Circling the Drain

I am not sure why it matters, really. After all the years and all of our many moments together, it wouldn’t make much of a difference to him one way or the other. It will still matter to me, though. It shouldn’t, but it will. Let’s blame it on my irrational humanity.

“This is my grandson. He is my rock, you know. He is a doctor too. He is my translator; after you leave, he’ll explain everything you say so that I can actually understand it.”

He has been to the hospital 4 times in the last 8 months; I have been there with him every time. I tell him that an MD doesn’t want to hear that I am a DPT, but I think he likes to tell them that that I am a “doctor” out of spite (and a bit of misplaced pride).

Since his wife passed away nearly five years ago, he has lost over 50 pounds and his health has been in a slow, if not purposeful, decline. He has had multiple falls, fractured his pelvis, shredded 10-inches of skin off his forearm, and flirted with more nurses in hospitals, rehabilitation, and home than he could possibly remember. Each time he has bounced back stronger than his 95-year-old body rightly deserves.

He isn’t necessarily thriving, but he still lives at home and (for the most part) on his terms. My mother takes him to his MD visits. A privately-hired aide supervises his shower twice weekly. Prepared meals are delivered to his home daily. He accompanies friends out to lunch weekly and hosts regular visitors. He tells me he thinks he is doing “pretty good” for his age, which he would confess isn’t saying much when he considers how everyone that he once knew of similar age has long since died.

Last night, my phone rang. The ringtone on the phone belonged to my mother and when I looked at the time [01:17] I knew it couldn’t be good news. Of course, he was in the hospital again. This time he required an emergency surgery for a hernia.

There was no time to taper him off the blood thinner that he has been taking since his stroke 6 years ago. The pain was getting worse. He was vomiting bile. There was no other choice to be made: he was going under the knife.

I asked one of his physicians, over the phone, “What kind of hernia are we talking about here and what is the surgical prognosis?”

It could be a simple hernia,” she replied, “or it could a strangled gut. We won’t know until we get in there. To not treat it is a painful way to die even with comfort measures. A surgical fix could be simple and a totally reasonable risk even with his advanced age and and medical problems.”

I assured the clinician that I wasn’t second guessing their expertise, only acknowledging the limits of my own and hoping for perspective. After the call ended, I sat at the edge of the bed, and – now awake – I tried to remember the last time that I visited him.

I had seen him 2 days earlier when I visited to hang new decor on the wall of his new retirement-community studio-apartment. I surprised him with a large map of the state of Virginia, where he grew up as a youth. I had hoped it would serve as a conversation-starter when guests visited his room. I recalled him standing up from his recliner on 3 separate occasions to walk to the map and point out places that he had traveled to with his family as a young boy. Most importantly, I remembered giving him a hug before I left and saying, “I love you.”

Tonight, I publish this posting from his room in the hospital’s ICU. He is fortunate –  it was a simple procedure after all. He has spent the entire day sleeping (but it is sounds better if we say that he is recovering). He is still in a lot of pain, but he is resting soundly and tomorrow they will get him out of bed to stand and walk. He has already quickly dismissed his male nurse at shift change after meeting the attractive young woman who will be caring for him for the remaining portion of the evening.

After a few more days recovering in the hospital, he’ll get to go home. Next week, he will receive home care until he is as strong as can be. Next month, he will have returned to his baseline. Sometime soon after, he will return to the hospital once again. We will bring his do not resuscitate (DNR) documentation with us and be certain that one of his two health care proxies are present or nearby throughout his stay.

I have now asked myself the same question 3 times before. Not too long from now, I will be asking myself the same question again. Maybe the next time will be the last.

“What was the last thing I said to him?”

 

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Elementary Education

Three nights ago AJ fell off his swing in the backyard;  he landed awkwardly and injured his 5th finger on his left hand. It swelled instantly and – while he was trying to put on a brave face – it was clear that he was hurting and worried when he re-entered the home.

“Why does it hurt, Daddy?”

I placed him in a chair. I sat on floor beneath him. I asked for permission before manipulating his (uninvolved) right hand and fingers while I tried to explain to him what was happening.

I explained that he has all of these little “feelers” in his finger that are sending messages to the brain all day long … he wasn’t following me yet and had no idea where I was going. Time to change tactics – quick. “Don’t lose him,” I thought to myself.

I asked him to concentrate for a moment and tell me what he could hear in the room (it was a nice distraction and refocused his attention away from the throbbing finger) – he could hear the fridge running. As we talked about how it is that he hears things, he recognized that his ears hadn’t suddenly worked to hear the fridge and the fridge had been running all along – his attention had become more pointed. I told him that the “feelers” in his finger worked all day and he usually ignored them (like the fridge) unless something caught his attention…banging his finger on the ground was sudden and alarming for those feelers, just like a loud thunder clap in his ear. His eyebrows raised … now he was with me.

[forgive the homuncular fallacy] The feelers – I told him – provide information to the brain like gauges on the dashboard of a stock car … more often than not, the driver is too busy driving to pay attention to what the gauges say until the crew chief asks him to look (just like the fridge running). But, occasionally, the gauge will start to flash colors to attract the driver’s attention, like a thunder clap. Sometimes the driver needs to worry about the flashing light (“Oh no, the car is over-heating!”) or you need to worry about lightning (“I have to get inside!”). But, sometimes the driver doesn’t need to worry (“Who cares? There’s only 2 laps left.”) and the lightning is of little concern (“Phew, I ‘m glad I’m not outside, I’d be getting soaked.”). In each example, though, the flashing light or the thunder clap is almost sure to get your attention. [/fallacy]

The pain in his finger was simply his mind’s way of getting his attention so that he could figure out if something else needed to be done. Sometimes it is clear what a driver must do, other times he may not know. Sometimes he needs to ask his crew chief for advice when the gauges are confusing or he lacks confidence. I explained to AJ that when his finger hurt like it did, it can be confusing, so he asks his crew chief (me) what is going on and what he needs to do.

[He was now agreeable to me gently assessing the finger, gently moving each little joint, finding where and when his pain was the most severe while I knew that the findings of my “assessment” were extremely unlikely to change the trajectory of his care.]

He was able to understand that that he has “feelers” everywhere in his finger – I showed him a picture of nerves in the hand and explained that the feeler’s job is to inform the rest of his body/brain what is going on down there. He appreciated that if noises are too loud, he feels compelled to place his hands over his ears to protect them – the feelers don’t tell him to cover his ears, his mind simply tries to find a way to reduce the noise.

I explained how the new messages from all the feelers started after they got banged around in a way that is not at all normal (possibly “jamming” the finger) and it is surprising for all these messages to be coming from these feelers that are usually quiet. I explained that the best thing he can do for it to feel better is to protect (splint) it initially, but occasionally to move it to tolerance – after all, the first clap of thunder can be scary, but if it is a long storm, we get accustomed to the sound of thunder before the storm completely passes.

I explained how the straps that hold his bones close together can become strained and that the feelers in the straps might be sending signals to consider that the straps may need some time for repair – “Kinda like when we fix the cracks in our driveway … if you patch and re-seal a driveway, you can’t drive a car on it for a few days. right? But you can walk on it without doing any harm to it.” Again, the best thing he can do for it is to protect (splint) it initially, but occasionally move it to tolerance.

I even explained how bones can fracture, but the same process is true for bones as it is for ligaments (straps) – the best thing he can do for it is to protect (splint) it initially, but occasionally to move it to tolerance.

No matter what was happening beneath the skin, the plan would be the same and he would likely feel a little better after splinting it with a popsicle stick. 3 days later, it is still swollen and a bit black/blue, but he is moving it more freely, going to camp, and playing with his new (unpredictable) puppy. He is not going to taekwondo tonight; he can’t yet make a fist, but he is feeling better. Perhaps it would feel the same today no matter what I had said or done that night. Maybe not. I don’t know and wouldn’t dare to guess – I know better.

What I do know, though, is how cool it is to watch the anxiety related to pain fade from my son’s face after a brief 5-10 minutes of conversation. And while I doubt the intensity of his finger pain changed, his breathing quieted and deepened, he slouched in his chair, and he even grinned a bit.

Kids get this stuff – it is intuitive. It just needs to be framed appropriately.

Thanks to Bas for inspiring this post.

Midi-Chlorian Probabilities

(AJ is now 8-years-old; he is a HUGE fan of Star Wars.)

AJ: Dad…who do you think is the most powerful
jedi ever?

Me: I can’t say “ever”, because I have only watched
the films and cannot speak of any characters that
may have mentioned in the books you have read.

Okay…so who is the most powerful jedi in the
movies you have seen?

I would have to say Yoda.

I think you are mistaken, Dad; I think it is Anakin.

What makes you think that it might be Anakin?

His midi-chlorian levels are the biggest ever –
even bigger than Yoda’s.

I think your logic is mistaken, buddy – but give me
a moment to think about how I might explain why…

.    .    .    .

There are some days that I just wonder if I really know what I doing with this whole parenting-thing…then – every once in a while – there are days like these.

.    .    .    .

Did you know that Grandpa knows how to
build houses?

No, he doesn’t.

No, seriously, he does. His father was a carpenter.
Three of his brothers are carpenters and he helped
build his brother’s house and quite a few garages too.

I didn’t know that.

So, let me ask you this: Suppose I gave you the
best wood possible to build the sturdiest house you can.

Okay…

And then I give Grandpa some “okay” materials –
enough to do the job, but not as strong as the
wood that you have.

Yeah…

If I asked each of you to build a house, whose
house will stand the strongest in the wind?

Grandpa’s.

Why?

I don’t know how to build houses.

But your house has the best materials.

But Grandpa knows how to build a better house
than me.

All right, let me ask you this, then: When was
Anakin’s blood tested to determine that his
midi-chlorian levels were so ridiculously high?

In episode 1.

When he was an awesome jedi?

No…he hadn’t learned the ways of the force yet.

But if his midi-chlorian levels make his a
good jedi, then why did he need training?

Ooohhhh – because he has the potential to be
a great jedi.

Exactly. I would argue that while his midi-chlorian
levels gave him the potential to maybe be a better jedi
than Yoda, there were other qualities that he
possessed (or that were altogether missing) that
prevented him from being more powerful than Yoda.

The same thing happens all the time in life.

What do you mean?

What subject comes easiest for you in school?

Reading.

Would you say that you are a good reader naturally,
or that you have worked hard to be a good reader?

I have worked a little-bit hard, but not really
hard…more natural, I guess.

So – you are a good reader, because you had the
potential to be a good reader and you work at it and
you try to understand things more and because you
like it, right?

I guess so.

So should you ridicule a child in your class who
isn’t as good at reading as you?

No.

Why not?

Because, it is mean…and maybe it is hard for
them to learn and they are still working hard.

What if they aren’t hard workers? Should you
ridicule them now?

No.

Why not?

It’s still mean.

Maybe, but let me ask you this: You try hard
in almost everything you do. Why?

Because…I just do.

Do you think you try hard because it is natural
for you or because you have grown up in a home
with parents who have taught you the importance
of working hard?

[pause]

Both.

What if a child doesn’t have the natural ability
or desire to learn or try hard? What do they need?

Someone to teach them.

What if their parents don’t know how to teach them
and the child never learns how to work hard?

Then it’s the parent’s fault.

What if their parents never taught them?

Then it’s their fault…and then maybe it was their parents fault too?

I don’t think you can blame anyone, buddy. I would
just try to remind you that there are a lot of
things in this world that seem to happen because of
the many other things before them, and many of those
things are out of their control. The only thing that
you or I have control of is what we choose to do in
any given moment, and even our choices will be
influenced by everything that has happened to us before.

But, most importantly – that is why Yoda was a more
powerful jedi than Anakin.

So, you are saying everything is really, really complicated.

No – I’m saying it’s complex.

What’s the difference?

Not today, dude.

Not today.

Keeping House

She leaned over the railing from above, after already walking halfway down the stairs. “I am done making one bed, Daddy,” she said, “but I still have one bed to make.”

“Whose bed do you have to make?” I asked.

“I need to make Woof’s bed.”

[Brief backstory: Tori is very much into small stuffed toys. Every night for about 2 months, her favorite owl, Hootie, was tucked into a small dollhouse bed adjacent to her own and covered with an even smaller blanket. In the last couple of weeks, Hootie has lost his bed to an aptly-named stuffed dog.]

“I thought that was Hootie’s bed,” I said, purposefully antagonistically.

“Daddy, Hootie is awake at night…he is an owl. They hunt at night.” [Thanks Wild Kratts, for helping teach her about owls]

“Then you don’t have to make the bed after all. Hootie must be tired after not sleeping last night; you can just tuck him into the bed, instead.”

“Huh…” she said. She looked down to the floor, silently gazing into (otherwise) empty space for what seemed like 6-8 seconds. She was frozen in thought, perhaps even contemplation. How was she going to integrate this new (reasonable) information into her plans for this morning?

“I’m almost done making the beds, Daddy. [she turns to run up the stairs] I’ll be right down in a second.”

I laughed…I often witness the same thing in the workplace too.

A Better Father

“You are fine. Shake it off.”

.     .     .     .

Four years ago, I would have reacted differently if AJ (then 3-years-old) had begun to spontaneously limp and complain of posterior right knee pain in weight bearing and discomfort with active full knee extension.

But last night, on Father’s Day, I acted like every dad should. When Tori began to cry and limp after rising from the floor after playing with her toys, I held her in my arms, even though I knew there was “nothing wrong”. I asked her to point to where it hurt; I asked her to take my finger and point to the spot on her leg that was uncomfortable. I gently tried to help her straighten her knee without luck. We sat there cuddling for a few moments with my hands on her leg, doing nothing.

“I’m sorry that you hurt, but it is okay.
Everything is healthy and it will feel better in the morning.”

Last night, she received a playful piggy-back ride to the bathroom sink, where she stood on one leg to brush her teeth. She was tickled as she was swung side-to-side into her bedroom, giggling all the way – but she kept her knee flexed throughout. We laid on her bed, instead of sitting on the floor, to read her books before bed. She chose one story about Caillou, another about Clifford. I asked her to lay on her belly beside me and I purposefully read the stories wrong so that she could correct me (she has them memorized, after all). Before I was done with the first story, her knee was straight and she was still smiling.

After her stories were complete, I tucked her under her covers, kissed her on her forehead, and said, “Good night, hon. Sweet dreams – I love you.”

She woke up this morning and her knee pain was gone – or at least I assume it was; I didn’t ask and she didn’t limp.

.     .     .     .

She says that luke-warm bath-water is too hot, the dustbuster is too loud, the marinade is too spicy and the sun is too bright. One day she can also say that her father listens and allows her to express herself without judgement. Granted, she is only 4-years-old, and I understand that self-expression and understanding is something that she probably doesn’t appreciate today, but I know of no better way to improve her chances of having a happy and successful tomorrow.

Critical Thinking??

By the time I got home, the damage had already been done.

AJ had brought home an already-completed school assignment with a poor grade. He had shared with Kristy that he had been the first to complete the paper, handing it in to the teacher before any of his classmates. She made it very clear to him that effort is to be targeted at accuracy, not speed. AJ seemed to have gotten the message loud and clear by the time I arrived home.

I reviewed his assignment, designed to assess his reading and comprehension skills. The paper (and the 1st 2 questions that he answered incorrectly – ‘correct’ answers in bold/italics) are included here:

Sunny opened her lunch box.
“What do you have?” asked Angel.
“I have a cheese sandwich,” Sunny answered.
“I have rice,” Angel said.
“We do, too,” said Kim and Paul.
They all had rice. Kim’s rice was brown. Angel had rice and beans. Paul’s rice was yellow and smelled great.
That evening, Sunny set the table for dinner. Then she went into the kitchen. Her grandmother was cooking. Sunny wrinkled her nose.
“What are you making?” Sunny asked
“I am making fried rice,” Grandma said.
“What is fried rice?” Sunny asked.
“It is a rice dish from China, “she said. “It was my favorite food when I was your age. I ate it every day.”
“Can I taste it now?” Sunny asked.
“It is not ready yet. You must be patient and wait,” said Grandma.
Sunny settled down. “Can I watch?” she asked.
“Of course,” Grandma said. She showed Sunny everything that went into the rice dish. Sunny practice stirring the rice.
The next day, Sunny had fried rice for lunch.
“What is that?” asked him. “It is called fried rice,” said Sunny.
“Now we all have rice for lunch!” said Kim.

(1) What will Sunny most likely tell Grandma after school?
A) She never wants rice again.
B) She does not like fried rice.
C) She liked having rice for lunch.
D) Her friends made fun of her rice.

(2) The next time grandma makes rice, Sunny most likely will –
A) make a different meal for herself
B) help Grandma make the rice
C) stay out of the kitchen
D) tell Grandma to make something else

He is being graded (according to the paper) on his ability to ‘make and confirm predictions’. Perhaps…or maybe he is being taught to make dangerous assumptions about people without valid data based on intuition, the impact of peer-pressure and group think. Perhaps – as Kristy argues – this was a wonderful opportunity to learn the importance of taking one’s time…or maybe there isn’t a lesson to be learned at all.

Either way, I feel bad that I wasn’t home earlier this afternoon.

Without a Compass

Kristy came to me with a problem: there was water dripping into the basement from the floorboards above – not exactly what a homeowner wants to see, especially from a section of flooring that looks as if it might be next to the pedestal sink in the first floor bathroom.

I went upstairs and inspected the sink; there was not a leak that I could see or find. Bad news: it might be coming behind the wall.

At this point, I am stressing out. What is wrong? How much is this going to cost me? How long will it take for me to earn that money back?

I asked Kristy to stand on a chair/stool beneath the drip. My plan was to start at the pedestal sink and knock on the floor above her; she would direct me toward the section of flooring where the water was coming from. Knock by knock, I would eventually be able to find the offending area/structure.

I walked upstairs, knelt on the hardwood and knocked to the left of the sink. “No, not there,” she yelled, helpfully.

I knocked to the right of the sink. “No that is farther away,” she yelled again.

“Where should I go from here?” I shouted as I knocked again to the left of the sink.

“Left,” she replied.

.     .     .     .

My wife is a great mother and a lovely woman, but directionality is not her strong suit. She was underground and had no way to communicate with me in a way that was beneficial for either of us. She struggles to discern which wall in the basement corresponds to which wall on the outside of the home (the stairs turn 90 degrees on the way down and portions of the basement are notched as crawl spaces) and even if she knew which wall were which, she doesn’t know East from West or North from South. She had no idea of how I was positioned above her, only how she was positioned below. “Left” was the best answer she had at the moment.

.     .     .     .

What I should have done in response is clear, in retrospect. But hind-sight is 20/20 (as they say) and I was freaking out about the mounting bills for fixing this leak behind the wall – I snapped. “What the hell do you mean left?! [as I run down the stairs] How am I supposed to know how you are standing?! Left?! Really?! Jesus! Come on! Help me out, will ya?! [pointing to the south wall] That wall is towards John’s, that one [pointing to the east wall] towards Dave’s and that one [pointing to the west wall] toward Amy’s. When I knock, tell me whose house I need to move to.”

After I got upstairs, we were able to find the source…a steam mop in the closet adjacent to the bathroom wall. A little bit of water had dripped out between the hardwood. Upon closer inspection, the floor board beneath was only wet in a small little spot; the board was not wet enough to consider it a leak of epic proportions, as I had initially feared. I emptied the mop and placed a cup on the basement floor to catch the one single remaining drop of water overnight.

In the end, all that stress  that I was experiencing about what might be wrong was all for not, but that wasn’t how I felt in the moment.

I am still thinking, too, about how I communicated with Kristy in that moment. Sure, we found the source of the water, but we didn’t find a leak. I could have just as easily walked down the stairs, looked where she was standing and walked back upstairs again.

Even though I can’t fit in her shoes, I could have at least taken a moment to step out of mine to see which direction she was facing. If I had done so, ‘Left’ would have made perfect sense.