Monday, April 29, 2013
Vigil
Sunday, April 28, 2013
Vigil
Saturday, April 27, 2013
Vigil
“The healing process of the brain is more like running a marathon than a short sprint. It has a longer time frame.” ~ ICU doctor
There are three things that influence your perception of a patient’s recovery: 1) The placebo effect – or the expectations of both patient and observer. 2) The variability of the mind – mental activity follows a natural cycle. It’s wave-like; waxing and waning on it’s own. 3) The observer effect – the tendency to focus on one phase of the cycle more than the other. Expanding wanted periods and minimizing unwanted periods or vis versa.
Day fourteen: Laura had endoscopic surgery this morning to create an opening between ventricles that will allow one to drain into another. They left the external drain in place but clamped it in hopes the ventricles will take over. Now all we can do is wait and see. Like watching anything in nature, I’m reminded of the ‘observer effect’. After the anesthetic wears off ..Laura sees me, Vanessa, doctors and nurses hovering anxiously over her asking the same questions as before. I don’t place much stock in the answers and don’t remember them. She nods back to sleep. Periodically throughout the afternoon I grasp her hand ..wake her up ..and guide her through some deep breathing exercises ..squeezing her hand while inhaling and relaxing it while exhaling. I go “Breathe in ..hold your breath ..breath out ..relax yourself.” I use dramatic gestures to indicate my own breaths. Whether or not she can follow is almost beside the point. I figure just observing can effect the mind and simulate the action (Dr. Ramachandran). I know I look silly but I don’t care. Her intracranial pressure (ICP) is running high right now due to the procedure and it is my intent to do anything I can think of that may help bring it down. Her ICP is an indication of how well the ventricles are doing on their own. After half an hour it has gone from 18 to 13 (it’s normal range is between - 6 and 20). During the next half hour it has remained at 10-13. I’m aware I’m observing a fluctuating system that changes on it’s own. How much of it is due to the healing process, my efforts or just the passage of time ..I have no clue. When the nurse comes in I mention what I’m doing. He shows me another line on the monitor that measures her respiration. It has been elevated for the last half an hour. He says there’s a loose relationship between it and her ICP. Sure enough, when her respiration was high ..her ICP was lower. He explains that high respiration means a higher rate of CO2 exchange between blood and cells, which leads to enhanced drainage. Now I don’t know if he’s telling me this just to make me feel like I have a better handle than I do on what’s going on. I’m aware that the observer effect extends to everyone in the system. The CAT scan tomorrow morning will be more telling.I feed Laura lasagna and salad. She’s ravenous but insists I finish it. I take a couple of bites then she nods off to sleep. I go to the cafeteria for BBQ chicken and rice.
Friday, April 26, 2013
Vigil
Day thirteen: I bring Laura coffecito and a banana, which helps relieve her stomachache and constipation. PT comes in and has Laura marching in place. She helps her into a chair where we continue our discussion of images from a book of design. Shannon comes in and conditions and combs out Laura’s hair. An assistant braids it. We try resuming our discussion but Laura is in obvious pain. Her sacrum hurts from lying in bed for almost two weeks now. She attempts to leave the chair and transfer into bed. I applaud the effort but it’s a chance I’m not willing to take. She gives me a look like: don’t be such as wuss .. I don’t need no nurses. I manage to stall her until Shannon arrives. She falls asleep immediately. The physical therapist will be in tomorrow to show me some bed exercises we can do to help relieve the soreness in her tailbone.Dr. Kamilla Vagnerova from the ICU surgical team comes in for an extended visit. On a high definition monitor she shows me Laura’s CAT scans from day one. I see the injury site. It was a nasty hemorrhage. 4 on a scale of 1 to 4. She bled in the space between the brain and skull. The surgery was a success but blood and cerebrospinal fluid don’t mix. It interferes with the drain action in the ventricles. I see the results on the scan. The endoscope procedure tomorrow should relieve this. She shows me the site of the ischemic stroke Dr. Dogen told me about. She re-affirms what he said ..it’s not in a significant location. OK. She also re-affirms what Dr. Hardaway said ..the vaso-constriction is mild and limited to one vessel.While Laura sleeps I take one of my many walks through the forest outside.This evening while Shannon wheels out the dinner tray, Laura bolts upright and shouts: “Hey, what about him ..?” meaning where’s my dinner and what kind of host are you. We laugh and I assure her I’ve already been taken care of. After this Laura insists on sharing her meals with me. Very Laura-like.
Thursday, April 25, 2013
Vigil
Day twelve: At 9:00 am I bring Laura coffecito and a banana to hold her over until breakfast arrives. Vanessa arrives at 11:00 am. Dr. Francine Hardaway ..a brain surgeon who looks like Reese Witherspoon comes in and tells us that the upcoming endoscopic surgery has a 90% chance of success. The opposite of what Dr. Dogen told us yesterday. I like those odds better and decide I’ll stick with them. I really don’t want to see Laura leaving here with something foreign in her head. She gives us the results of this morning’s angiogram:
- There’s only a slight constriction (vasospasm) going on in her prefrontal cortex, which accounts for Laura’s confusion. Normal for 12 days out.
- Her speech centers were not involved as Dr. Dogen previously thought .
- The blood vessels at the injury site look good! No sign of weakness there.
I finally feel like we’re out of the woods. I could kiss Dr. Hardaway.Nurse Shannon who I greatly admire ..gets Laura sitting in a chair. Something neither Laura or I can do because of the drain. I feed her lunch then bring out the design book. Big pictures of remodeled homes. Laura is transfixed. We chat and I ask her what she likes and doesn’t like. She studies them and comments on the size of the kitchens ..the height of the tables ..and the wall hangings. I ask her about the design of one that looks particularly Japanese. She calls it ‘bamboo’. Close enough.
Wednesday, April 24, 2013
Vigil
Tuesday, April 23, 2013
Vigil
Day ten: “Laura! Are you there ..?” She opens her eyes. A hint of recognition crosses her face and she smiles faintly at everyone looking anxiously down at her. “Can you tell us where you are right now ..?” “Umm, church.” “No, you’re in the hospital ..what month is it?” “Uhh, December ..(?)” “No, it’s April.” She looks confused then disappears until next time they wake her with the same drill. I just arrived at her room in ICU - Neuroscience unit. The doctors call it delirium. It is where they expect her to be for right now. I call it the fog of fever .. aftermath of a traumatic brain episode (subarachnoid hemorrhage). Sometimes she emerges, calls me by name and rolls her eyes when I ask her about today’s nurse. Other times she wakes up but the dream lingers on .. obscuring the view. Any answers we get may be referring to that. She may also be struggling to find the right word. Either way, what’s comforting to me is that I hear and see the Laura I know and love. Even though ten days have gone by, that’s still pretty early in brain-time. There’s much more healing left to go. Patience.
Saturday, April 23, 2011
Austin city limits
Friday, September 25, 2009
Gone
Laura calls from Austin and tells me her truck has just been repossessed. I rack my brains trying to think of what I can do to help, but the best I can come up with is .. “let me see what I can do.” Guess she’s heard that often enough because she says “ ..that means you aren't going to do anything” ..and hangs up pissed. Well, that’s disturbing news ..I feel my heart racing and my mind spinning. I’m frantically trying to find a way to help, but keep coming up short. Perhaps I should make a few phone calls and get some advice. I figure this probably isn’t the best time to do that, so ..I grab my fins and head for the shore ..the words “aren't going to do anything” still ringing in my ears. The water is calm and classy, again ..like yesterday. Offshore conditions have definitely prevailed. I swim vigorously, then relax and float. My heart has stopped racing and my mind has stopped spinning. I still hear the words “aren't going to do anything” circling my head ..but at much longer intervals. I still haven’t figured out what to do ..but at least I’m not taking it out on myself anymore. Hopefully clarity will prevail.
Tuesday, July 29, 2008
Laura
Tropical storm Laura passed through town today ~ in her hand was a pre-paid attorney's plan. Looks like someone's in for trouble ~ I’m not going to go into that now however. We had breakfast at IHOP. Although she prefers the hot salsa heuvos rancheros at Rose’s ~ so do I for that matter ~ my stomach won’t allow it. Afterwards we collapse into lounge chairs on the deck ~ she plays a CD she bought from a singer she saw performing at the airport in Austin ~ Amanda Lepre ~ a folk rock artist who plays a mean guitar [see video below]. We talk about life in Austin ~ and how US drug policies are turning her trips to Mexico into some kind of obstacle course ~ where military checkpoints send her back and forth to get the proper visas and identification to continue her trip south to the town of Monterrey ~ where she was born and raised for god-sake.
Saturday, June 21, 2008
Solstice
I drag my tired ass outta bed ~ pop a couple vitamin C and chase them with coffee ~ reminding myself that this is not the best way to absorb them ~ I trudge down to the parade route ~ planning to catch the tail end and follow it to the festival at the park ~ a plop my ass down on the curb and watch the parade pass ~ I see Arabian belly dancers ~ King Neptune and his mermaids ~ Egyptian pharaohs ~ contortionists ~ acrobats ~ Swedish campers wearing only backpacks and hiking boots ~ Ojai girl riding a bike ~ wearing only pasties ~ children chasing bubbles blowing out the back of a float ~ and it dawns on me ~ this isn’t the tail-end ~ it’s somewhere near the middle ~ which suits me fine ~ I haven’t been keeping track of time ~ particles of shimmering colors rain down from the sky ~ and I’m mesmerized. After the grand finale I duck into Starbucks ~ it’s like 100° out ~ and the humidity is like 100% too ~ so, I figure I’ll sit here and conserve energy (and fluid). When I arrive at the park I see a swirling mass of multi-colored humanity ~ I plunge in and collapse under a tree ~ the drummers are drumming but there’s no one dancing ~ I sit up and see everyone passed out ~ I’m drenched in sweat ~ which mixes with sunscreen ~ and goes into my eyes ~ burning like hell ~ I flush them with bottled water ~ do some deep breathing exercises ~ feel hot air burning my lungs ~ and still see no one dancing ~ someone passes me some herb ~ which makes my lungs burn even more ~ sweat and sunscreen continue to fall into my eyes ~ I’m parched and blind but too stoned to get up and look for water ~ or anything else that may refresh ~ Laura is going to meet me here but I’m wondering how long I’m gonna last ~ when a beer vendor drops off several bags of ice in front of me.
Wednesday, March 19, 2008
The pioneer
The telephone wakes me from deep sleep ..it’s Laura’s voice on the other end and I’m instantly wide-awake. She’s in Austin Texas ..scouting the housing market, the job market and schools for her and Karla. Yesterday she was in San Antonio ..but says she prefers Austin ..where there seems to be a lot more going on ..economically and culturally. I agree, although I’ve never been there ..I used to watch ‘Austin City Limits’ ..so I tell her it’s the ‘capital’ of country music. She doesn’t sound impressed. She tells me she had to drive through a brutal storm to get there ..and the wind and rain made her pull off the road several times. Today, however, it is clear and she’s OK ..which makes me feel greatly relieved (Later on, I find out that parts of Texas were flooded ..and the Dallas airport closed). In Austin, she actually made contact with a couple of Architects ..one through the paper ..and the other one outside an OfficeMax ..which was next to a HomeDepot ..which was next to the Starbucks where she was having coffee. Sounds promising. Later on, she drove by the high school ..where she says even the ‘gothies’ look busy ..reading ..or working on their laptop ..not scary .. traveling in gangs ..or anything like that ..making her feel less anxious about Karla’s safety. She’s driving back to Monterrey Mexico now ..five more hours to go. I’m impressed with how tuned-in she is to American culture ..it’s very different than Mexico ..where her sister ..and most of her girlfriends still lead traditional lives as wives and homemakers. She says she had to laugh ..her sister thought ‘Juno’ was a great movie .. but the ending made her cry.
Friday, August 31, 2007
Breakfast of demons
The telephone wakes me in the morning ..it’s Laura asking me if I want to go out for lunch today. I say OK ..stumble out of bed and go downstairs ..where I’m confronted with forces sent to destroy my breakfast ..and thrash my kitchen. While I’m not paying attention, the coffeemaker overflows ..spilling coffee across the counter top, down the cabinets and out over the floor. I stop what I’m doing to mop it up ..and clean the cabinets ..both inside and out. Next, the oatmeal explodes in the microwave ..I stop what I’m doing to remove the mess ..burn my hand on hot sticky oatmeal ..react by swearing and waving my hand in the air to cool ..causing the bowl to crash on the floor ..splattering oatmeal everywhere. I stand and stare ..dumbfounded by the gooey mess I’m in. I breathe deep, wipe everything off and start over again. I’m slicing a mango, wondering if the oatmeal is going to explode again ..when the mango slides out of my hand and the knife cuts into my finger ..sending my composure out of sight. I perform first aid ..wipe the blood and mango juice from the counter top and cabinets ..both inside and out ..scream at whatever demons are screwing with me ..and sit down with a glass of orange juice ..figuring this outta’ hold me till lunch.
Friday, August 3, 2007
Ash Friday
The darkest part of the day is around noon ..the sky is a gloomy shade of black and orange ..the colors of Halloween .. heavy metal goth ..or doom ..there’s a fire in the mountains ..and an onshore flow from the ocean ..creating an eerie glow ..ashes fall like snow ..piling up on my shoulders ..and going up my nose ..I choke, spit, bitch and moan ..while Laura looks up ..she was in Mexico City during the earthquake of ’85 ..and says ashes also fell from the sky ..and I’m like ..from what, a volcano ? and she says no, from broken gas lines and burning people ..I cringe ..how ghastly that must have been ..yea, she says ..but not when you stop to consider how we’re always inhaling the molecules of our ancestors ..and I’m thinking ..how metaphysical.
Friday, July 6, 2007
Day eight
Karla arrives here right after school ..we go to IHOP then to the mall for tennis shoes. They don’t have my size so I get a pair of sandals instead ..they don’t have the one’s Karla likes ..so we go looking for a store that carries Adidas without the colored stripes. We find them at a Footlocker store ..but then she remembers that Laura told her not to get them until she sees her grades ..which means I can’t get them without undermining Laura’s authority ..so, we take Andy to the park instead. They wait there while I go to physical therapy ..where I put on a pair of goggles so they can track my eye movements while moving my head around ..to see if my eyes get spastic trying to compensate for problems with my inner ear ..(?) (sense of balance). They say I have problems with ‘gaze stabilization’ ..who’d of thought ..this means I can’t even gaze properly. I thought it was my speciality. Back home, I have a smoothie while Karla has broccoli, avocado and cheese with mayonnaise and soy sauce ..I feel light headed so I lay down for awhile ..later we watch Shrek 2 ..which makes me laugh ..and feel better .. so I make some pasta and stay up to watch Wimbledon highlights ..and Jay Leno. Tonight is Karla’s last night here ..tomorrow Laura arrives home after eight days in Mexico ..untangling immigration/adoption problems. I’ll miss Karla’s company ..she’s good natured and delightful to be with.
Thursday, July 5, 2007
Day seven
Karla comes home right after school today ..thinking its Friday ..so, she plays with Andy ..cleans Fred’s cage (Aria’s pet rat) ..and I take her skateboarding on the strand. I unhook Andy and let him go running on the beach ..where he runs into Judy and Michael ..who love Andy because they once owned an Airedale too. On our way by the skateboard park, some boys howl at Karla and hide .. she is embarrassed ..she knows them from school and says that they are only doing it because they know it makes her mad. Afterwards, we have Pho and Dover Sole at Little Saigon ..I love the way they prepare the fish ..and I drink fresh coconut out of the shell ..which I haven’t done in a long time ..I don’t know why. I ask a couple of the waiters, who recently emigrated from Vietnam ..if they had problems with Hanoi about coming to the US. They say no ..they are foreign exchange students. I tell Karla that relations between Vietnam and the US must be better. She has no idea what I’m talking about ..or even why I asked the waiters anything. See, she says .. even they say there’s no problem ..and I start thinking: maybe I’m the one who’s out of touch. Later, Karla shows me her interior decorating job ..she corrected a problem with the lighting in the guest bedroom. Now people won’t have to grope in the dark to find a lamp switch. I tell her what an excellent job she did.
Wednesday, July 4, 2007
Day six
We Drive to Ventura to pick up some more stuff for Karla ..and attend a possible Fourth of July block party ..but there’s no one around ..so we grab the stuff and get out of town. I drive back to Santa Barbara and take a detour through the mountains ..which annoys Karla. Back home, she reads the lyrics while listening to another Grateful Dead CD (Workingman’s Dead ..my favorite). I think she has near perfect pitch ..not because she can follow the Dead ..but because she can match the sound of just about any of the hip-hop singer she hears ..as well as the sound of the blender and coffee grinder. She says she wants to learn the flute ..and play in the high school band. I tell her she’ll be the first hip-hop flute musician. This evening we have soup, broccoli and avocado ..with mayonnaise and soy sauce ..kind of like a California roll without the fish ..afterward, we watch the fireworks from my bedroom window ..even Andy gets up on his hind paws to see. I remind Karla to come home right after summer school on Friday ..so we can have lunch at IHOP ..then go shopping for tennis shoes.
Tuesday, July 3, 2007
Day five
Summer school and the Boys and Girls club ..Karla is making a pouch for her iPod ..and learning ‘relative clauses’. This evening she reads lyrics while listening to a Jerry Garcia CD called 'Shady Grove' ..which is made up of nineteenth century British and American folk tunes ..sung to guitar and mandolin ..each one tells a story ..some of which she finds funny. I switch to some early Grateful Dead ..and get out a book of lyrics (Box of Rain by Robert Hunter). It’s really not her preference in music ..I know she listens to some pretty classy hip-hop ..people like Chris Brown, Akon and Gwen Stephanie. To her, rock and roll sounds like a party full of loud and obnoxious drunks. That makes me laugh ..but I know what she means. Anyway, she reads along to a few Dead tunes .. says she likes ‘Tennessee Jed’ and ‘Ramblin Rose’ ..and tells me she can hear the similarity between Celtic music and Bluegrass ..and Bluegrass and Grateful Dead (Jerry Garcia started out playing bluegrass in a jug band) ..I feel proud ..we eat leftover chicken and salad for dinner.
Monday, July 2, 2007
Day four
Karla leaves for summer school at 8 am ..from there she goes to the Boys and Girls club until 5 pm ..meanwhile I play with Andy ..discuss the creek situation with Raul ..plan my day ..my week ..and my month (don’t know why, everything after this moment is a crapshoot anyway) ..I catch up on my ‘book-keeping’ ..which means paying bills that are either due ..or past-due ..I pick up Karla ..and we go to the post office ..tri-county produce ..trader joes ..and scolaris ..we stock up on sparkling apple cider ..avocados ..brie cheese ..crackers ..oreos ..ice cream ..cup of noodle soup (I hope Laura isn’t reading this) ..and carrots and broccoli (just in case she is) ..but couldn’t find any fresh papaya or mangoes ..we have baked chicken and one of my masterpiece salads for dinner.
Sunday, July 1, 2007
Day three
I sleep late ..Karla has been up since 7 am watching cartoons ..we go for bagels and cream cheese on Milpas ..then skateboarding and walking on the strand with Andy. We swing by the skateboard park ..but Sean isn’t there ..he’s a surfer dude with long blond hair who sits next to Karla in one of her classes ..there is plenty of sunshine though ..and crowds everywhere ..big pelican convention going on in the tide pools ..and tourists galore ..there’s a van in the parking lot drawing a lot of attention ..it’s plastered, inside and out, with every imaginable icon of American culture ..from the fifties to the present ..in pictures ..figurines ..dolls ..and various assundry paraphernalia ..real kitsch. A picture of Timothy Leary immediately pops out at me ..Karla recognizes Sponge Bob .. Justin Timberlake ..John Lennon ..the cast of Star Wars ..Taz ..and Barbie ..or is that Marylyn Monroe ..Karla says it’s Madonna ..we sit and vegetate at the end of the pier for a while ..then go to Nature Cafe for avocado sandwiches and smoothies ..and another humongous So Cal day slips away.