Wednesday, March 25, 2009

The Good Ones Are Always Taken

I walked into the intensive care unit at Arkansas Children's Hospital.  I was apprehensive as the nurse helped me don the gown and mask over my cutoffs and t-shirt; I was only 17 and not yet accustomed to the medical environment.  There was one isolation booth at the center of the ICU, it was a square glass unit reminiscent of a transparent house of cards.  The life inside was propped up as tenuously as my brain's analogy.  It was my brother, Michael.  He was 10 years old.

It was 1990, and I had only been off to college for a few months.  My previously robust brother had been undergoing aggressive treatment for a diagnosis he had received while I was spelunking on my pre-orientation trip to Hendrix College in Ponca, Arkansas.  He was being tested at that time because he had become cachectic and sallow over a period of a few months and no one could figure out the etiology.  Before we knew it was serious, my sister and I jokingly dubbed him Skeletor, the villain on the He-Man cartoon he liked to watch.

I was reluctant to go on pre-or for many reasons:  I was worried about my brother, I was 16 and headed off to college, I wondered why I in the hell I had picked spelunking on the form a few months earlier.  I had no experience with spelunking.  Neither did our guides, a young chemistry professor and his wife.  Although there were 12-15 other freshmen on the trip, I don't remember any of them.  I do remember sweating profusely as we hiked through the forest to the entrance of the cave, and silently cursing our guides who had advised us to suit up for subterranean temperatures under our backpacks that morning; it is over 100 degrees and extremely humid in Arkansas in August and the hike was a lot longer than they had anticipated.  My gear was weighing as heavy on my body as my brother was on my mind.  At one point, I stopped and fell behind to strip off a few layers down to my t-shirt.  I don't function well when I am overheated, and I am easily overheated.  I wanted to quit.  Then I thought of my brother, the rigorous testing he was going through, the uncertainty of it all, and felt inadequate indulging in my own seemingly incomparable struggles.  This marked the first instance of a pattern I unconsciously created of using Michael as a benchmark to push myself forward throughout my life.

I have two other vivid memories of that spelunking trip.  One is sitting in the cold cave in the dark (my layers were back on).  Our novice leaders had advised us to turn off the lights on our hats to save batteries; we were lost and they spent the better part of two hours arguing over which way to go next on the map.  It seemed like an eternity.  I was hungry, but worried about delving into the last of my granola bar stash; after all, how hungry was hungry?  If we were really lost, wouldn't I need every bite?  I hoped I would make it out of the cave, I was supposed to call my mom that evening and find out the results of Mike's tests.  I hoped that if I didn't call she would realize something was awry and call for help.  Luckily, a decision was finally reached, and we pressed on uneventfully.

When we emerged from the cave at the end of the day it was raining.  We hiked back to camp and someone drove me into town to the pay phone at the Ponca General Store.  In 1990, cell phones were not yet ubiquitous; the chunky premature versions were only possessed by important people like doctors and government higher-ups.  Soon after I dialed the rotary phone, my mom picked up and recognized my voice.  "Thank goodness it isn't cancer!  They thought it might be cancer.  It's something different.  Inflamed bowels.  Something called Crohn's disease."

Later I would learn that the diagnosis meant my brother's immune system was launching a full-scale attack against his bowels, stem to stern, as if they were an alien intruder, and would continue to do so for the remainder of his life.  Currently, it was the treatment that had landed him in the situation he was in.  The battery of drugs that was suppressing his immune system from attacking his gut was also leaving him susceptible to all sorts of invisible microbes and viruses, ones that could plan their attack with stealth and surprise.  My dad had called me at Hendrix earlier that morning summoning a family lunch meeting at a restaurant in downtown LR.  My brother was in a coma at ACH.  My mom was somewhere in India, as yet unaware of the situation.  I slowly pieced together the details from my sister, who was still in her senior year of high school, and my dad.

My brother had been complaining to my dad about his legs hurting.  Although my dad was on call and was supposed to be at the hospital, he was home between admissions, resting.  Michael wasn't letting up, and was uncharacteristically clingy - at 10 years old he was mostly beyond that stage, even in illness.  He suddenly seized and arrested.  My dad resuscitated him and yelled for my sister to call 911 between breaths.  The ambulance came and took him to the ICU.  He was diagnosed with Varicella - the chicken pox virus.  Rather than break out in spots all over his body, like it had with my sister and I, it had sneaked into his brain and created swelling that caused the seizures, arrest, and coma.

Michael looked so vulnerable with all the tubes, and angelic, like he was sleeping.  I felt horribly helpless.  We were told that he would be given supportive care until he came out of the coma.  If he came out of the coma.  There were no guarantees that he would, and if he did, we had no idea what damage his brain might sustain.  At a certain point, medicine becomes a giant guessing game.  We were there.

As I sat with Michael I thought of all the times my sister and I persecuted him, and felt guilty.  When he was three, he had this cute habit of stuttering as he was learning to talk and often shrugged up his shoulders when he walked.  We called him stuttering Frankenstein, and teased him lovingly (most of the time).  My sister, who was much more mischievous than I, used to hide tape recorded conversations of herself pretending to be his stuffed animals under his bed.  She sneaked under and pushed play to freak him out at night.  We dressed him up in girl's clothes for fun and fed him Tobasco sauce, promising him it was ketchup, just to witness his reaction.  

I silently prayed to the idea of God that I had at the time.  I had rejected the punishing, judgmental God I had come to know through my childhood organized religion, and was then entertaining the vague notion of an pantheistic God, one that could best be experienced through actions and nature.  I was optimistic that I might get to know and expand my idea of this God better through Buddhism and Wiccan classes at Hendrix.  I made fear-induced promises to this God, ones that are easily forgotten when danger has passed.

I turned to Michael and resolved not to get all emotional.  I tried to model my Dad's behavior earlier in the day - fully present, calm, rational, and optimistic.  I refused to entertain any other possibility than the one that Michael would wake up shortly, and speak to me like nothing had happened.  I opened a Nintendo magazine.  I remembered the last time I talked to Michael he had been talking excitedly about SimAnt.  There was an article on SimCity, something new coming out.  I read it and the entire magazine, interspersing each sentence with my own thoughts and unanswered questions, attempting to entertain him, and willing his safe return to our family with every molecule of my being.

When Michael came out of his coma, a couple of days later, one of the first questions that he was asked was "Do you remember anything?  From when you were in the coma?"  He replied with a sigh, "All I remember was Liz going on and on about SimAnt, and SimCity.  She was really loud."  That is definitely up there as one of the proudest moments of my life.  Annoying my little brother in his coma.  Maybe I was so annoying I drove the virus right outta his brain.  As for his brain function, he kicked my ass on the S.A.T.'s.  

While Crohn's has repeatedly attempted to de-rail my little brother, it has not succeeded.  He won a Barry Thomas art show in elementary school.  He published a recipe in high school.  He is one of the smartest computer people I know (but he doesn't know mac - I am trying to get ahead of him there - no laughing allowed - I am putting together an awesome slide show for the rehearsal dinner).  I attended his graduation from the fabulous ancient monastery renovated for state of the art cooking - The Culinary Institute of America in Hyde Park, NY - the Hogwarts of the cooking world, according to my mom (it is certainly magical, has gargoyles, and fabulous food - a wonderful trio).  He finished his masters in food science at Cornell and is pursuing his Ph.D. there now, studying the coolest molecule on the planet - capsaicin - a metabolite of chili peppers that activates the same pain pathway as tarantula venom.  It gives spice and heat to food, causing a pain-induced endorphin release that creates a pleasurable sensation.  No wonder my food drawer at work is full of red peppers.  He's a great brother-in-law, and a wonderful uncle.  An inspiration, and a hero.  Next week, he'll be a husband.

Michael is marrying a very cool chick - a sensory scientist he met at Cornell.  I had never heard of a sensory scientist, until I met Effie.  I love to say it - sensory scientist - it evokes mystery and excitement.  And I have learned that she does mysterious and exciting things, most of which are top secret.  I learned a little, but I have been sworn to secrecy, and if I told you, I would have to kill you (tee hee).  She and Michael are among the tiny handful of my faithful readers.  They have been engaged 2.5 years, a period of time that has tested the very limits of my daughter's ability to wait to be a flower girl.  Next week, she finally will get to perform in sparkly shoes and a beautiful dress with a hot pink bow.

One day shortly after Christmas one of the all-day assistants pulled me aside, and whispered excitedly, "Who was that really hot guy who picked up Sicily last week?"  If you have ever been to all-day at my kids school, you would know that there is an over-abundance of incredibly beautiful 20-somethings that work there.  This was one of them.  I told her it was my brother.  "That's YOUR brother?  Wow!  How old is he?  Is he dating anyone??"  I replied apologetically, "Yeah, he's engaged to be married."  She sighed, "That figures.  The good ones are always taken."


Thursday, March 12, 2009


This evening, as I was heading out the back door of the lab across the street to the doctor's parking deck, a car stopped - it was headed toward the ER.  The guy in the passenger seat, 40-something with a short graying beard and ball cap, rolled down the window and stuck his head out.

"Which way do we go to get to ICU South?"

I go to ICU South frequently to do apheresis treatments - it is a hotbed of Guillain-Barre, myasthenia gravis, new acute leukemia patients with massively high white counts, thrombotic thrombocytopenic purpura (TTP) and many other indications to have your body hooked up to a giant washing machine that scrubs the individual disease's offending agent, whatever one is threatening your life at the moment, out of your blood.  Nevertheless, I paused, and answered sheepishly,

"Well, you know, I go there in the building all of the time.  But I can't seem to translate from where we are, here, outside the hospital.  Let me think about it a minute."

They stared at me expectantly - I was wearing scrubs, I looked somewhat official - as I struggled through the route in my mind, trying in vain to figure out where to begin to point them in the right direction.

This is not a new sensation for me.  I first started driving at age 14 on a hardship (a 1983 Oldsmobile Toronado convertible - wreck-proof, well-tested) - I had three younger siblings and my parents were itching for an extra driver in the family.  I was completely clueless how to get anywhere.  Major roads like Markham, Cantrell, and University were a mystery.  I had no map in my head, didn't understand what ran parallel to what, and needed assistance even to get to the neighborhood video store.  My friends and family where aghast.  After all, I was born here and had grown up here; yet put me behind the wheel, and it was like I had been dropped on a different planet.  I got the same question over and over.

"Gizabeth, what have you been looking at in the car, for the past 14 years of your life?"

I guess I usually had my nose in a book or my head in the clouds.

These incidences repeated themselves:  I remember once, at 15, trying to get to Conway for the first time to a college party.  It was still broad daylight, but somehow I got the directions confused and ended up in a continuous loop around Little Rock, winding around I-630 and I-40.  Finally, after 2 hours and many loops, I realized I had to overcome my stubbornness and call my dad for help or I wasn't going to make it.  He listened incredulously to my frustrated torment and figured out immediately what I was doing.  He pointed me in the right direction - one of many times.

By far the most traumatic experience I have had involving lack of orientation occurred during a gross anatomy exam in medical school.  I have always thrived and succeeded in test-taking situations; that's how I got into medical school in the first place.  I often had nerve-wracking, sweat-inducing dreams during spring/Christmas break about receiving devastating news regarding grades on my recent trimester finals, but I rarely made anything below an A.  

When you walk into a gross anatomy exam (at least at the time, the computer age was quickly advancing and had taken over micro by my second year) you are handed a clipboard and a piece of paper with blank lines numbered 1-60.  There are 60 stations, with one minute allotted at each station.  Station change is signaled by an egg timer.  Each station contained a body, on a stainless steel gurney with a flagged pin in either a muscle, nerve, blood vessel, or organ on the region of the body we were studying at the time.  There was a tall bar stool to sit at and ponder the position of the pin, but if you had studied and knew the answer, it rarely took the full 60 seconds.

Unless you are the student in our class who demanded unlimited time to name that pin because of a documented condition of Attention Defecit Hyperactive Disorder (ADHD - I am sure you have heard of it), requiring medication, to which the administration eventually begrudgingly assented.  The rest of us whispered angrily when you weren't around.  "What if he (oops or she) is in the ER and a patient comes in bleeding to death?  Will he get extra, unlimited time to save that patient's life because of his A-D-H-D?"  We drew the acronym out mockingly, and bitterly.  First year medical students are pretty darned bitter, in general.  But I digress.

The segment we were studying at the time was pelvis.  They did something kind of interesting, in order to "preserve the body's dignity" - even medical school gets more politically correct every year.  The only region of the body that was uncovered, at any time, was the one that we were studying.  The rest was draped in white sheets.  The head was saved for last, so we never saw the face of the body we were working on for six months until the very end.  Pelvis was somewhere in the middle of the semester, so much of the body had already been dissected and distorted.  And these bodies, the first dead bodies that many of us had encountered, were not like the nice (I use that word in the best possible way - fresh bodies are a million times easier to dissect), fresh specimens we get to work on at autopsy.  They had been pickled in preservatives so that they would last for six months without starting to decompose and stink up the room.

There is an intricate system of vessels, muscles and nerves that runs through the pelvis.  In order to prominently display the test question at each station, bodies were shifted sideways and sometimes laid prone.  However, with the sheets draping the rest of the cadaver, I found it impossible gain orientation.  Suddenly, those dreams I had been having my whole life had become a reality.  The first 60 seconds went by and I had absolutely no idea what I was looking at.  I began to sweat, but knew that if I just concentrated and kept my head on straight I would get it together.  I went through another 10 or 15 stations and it still didn't happen.  It was getting harder and harder to convince myself that this was going to turn out ok.

Strangely, instead of freaking out, I became serene and calm, almost like an out of body experience.  Maybe this was a dream (not).  It sure was the longest gross test I had ever taken; each 60 second segment seemed to drag on for an hour - highlighting my lack of knowledge even more dramatically.  At one point, I experienced magical thinking, "Surely if I am struggling this hard, everyone else is too, and this test will be thrown out."  But the cold hard fact that the others in my group seemed to be writing down answers on the page did not support this hypothesis.

About three-fourths of the way through, I sat down around number 45 and half-heartedly attempted to orient myself.  I would be over-exaggerating to say I had written absolutely nothing down - I had studied and was making some educated guesses.  But that's all they really were - guesses.  Suddenly, I glanced back and noticed that the sheet had fallen off of the cadaver's head.  I was having my first encounter, outside of a funeral, with a dead person's face.  I supposed she was in her mid-60's, curly, graying hair, slack jaw - the preservatives had not been kind to her features. She looked waxy, but not in the "trussed-up-Catholic-wake" way, more in an "ignored person in a wheelchair in the corner of a nursing home" way.  My out-of-body experience gained an exponential or two, as I craned my neck to keep catching glimpses of her for the next few stations, until it was no longer feasible.

Toward the end of the test I picked up momentum.  It was the verumontanum that triggered my brain.  Thank goodness for the verumontanum.  It lies about 2/3 of the way down the prostatic urethra.  The opening in the middle of this smooth eminence is the prostatic utricle, a slitlike opening that is considered to be the homologue of the female vagina - the vagina masculina.  The ejaculatory ducts lie on either side of the utricle, but they are not visible to the gross eye.

I got the next few questions, but not enough to keep me from my dreaded first F.  I learned that there are no nervous, sweaty dreams when you know you failed.  Luckily, it was a high F, and I still managed to pull a B in the class.

I turned to the guys in the blue Chevy and pointed across the lab and the helicopter pad to the main hospital.  "ICU South is over there.  At the far end of the main hospital."  I smiled.  "Good luck."  I walked to my car and headed home, grateful that I was able to orient myself, and them.

Monday, March 9, 2009

Golden Girl

Tomorrow is Sicily's 6th birthday.  We've been celebrating for over a week -- pierced ears, mani/pedi and hair before soccer practice, mad celebration including phone calls to the entire family about a wiggly tooth, nightly exercises in preparation for her first ski trip with her dad next week, and a Mad Science party.  One day in the back of the car on the way to school she said, "wow, I must really be growing up!  So much is happening right before I am turning six!"  I just baked an orange dreamsicle cake and tucked some tiny photos into a heart-shaped locket that I can't wait to give her in the morning.

I remember waking up at the crack of dawn on March 10, 2003, two hours before I was induced the day after her due date, to write her a long letter that I can't wait to show her someday.  I can't wait to crack into it myself, I can't even remember what it said.  

I remember waking her up at 4am to nurse, watching her eyes roll drunkenly back in her head as her sweet milky breath became heavy with sleep, her starfish hands, attached to her arms by rubber band wrists (I still mourn those wrists), clutching my finger.  This was the highlight of my day, before I showered, studied for an hour for Step III medical licensing exam, got to work an hour early to do molecular research for a paper, then joining the cytology crew on my first rotation of the specialty that was to become my future area of expertise.  I was continually astonished at all the time I wasted before I had a baby, never knowing the true meaning of efficiency.

I never imagined that I would already be receiving intentional dramatic eye rolls and statements like, "it is my body and I can choose to eat what I want," or "it is my present and I can do what I want (giving it away)."  That girl knows herself at 6 better than I did at 16.  I hope to help guide her through all her future self-confidence threatening experiences in junior high and high school and see her come across intact at the other end.

I also never thought that at age 5, she would be such a big help to me - getting John out of his uncontrollable bursts of three-year-old morning temper in 2 seconds after watching me struggle for 20 minutes.  Sometimes I feel a sting of guilt as I realize she is trying to joke me out of a mood I didn't even realize I was in.  Her capability and sense of self dazzle me.

Tonight as we were reading book and singing song -- Ike and I shuffle back and forth in what tends to drag out into an hour and a half long bedtime routine -- she was playful, as I was trying to rush through in order to get to my afore-mentioned projects.  Eventually, she sucked me into a silly-face making game.

"C'mon mom, just do it.  One more time.  Do this."

She pulled her mouth down in a frown and rolled her eyes in the back of her head like a zombie.  I reluctantly mirrored her, and she collapsed into a fit of giggles, with a bright white smile and slitted eyes - her eyelashes so long they remind me of caterpillars when she laughs.  Her skin is golden.  She's my golden girl.  No, she's her own golden girl.

Happy Birthday, C.

Wednesday, March 4, 2009

Dizzy Lizzy

It's just that mean old Texas sun
It makes me dizzy, dizzy, dizzy in my head
Love that villain on the run
He's got me spinning 'round and falling on my head
And dizzy . . . in my head

-- Throwing Muses

I love this song.  And it was going non-stop in my head in Amarillo.  Especially when I was running.  Running in Amarillo is an unparalleled experience.  Any single bead of sweat that attempted to materialize on my body was instantly vaporized by the intense wind, which occasionally carries the stench of cow manure from the invisible yet ever present stockyards.

I got to hike the Palo Duro Canyon, which was amazingly beautiful -- almost as impressive as the Grand Canyon.  The trees were leafless (as evidenced above) but the bugs were slowly starting to emerge from their wintry slumber.  The temperature in Amarillo is as labile as my three year old John's moods - 30's at night, 50's in the morning and evening, and 80's in the afternoon.  I wasn't sure, while running, if I was getting sunburned or windburned.

Route 66 is a little disappointing.  It is evident, during a quick drive-by, that there is a community attempt at work to revive the historic district, but currently it falls flat.  Maybe we were outside the tourist season, because everything was closed.  But I did get to see some of the infamous road signs.  My fave was about Lizzie Borden, of the forty whacks fame, with whom I identified, in namesake only, when I was growing up. 

The twins were not disappointing.  Except for the fact that I was disappointed in myself, as a human being, when comparing myself to my sister-in-law, who makes having twins look like a walk in the park.  Neither was the Vino's stabbing story.  She was stabbed randomly in the back, in a mosh pit, listening to an early 90's band whose name I recognized at the time, but now it escapes me.  She intelligently declined to prosecute, since another victim that night did.  Her reasoning:  "Why, in my early 20's, would I draw extra attention to myself by placing a name in the perp's head, when I could just heal anonymously?"  Well, as anonymous as you can be when you are a beautiful 20-something in the ER at UAMS with as many residents and attendings as can fit in the room staring at the stab wound right above your butt.  

We drove home Tuesday.  I love being off work, and at home.  Except for the fact that I manically invited around 30 kids to my house on Saturday for Sicily's b-day while bored at work, and I can't seem to make more than 7 CD's for party favors.  Itunes is slamming me with copyright issues, even though I swore I read about three weeks ago in an article on the New York Times that from now on, once you buy a song in itunes, it is no longer policed -- it is yours.  So I'm confused.  Nothing new, in the technical arena.  Hopefully my mac teacher can help me out during class tomorrow.