Essays

Dear Diary,

Took a break when my father died.

I seem to be back, more or less.

As I write this the coronavirus is raging through southern states, notably Florida, Texas, and Louisiana, as well as southern California.

We are making tentative plans to fly out to the east coast to get the older one to her freshman year of college. We have a “plan”, such as it is, but I’d be lying if I didn’t say I was genuinely worried about the trip. Some airlines are cramming planes full of people (American, United based on Twitter pics) and not requiring masking, although Delta and Southwest seem to be doing both of these things. I’m pinning a lot of faith on masks, based in part on the evidence from other countries.

Other, well masked countries (I’m looking at you Hong Kong, Taiwan, South Korea, Vietnam, New Zealand) are doing a significantly better job at containing the virus. Maybe these countries lived under the shadow of SARS (the prequel) and so were much more willing to adapt to public health mandates? Maybe people in these countries have a different relationship to the idea of public health.  It’s honestly very depressing to see how poorly the US is managing this crisis .  The fact that masks have become political puts us firmly on the lunatic fringe.

At the very least it suggests that large swaths of people in the U.S. don’t trust scientific advice or can’t be induced to take an action in the name of “public good”.  Or it’s the case that we don’t actually contain “a public” anymore, now it’s just “us” and “them” which feels as bad as it sounds.

Every day’s news coverage feels like a deeper descent into madness. The Mayor of Portland was tear gassed while out on the streets? Did he pose a credible threat? It reads like poorly plotted science fiction and I’d love to turn the page and find something else. My only somewhat helpful approach is to turn off the mainstream news and focus on science reporting in JAMA or NEJM or Nature, outlets that report on our progress, what’s been learned, what practices have been adopted and which ones have been overturned.

And these outlets do offer a ray of hope. Monoclonal antibodies. That’s where my money is.  I just read an article in Nature about how scientists have identified a handful of potent, neutralizing antibodies (19) from patients who’ve recovered. They’ve isolated these antibodies and understand WHY they work, i.e. some of them attach specifically to the spike protein and block it from connecting to the receptor on the surface of cells, a receptor that acts as the gateway to inflitrating things we’d like to keep, such as lungs, blood vessels, etc.  The scientists have isolated these antibodies (no small task) and injected them into too-trusting hamsters. Then they expose these hammys to coronavirus by making them hang out in crowded bars (jk, they spray coronavirus in the hammy’s nose) and then check the viral load in hamster lungs. And: good news! the antibodies do a great job of keeping the viral load down.  If and when we figure out a cocktail that works, this could be a very usable bridge between now(ish) and a vaccine.

I have fingers firmly crossed.

Until Tomorrow.

Dear Diary,

Day 40 has arrived in quarantine.

This is the status:

Older Teen is antsy as the day is long….going on long drives, complaining of lonliness, walking around a bit forlornly. Who can blame her? This is supposed to be the second semester of her senior year: a time to spend far too much time with her friends socializing in lieu of working constantly. While the work load has eased up some due to both the time of year and the pandemic, work continues to be assigned and there is essentially no time with friends. To make matters slightly worse, some of her friends are ignoring the shelter in place order and hanging out. I’ve got to find a way to get right with this parenting style, because as of today, I find it wildly irresponsible–a terrible example of social responsibility for our kids and a self centered response to the sacrifices the rest of us are making to move to beyond the pandemic–what’s the lesson here? The rules apply to everyone…except my kids? (As of today, I have not mastered this anger…)

Younger Teen is doing well–she’s established a routine that includes exercise, work and play. She is spending lots of time with older sister–which is a boon, something she definitely wouldn’t have if we weren’t being ordered to stay home.

Husband has been on many conference calls, and when he’s not working with clients, is working in the garden and spoiling dogs.

I continue to search for some measure of equanimity with respect to my health issues. Continually reminding myself that I have no control over my heart issues slowly works its way deeper into my psyche, giving me more calm about the arrhythmia’s that continue to visit me.

And the slower pace of each day creates a space in which to notice the accumulation of small daily changes in the world around me (new plants flowering, a backyard that’s slowly being consumed by grass, a coyote sighting) and changes in myself: a nano-increase in the time before I respond to negative news, an awareness of the good fortune to go another day with my family’s health, more or less, in tact.

Until Tomorrow

Dear Diary,

Yesterday I was back out there, against my will….testing to see if I did, indeed have a mini stroke on Sunday, using noone’s favorite test, the MRI. My distaste for MRIs is well documented. I’ve probably had six at this point, the first of which was in college, the most recent before yesterday, about 5 years ago.  It’s always fantastically stressful–the exceedingly loud alarm bursts, the dark and airless coffin-like machine. When they are examining your brain they pour some extra claustrophobia sauce on the situation by locking your head in its own little cage.

I was the only one in the waiting room. There are signs on all the chairs that say “do not sit”. After standing for 25 minutes (despite being the only one in there) I checked in with the receptionist to see if it wouldn’t be a better idea to wait in the car. She agreed.

While in the car I had another episode of a fib. My heart felt like something rumbling around under the covers, identity unknown, except it was trapped in my chest and I knew exactly what it was. I tried to put my foot on it’s neck through deep breathing, imagining that I’d grab hold of my CNS and calm it the fuck down. In the midst of this wrangling, my phone rang.  It was the MRI office calling to tell me to come back.

I walked across the empty underground parking lot, back into the building, back into the MRI office, back into the room with the device. I’d come dressed in multiple layers, none of which contained metal. My heart was still eggregiously out of sync. The tech instructed me to get on the specimen tray. I asked him, “how do I let you know I’m freaking out? I’m having a fib right now!”

“That’s okay,” the tech said. “You’ll be fine. But squeeze this panic ball if you need help, okay? Off we go!”

He closed the cage over my face and pushed a button to move my specimen tray into the belly of the beast. Then the alarms started. It literally sounds like you are inside a firehouse with a four alarm blaze threatening outside the body of the machine. I thought, “how on earth will this work for the a fib? I’m going to press the panic ball and get the hell…out of here.”

But then I didn’t–because I didn’t want to go through this drill again, and I wanted to figure out if I’d had a stroke Sunday night or not. And miraculously, about 5 minutes in, my heart quieted down–in the midst of the agonizing claustrophobia and the blasting noise, I settled into a deep breathing routine.

I went home, did the Silkwood, waited to hear about the results. Hours ticked by. I convinced myself both that my neurologist would sit on bad results, and why she’d call me immediately with bad results and what it possibly meant to have no results.

More hours went by.

And then she EMAILED–total victory.  Scan was clean.

That is more than enough excitement for one day. I went to bed at 7:30.

Until tomorrow.

Dear Diary,

Apparently the exciting part of this months long shelter in place is not over.

Yesterday I woke up and my right leg below the knee was numb. By the time I actually got out of bed, around 7, I had strong pins and needles. My foot and patches of my calf and ankle had been in various states of numbness since 4 am.

Although it was Easter, I called my cardiologist early to get his take. I’m new to these issues, but I’d been told to worry about a blood clot with a fib, and this numbness felt like the physical representation of a blood clot to the uninformed. Despite being called too early on Easter, the cardiologist was very nice, and strongly encouraged me to go to urgent care. He, it turns out, was worried about a TIA-transient ischemic attack, aka a mini-stroke.

After repeating the covid precautionary course at my doctor’s office, I made it in to the urgent care waiting room. Again, I was the only one in there. We did some bloodwork and the urgent care doctor ran me through the standard physical exam for someone with suspected stroke: looking for coordination and weakness issues.  I passed all those tests, but couldn’t get an MRI because is was Sunday and radiology was closed. As a consequence, I was released in a state of semi uncertainty. It was either a mini stroke or a pinched nerve in my back.

The doctor chose to treat the biggest threat from those two diagnoses: a much larger stroke. If I had had a TIA, the probability of a stroke is much higher in the following 48 hours. The TIA is to a stroke what a tremor (or foreshock) is to an earthquake.  The urgent care doctor put me on serious blood thinning medication.

I may or may not be cleared from the stroke diagnosis on Wednesday after my MRI.  I have been alternately completely freaked out, and completely zen about this crazy state of affairs. The zen feeling comes when I remind myself that I have no control over my beating heart and the way my blood does or doesn’t clot. All I can do is be careful about my interaction with people outside,  seek medical care when necessary, and try to remain calm. That’s about as far as my influence extends. My body will do what it always does, whatever the hell it damn well pleases.

Having said that, a mini-stroke in the midst of a pandemic? To quote Jennifer Mendhelsson’s twitter feed: Go home 2020, you’re drunk.

Until tomorrow.

Dear Diary,

Apparently I’m desperate for excitement. Chomping at the bit..totally unbeknownst to me.

It happened yesterday morning. I woke up feeling…off. It felt like maybe my heart was kartwheeling when I went to get my coffee. But then the feeling left me.

I walked the dogs, and the kartwheel-feeling returned, and this time it was pissed. It felt like three cue balls were rolling around in my chest. I fell on the coach and shakily called my primary. The advice nurse told me to call 911.

Lying on the couch I could hear the sound of the ambulance through the open front door. The dogs, locked in the backyard, bayed at the wailing siren. The EMTs swept into the house in their big boots and face masks, filled with confidence and calm. My EKG didn’t show arrhythmia, but it did show a super high heart rate for someone who’d been lying down for the last 10 minutes. The EMTs kindly loaded me into my car and sent us to urgent care.

We drove to urgent care and found…a careful covid gauntlet. A string of people with orange flags waved us through the underground garage to the far back corner where we stopped and talked to health care workers about the purpose for our visit.

Two nurses, wearing masks and gloves, came to the entrace of urgent care to let me in what appeared to be a locked front door. I was the only patient in the waiting room, and ultimately the only patient in the urgent care ward. The ratio of healthcare workers to patients was about 10:1, me being the one.

The first EKG showed atrial fibrillation and a relatively high heart rate (101 bpm lying down). I did bloodwork (at my bedside), took X rays, and had an IV. Two hours later, filled with saline, my EKG and heart rate snapped back to  normal…and I was released!

I came home and, Silkwood style, peeled off my clothes in the laundry room and showered immediately.

It sucks to have a problem during corona lockdown–everything seems more intense. But the nurses and doctor tending to me seemed completely composed and not as afraid as I was. I think the urgent care clinic I visited had made the executive decision to divert all respiratory illness to a different location, that choice, in conjunction with the underground garage routine potentially made the staff feel relatively confident that I was not dragging in any unwanted virus. Or maybe it’s just their excellent training and professionalism.

Whatever the source, I am totally grateful for their attention.

Until tomorrow

Dear Diary,

Q; Have my dogs been accused of being uncivilized in the past?

A: you bet.

Q: Has it been a moniker that’s deserved?

A: To be fair, it depends. They tend, as a breed (spanish water dogs) to be distrustful of men…so there’s not alot of tail wagging greeting of strange men going on–which, who are we kidding, is fine by me. Although less fine when it’s my friend’s husband, or my husband’s friends.

It’s also true that the dogs can be initially obstreperous with women they don’t know either…but once they know you, there’s lots of happy yipping, jumping to kiss, tail wagging, etc.–basically the handshake of the yellow lab.

Little did I realize that what these dogs are, in what can only be described as a complete marketing oversight, is pandemic dogs.

I’ll set the scene. We are out walking. A jogger/walker/gaggle of teens is fast approaching from behind- which I might not hear because I have one ear of my headphones in. If said J/W/GT comes anywhere near me, where near is defined as within the perimeter of their leash plus my outstretched arm–about 7 feet– my dogs will lunge wildly at said J/W/GT and bark like there’s no tomorrow.

In the pre pandemic world I thought about this behavior as…bothersome. I’d have to apologize profusely, keep their leashes shortened in my tight fists, etc.

Now, however, during social distancing, they turn out to be a pandemic must have. Let’s face it, my dogs are basically sitting at home making N-95 masks for people in our neighborhood by keeping me 7 feet from others, and others 7 feet from me. True heroines.

To appropriately commemorate what I now recognize as their valiant actions, tonight they will be generously rewarded with bones and treats for their brave pandemic efforts!

Until tomorrow

Dear Diary,

Last night right before bed I made some comment about quarantine life and my hub said “it is what it is”.

That phrase may just recall the late 90s for some people, but thems are trigger words for me.

The last time in our lives when my hub and I uttered this phrase to each other daily, passing it back and forth because it encapsulated some of our more untouchable fears when we couldn’t state them directly, we were waiting on the outcome of my first pregnancy.

Half way through that pregnancy, at 25 weeks, our baby-in-progress was diagnosed with a potentially lethal cardiac problem. The high risk OBs that hastily replaced the gynecologist I’d seen for years, predicted our baby would die.  Likely with this heart problem she’d die during the pregnancy, but if by chance she managed to survive her gestation, she’d likely succumb during the birth. Birth puts an incredible strain on a baby. Blood flow reverses in the heart. Lungs have to expand. Transforming from a fetus to a baby is an enormous undertaking.

Our condition was exceedingly rare. It’s estimated that 120 of the almost 4 million births a year in the US will experience this mistake. The working theory at the time was that my immune cells attacked cells in the fetal heart, mistaking them for a threat. They didn’t destroy any ol’ cells, but focused on one of the two cell bundles that set the heart rate, the AV node.

The fetal heart rate dropped from 120 bpm to 50 bpm in a week, while we watched, helpless. We couldn’t deliver her because she’d be a preemie with a serious heart condition. If we left her in utero her heart could fail at any moment. We were trapped.

We lived with the fear of her imminent death for twelve weeks—2 and a half months. We lived every minute of every day for those two and a half months. I tried to establish a routine that distracted me from the very real possibility that her heart would stop and I wouldn’t know it until the next ultrasound. I went for walks, I spent hours working, I watched TV with my husband at night. Lather, rinse, repeat. For 75 days.

When I walked around the city I’d check behind me to make sure I wasn’t being followed by anyone even remotely resembling the grim reaper.  Spotting someone in a long black coat was enough to make me change my route.

Being trapped with the fear of our future daughters death is an experience that shares some things in common with the pandemic. It was a daily struggle in which I had very little control and few opportunities to change outcomes. It required enormous patience and a new focus on the ‘now’ that had never been attractive before and ran counter to many facets of my personality.  Like most people, I don’t want to wait for results. If something bad is going to happen, I’d rather know sooner than later.  It required a faith in our medical team, even though we all knew that there was scant medical knowledge to be had.

My pregnancy lasted for 37 weeks at which point our doctors decided to “get her out of there”.  Contrary to prediction, she survived her birth–although she failed the apgar immediately and was whisked off to the NICU.  She survived the open heart surgery performed two days later to implant a pacemaker. And was released from the hospital after nine days.

She will turn 18 in May.

That was one of the most stressful experiences of my life. I tried to carry on a semblance of normal life while also holding tightly to my fears for what felt like a long stretch of time. I have been haunted by that trapped feeling in the years since that experience. It pops up in unexpected places, and takes some time for me to dig it out. But here we are, still living our lives.

Now we find ourselves waist deep in the uncertainty of the pandemic. Once again I’m trying to take it one day at a time. If my family wakes in the morning and has no symptoms, and we all go to bed without said symptoms, I’ll take the win. Lather, Rinse, repeat.

Our reality bears no resemblence to what we’d planned for this spring, but, It is what it is.

Dear Diary,

I guess you could say that what we are doing at this point feels like it has a rhythm.

Kids have zoom school Mon-Thursday from 8:45 to 3:30…with breaks for which I am entirely grateful. It’s strange enough to be trapped inside all day, any semblance of normalcy will be pawed with appreciation (since it’s the only safe thing to touch).

The hub is working from home, taking many calls, either in my office, or our bedroom or outside among his Japanese Maples in the backyard.

I’m trying to write and or research (which is hard when the medical library is closed and all the good journal articles require special access)  from the various places he is not taking a call.

Somehow the days have a strange elastic quality to them.  Somehow they are both shorter and longer than the pre-pandemic days.

I am waking up later, so staring work later, and probably stepping away from the computer earlier in the evening…which should make the day feel abbreviated.

But when I’m not writing or researching, I’m trying to track down toilet paper (so far, unfailingly unsuccessful–I don’t understand where it’s all gone and why it’s not being replaced?), trying to order groceries from somewhere, researching recipes to make the 9 zillionth meal for someone, cleaning everything that’s too slow to get away from me with lysol (so dogs still require a bath), washing clothes and dishes, walking dogs, reading about the latest Covid updates, talking to my family and a few friends, texting, twittering, working on this website….

Its a very weird suspension of time and space, and that’s only for the lucky ones who aren’t sick yet….what’s going on in hospitals all around the country feels like it’s happening in another country. Doctors, nurses, hospital staff and working themselves far too hard while the rest of us are idling…unable to do anything helpful other than distancing. It’s a strange distribution of effort (and I for one am opposed to it).

until tomorrow