the modernity ward

ParaGardian Angel

I picture it in there like a tiny copper referee, arms outstretched to signal...um...Unsportsmanlike Conduct! If the crossbar of the T were angled differently it would be all, "It's GOOD!" but no, Unsportsmanlike Conduct is what the ref says. Maybe it's what the egg thinks when it hops off the Fallopian twisty slide and encounters a towering metal obelisk, cue 2001: A Space Odyssey theme. duunnnDUNNNDUNNNNNN  DUN DUN! BOMbomBOMbomBOMbom.

And this is the university's faculty practice so of course I let the student midwife do the insertion. She was sweet and very nervous, and I got to chat with her and the director of the midwifery program while they viewed my cervix and poked things into it. Seriously, if you need to learn how to do some uncomfortable gynecological procedure, I'm your woman. I have a high pain threshold, can relax everything, and even if something does hurt I'll hold still and tell you calmly instead of freaking out. I can tell you whether you've got ahold of my fundus or not. I am a goddamned educational aid! And I am awesome.

The insertion went off without a hitch (when you factor in extra time for teaching) and now? I neither have to fear nor hope for pregnancy. The latter can be more of a burden then you'd think.

So far I haven't noticed any extra bleeding or cramping; we'll see how the next few periods go. There is one thing they don't tell you about, though. It's a really bad idea, I have discovered, to come home from the procedure and sort outgrown toddler clothes for the thrift store.

 

 

 

State of the Leery Polyp

• Rocked the GRE. 740 verbal, 710 math, writing scores pending. You know, just in time for me to not apply to grad school. Har. Believe me, I don't report this out of a desire to expose my superior test abilities, but because it shocked the heck out of me. Not the verbal so much, but the math! The math! I credit this book for taking me from a 490 to a 710.
• Our house now boasts four humans, one cat, one dog, one turtle, and four chicks. Sometimes the answer to chaos is more chaos. It's awesome. Frankly the turtle and the chicks are the easiest inhabitants of the house.
• I am righteously sick with a real bear of a virus. Sophia and Daphne have already had it; Sophia earned two very infected ears. I just feel awful and have to, you know, keep doing the do. Cook and serve food to the ingrates and be crawled upon and dispense Band-Aids and pick up all the tiny socks that have been tied into knots and strewn about the house (Why? WHY?).
• And it's spring break for Sophia so I'm sitting here feeling guilty that we're not hanging out with friends and doing all sorts of awesome things but I can't even handle the grocery store at this point.
• Ooooh and Thursday is IUD day! It should be interesting, as I shall be traveling directly from the midwives' office to my A&P lab where I may be expected to give a PowerPoint presentation about the female reproductive system. If I get any crap about being late I will describe my recent procedure in detail and boy, won't that show 'em.
• It is so strange and so freeing to make the transition from my fertility defining everything I think to being able to contemplate something happening a month or six months or a year away without at least some part of my brain rubbing its hands together and thinking, "oh, but what if you get pregnant?" Every month I was in danger of sabotaging myself around ovulation (that powerful hormone brain!) and toward the end of each cycle I got antsy and preoccupied, hoping and worrying. No more of that, now. It's like clearing out a pile of junk that's been sitting on the kitchen counter for ten years. Ten years!

 

Running Up That Hill

When I was in fifth grade and we ran the mile in PE, doing laps around orange cones in the field next to the school, I made it around once before my chest started to burn and the roots of my bottom teeth started to ache. I slowed to a jog, then a walk; finally I bent over, hands on knees, and gave up.

Our PE teacher seemed disappointed, although not surprised; if there was a volleyball flying through the air, it was sure to whack me in the head. On the other hand, if a softball came my way, I'd shy away and let it bounce off into right field. I was just...unathletic. Terribly out of shape. He shook his head in exasperation, and I felt guilty, but I just couldn't make my body run any more.

My cousins would come over to play, wanting to run up and down the creek bank, and I'd make up excuses, the most notable of which was that my bones were brittle and would shatter if I tried to run. That one prompted a call from my aunt to my mother. (We knew someone with osteogenesis imperfecta, so it wasn't like I'd made it up out of whole cloth.) I just didn't like running, I told my mom.

Sometimes doctors' kids get a trip to the pediatrician for every scrape, although most I've encountered are more like us, dependent on Dad bringing home a throat culture kit or writing a scrip for amoxicillin. Once, after a long bout of bronchitis, Dad brought me an albuterol inhaler. It felt wonderful, but after my cough was gone I lost it and never gave it another thought.

I never complained about the breathing because I never knew it was supposed to be different. I assumed I was out of shape and would always be, that this was some failing on my part that I would just have to accept. None of the adults in my life -- teachers, parents, the pediatrician we saw maybe once a year -- noticed anything amiss. I never had "asthma attacks" the way we think of them -- just couldn't run without that chest locking up.

When I was in my 20s, newly married and a few months away from figuring out (on my own) that I had PCOS, I decided I was going to get in shape. Walking was great, but I had to do it for an hour at a time to feel anything in my muscles. I tried rollerblading, but it was just like running: after five minutes my rib cage was aflame on the inside, my chin and teeth alternately itching and electric with shooting pains. About that time, I picked up a lingering cough, and instead of getting better it just got worse. Unable to lie down flat at night, and even propped upright barely able to breathe without hacking, I went to student health (Sean was a grad student at the time, and our insurance was...yeah).

After a listen to my chest and a brief interrogation, the NP determined that I had asthma and I'd had it for a long time. She set me up with a short-acting inhaler, a long-acting inhaler, and instructions to report to a pulmonologist for testing. After a twenty-minute session inside a weird vacuum-tube thing, it was determined that not only did I have asthma, but that my lungs had undergone remodeling -- permanent changes in function as a result of more than a decade of untreated asthma.

So. Now I have a maintenance medication, an albuterol inhaler, and I make sure to control my allergies. I don't even go into smoky bars, and I stay in on bad air days. But I was still dependent on walking and T-Tapp for exercise. And those things? Just were not cutting it. I needed to move fast. Something made me dig up DoctorMama's old posts about running, and damned if it wasn't finally time. My asthma is under control (although I pretreat with albuterol, every time). My worst foot problem has been surgically repaired; the lesser ones (osteochondral defect and weak ankles) improved enormously with frequent wearing of MBT shoes (really!). And, you know, shit. I'm 34 years old -- physiologically either on the plateau or the downslope depending on how you measure. If not now, when?

I'm not running to lose weight, oh no. If anything I'm running so I can eat a shit-ton of food and stay the same. I'm not running to look better in my clothes or maintain muscle mass or decrease disease risks. No, I'm running because if I don't get outside and move fast down the street and through the trees, under the sky and in the rain or the cold or the sun, my animal self will be lost. And that's the part of the brain, paradoxically, that keeps you sane.

I run slow. Probably comically slow. But if I keep my gaze off the ground I feel fleet and lithe. I don't feel angry any more that I was denied this experience for so long. I just feel grateful that I get to have it now.

 

 

No More, Kids.

Last night was my first class of Back to School: The Prerequisitioning: Part II. Two nights a week, 6:30 to 8, of the kind of class where the professor spends the entire first session making sure we've all Learned A Little Something About Each Other. It's an interesting enough subject to be engaging but it's a slow pitch, some nice academic training wheels to get me back on the road to Nurse Know-It-All.

Sophia's in school and I am, okay, totally unsurprised by how much we're all liking that. One might argue (cogently) that my need for externally imposed structure was generated in the first place by traditional schooling, but hey, there it is, and it's a little too late to do anything about it now. I yam what I yam, and what I yam is someone who can quite ably get up at 6 a.m. and pack lunches and have school uniforms neatly arrayed in a closet as long as Someone Else is requiring it of me. For her part Sophia seems to love school -- and her kindergarten is worlds away from my own in terms of good teaching and learning expectations.  Daphne is enjoying the opportunity to play with all the cool toys without someone snatching them out of her hand.

La Leche League continues apace and I love that too. It's certainly firmed up my resolve to work at least part of the time with new mothers.

So this is all good, right? I have certainly had an easy enough time bidding goodbye to plans for homeschooling, at least until the girls are a little older; as amazing as I think it can be, I think I might not have the right personality to handle my particular kid at this particular age. (Especially not with the other one in the picture.) No regrets there; even if I do feel differently about it later, that's a door we can always open later.

There's one thing I keep worrying like a hangnail, though: whether our family is complete. I am the first to admit I am at my limit right now. "NO MORE, KIDS!" leads nicely to "NO MORE KIDS!"

But then that turns into "No...more kids?" Are we really too far away from "NO! More kids!"...?

I know I can't handle any more right now -- and I know I don't want to delay nursing school much longer. But in focusing on school, am I necessarily closing the door on having more children? My fertility was not so impressive to begin with; I'll be 34 this year, and we all know that your ovaries turn into dessicated cat turds after that. I mean, I know the hot new trend is having your entire ladyparts cryogenically preserved for after you've made partner, but come on, anyone who's ever read an infertility blog (or, um, injected her stomach fat with potent synthetic hormones for months on end) knows what a load of horseshit that is.  To even consider adding more when the first one was a shock and the second one a pleasant surprise seems like the height of hubris.

Oh yeah, plus we are seriously going to need my income in another five years. Frankly we could use some now but no job I could get currently would do much more than cover daycare for Daphne.

Of course none of these arguments carry enough weight to make me want another baby now. Therein lies the conflict: I know two is about as much as we can manage right now -- and I'm not entirely happy about that. 

Vampire Weekend

Y'all.

I have a True Blood problem.

First season was compelling enough for me to watch episodes one after the other on my mother-in-law's On Demand, and then go home and rent the rest. Second season was the reason I signed up for Netflix, and the third season has me pulling up a big soft chair in front of my slow-ass computer to watch probably pirated episodes in pixellated glory. And ignoring my children to read the Jezebel episode recaps.

The real bummer, though, is that Eric Northman is 1) not an actual person, and 2) not going to come to my house. Which might sound ridiculous coming from a married lady in her mid-30s, but something momentous has happened: my period has returned after a 27-month absence (9 months of pregnancy, 18 months of nursing amenorrhea) and, as happened last time, somebody told my glands that they belong to a fourteen-year-old boy and they are responding accordingly. I'm afraid my voice might start changing.

But hey, anybody can get all hot and bothered when supplied with saucy vampire teevee. The truly shocking part of this whole hot mess is that when I settle in to watch an episode, I don't want to eat; in fact, my stomach gets that tense fluttery feeling...you know, like when I was sixteen and some sweet, sarcastic boy aswirl with pheromones and his mother's laundry detergent wrote me an illustrated note with a Flair pen.

That kind of feeling.

It wasn't a feeling I missed, exactly, but it was one I thought I'd said goodbye to forever. That feeling just doesn't keep well, not in relationships that last more than five weeks. But here it is again.

For a goddamned television show. Could I be any more ridiculous?

The thing about being profoundly happy and profoundly settled is that it isn't always very exciting, especially when you have to will yourself not to discuss the school lunch program as part of foreplay. If fifty-four minutes of titillating comic-book horror can shut off the "buy-peanut-butter-oh-shit-we're-out of-cat-food-there-are- no-clean-socks-for- the-kids-need-to-pay-the-gas-bill" faucet for a week, then who am I to deny myself? And if I feed my children cat food so I can moon around the IKEA catalog imagining the beautiful Swedish homeland of one Alexander Skarsgard, if I pick up my college books with the Old Norse and Old English and Old Icelandic so I can replay certain scenes and try to understand them without subtitles -- well, who are you to judge?

Every Time I Tried to Tell You, The Words Just Came Out Wrong

There are certain foreseeable ailments that take us by surprise even though they shouldn't. The common cold. Pregnancy. The crabs you got from that sofa in the frat house. (Sure you did, honey.) Sometimes when you have gruesome reciprocating-saw-to-the-face surgery, you get IV antibiotics and steroids, and then a couple bottles of each to take home, and then you eat starch and sugar for a month, and then you have another surgery and more antibiotics and steroids, and then bam! Out of nowhere, a yeast infection!

But not in the ladyparts. More in the gender-neutral parts. If it was jock itch, it would have attacked the tight end. If it was diaper rash, it would have been...not appreciably different.

Remember that apocryphal Newlywed Game story, in which the young husband is asked about the strangest place he'd ever "made whoopee"? And he says, "In the butt!"

It's like that.

It probably didn't help that I mistook the itching for hemorrhoid irritation and started applying cortisone to it. And it probably didn't help that my doctor forewent the look-see last time. She correctly identified the problem this time and sent me home with a LOT of Diflucan, which is helping some. I mean, I am the queen of self-care, and I have been doing all the things Glamour told me to -- you know, hanging around in a wet bathing suit, applying a thin sheen of bacon grease to the affected area to keep it moist -- but all for naught.

So let's hope the Diflucan clears it up.

All Will Be Revealed

...in time. Like, maybe later today. It's time to return to this blog's proud tradition of making public the pubic, in entirely too much medical detail, for the purposes of infotainment -- but at present I am being served play-doh pie mixed with hair and crumbs from the floor, and it wouldn't do to offend the hostesses.

Oh, and we're all going back to school soon here. Eek.

This Side of the Blue

I am stealing my post title from one of my favorite songs, Joanna Newsom's This Side of the Blue. Go here to listen, and here to read; it's rare to find song lyrics that aren't sort of a compromise between the poetry and the demands of the music, but this one is amazing (praise from a snooty English major!). The YouTube thingy isn't the more-produced version off her album The Milk-Eyed Mender, and I actually like that one better, but this'll do.

I know it's much in vogue to hate on Facebook for its (very real) privacy issues and commercial tawdriness, but I can't quit. I can scan through the minutiae of all those people who might have been lost to me, let their ambient presences surround me and feel -- not anchored, but enmeshed. I let the gratitude spill over me, that these people still want this little connection with me. Maybe it's superficial but maybe it's the opposite. I love to know that the people I care about are out in the world, having adventures in India or helping in Haiti or sweeping up the one millionth Cheerio of the week, and considering their own lives in the context of the hundreds of other people they're connected to, choosing certain moments to share, leaving out others. It's that sliver of someone else's inner life that I love, and all those fragments reflecting each other. We're all smaller, but we're all bigger too. I feel more real when I'm bouncing off all those other people, and my distant friends seem more real when I'm getting the snippets of their lives instead of just the "hey-I-got-married-had-two-children-and-am-fine" thing you get when you run in to them at the 7-11 in a town that used to be your home.

I buy my shoes at this store in the mall, the only thing I go to the mall for ever, and I'm in there maybe once every four months. But every time I go in there the same woman is working there, and she sees me walking in the door and remembers me -- every time! She sees Daphne and remarks on how much she's grown, and she knows what kind of shoes I like. Today I could tell something was a little off, and I finally asked her if she wasn't feeling well. She admitted that no, she wasn't, and it wasn't something contagious, but she'd been trying to hide it -- hoping she was hiding it well --  and I said yes, she did hide it well, but the same way she recognized me coming every time, I knew her usual demeanor and could tell the difference.

I wanted to give her a hug and take her home and set her up on the sofa with the remote, but that would have been weird.

I take one oxycodone per night to tone down the constant sensation of having just slammed my foot in a car door -- that's how it feels today, yesterday it felt like road rash -- and in the context of current trends in addiction, and of the recent death of Henry Granju, it feels just a little uncomfortable to look forward to it each evening. I'm not after a buzz, I just like it when red hot needles aren't being plunged into my toes. I do notice this, what? This feeling of peace and joy and connectedness, the profound knowledge of how very fortunate I am, how blessed. Is that a buzz? Is that why everybody's taking this drug?

But here's the thing: I feel like that almost all the time. Except, you know, when I'm yelling at the kids for pouring milk into the sofa cushions or the damn dog for waking the baby up too soon. I don't know. The membrane between me and the universe is pretty thin, for good or ill. I'm this side of the blue, but it's just surface tension separating us all, you know?

Still. The whole thing makes me uneasy.

An Update; Y'All Are Good Doctors

Girl in greenwood called it -- they wanted to give me neurontin. Which does transfer measurably to breast milk, and in this case we couldn't truthfully say that the benefits outweighed the risk, since I was having annoying pain and not, you know, seizures so we decided to go with scheduled NSAIDs plus oxycodone as needed. So, pretty much every night around 8 p.m. I have enough for several weeks and we're hoping that's enough time for the nerves to heal; I will definitely be rescheduling my other foot's cheilectomy until I'm sure the nerve pain has resolved. 

I'm writing "we" up there for a reason. I have to give credit to both my surgeon at Vanderbilt and the anesthesiologist at the outpatient surgery center; both have been remarkably easy to get in touch with, and when I called the surgery center they actually paged the anesthesiologist so I could talk to him in person. And after he sussed out that I kind of knew what I was talking about, he actually let me help determine the direction of my care! He took my concerns seriously, asked me questions and considered the answers, and did some research. Plus he called back promptly. I -- I just don't even know what to say.

Thus far my medical experiences at Vanderbilt have been so utterly different from those in Princeton and Philadelphia -- the communication between practitioners has been excellent, people have been friendly and the system isn't so impenetrable from a patient standpoint. Of course I'm about as privileged as you can get -- I have health insurance, am a white English-speaker with semi-local accent, and I am comfortable dealing with doctors and nurses -- but you know what? That got me doodly squat in Princeton (with the notable exceptions of my RE and midwives). That got me, if longtime readers will recall, a dangerously misdiagnosed ectopic pregnancy. 

I'm not sure what's different here, but I know I like it. I might just have an operation every six months because it's so awesome.

Oh, and the nerve pain: it's an uncommon but not unheard-of side effect of a nerve block. The pain radiates from the needle insertion site behind my knee, down my leg, and into my four smaller toes. There's some surface numbness remaining, and as the deeper numbness resolved it was replaced by pain -- a throbbing ache at the end of the day, plus electric-shock feelings if I stretch that leg and sometimes random burning sensations just for fun. Amusingly enough, the surgical site is mildly sore (just from the tissue recovering), less so as I work it in physical therapy, but there's no nerve involvement there. 

Honestly, I knew it was going to be a problem from the start -- it hurt a little too much when they blocked the popliteal nerve, and then my leg didn't regain feeling fast enough (it was totally dead for 72 hours instead of 12-24). Dr. Anesthesiologist tells me it's a bruised nerve. Same shit happened to my sciatic nerve when I got pregnant. Wonky nerves or something.

Kansas City, Here I Come

How could you not sing that every time you go to KC? Unfortunately my main memory of that song is from some local Wichita newscaster singing it, every post-Wheel of Fortune commercial break, as a promo for some shopping-themed Kansas City excursion story, circa 1991.

But. Yes. I am going to Kansas City to visit my dad, who is currently still in ICU following his liver transplant and several subsequent "bumps in the road" -- none of which seem to be related to the liver itself, as it reportedly seems to be functioning well. There has been some mysterious bleeding, possibly from the GI tract but nothing showed up on endoscopy. He has an enormous, complicated hernia, so his intestines are not in good shape, so that's a possibility. Anyway, I am abandoning Sean and the girls for a couple of days to fly out there.

Meanwhile my own body seems to be rebelling -- there are the previously blogged 'roid problems, and while my hallux rigidus correction is doing what it's supposed to be doing, I seem to have sustained some nerve damage from the ankle block I received for the surgery. Instead of the usual 24 hours of numbness from the block, I got about three days of dead leg, plus gradually returning sensation along the nerve pathways -- and then about a week ago (presumably as the nerves started to heal up) I realized my foot was hurting all the time, especially at night -- everywhere except the surgical site.

You know what NSAIDs do for nerve pain? Not a dingdang thing. I got two nights of decent sleep with the last of my Lortabs, but didn't have any left so spent last night waking up uncomfortable-to-miserable.

So, um, yeah. The next foot is planned for mid-July, but if this nerve pain hasn't resolved itself by then, either I'll have to reschedule or talk about different anesthesia options. Because if I had two legs like this, I would not be a very nice person AT ALL.

I am waiting to hear back from the surgeon and the anesthesiologist about this, but you are invited to weigh in.