If the only coping mechanisms you have ever known are drama, tantrums, accusations, the silent treatment, etc, it takes time to figure out that these are dysfunctional and abusive. And since Adult Children of Narcissists (ACoNs) often are drawn into adult relationships with narcissists, the story tends to perpetuate itself down the generations. After all, when we meet someone who “feels like we have known them all our lives,” well, we probably have, because they “feel like home,” our family of origin.

The first thing we must learn is insight: it isn’t our fault, we are not defective, we do not deserve to be treated like a mouse being tortured by a cat.

Some people are fortunate to realize that something is very wrong–usually after multiple failed relationships, suicide attempts, or other catastrophic life events–and seek help, sometimes from the right person, like a good therapist, and sometimes from….someone who “feels like home,” claiming that they want to help, but really being a wolf in sheep’s clothing, as we unfortunately see with some religious leaders. I have even had a narc therapist! She had a hand in destroying my marriage. I sat there mesmerized while she smiled and preened, not realizing what it was about her that was so familiar (she was like my mother, who used to court my boyfriends), until it was too late. She stood up, announced that it was her opinion that we should divorce, and left us sitting on her couch looking at the floor.

Memoir Notes

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So Long, Pluto

By one of those curious twists of the state of time, space, and matter, it seemed good in my eyes on Thursday night to seek the reliable shelter of a State Park, in which to interrupt my trajectory while hurtling across the awe-inspiring hugeness of the State of Texas.
_________________________

A Texan went to visit Ireland.

He saw an Irish farmer out working in his potato field, got out of his rented Cadillac and approached the fellow, and hollered:

(Texas accent): Say, pal, is this your land?

The Irishman cuts the engine on his ancient tractor, removes his battered hat, scratches his balding red head, mops his pate with his tatty handkerchief, jams his hat back on.

(Irish accent, with pride):  Sure and it is, Mester.  Been in my family for a hunnerd years. (Beams, gap-toothed, at the Texan, who is now standing in the dirt road in his cowboy boots, dove-grey Western suit, string tie, rocking with his thumbs hooked over his tooled leather belt with its garish silver buckle.  Door of Cadillac stands open.)

Texan:  Why, that’s mighty fine, mighty fine.  How much land have you got, if you don’t mind my askin’ ? (Chews a toothpick)

Irishman, with pride:  No, I don’t mind a wee bit, sence you’re askin’.  You see that tree stump off there in the distance?  Why, our land goes all the way from that stump, back aways past the house and farmyard, barns, horse pasture, to that stoon fence, ye can just barely see it from here.  (Scratches head again.)

Texan:  I declare.  That’s a right purty leetle piece.  You know, Farmer, back in Texas where’n Ah come from, Ah kin git in mah truck an drahve from sunrise to sunset, and Ah will still be drahvin’ on mah own land.  (Air of superior self-satisfaction)

Irishman: (Shaking head sadly)  Ach!  I had a truck like that meself, once.
__________________________________

The twist of fate is made curious by a happenstance: the first Texas State Park I spied on my map happened to be full, but the sweet and adorable Mescalero Apache ranger at the park office told me that there was plenty of room at the next park down the road, which happened to be right down the road again from the famed McDonald Observatory, home of the second biggest and most scientifically unique telescope in the world.  Yowie zowie, I love space stuff!  And my knowledge base is terrible, so I got all hot and sweaty at the thought of increasing it in such a majestic way.

I scuttled down the ranchy road, reaching the park just about closing time.  Picked myself out a choice spot and settled in, nervous about the javelinas (pecaries, a nasty species of wild pig that stinks and had it in for dogs) and wild boars, that can tusk up a dog or small human faster than you can say “Old Yeller.”  We have seen a lot of their poop, fresh, in our campsite, and if they only come sniffing around of a night, that’s fine, as long as they respect the rules.

The next day I mounted Old Jenny and climbed up the twisty road to the Observatory.  They were having a program on Sun Spots, but since I regularly check the Solar Weather I wasn’t so interested in that.  I wanted Deep Space.  Wormholes, Dark Energy, you know, cool space stuff.  I wanted to see the giant telescopes, but the next available date is a couple of weeks from now and I don’t plan to be here then.  Plus it costs $115, which would be money well spent, but that’s a week’s worth of camping money, so.

But they have “Star Parties,” interpretive viewings of the heavens both aided by normal size telescopes, and with the naked eye, so that one comes away with greatly augmented knowledge of celestial bodies and visible galaxies and nebulae (one, beside the Milky Way: the Orion Nebula.  I was hoping to get a glimpse of the Horsehead Nebula, but you need a higher power telescope for that).

The McDonald Observatory is located on top of a mountain situated above the Sonoran Desert, and is one of the darkest places in the world (at night, and not a cave).  Thus, I was tremendously exited at the prospect of guided stargazing in that spectacular location.  I bought a ticket for $15 and returned to my campsite to do a bit of dog hair mitigation and await the appointed hour.

We got there early (“we,” unless otherwise noted, means my dog and I) and cooled our heels till show time.

Big tour buses pulled up.  I noted them, then blocked them out of my consciousness.

With the approach of show time, I took Atina out for a potty break and put her in the van, ignoring her rueful expression.  It’s tough being a dog.

When I entered the lobby my heart went splat on the floor, then went into a run of sinus tachycardia.  Panic attack. 

Hundreds of lovely young people wearing Texas Tech and University of Texas and Texas A&M sweatshirts milled and shouted in the lobby.

I bailed into the gift shop, which was geared toward children, with book after book after book on the constellations…fer krissake, how many books on the constellations do they need?

I perused the wall charts, the glow in the dark universes that I stuck on my erstwhile son’s ceiling, to give him something to do while he wasn’t sleeping….and noticed something odd.

There were only eight planets.

That is wrong.  There are nine.  Everyone knows there are nine planets!

Then I remembered: Pluto has been decommissioned as a planet, because it is made of frozen water and no rocks.  You have to be made of rocks to be a planet.

It’s not fair.  Other planets are made of weird shit, so why, after all this time, could they not make Pluto at least an HONORARY planet?

I bought a placemat of the Periodic Table, which has picked up a number of new elements since the last time I studied it, and bolted for my van.

The rest of the evening was devoted to doctoring my crushing panic attack.

It wasn’t merely the prospect of standing in loud lines with droves of college students.

It was the sudden realization that I, too, have been decommissioned, like Pluto, and for the same reason: lack of a solid core. 

In our last bitter conversation, my son made it clear that I am not the mother he wanted…or, in his opinion, needed.  He needed stability.  He needed a rock core, not just some object made of frozen gasses.

Pluto and I are no longer welcome in his universe.

Well.

Since I have cried all the way across the enormous state of Texas, I have very clean eyes.  It seems that tears do not simply run out.  The body just keeps making more.

And since my decommission I have had plenty of time to reflect on the universe of mistakes I have made in my life.  Mistake after mistake after mistake.

And all boiling down to what?

Well, at least I have money, for a couple more years, to pay my expenses.  That’s a plus.

See, me and Pluto just keep going around and around and around, but the end is interincluded in the beginning, so there is no getting off this particular merry-go-round.

So me and Pluto and Atina will go ’round until it all winds down and it’s time to bail out.  That’s what happens to stars before we blow up and become Something Else.

So Long, Pluto

By one of those curious twists of the state of time, space, and matter, it seemed good in my eyes on Thursday night to seek the reliable shelter of a State Park, in which to interrupt my trajectory while hurtling across the awe-inspiring hugeness of the State of Texas.
__________________________________

A Texan went to visit Ireland.

He saw an Irish farmer out working in his potato field, got out of his rented Cadillac and approached the fellow, and hollered:

(Texas accent): Say, pal, is this your land?

The Irishman cuts the engine on his ancient tractor, removes his battered hat, scratches his balding red head, mops his pate with his tatty handkerchief, jams his hat back on.

(Irish accent, with pride):  Sure and it is, Mester.  Been in my family for a hunnerd years. (Beams, gap-toothed, at the Texan, who is now standing in the dirt road in his cowboy boots, dove-grey Western suit, string tie, rocking with his thumbs hooked over his tooled leather belt with its garish silver buckle.  Door of Cadillac stands open.)

Texan:  Why, that’s mighty fine, mighty fine.  How much land have you got, if you don’t mind my askin’ ? (Chews a toothpick)

Irishman, with pride:  No, I don’t mind a wee bit, sence you’re askin’.  You see that tree stump off there in the distance?  Why, our land goes all the way from that stump, back aways past the house and farmyard, barns, horse pasture, to that stoon fence, ye can just barely see it from here.  (Scratches head again.)

Texan:  I declare.  That’s a right purty leetle piece.  You know, Farmer, back in Texas where’n Ah come from, Ah kin git in mah truck an drahve from sunrise to sunset, and Ah will still be drahvin’ on mah own land.  (Air of superior self-satisfaction)

Irishman: (Shaking head sadly)  Ach!  I had a truck like that meself, once.
__________________________________

The twist of fate is made curious by a happenstance: the first Texas State Park I spied on my map happened to be full, but the sweet and adorable Mescalero Apache ranger at the park office told me that there was plenty of room at the next park down the road, which happened to be right down the road again from the famed McDonald Observatory, home of the second biggest and most scientifically unique telescope in the world.  Yowie zowie, I love space stuff!  And my knowledge base is terrible, so I got all hot and sweaty at the thought of increasing it in such a majestic way.

I scuttled down the ranchy road, reaching the park just about closing time.  Picked myself out a choice spot and settled in, nervous about the javelinas (pecaries, a nasty species of wild pig that stinks and had it in for dogs) and wild boars, that can tusk up a dog or small human faster than you can say “Old Yeller.”  We have seen a lot of their poop, fresh, in our campsite, and if they only come sniffing around of a night, that’s fine, as long as they respect the rules.

The next day I mounted Old Jenny and climbed up the twisty road to the Observatory.  They were having a program on Sun Spots, but since I regularly check the Solar Weather I wasn’t so interested in that.  I wanted Deep Space.  Wormholes, Dark Energy, you know, cool space stuff.  I wanted to see the giant telescopes, but the next available date is a couple of weeks from now and I don’t plan to be here then.  Plus it costs $115, which would be money well spent, but that’s a week’s worth of camping money, so.

But they have “Star Parties,” interpretive viewings of the heavens both aided by normal size telescopes, and with the naked eye, so that one comes away with greatly augmented knowledge of celestial bodies and visible galaxies and nebulae (one, beside the Milky Way: the Orion Nebula.  I was hoping to get a glimpse of the Horsehead Nebula, but you need a higher power telescope for that).

The McDonald Observatory is located on top of a mountain situated above the Sonoran Desert, and is one of the darkest places in the world (at night, and not a cave).  Thus, I was tremendously exited at the prospect of guided stargazing in that spectacular location.  I bought a ticket for $15 and returned to my campsite to do a bit of dog hair mitigation and await the appointed hour.

We got there early (“we,” unless otherwise noted, means my dog and I) and cooled our heels till show time.

Big tour buses pulled up.  I noted them, then blocked them out of my consciousness.

With the approach of show time, I took Atina out for a potty break and put her in the van, ignoring her rueful expression.  It’s tough being a dog.

When I entered the lobby my heart went splat on the floor, then went into a run of sinus tachycardia.  Panic attack. 

Hundreds of lovely young people wearing Texas Tech and University of Texas and Texas A&M sweatshirts milled and shouted in the lobby.

I bailed into the gift shop, which was geared toward children, with book after book after book on the constellations…fer krissake, how many books on the constellations do they need?

I perused the wall charts, the glow in the dark universes that I stuck on my erstwhile son’s ceiling, to give him something to do while he wasn’t sleeping….and noticed something odd.

There were only eight planets.

That is wrong.  There are nine.  Everyone knows there are nine planets!

Then I remembered: Pluto has been decommissioned as a planet, because it is made of frozen water and no rocks.  You have to be made of rocks to be a planet.

It’s not fair.  Other planets are made of weird shit, so why, after all this time, could they not make Pluto at least an HONORARY planet?

I bought a placemat of the Periodic Table, which has picked up a number of new elements since the last time I studied it, and bolted for my van.

The rest of the evening was devoted to doctoring my crushing panic attack.

It wasn’t merely the prospect of standing in loud lines with droves of college students.

It was the sudden realization that I, too, have been decommissioned, like Pluto, and for the same reason: lack of a solid core. 

In our last bitter conversation, my son made it clear that I am not the mother he wanted…or, in his opinion, needed.  He needed stability.  He needed a rock core, not just some object made of frozen gasses.

Pluto and I are no longer welcome in his universe.

Well.

Since I have cried all the way across the enormous state of Texas, I have very clean eyes.  It seems that tears do not simply run out.  The body just keeps making more.

And since my decommission I have had plenty of time to reflect on the universe of mistakes I have made in my life.  Mistake after mistake after mistake.

And all boiling down to what?

Well, at least I have money, for a couple more years, to pay my expenses.  That’s a plus.

See, me and Pluto just keep going around and around and around, but the end is interincluded in the beginning, so there is no getting off this particular merry-go-round.

So me and Pluto and Atina will go ’round until it all winds down and it’s time to bail out.  That’s what happens to stars before we blow up and become Something Else.

Lost

After my 30 year old son threw me out the day after Thanksgiving, I sat with the pain until after Christmas.  I thought the pain would fade, but it only intensified.  It was eating me up from the inside out.  I thought we had a good relationship, and then this.

So I wrote him a letter, asking what I had done to cause him to do this thing.

A couple of weeks went by.  He was kind enough to send me a note saying that he wanted to take time to sit down and write me a well-thought out letter.  I waited eagerly, hoping for a positive answer.

What I received tore my heart into even smaller shreds.

He detailed grudges that he held from childhood, that I thought had been addressed during the two years of intensive family therapy at the therapeutic boarding school I sent him to as an alternative to jail after he got arrested when he was 16.  I guess that wore off.

More grudges for things I had done unintentionally, that I did not know had bothered him, or even knew anything about.

Worst of all, he disapproves of my current lifestyle, my past lifestyle, and I got the impression (or maybe her wrote it) that he believes I am irresponsible, and worries that I will run out of money (possible, since I have given so much of it to him, in one way or another).

I waited another few weeks, went through the letter with my therapist, discussed the triggers…

Being thrown out by my own son would be bad enough.  For krissake, I wasn’t drunk or abusive or anything that would merit being shown the door.  But since my mother used to do that all the time when I came to visit her, hoping once again that I would find her transformed into the Mommy that I never had, the trigger was like a hammer brought down on my head.

And his letter, so full of judgement and criticism, triggered my childhood of constant criticism by both parents.  How can I relax if I never know whether what I’m doing will be accepted or considered wrong?  How can I trust him ever again, since he holds grudges even for things I didn’t know were wrong, in his eyes?

And who the hell does he think he is, to judge his mother?  I have never abused him: the opposite.  I have struggled ever since he was born to find ways of helping him to be happy.

As one of my first boyfriend’s Irish mother said to him when he criticized her, “Don’t you judge me!  I wiped your shitty ass!”

I wrote my son another letter, explaining that we are different people with different values, and just because someone is different doesn’t mean they’re a bad person (you’d think someone would know this by the time they’re 30, but I guess not).

I also reiterated how much his behavior had hurt me, and how my current financial situation is largely due to the more than $200,000 that ate up my retirement fund, plus having to borrow another $75,000 from my parents, who amazingly mortgaged their paid-for home to save his life.  He has never thanked any of us, nor offered to pay us back even a fraction.  I have never mentioned the money thing to him before, not wanting to lay a guilt trip on him.  But since he brought it up, and since he is behaving like an entitled brat, I let him in on the secret.

I have not heard back from him yet, and I wonder how he will take these harsh realities.

I also told him something of my health issues, both physical and mental, and that since I have no one to care for me and I refuse to go into a nursing home, at some point this life will end, either naturally or, if the pain is too severe, by assistance.

I feel that I have lost him.  This too is triggering, as I had the same feeling when he was a lying, stealing, addicted teenager, running with others of the same ilk, in and out of every kind of rehab, even a stint of involuntary hospitalization that turned out to be a nightmare.

He managed to either fake his way through the programs or get himself thrown out by fighting or otherwise flagrantly breaking the rules. 

Finally his stepmother threw him out, and he ended up in a homeless shelter, where he broke the rules and I don’t remember what happened after that because I was having my own catatonic breakdown and two hospitalizations.

During those times I felt like I had lost my son, but he was still alive, which was worse than having lost him by death in some ways.

If he had died, at least I could have grieved him and kept the good memories.  But losing him alive was unremitting torture, as it is today.

Why, all of a sudden, have I become a villain?

I think I know.

Now that he’s become known in the scientific world, he’s emulating his famous scientist dad.  He’s dressing like his dad, even talking like him.

I’m sure people ask him what his mother does, and he doesn’t know what to say.

He’s not proud of me; in fact, he’s embarrassed, because I am disabled by mental illness, I don’t work, and I don’t even have a home.

He writes that he wants me to settle down and have a real bed for him to sleep in when he visits.

Funny about that: when I did have a real home with a real guest bed, he never visited.  Of course, my real home was in Israel, and although I offered to pay his fare countless times, he always had an excuse why he couldn’t come.  But he was happy to go to Hawaii with his dad.

I told my mother, who is not the greatest role model; nevertheless I told her, and she said, “Let him go.  He’s never been a part of our family anyway.” 

That hurt me even more, and made me wish I hadn’t said anything.

Thirty years ago today, I was great with this child.  I have a photo of myself in profile, naked and glistening with oil like a wrestler.  I am very short.  I looked like I had swallowed a giant watermelon.  I was so happy.

Now, I wonder whether having him was the right thing.  He has never been happy.  He screamed constantly for years.  He started seeing a child psychologist when he was three.  My ex-husband started sleeping with him when I started my internship, because otherwise he just screamed all night.  This child drove a wedge between my former husband and I.  I’ve observed, during my 20 years practicing pediatrics, that a sick child will either cement or destroy a marriage, depending on the health of that marriage to begin with.  I consider the child to be a symptom of family dysfunction.

Usually divorce will help the stricken child; in our case, that was not to be.

Anger, and more anger, has been this child’s life.  I thought he had developed coping skills and self awareness.  I was so proud.

Now I am lost in a sea of pain.

If I had known then what I know now, I believe I would not have conceived him.

Jets Are Circling: War Trauma

Here I sit in my safe little corner of America.

But jets are circling overhead.

Why?

If I were back in Israel it would mean only one thing:  war.

Israel is a very tiny country, surrounded by hostile nations on all sides.

Our greatest love, as the Jewish People, is our Holy City, Jerusalem. 

Three times a day, in our regular prayers, and after eating bread, we pray:

“U’vanay Yerushalayim, ir ha’kodesh, bi’m-hayrah u’vyameynu, ahmein.”

And (please, God,) rebuild Jerusalem (and the Holy Temple that is the definition of Jerusalem,) the Holy City, quickly and in our days, amen.”

In times of threat, the Israel Air Force jets circle Jerusalem endlessly, protecting her from harm.  Jews, Christians, Muslims, all protected by the IAF.

No other air traffic flies over Jerusalem airspace.  If it does, it gets promptly escorted out by IAF jets.  Sometimes it’s an innocent mistake, but even a private plane owner (of whom there are very few) will find himself in big trouble for inadvertently flying over the Holy City.

The jets have left now but I’m still shaking.

I think of those unfortunate people who live in countries where jets overhead mean bombs and death.

During the 2009 war with Gaza, which is such a complicated situation that I can’t begin explaining it here, my windows were in just the right position to hear the mortars and missiles coming out of Gaza, and the bombs dropped on the tunnels and munitions dumps roaring, columns of smoke belching into the air as the cached explosives went up.

And I knew, each time, that innocent lives were being torn apart, killed, burned, limbs lost….And the jets circling, always circling, and the mortars going “whump…whump…”

One day I was sitting learning Torah in my yeshiva (house of Jewish learning, study hall), when the air raid siren went off.  We students did what we were trained to do: head for the nearest miklat, bomb shelter.

But when we got to the door of our yeshiva, we ran into a group of IDF soldiers.

“Where are you going?” They asked us.

“To the miklat!  What are you doing here?”

“We came to sit and learn.  That’s the best bomb shelter!”

So we all sat down to learn together.

But still, when the jets circle over overhead, my heart pounds, my mouth gets dry…