Sleep and the Raveled Sleeve of Care

Shakespeare said it best: "Sleep that knits up the raveled sleeve of care, the death of each day's life, sore labor's bath, balm of hurt minds, great nature's second course, chief nourisher in life's feast." (from MacBeth)

Ahhhhh, sweet sleep. After three fitful nights spent with my Mom, serving as companion, sitter, and daughter, I finally sneaked in a night of more restful sleep last night. Yes, I was still there with Mom but she slept in her recliner and I laid myself out on her bed instead of the floor inside of a sleeping bag (such a misnomer; when was the last time you ever had a really good night's rest in a sleeping bag?) She drifted off around 8:15 PM and I wasn't far behind. She had a good night overall and even though we began the day at 5:30 AM, I added much needed sleep into the depleted account. Tonight I'll catch up even more as I'll be in my own bed at home.

Whenever I'd get over wrought, stressed and tired, Mom always quoted Shakespeare and told me that sleep (always), sweet sleep would "knit up the raveled sleeve of care". As a youngster and young adult, I never really understood what she was saying. After many nights that turned into 36 hour plus "on call" shifts as a medical resident in training and sleepless nights with my children as infants, I began to understand.

That raveled sleeve with its gorgeous pattern of continuous looping threads, damaged by the constant tugging of care in all its forms, is woven back into health by the restorative powers of precious and essential sleep. I enjoy the image, the metaphor of the raveled sleeve as life's rugged and powerful potential eats away at our serenity and balance. But sleep brings back our greatness, "as chief nourisher in life's feast".

These are difficult days for my siblings and me. We face new decisions, new twists and turns, and heartache as we do our best to care for our parents. Nothing is clear; there seem to be no good choices, just an array of options that have no guarantee of success. We do the best we can.

For now, I need to step back, accept that the sleeve of my life is severely raveled and ask sleep to work its miracle of re-weaving. For if not, I will see nothing but darkness.

My First Job

"G", one of my favorite bloggers, at Doves Today participates in the weekly "Prompt Tuesday" writing exercise from San Diego Momma. I happened upon the prompt for this Tuesday: write about your first job and thought I'd give it a shot. The "rules" are fun and easy. I figure that anything that sparks the writing bug has got to be good.

Those first paychecks came my way for work in the clerical section of the Methodist Hospital Laboratory in Houston, Texas. This was the summer of 1973, between freshman and sophomore years of college. I made minimum wage, $1.75 an hour. For the entire summer, I banked only $500 which sounds like nothing these days. As a premed student, I was hoping for a job at a hospital and this was the closest I could get to interaction with patients. None. I worked in what was called "the cage", a glass enclosed office in the center of the lab, filing lab reports and preparing others for transport to the patients' chart. Sometimes I answered the phone but that was a tough go since I usually had no idea what people were asking of me. The learning curve was slow but the filing part I had down in nothing flat. There were four of us in "the cage"; two long time employees and two (me included) as summer help. The other summer hire was a gorgeous blonde with a thick Texas twang. I forget her name but I'll never forget the name of one of the long timers; "Nadine Penix". How could anyone forget a name like that?

Towards the end of the summer, I summoned courage and asked if I might join the team of phlebotomists (we called them "blood draw-ers" back then) and was glad when someone approved my request to do something other than answering the phone and filing in "the cage". The "blood draw-ers" were much revered; I coveted being a part of their group. They were a young and energetic mix of girls and guys, and seemed very cool. Plus, I longed to work with patients which was a plus. I was fascinated by all the blood drawing paraphernalia; the tourniquets, the blood tubes of all sizes with different colored rubber stoppers, the alcohol wipes, the needles of various gauges (the larger the gauge number the smaller the diameter of the needle; go figure) all housed neatly in a open metal carrying case; one to a phlebotomist. Our job was to collect the early morning blood draws all over the hospital and stay on the ready for add on requests through the rest of the shift. The team of five or six of us would wait our turn to be dispatched out by the lead phlebotomist.

I learned a lot that summer and returned several years later to do the same job again. I don't think I was ever very expert at drawing blood but I tried hard. If the veins were good, my work was a cinch but I had my share of troubles too and had to call for back up. The amazing thing, thinking back.....we NEVER wore gloves when drawing blood. That wasn't standard of care in the early 1970s.

When was the last time you had blood drawn by a person NOT wearing any gloves?

Little Black Bag

For the second time this month, a small black suitcase stuffed with requested items for my dearest daughter in Florence leaves my home, entrusted into the care of one of her friends who journeys to Italy for a visit. That friends can afford to travel so far afield now-a-days amazes me but so be it. For several weeks before said bag is scheduled for pick up, I receive emails from L.with small lists of things, needed and wanted. Clothing, snacks, DVDs, her graphing calculator from high school, and various other requests. The same bag made the trip just after the New Year and returned stuffed with items no longer needed in Florence; lots of souvenirs and things she'll put in a scrapbook chronicling her travels through Europe, plus clothing that she was tired of wearing.

I always tuck a small note in the suitcase wishing her well. Even though we chat frequently day to day, putting pen to paper, folding the note and putting the sealed envelope inside the bag does something to me. Today it made me miss her all the more. She's been away since early September and won't be home until early May. Her time away has been important for us both; she has become so much more independent and I've had to learn to let go. Sometimes we "push-pull" this process; I become overbearing just when she's trying to spread her wings and then she'll suddenly seem to need my every bit of advice on an issue just when I'm trying to surrender her to forging her own experience. Maybe that's what mothers and daughters do; I don't know. No one talks about it much.

Bottom line: I miss her.

I take pleasure in unpacking this little suitcase and re-packing it with whatever is on that list. This time much of the space is taken up by items that will not need to make the return journey to Seattle come May. Things like Rolled Gold pretzels, Tim's Cascade potato chips, and Better Chedder crackers are tastes of home amidst all the amazing cuisine of Europe. And, that's good because she's already got so much stuff to drag home that much of it will get left behind at the pensione for lack of luggage capacity. All those textbooks, school supplies, bedding and the like may come in useful for the students arriving this fall to start out the next season of study abroad in Florence. Recycled goods; why not?

Safe journeys.

Makes no Sense....

I find it strange in a not-so-funny way that we're now trying to convince a 91 year old who is continent to let go of one of the last vestiges of control and "pee in a diaper". All this for the sake of the caregiver's back which strains under the oft times dead weight of a sleepy elder who needs to urinate during the night. Elder will have none of it and wants to use the bathroom. Who knew that this insistent choice costs thousands of extra dollars a month to pay a second person to be on the ready to help make this transfer from bed to toilet safely? The care of our beloved elders is a challenge beyond my comprehension. There is always something new and often absurd coming our way.

How is it that we toil to "toilet train" our youngest and turn around to beg our continent elders to just let loose and pee in a diaper? How crazed is that?

I have no other words for this insanity.

O Happy Day!

Mammogram Blues

I'm not completely sure of the point to this post; perhaps there are many.

1. Don't have a mammogram on a Friday.
2. Don't borrow trouble.
3. Don't take what people say so seriously; they are usually just casual, insignificant comments.
4. Being a doctor and having your health care provided where you work is a mixed blessing; in other words, knowing how to access ones own records can bring unnecessary angst.

I had a miserable day today waiting for the result of my mammogram done last Friday. All weekend long I worried because the report wasn't out by Friday afternoon. The clinic where I work is amazing; reports are available within hours of the test. There are very few delays on blood work or Xrays. Have a test done in the morning; get the result by the end of the same day. Unless....unless, there is something wrong or the study needs to be repeated, reviewed by a second person for verification or any of a host of other reasons.

When I had the study done Friday at 1 PM, I expected by day's end to have the result. Instead, I had to wait till today (poor me, you say....how spoiled we insiders get in the medical profession) and played over and over in my mind what the technician said to me after she finished processing my films. "Let me just verify your phone number so the doctor can contact you if there are any problems." I've never been asked that before and since the images were right up there on the screen for her review, I felt certain she had seen something amiss. I could have asked but that's being too pushy and out of line. I would just wait for the report later Friday afternoon.

The report never came and as I checked all through the weekend what I got all 10 times was "results pending". Eeech! I know waaaaay too much and I got waaaaay out of line in my thinking.

Part of the issue is that I have had 2 breast biopsies (benign) but breast cancer does run in the family. I'm ever faithful about breast self exam and show up annually for my mammogram. But, I always have a spike in the old anxiety titer whenever those films are finished and I'm waiting for the results.

My primary care doc forwarded me the report by email this afternoon and all is well. A huge sigh and a mental note to do my mammograms in the future on a Monday through Thursday. Weekends make for a back log that is intolerable for an impatient person like myself.

Sound odd? I know. But we docs get like this, for better or for worse with our own medical care. That's why most docs don't like taking care of other docs (or nurses). We know way too much but not enough to keep us grounded and realistic. We are pains in the ass sometimes. This time, I kept quiet and the angst was all my own. It sure was a relief to know everything was OK after traveling down ever so scary roads in the dark parts of my mind.

"At Sixes and Sevens"

The phone rings at 2:50 PM; it's for me.

Me: Hello?

Him: Your Mother is upset and I'm upset. I'm going to pass the phone to her now.
......noise of phone fumbling.....

Her: Hi.

Me: What's up, Mom? What's the matter? Dad says you're upset.

Her: Oh, nothing. I'm OK. Just the same as usual, just another day.

Me: Anything specific? Dad said you were upset.

Her: No, we're just at "sixes and sevens" around here.

Me: Are you having an argument with him?

Her: Yes, sort of.

Me: About what?

Her: I'm not really sure.
(Pause: I'm really thinking hard here......)

Me: Mom, what would you like me to do?

Her: Nothing. There's nothing to do.

Me: What does Dad want me to do?

Her: (asking Dad) What do you want her to do?
(no answer from Dad....)

Me: Well, Mom; give me a call back if you have something you think I can do for you.

Her: OK. Bye.

Click.

I felt angry. I felt sad. I felt helpless.
And it is what it is.

Later, I called back and got more insight into the situation. And later still I drove over for a brief visit and got even more insight. Simply feeling my way in uncharted territory, sandwiched today between Him and Her and their personal frustrations with each other. Yet, I am asked to play a role, to do something, anything to fix the situation. I don't know how to respond but I do the best I can. It's just got to be good enough I tell myself.

Out of the Mouths of Elders...

Two years ago when I scaled down my medical practice to work part time I turned over many of my longtime patients to colleagues. Periodically however, I still see some of my former patients when they're hospitalized since much of the work I do is inpatient rounding on weekends. Today was one of those days. A 92 year old, spunky lady who I'd not seen for some time was on my list; she'd been hospitalized for a week but was clearly much better and actually ready for discharge; all good. I had been her doctor for several years before I left my full time work.

When I introduced myself to her, she looked at me with her piercing blue eyes and a flash of recognition came over her face.

"I remember you, Doctor", she said. And then, "How are your parents doing?"

I was shocked that she recalled that one of the reasons I had to cut back on my work was to care for elderly parents in declining health. Plagued by her own issues with short term memory lapses, she may have been able to pull up this memory of my parents because I'd always told her that they were her same age and that being born in 1917 was "very cool". Frankly, I was touched that she inquired.

"They're doing pretty well", I told her. "They're just old; the same age as you." and I grinned at her.

She laughed and said, " I can't remember if I'm 91 or 92, maybe it's 93. All I know is that getting old is the SHITS!"

I cracked up, laughed out loud, and reached for her hand giving it a good squeeze.

"You make me laugh!", I said.

"I love you, Doctor".

"I love you too."

In some ways you had to be there; it was a grand scene. She was laughing, I was laughing, the woman in the next bed was laughing. Never one to mince words, this not-so-little white haired lady hit the nail on the head. I'm glad she was able to go home today, that her health is better. And, I think she's right; getting old is "the shits".

I told the story to Mom and Dad today. I got a laugh out of both of them and saw a happy tear in my father's eye.

Out of the mouths of our elders....listen closely one and all.

'

My Challenge

Dementia relentlessly casts its evil spell bit by bit until the person that was is no more. I'm left with anger and frustration as paths of least resistance when I'd prefer the paths of love and compassion. Would that I could overcome consistently the urge to lash out at the person who never chose this disease and who suffers mightily. Would that love infuse this kingdom of pain, beating off the woeful beast that destroys a life while nurturing the nuggets of what remain.



View of the collapsed Natural Bridge on Aruba's north coast

Monday's Lessons

Things I had to learn (again) today:

1. Never argue with someone suffering from dementia. The playing field isn't level. It's not fair by any stretch of the imagination.

2. Quit being selfish; frustration is understandable but how I express this is totally under my control. Think first. Take a breath and think first before letting words out of my mouth.

3. I have incredible power to hurt with my words; remember this every day.

4. I am part of any problem; sometimes small, sometimes large but always play some role. The role is under my control.

Happy Saturday

This is what brought me JOY yesterday. We found a great Mexican restaurant on the main drag in Monroe, Washington called Tijuana. It's the real deal, a find in a land dominated by Northwest cuisine. We drove an hour each way in the rain to enjoy lunch, seated in a booth at this family run business with these two wonderful people, Chris and his girlfriend Heather. Laughs and good food shared with those we love. What could be better?

Sleepless in Seattle

My internal clock went "zing" at 4:30 AM today. After pretending that I could overcome the call for coffee and a start to the day, I gave in at 5 AM, poured the first cup and started reading blogs. The glow of my laptop casts an eerie light in this shared bedroom of mine but Denny doesn't seem to mind my early morning clicking on the computer. He's become immune.

So now, I write my own post for the day on a morning when I felt certain I'd "sleep in" just a bit after a "bust-ass" busy week at work. No way. My brain, on "work-overload" for six out of the nine days into our New Year, has me on the eternal treadmill of thought after thought after thought. I'm in sore need of a restorative yoga class with an emphasis on pranyama and shavasana. Maybe soon, I say. Wasn't my New Year's promise to myself the gift of time to pursue joy in my life? I'm about 10 days behind on that plan but hope springs eternal. I'm off work for the next 6 days and WILL launch, even if it's baby steps, my plan.

One of the first things I need to do is to cure myself of this addiction to modes of communication (including email) but especially the telephone. I walk around so worried that I'll miss an important call (from either my daughter overseas or the adult family home where Mom and Dad reside) that I walk around all day with my cell in my pants pocket and a beeper on my belt. Plus, when I'm home, the cordless phone is never more than a foot away (because if I'm in the shower, I'll certainly hear it ringing). Sicko. But even worse is the insanity that goes on at night. When I'm on-call for work, I've got the pager under my pillow on vibrate mode, the cell phone on my nightstand, and the cordless house phone right next to the cell. Oy. No wonder I'm a jumpy mess.

Do I have an addiction to being "needed"? Duh!

This is dumb and it isn't healthy. I look back on the early days of the cell phone when my clunky apparatus stayed on "off mode" in my purse. I only turned it on and made a call when I needed to do so and incoming calls weren't even on the radar. This sounds so foreign to me now as I live in a world where I feel that unless I'm connected minute to minute 24/7, something bad will happen or something important will get by me. Perish the thought.

So, Sleepless in Seattle (me) is going to work on this problem in baby steps. In fact, I had my first lesson that I don't have to be first up to bat 24/7. Yesterday, unbeknown to me, my cell phone which was dutifully minding its duties in my pants pocket, was on the fritz and all 6 "important" incoming calls went directly to voice mail only to be discovered later. Lo and behold, the world did not come to an end! In fact, those who couldn't reach me somehow made do and figured out a plan on their own for whatever the issue happened to be. Amazing how these folks just forged ahead on their own without me!

I'm learning that if I kick the bucket take myself out of the loop, people all over the world keep breathing, making plans and living quite nicely, thank you. It's a tough lesson, but I gotta learn it. However, I am up for the day, early as it may be. It's still dark in Seattle. I'm on my second cup of coffee and very awake. But, I'm determined today to find joy and to throw the cell phone down the toilet (well, sort of...).

One lovely plan is a road trip with Denny, Chris and his girlfriend Heather to a fabulous and authentic Mexican restaurant in the great town of Monroe, Washington today.

Reflections on Holidays 2008

It is dawn in Seattle and I'm sitting in the living room listening to the grandfather clock tick away the seconds. The Christmas tree is still up and amazingly still smells wonderful. We bought the tree a week before Christmas, fresh, very green, and fragrant. Usually by this time of year, I want it out of my life. Packing up all the ornaments and lights, putting away the other holiday decorations and sweeping up the living room of stray needles and other debris gives me a "new year" feeling. This year, I feel differently.

This Christmas was so strange; unlike any other in my memory. Although we stuck to our typical traditions, we never had a "gathering of the clan" as I like to say. No Christmas pudding, ignited with 151 Rum, brought from the kitchen on a serving platter, blue flames lighting up the darkened room with cheers all around. I really missed those moments. Although I doubt Mom and Dad had this thought, I certainly did: this was the first Christmas in all of Mom's 91 years that she didn't re-live this tradition and for Dad, 67 years of marriage came with the same number of holiday puddings. Sigh. This photo is from Christmas 2007 as my sister and Mom prepared the foamy yellow sauce for the gathered clan. I'm hoping she has another chance to do this again.

Now we are into the New Year. Mom is out of the hospital as of yesterday. We enjoyed a celebratory cake and coffee when she arrived home and a banner just inside the door said, "Welcome Home Doris". She is better. Dad is better. I'm grateful.

Mom mentioned yesterday, "My, I haven't done any Christmas shopping this year; the time got away from me."

I responded, " That's all OK, Mom. Christmas has come and gone and you don't need to worry about it anymore." And as we often say in our family once the day has passed, "Christmas is as far away as it will ever be." I got a chuckle out of Mom on this one; maybe some relief knowing she wouldn't have to think about things Holiday for awhile.

And so today, as I sit in my living room enjoying the last bit of what was Christmas, I'm accepting of where my life is right now. "It is what it is.", as my sister reminded me many times over the last two weeks. We move forward from here. In 2009, I'm going to focus on what brings me JOY and pursue that with more vigor. That's my New Year's plan. Stay tuned for my idea of JOY. I'll probably be writing about it on this blog off and on.

Goodbye Holidays. Happy 2009.

Happy New Year

Happy 2009 to all!

We're about to enjoy some black eyed peas served over rice with a side of collard greens. Our southern roots shine through.

Photo of Seattle's Space Needle fireworks just after midnight last night, courtesy of Crashworks.