Walking the Dog

After I posted yesterday about my depression flare-up, my dear friend Claire sent me this New York Times op-ed piece by Andrew Solomon:

"Despite medical advances in the last 20 years that have greatly improved our ability to help those who suffer from depression, we lack an effective system for administering care. Only a very small percentage of depressives who seek help receive appropriate treatment for their condition. Research often stalls short of being translated into useful medicine. Depressives continue to be stigmatized, which makes their lives even more difficult and lonely. Finally, many sufferers are left to spiral, unsupported, into despair because their insurance companies refuse to pay for treatment.

"These problems are similar to those cancer patients once faced, and the best way to address them might be similar as well. We need a network of depression centers, much like the cancer centers established in the 1970s."

I'm all for a network of depression centers; I think that's a great idea, although I'm not sure I agree with Solomon that depression continues to be stigmatized. If anything, I think it's become a household word, right up there with certain male performance problems that also used to be discussed -- if at all -- in hushed whispers behind closed doors. Depression as malady-du-jour, though, may have the effect of trivializing the illness, always a risk in a pharma-crazy society anyway. Depressed? Pop a pill! Nothing to it!

Cancer's in no immmediate danger of being dismissed this way. I don't mean for a second to deny the devastation of the disease; I've lost friends to it, and my mother's survived both breast cancer and lung cancer. But because there's no quick fix for cancer, or even the perception of one, there aren't cheery little pop-a-pill-and-you'll-feel-better ad campaigns.

Instead, cancer's produced a rhetoric of heroism. Cancer patients are invariably described as "brave," even when they don't want to be. When my mother was being treated for breast cancer, this drove her nuts. "I'm not brave! I'm doing what I have to do. It's not like I have any choice!" Even so, cancer survivors like Lance Armstrong achieve iconic status. Military metaphors abound: cancer treatment's always "a battle," and patients either "win the battle" or "succumb after a long, brave battle."

And then there are all those blasted ribbons. Is anybody else heartily sick of perky colored lapel ribbons for every cause under the sun? Has anybody else completely given up trying to keep all the colors straight? Gary and I went grocery shopping recently, and I picked up a box of coffee filters adorned with a pink breast-cancer ribbon. Coffee filters fight breast cancer? What the hay? This brand filters carcinogens out of your coffee?

The first ribbons I remember seeing were yellow ones, probably during the Iran hostage crisis; according to Wikipedia, the yellow ribbon has a long history -- dating back to 1917 -- in military and political conflicts. Given that history, I don't think the connection to cancer ribbons (even though ribbons now signal all kinds of other things, too) is an accident. Cancer patients are, in a sense, prisoners of war, held hostage by an enemy force. It's easy to see cancer this way because it's an invasive illness, often with clearly visible battle lines drawn on x-rays and CT scans. Cancer cells are "other," hostile mutations bent on overrunning the body's defenses.

As I've said here before -- in a discussion with Will Shetterly that I can't locate at the moment -- I have trouble with battle metaphors for illness. I prefer the metaphor of the journey, with illness as a foreign country which, for all its perils and pains, may also be a place to learn new skills and meet new friends. Sometimes we get to return from that journey and come back home, at least for a while; sometimes the foreign country is the end of our travels. But since everyone's travels in this world will end one day anyway, I don't think it's helpful to imply that people who've gone on to their final destination have lost a battle, or are losers in any other sense. I've heard too many people who were ill vow to "keep fighting" even when they were exhausted and clearly needed rest instead. I suspect that in at least some cases, military imagery encourages patients to push past their limits, instead of honoring their own needs.

Battle metaphors, though, are undeniably sexy. They thrill us; they get our adrenaline going. And that means that, in some twisted way, cancer's sexy, or has been made sexy for the sake of raising money and awareness.

Depression's not sexy. It's common as dirt and every bit as dull. Depression's boring, both for the patient and for everyone else in the vicinity. For one thing, there aren't visible battle lines. Depression isn't an invasion by foreign or mutated cells. If anybody's come up with a sexy metaphor for neurotransmitter imbalances, I haven't heard it yet. There are, of course, famous literary metaphors: Styron's Darkness Visible, Churchill's "black dog." I'm quite fond of the latter; I've tried to domesticate my dog, to train it to heel. When my depression starts howling, I tell myself, "Okay, time to walk the dog," with "walk" as a shorthand for self-care. That's not very sexy, though: nobody's going to start wearing chartreuse pooper-scoopers on their lapels. The very dailiness of depression, and of other long-term chronic illnesses, mitigates against dramatic metaphors.

My "dull as dirt" simile above suggests another metaphor, an agricultural one: depression as the field in which our pain germinates and bears the fruit of compassion. This metaphor is both daily and seasonal, and works well to describe the condition. But it's not very sexy, either.

We don't have depression heroes. We don't have depression icons. There actually is a green ribbon for childhood depression (of course there is), but I had to do a Google search to learn about it. What we have instead is a pop-a-pill mentality that reduces depression -- and male performance problems, and lots of other things -- to the status of a headache.

I'm not sure there are any simple solutions to this situation. As I've said, I don't like battle metaphors, and the metaphors I do like aren't likely to raise anyone's adrenaline levels. But I do have a request: if you know someone who needs to walk the dog every day, offer to come along for companionship and support, even or especially if it's raining out. You may learn things about the neighborhood you never knew, and when you get back, you'll be newly and deeply grateful for that cosy armchair and the roof over your head.

Walking the Dog: Addendum

Driving home from work tonight, I heard a piece on NPR's All Things Considered by a cancer care nurse, Jeff Curl. One of Curl's patients, named John, had both depression and cancer, and John's comments about the two illneses resonate with my post Walking the Dog. He talks about how when he just had depression, his family thought he was lazy and didn't want to get up and work; but when he got cancer, previously judgmental relatives suddenly started being kind to him, and strangers bought Christmas presents for his kids.

It's a moving audio essay, and you can listen to it here. Or you can read a slightly longer, fuller print version here:

I think a part of him was relieved to be dying. He had endured a tremendous amount of physical discomfort battling his lymphoma —- pain caused by tumors growing throughout his body, all of the lab tests and intravenous lines, the excruciating fatigue and dangerously low blood counts that come with a transplant.

Yet despite all he had suffered through the course of his cancer, it was easier than the burden he had carried all those years from his other disease.

In personal depression news, today the friend who gave me my lightbox stopped by my office to chat, and asked how the lightbox was working. I told him that I think it is working, but that I'm still having a tough time at the moment (as almost always happens at the end of the semester). It made me sad to have to say that; I wanted to be able to tell him, "Yes! The lightbox has fixed everything! I feel 100% better!" On the other hand, it was really nice that he asked.

Tomorrow I see both my therapist and my primary-care doc (for my quarterly meds-management appointment), so we'll see if they think I need to have the meds situation evaluated by an actual shrink. I hope not. I'll try to convince them that this is just the time of year, tra-la-la. I truly do always feel immensely better on January 1, so with any luck, that pattern will hold this year.

Part of my melancholy at the moment is that my last classes were today, which is a happy moment but also, always, a weirdly anticlimactic one. Now it's all over but the grading. And the shopping. And the planning courses for next semester.

But tonight, we watch DVD TV: namely Rome, which we just started and are warming to after the first four episodes. The first two were pretty lurid, even for HBO (and even for Gary, who has a far stronger stomach for this stuff than I do). It's a gorgeous and fascinating show, but if you're squeamish about blood, guts, and full frontal nudity -- of both genders -- you may want to avoid it.

The Coolest Patient

This morning, one of Dad's doctors told us that her team has voted him "the coolest patient on the floor," partly because of his nifty sunglasses. We bought them for him when he was in the oceanview room, where the sun got pretty bright, and he's been wearing them steadily ever since. The doctor also commented appreciatively on how good he is about letting medical and nursing students practice on him. Dad's happy to do that, partly because he really cares about education and partly because he's always happy to talk to new people.

The doctor teased him about how he always has his little radio tuned to NPR. "One morning I came in and your radio was off, and I knew you must be feeling sick! I was like, 'We may have to put him in the ICU!'"

Everyone, from doctors to janitors, notices when Dad's radio isn't on. "Hey!" said the guy who showed up to empty the trash yesterday. "Where's your music? You always have your music on. I can't dance if you don't have your music on!"

We hope to learn tomorrow what will be happening next: with any luck, VA-provided transport to a SNF, which Dad plans to leave as soon as possible. Everyone will be much happier when he can play his radio at home!

The only possible hitch is that he's reported new swallowing problems, a lump in his throat on top of the difficulties with swallowing he's had since his stroke in 2001. He had an upper GI last week, and I'm sure that would have shown anything abnormal in his throat, but Gary and I hope this latest issue can be resolved without more delays.

In the meantime, here's my other Cool Guy. I took this photo during our beach walk this afternoon. Gary hates having his photo taken, and took his revenge on me for this one by not alerting me to the fact that a wave was about to soak my shoes. Luckily, I was wearing waterproof Keen sandals and quick-drying fleece socks!

We had a fine adventure clambering among the ruins of the Sutro Baths. I have a morbid fear of falling and don't trust my balance, so walking along the tops of stone walls, even fairly wide ones, was a bit nerve-wracking for me, especially since the walkways were crowded with other tourists. Climbing up the steep slope from which I took this photo was actually easier: I don't mind heights if I'm going up, and especially not if I'm using both my feet and my hands to climb, as I was in this case. Gary commented admiringly, "You're becoming a climber in your old age."

Between the stone walkways and the scramble up the hill, we spent some time on a pocket beach which afforded the usual Bay-Area gorgeous views. Here's one of surf crashing against rocks. This is a very pretty place, and I wish I could bring the beach home with me.

After the Sutro-Baths adventure, we took a more sedate, level walk on Ocean Beach, always one of my favorite spots. Ours walks there drive Gary crazy, though: he's into walking as aerobic exercise, whereas I view these expeditions as a chance to pat every dog on the beach and look for interesting rocks. I didn't find any good rocks today, but there were tons of adorable dogs. At one point, I was patting two Corgis and two English Bulldogs, more or less simultaneously, and one of the owners told Gary, "You'd better get her a dog."

I don't want a dog (largely because a dog would make Gary and the three cats miserable) but I sure enjoy other people's!

After our beach walk, we went back to the VA and visited with Dad for a little while, and then went out to dinner with our friend Ellen. We went to a Vietnamese place that had been recommended by her sister, and that isn't far from the VA. I ordered soup; Ellen and Gary ordered crab.

Y'know those horror movies from the 1950s, the ones about giant radioactive crabs that, oh, invade San Francisco? We had two of those crabs for dinner. We had a lot of crab, and we all got very messy eating it. It's good stuff, but the meat isn't easy to extract, even when the crab you're eating is larger than your head.

And then the bill came, and it turned out that each crab had cost $50. *Gulp* But as I told Gary on our way back to the car, at least the dinner was an adventure.

Susan and Sharon's Excellent Adventure

As previously advertised, Sharon and I drove to Gabbs today, and then took 844 through the Paradise Range. Here's one of my favorite pictures from the trip, taken as we drove back over the Paradise Range to go home. This gives you a small idea of the kind of vista that regularly greets anyone driving across central Nevada. Our basin-and-range geography makes for stunning vistas!

(Note: You'll get much more detail in all of these shots if you click to enlarge.)

Here's another shot, taken through the car windshield as we headed east on 50 towards 361, the Gabbs turnoff. Wherever you drive in this part of the state, you can see mountains.

Sharon and I weren't alone; we brought her little dog Misty, who was excellent company and gave us a great excuse to get out and stretch our legs periodically. I'd been a little worried that Misty would bark, but instead she just whined politely when she needed to take a rest stop.

Good dog!

This shot of Sharon walking Misty by the side of the road gives you some sense of how easily the Nevada landscape dwarfs humble creatures like people and dogs. Alkali flats like this are especially humbling!

Later on, Misty had a fine time scampering through sagebrush. We kept her close, though, because we didn't want her to become coyote bait! She spent a lot of time waiting patiently in the car, often sleeping. We had water for her (and for ourselves: one never ventures into the desert without water!), and Sharon had also brought some food for her, so she was well cared for.

Our first sight of Gabbs, population 350, was this set of signs. You can see that there used to be many more. Gabbs was a much larger community during WWII, when the magnesium in the area was in high demand for munitions. The valley's also rich in brucite, and there's at least some gold.

Mining still goes on here, as you can see from this photo. Someone in Gabbs told us that geologists and mining companies seem to be newly interested in the area, so someone may have found some kind of new deposit (or figured out a way to get more from an old one).

In Gabbs itself, there's a definite theme: tarantulas. A friend of mine says that there's a tarantula migration through town every year -- although a local who's been there for four years told me she's never seen one -- and tarantulas are the mascot of the school teams. This is a mural painted on the wall of one of the schools (all the school buildings are clustered together; I think this one's elementary, but I'm not sure).

And here's another! You can never have too many tarantulas! I'm also now the proud owner of a lapel pin, shaped like Nevada, with "Gabbs NV" and a tarantula on it. This item's too small to photograph well, unfortunately.

I'd really wanted to see St. Michael's Catholic Church, because an important wedding takes place there in my book. It turns out that the building is tiny and can probably only hold about fifteen people, so I'll have to pare down the guest list!

My favorite thing about Gabbs was the library. It's only open two hours a day during the summer, but we hit it just at the right time, and the librarian, Myrna, was very warm and welcoming (as was just about everyone we spoke to). She photocopied some historical documents for me and, when I bought a copy of a book about the area, gave me a free copy of a cookbook compiled by the local Republican Women's Club, "because you've been nice to us." When she mentioned that they have a hard time coming up with money for new books, I gave her a small donation, and she threw her arms around me and said, "Thank you!"

Isn't this a beautiful little reading room? If I lived in Gabbs, I'd spend a lot of time in those comfy chairs! (Sharon and I were fantasizing about buying a house there, since the median home price is only $27,500, but it's not really practical. We might go back and visit, though. There's a tiny hotel, although I couldn't find anyone to ask about room rates.)

The library also has a pretty substantial SF collection. Myrna told me that the kids who live there love fantasy (after I told her that I write fantasy), although I suspect my stuff's a bit darker than they're used to! Anyway, it was nice to see lots of Tor books in remote Nevada, even if none of mine were there.

And, of course, the library had its own collection of tarantulas. I was especially tickled with this specimen, fashioned out of a seedpod and pipe cleaners. What do you want to bet that half the kids in Gabbs dress as tarantulas for Halloween?

But you also have to love this plush guy, just waiting to leap upon the head of an unsuspecting reader.

And this stalwart fellow, loyally guarding a stack of children's books, is really very endearing.

I suspect that Gabbs kids have a healthy lack of fear towards spiders and other critters. Either that, or they're all traumatized for life!

Okay, so here's how things work in a small town: outside the high school, Sharon and I chat with an ambulance driver. I mention that I learned a lot about Gabbs from Ruth Danner's wonderful history of the town and the region, and the ambulance driver says, "Oh, sure! I went to school with Ruth. She's living in Elko now and writing another book." Then we go to the library and meet Myrna. Myrna doesn't have any copies of Danner's book, but is expecting more. "I have to call Ruth and have her send some." Myrna takes my card and promises that she'll call me when the books come in so I can buy one and have it shipped to me. (I can't renew it at the UNR library indefinitely.) When we're talking about the attractions of living in Gabbs, Myrna tells me about someone who came here from Cleveland to visit family and loved it so much she promptly moved.

Sharon and I go to lunch at the local cafe. The cashier, who's having some trouble with the register, explains that she's new at the job, and that she recently moved here from Cleveland. "Oh!" I say. "Myrna was telling us about you."

The door opens. It's the ambulance driver, who waves to us. As we're leaving, Sharon peers at a passing car and says, "Look, it's the librarian." We wave to Myrna, who waves back as she pulls into the cafe parking lot. "She must be having lunch there," Sharon says. Well, sure: not too many other places to have lunch.

Somewhat reluctantly, we left Gabbs to head across the Paradise Range into Ione Valley (I don't think it's officially called Ione Valley, but it's where Ione is, so that's what I call it). I'd wanted to stop near the summit and get photos and maybe do a bit of hiking, but it turned out that almost the entire road was under construction. A "pilot truck" with a big "Follow me" sign led us across the mountain.

In Ione Valley, we saw no tarantulas, for which we were very grateful. We did have a pleasant visit with a cow.

Nearly the entire area is open range, so we were on the lookout for cows, but this is the only one we saw.

She was a lovely cow, though, and she posed very patiently for photos. Misty, in the back seat, stood up on her hind legs and pressed her nose against the window to get a better look at the cow. The cow didn't seem in the least interested in the dog.

On our way back over the Paradise Range, we had a ten-minute wait for the pilot truck, which gave us a chance for a very pleasant chat with the flagger, a young guy who was as friendly and welcoming as everyone else we'd met.

He told us that he'd caught a lizard that he'd saved to show his friends. Would we like to see it? We told him that we'd like that very much.

I know people who are scared of lizards, but I adore them. They look like miniature dinosaurs.

The lizard was a lovely specimen, speckled with blue. The flagger had put it carefully in a cooler on top of a rock.

The lizard also had a blue belly; the flagger held it gently upside down so we could take a look. None of us knew what kind of lizard it was, but it was certainly pretty.

When the flagger was trying to return the lizard to the cooler, the animal got away. It stayed near his truck, though. He told us that he thought the lizard liked him. He also said that if that lizard went away, he'd find another to show his friends. I had the feeling that once they'd seen it, he'd release it. That made me happy.

Once the pilot truck showed up, we headed home, gawking at more beautiful scenery. At that point, though, we were both really tired. It was a lot of traveling for one day!

It was a wonderful day, and I want to thank Sharon and Misty for sharing it with me.

The cats wouldn't have been nearly as patient with a long road trip!

And, as a final wonderful treat, when I got home I discovered that Gary had picked wildflowers for me during his hike. They're beautiful, although unfortunately, Bali thinks so too, and has already had his way with several of them. ("Salad for me? How thoughtful of you!")

The Gormless Brigade: A Medical Horror Story

When I decided to become a volunteer hospital chaplain, I got a lot of negative reactions from family and friends. “Oh, no! You aren’t going to turn into one of those people who marches into a hospital room and starts thumping a Bible, are you?” “You aren’t going to turn into one of those people who shows up with a simpering smile, leaves a prayer card on the bedside, and vanishes again, are you?” “You aren’t going to turn into one of those people who says I have to accept Jesus for my illness to be cured, are you?”

No, no, and no. My training emphasized that the first principle of pastoral care is meeting people where they are, instead of telling them where they “should” be. Proselytizing is forbidden (and isn’t something I’d be inclined to do anyway). Our goal is to learn enough about the patient’s belief system to try to help that person marshal emotional and spiritual resources. This means that a lot of the time, I don’t even talk about God. I’ve had pastoral conversations about people’s grandchildren, about their pets, about Buffy the Vampire Slayer. I try to learn what people love -- whether that’s cooking or genealogy or Little League -- because the things we love are the things we live for, and that means they’re the things that heal us.

But listening to all those horror stories about hospital chaplains, I remembered one of my own.

Caveat Lector

I’ve dithered for a few days about whether to post this, because you can’t get the full effect of the gormless-chaplain story unless I first tell a gormless-gynecologist story and a gormless-ER-doc story. (Lest you think it’s all bad news, there’s a saintly ER nurse in there, too.) To tell those stories, I need to go into some fairly graphic and personal details that might embarrass people. They don’t embarrass me, but I don’t want to make anyone else uncomfortable.

I’m offering this as a cautionary tale to medical and pastoral caregivers about what not to do, although I hope most folks would know better anyway. But if you’re embarrassed by graphic medical stories, especially about the female reproductive system, please don’t read this. Also, this is quite long. I considered breaking it up, but my husband thinks it should all be one post.

The Gormless Gynecologist

Long, long ago, in a galaxy far, far away (popularly known as New Jersey), I had an abnormal Pap smear. This meant that during a routine pelvic exam, my gynecologist found pre-cancerous cells on my cervix. To determine the next step in medical treatment, I needed a colposcopy, a specialized examination and biopsy of the cervix.

Colposcopies are office procedures. Gary and I were living together, but not yet married. His best friend had just died of cancer, and so -- even though my gynecologist’s nurse assured me rather impatiently that the abnormal Pap was really nothing to worry about -- we were both anxious. Gary volunteered to come with me to the colposcopy, to hold my hand during the procedure. (This meant the world to me. Any guys reading this: if you really want to score brownie points with your significant other, offer to go along during medical procedures!) The day before the procedure, he’d popped a tendon playing tennis, but -- in typical male fashion? -- he stayed quiet about how much pain he was in.

So we’re in my gynecologist’s office. I’m up on the table, in stirrups. Gary's standing beside me, holding my hand. My gynecologist, who’s young and female and subscribes to the “tell the patient exactly what you’re doing at each moment” school of medicine -- which I normally appreciate -- is giving me a perky, chatty tour of the procedure. “Okay, Susan, now I’m inserting the speculum! Okay, now I’m staining your cervix with vinegar! The vinegar makes the abnormal cells turn white under this special light we’re using! Oh, look! There are so many abnormal cells that your cervix looks like a glazed donut!”

Those were her exact words. I felt like I’d been punched in the stomach, but at least I was lying down. Gary was standing up. His calf was massively swollen from his athletic injury. His best friend had just died of cancer. The room was also rather warm. The upshot of all this was that he turned gray and began sweating copiously. “You don’t look too good,” the doctor told him.

She and her nurse promptly abandoned me to make sure Gary wasn’t having a heart attack. (He wasn’t.) They left me dangling in those stirrups, worrying about him, for a good twenty minutes. Because of all the confusion, when they did come back, they forgot to give me discharge instructions.

Discharge instructions include symptoms of post-biopsy infection: “If you develop nausea or a fever, call your doctor.” I hadn’t gotten the instructions. So two weeks later, when I developed fever, nausea, vomiting and diarrhea, I assumed I just had the flu. But after several days, the nausea turned into periodic waves of wrenching abdominal pain: pain that, when it hit every few minutes, left me gasping for breath and curled into a little knot of agony. You know that 1-10 pain scale, with 10 being “the worst pain you’ve ever felt”? This was a 10.

Enter Saint Nurse

Gary and I went to the nearest ER, which happened to be a Catholic hospital. I was wearing jammies, slippers and a bathrobe, walking doubled over because of the pain, puking into a plastic bowl I was clutching to my chest. When we walked into the ER entrance, the person behind the registration desk took one look at me and said, “You go right back there and lie down, honey.”

By some fluke, the place was almost empty. I got prompt attention from a kind, funny, personable ER nurse. Between waves of pain -- now somewhat reduced by pain meds -- she asked me about my graduate work, chatted about my doctoral dissertation, and generally treated me like an intelligent, competent human. And when my bloodwork came back with a white-cell count of 29,000 (normal is between 5,000 and 9,000), she became very grave and quiet, and told me quickly and gently -- as someone else quickly and gently started an IV for antibiotics -- that I had a very serious infection and would have to stay in the hospital.

Enter Gormless ER Doc

I’d told Saint Nurse about the colposcopy, and the ER doc wanted to do a pelvic exam. This doctor had already lost points for telling Gary to go sit in the waiting room. My impression at the time was that he kicked Gary out because we weren’t married; he asked Gary to leave when he heard the word “boyfriend.” Maybe he would have asked a husband to leave, too. I don’t know. I wasn’t yet a churchgoer -- that wouldn’t happen for another few years -- and I was very conscious of being in a Catholic hospital. That definitely colored my perceptions of what followed. (I volunteer in a Catholic hospital now, and I love the place, but I’m also very sympathetic to patients who are nervous about being in a faith-based institution.)

Maybe the ER doc was having a lousy day, even though the ER was temporarily quiet. Maybe he was just very bedside-manner-challenged. Maybe what happened next had nothing to do with the fact that a) he knew I wasn’t married and b) I was about to be admitted to the hospital with a diagnosis of Pelvic Inflammatory Disease. PID is most often caused by untreated STDs; it sometimes results in infertility, which will become important later in this story. My interpretation of events may have been swayed by the fact that the doctor was clearly from India and that his English wasn’t terrific; this made me wonder if he had more conservative beliefs about sexual mores than an American doctor might. (Someday I’ll post about the role of gender, race and social class in the emergency department. They definitely affect patient-staff interactions, but they aren’t often discussed.)

Whatever his reasons, this doctor gave me the roughest, most painful, most callous pelvic exam I’ve ever had. I clung to Saint Nurse’s hand, trying to be a good patient, trying not to whimper. When the exam was over, he took out the speculum, held it up so I could see the bloody pus on it, and glared at me as if I was something he wanted to scrape off the bottom of his shoe. “This is bad discharge,” he said, his voice dripping scorn. Saint Nurse squeezed my hand.

“I’m due for my period,” I said. “Could that be some of the blood?” (As it turned out, I had indeed just gotten my period.)

“Yeah,” Saint Nurse chimed in eagerly. “Could it?”

He curled his lip. “This is really bad discharge.”

I felt like the Whore of Babylon. Why was he talking to me that way? I was already sick as a dog and about to be hospitalized; was he trying to make me feel even worse? Later, when Saint Nurse was taking me up to my hospital room, I told her, “You have a much better bedside manner than he does.” She giggled. She didn’t seem to think he was a horrible doctor, so maybe he really was just having a bad day. He shouldn’t have taken it out on me, though.

Enter Gormless Chaplain

Upstairs in my hospital room, where I went through severe separation anxiety because Saint Nurse had gone back downstairs to the ER, I lay in bed, wondering when I’d see another doctor. My eyes were tearing from the pain of the IV: they had me on doxycycline, which is great stuff (it brought my white count back down to 9,000 in two days) but also burns the veins going in. I didn’t expect to see another doctor that night, but I was sure I’d see one in the morning.

The next day, my sister and mother visited, and Gary came and played Scrabble with me to distract me from the pain of the IV -- I got a new dose of doxycycline every twelve hours, and quickly learned to dread it -- but no doctor came.

The next morning, my aunt and uncle and several friends visited. Still no doctor. In the afternoon, my sister came by again, and she was still there when a short, excessively cheerful man appeared in the doorway and said, “Hi, Susie! I’ve come to see how you’re feeling!”

I stared at him. “My name’s Susan.” Blood relatives and extremely close friends who’ve known me for longer than twenty years get to call me Sooz. Nobody calls me Susie. “Are you my doctor?”

He chortled maniacally and bounded a few feet into the room. “Well, hi there, Susie! So how are you today?”

My sister looked alarmed. I shrank back against my pillows and tried to stay calm. “I prefer ‘Susan,’ thank you. I’ve been waiting to see a doctor. Are you my doctor?”

He beamed at me and hopped closer to the bed. “So, Susie, you seem to be in a good mood!”

At that point, I lost it. ”My name’s Susan. Who are you?”

“I’m the chaplain!” he said, chuckling. (My sister told me later, “You should have seen the look of relief on your face when you found out he wasn’t the doctor.”) He asked me if I’d like him to pray with me. I thanked him but explained that no, I wasn’t religious. It turned out that he was a Catholic priest. Somehow we started making small talk -- I didn't know that I could tell the chaplain to go away, and I wasn’t going to kick a priest out of my room in a Catholic hospital -- and discovered that we were both writing doctoral dissertations. He asked what mine was about, and I told him that I was writing about runaway mothers as figures of social reform in nineteenth-century British and American women’s writing.

He beamed at me. “Oh, how wonderful! Motherhood is women’s highest calling!”

I think my jaw dropped. The dunderheaded sexism of the comment would have been bad enough, but I was in the hospital with a diagnosis of a condition that could have left me infertile.

Now, I was positive that I didn’t have classic STD-related PID (and indeed, the STD tests came back negative). I was positive that the infection was somehow related to the colposcopy, although there was no way to prove it. And I’ve never wanted kids, so the fertility issue was far less important to me than it would have been to most women.

But he had no way of knowing any of that. If fertility had been an issue for me, his comment would have been devastating (even aside from its dunderheaded sexism), especially after I’d felt so judged by the ER doctor. “Whore of Babylon, your licentiousness has barred you from Woman’s Highest Calling!” For many reasons, I wasn’t about to buy into that message, but many other women might have.

I don’t know if the chaplain had access to my chart or not, and I don’t know if he’d have had any clue of what “PID” meant if he’d read it. When I became a chaplain myself and worked on medical floors, before I discovered that I preferred the ER, we were required to chart on patients (“Prayed w/pt” was the standard note). When I could find the chart -- which wasn’t often -- I usually tried to make some sense of the History & Physical section so I could suss out any potential landmines before I met the patient.

Nobody’s perfect. I believe that this chaplain was a genuinely sweet, if gormless, man who was truly trying to cheer me up. Even at the time, I wasn’t as upset with him as I was with either my gynecologist or the ER doc, and now I have quite a bit of sympathy for him. I know I’ve put my foot in it with patients sometimes too, and we worship a God of forgiveness.

But the lessons remain. Medical caregivers: please try to think about how your words would sound to you if you were the patient. Pastoral caregivers: please remember to introduce yourselves and your function right away, and try to avoid bringing up potentially sensitive subjects unless the patient does so first. And if you have any access to information about the medical condition being treated, educate yourselves!

Epilog

After I’d gotten out of the hospital and had recovered completely from the infection, I had laser surgery to remove the abnormal cells from my cervix. (I had a bunch of other tests, too, to make sure nothing else was wrong, but that’s another set of posts.) I’m delighted to report that since then, I’ve been fine, and all of my Pap smears have been normal.

Meds for Life

I spent all morning at my mental-health group: first I had an appointment with the psychiatrist to discuss meds, and then my regular weekly appointment with my therapist. My primary-care doc, whom I adore, has been prescribing and monitoring my meds, but when I was having trouble on just the nortriptylene, my therapist got me in to see this shrink, who's evidently excellent (and whom I like very much).

In the meantime, my primary had put me on an additional, very small, dose of Effexor. That combo's been working pretty well, and the shrink says that she sees no need to change it. After taking my history, though, she did tell me that I'll probably need to be on antidepressants for the rest of my life. People who've had three episodes of major depression -- and I've probably had more than that, although I didn't recognize all of them when they were happening -- have a 90% change of recurrence, and the episodes become more severe and happen closer together as the patient gets older.

The psychiatrist who put me on Prozac back in 1994 had told me the same thing; when I went off Prozac in 1998 and stayed off for eight years, I thought I'd proven him wrong. Regular readers of the blog know that I hated going back on meds, and also hated having to start a second med when the nortriptylene wasn't working by itself. I'd really been hoping that the latest bout of depression was just a result of the situational crud that started three years ago, and that I could get off meds in a year or two, so I wasn't happy about today's pronouncement. When I told the doctor that I'd been off the Prozac for eight years, she said gently, "Sure, but then you had to go back on. Maybe you can get off again for a while. You probably won't be able to stay off, though." And then she gave me the speech -- which I know by heart, because I've given it both to myself and to other people -- about how I have to tell myself that I have a chronic medical condition, like diabetes or high blood pressure.

Intellectually, I know all that. But I'm still bummed.

So, anyway, I'm going to switch my meds management from my primary to this shrink, because if things go south again, I want to be an established patient of someone who has more experience. (My primary's very good, and the shrink was impressed by the nortriptylene-Effexor combo, which wasn't one she'd have thought of; still, in this case I think a specialist is better.) I'm seeing her again in a month, and she said that if I feel worse again before then, I should call her and she'll get me in right away. If I were doing worse, she'd either raise my Effexor dose or put me on Cymbalta. I'd probably opt for the Cymbalta; the doctor confirmed that Effexor is one of the drugs that tends to numb creativity. I'm really, really hoping that none of that will be necessary!

After seeing the shrink, I kvetched to my therapist, who was very sympathetic and said, "Look, you can try to go off. It's not a big deal. You might just need to go back on, that's all. You're very aware of your emotional states. You know when you need to be on meds. You'll take care of yourself."

So there you have it. And now I'm going to go swimming, today's version of walking the dog.

Berkeley Bliss

I'm having a grand time, as I usually do here.

The fun started with my trip into the city on BART last night. I love public transit, because you see everything and everybody, all crowded together (like the ER, but healthier). There I was, knitting, and next to me was a guy covered in tattoos who had his bicycle with him, and across the car were an elderly couple in black-tie formalwear -- she had a corsage on her wrist -- and cattycorner to me were three lively women who sounded Jamaican, and various of us were trying to help a tourist family who weren't sure where they needed to get off the train. BART always presents a kaleidoscope of skin colors and a medley of languages. It's just delightful.

Dinner before the reading was a lot of fun; we wound up talking about emergency medicine, of all things. One of the dinner guests is engaged to an ER doc, and Jay Lake is getting over some serious medical issues and has done more than his share of ER time. He's brilliant, by the way; I intend to read his books, and recommend that all of you do the same.

I enjoyed the reading; I'd planned to read something fairly light (or as light as I get, which isn't very), but our MC, Terry Bisson, semi-goaded me into reading a complete short story rather than excerpts, so I decided to read "Sorrel's Heart," which is certainly one of my darkest tales. Several people in the audience responded very enthusiastically (one man, an eighth-grade teacher, wants to include the story in his Holocaust curriculum, which blew my mind just a bit), but there was a notable lack of comment from other people. Oh well. It was an experiment, and it may not have worked, but I'm glad I tried it anyway, even though two of the folks in the audience were my college roommate Ellen and her mom, Sonia. Ellen tends to avoid anything dark or graphic, and I'd warned her about the story beforehand, but I hope she wasn't too green around the gills. I couldn't see her face from where I was sitting; I did have a good view of Sonia, who was staring at me with a Good lord, I thought I knew this woman! expression. They had to leave right after I finished, and I haven't gotten feedback from them.

Jay read a story almost as dark as mine, but funnier, which I think the audience found a welcome relief.

After the readings, we took a short break before the Q&A session. A tall, bald man walked up to me, grinning, and handed me a chocolate bar, and I recognized another old friend from college! David had been in a local SF bookstore, seen a flyer for the event, spotted my name, and decided to come. We were both members of the college science-fiction club, and we shared a house one summer with a group of other friends.

David also has the distinction of being the first gay person I ever met, or at least the first one who talked about it. When we were catching up, he told me that he and his partner of thirteen years are getting married on August 23. God bless California for legalizing same-sex marriage! He invited me and Gary to the wedding, and we're planning to attend even though the logistics are complicated; I'm preaching the next day, and school starts the day after that. Because of tight timing, we'll have to fly instead of driving. Still, I wouldn't miss it, especially since other college friends will be there.

David and I talked through the whole break, so I didn't even have a chance to get up from my chair before the Q&A session. But that was fine! The Q&A was lively, but I felt a bit disjointed, and -- as at WisCon -- I think I was coming across less well than I might have because I was being more personal than analytical. (Oh well.) Terry asked us to talk about our writing processes, and both he and Jay responded with disbelief when I explained that I'm a formalist and that I plan out projects according to length, not plot. (My outlines consist of knowing how many pages each chapter will be and who'll be narrating it, in what voice and tense, rather than dealing explicitly with which character does what.) "Oh, come on," Terry said. "Nobody does that. You don't really do that. You're making that up."

But I do do it, and is it really so strange? Is it any different than a poet knowing that each line in a sonnet has ten syllables, or than a journalist knowing how many column inches need to be filled?

Jay, meanwhile, talked about how he'd trained himself to increase his "span of control," the amount of story he can keep in his head at any one time: he's increased that from about 2,000 words to about 20,000, which I found as mind-boggling as he and Terry seemed to find my method.

The moral of this story is: use what works!

Terry had planned to give me a lift back to Berkeley, but David offered to do it instead. We're going to have dinner sometime this week. He wanted to stop for coffee or dessert, but the coffee place near the PSR campus was closed, and I was too tired to schlep all over Berkeley. So we'll see each other in a few days.

I slept late this morning. I had a leisurely breakfast in my room (I'd brought power bars and a coffee maker) and then walked around town and did some desultory shopping: a t-shirt on Telegraph Avenue, groceries at Andronico's. The find that delighted me came at the Elephant Pharmacy, which was selling inexpensive rock-and-metal sculptures that look like bodies with heads: very stark and primal. Remember back when I said I wanted to knit a depression doll? Well, I think this sculpture is my depression doll -- she's certainly heavy and misshapen enough! -- but I'm going to knit her a miniature prayer shawl. I also bought a lavendar-scented candle, so now I have a small shrine on my desk. I don't have my camera with me, but I'll post a photo of the sculpture when I get back home.

One of the things I'd forgotten about Berkeley is how many dogs there are: both the PSR and UC campuses are prime dog-walking spots, and last night David and I saw a lovely young cat on the PSR campus, so I'm getting my critter fix.

Tonight I went to a local restaurant for dinner and wound up eating with two women who'll be in my class (I'd met one of them earlier, as she was getting off the airport shuttle). So that was fun.

And now to bed, so I'll be rested for class tomorrow!

Thank you!

Many thanks to everyone who's e-mailed or commented with messages of sympathy. Gary and I really appreciate them.

Our doorbell just rang (very unusual if we aren't expecting anyone) and Gary opened it to find Dr. Wilson, Harley's non-emergency vet. She'd stopped by the house to give us flowers and a beautiful sympathy card. So thoughtful!

That was definitely the nicest possible ending to a surreal day. Yesterday, I slept most of the day. I got up before dinner thinking I'd work until one or two in the morning, since I had heaps of grading to do for today's classes. But I conked out again around ten. My stomach hurt, and my back hurt, and I couldn't keep my eyes open, even though I'd napped all afternoon, and I figured that if there were any time when it was okay for me to give myself a break, this was it. I wasn't getting much work done, anyway.

So I went back to bed and slept through the night. I woke up at 6:00 -- on my own, without an alarm -- showered and had breakfast, and started working through the piles of papers. I was frequently interrupted by Bali, begging for attention and affection: both he and Figaro have been much needier than usual today, and have clearly been searching for Harley.

At 9:00 a.m., the phone rang. I thought, I bet that's Dr. Wilson. I bet she got the faxed report from AEC and she's calling to give us her condolences.

It was indeed Dr. Wilson. "Isn't this just a kick in the teeth?" I said.

"Yeah, I know. So how's he doing?"

I blinked. What? "He's dead! Didn't they tell you?"

"What? Oh, Susan, I'm so sorry!"

It turned out she'd gotten the first report from AEC -- the one about Friday night's visit -- but not the one from the second (and final) visit. She was clearly shocked. "He did so well with us! We were so careful!" But when I described the symptoms, she agreed with Dr. Pratt that it absolutely sounded like a blood clot.

The weird thing is that she says he was walking fine after the surgery -- "I wouldn't have sent him home with you otherwise!" -- but the minute he got out of the carrying case at home, that back end was down. Gary says that when we picked Harley up after the surgery, as he was carrying the case out to the car, he felt a thump, as if Harley had fallen down inside. At the time he just thought Harley was woozy from the surgery. Now we're all thinking that that's when the blood clot hit him. When he got out of the case at home, I assumed he'd been walking that way at the vet's office, too. Now I wish I'd taken him back right away, although Dr. Wilson said we would have wound up at AEC anyway.

It probably wouldn't have changed anything. I have to believe that.

So, anyway, she stayed on the phone with me for fifteen minutes, saying all the right things, and then I got off and got back to my grading and went to work.

Work was surreal. A colleague across the hall told me that his two cats were in and out of emergency care all weekend too, and that one might die. Another colleague said she'd just finished writing a condolence note to a friend whose dog died last week. One of our priests at church sent me his homily from yesterday, about his dog who died last week. And Dr. Wilson says they've been doing more euthanasias than usual. Is there something in the water? Is it the change of seasons?

Classes went fine, I think; I got all the grading done, anyway. I had to cancel my office hours to make that happen, but that's okay. Students can e-mail if they really need me, and again, if there's any time I cut myself a break, it should be now. It's strange, though, because I was very conscious of the whole disenfranchised-grief thing that happens with pets. I told a number of people what had happened, but most of them (not all) had very casual reactions -- "Oh, that's too bad," as if I'd broken a favorite vase -- even if they have pets themselves.

Okay, so we all know that cats and dogs don't live as long as we do. But most of us expect to live longer than our parents, too, and no one treats that loss as a minor one. Because pets are so dependent on us, they're woven into our lives more closely than anyone except infants, or loved ones of any age who've become disabled by age or illness. Even if they're small, furry, short-lived, and don't have opposable thumbs, their deaths leave huge holes in our lives.

But my friends with pets certainly know that, so their reactions were probably just part of the general cultural cluelessness about dealing with death. For all that cluelessness, we have a slightly better sense of what to say when a person dies.

When Dr. Wilson dropped by with the flowers tonight, we talked about all this a little. I asked if vet students get any special training in dealing with grief. She said they don't. There's no mechanism for veterinary folks to process their feelings about having to euthanize animals, which has to be the toughest part of the job. Gary told her, "You need a chaplain." (And he's an atheist!)

She'd read Harley's obit and said, "Yeah, I noticed a pet chaplain on your blogroll!" I said I could never do that kind of work; it would upset me too much. Having now gone through hospice, albeit briefly, with both of my parents, I think I could do human hospice work, and would in fact find it very fulfilling, but most dying humans can, at some point, talk about what they think is happening to them. They can make sense of their experience. Animals can't do that in any way that's accessible to us. Their people can, but it's still a lopsided process. (Although I believe there are now veterinarians who specialize in hospice/palliative care/end of life issues.)

Since there are such vets, shouldn't there be more training for vets in regular practice? I need to do more research on this. In the meantime, if anyone's aware of any grief-related resources for veterinarians -- other than vet-school grief hotlines like the one at Davis, which Dr. Wilson knew about and which are really more for owners, anyway -- please fill me in!

There was just a huge crash as Bali knocked over Dr. Wilson's flowers, shattering the vase (not a favorite) and showering the floor with glass and water. We've gotten that cleaned up. Now Bali's stretched out on my desk, looking for things to chew.

Must go play with the kitty.

Lovely New England

I got to Penn Station hours ahead of time this morning and had a pleasant visit with my friend Alan, who works and lives nearby and popped into the waiting room to say hi. We've known each other since high school, but haven't seen each other for twenty-five years, so it was great to visit with him, however briefly.

The train ride to Amherst, through the never-ending rain (will I ever see the sun again?) was peaceful and pleasant. I got a lot of knitting done on a hostess gift for Deirdre and listened to music. I did not, alas, get any work done on the Secret Project, but I will! I promise! Soon!

Deirdre and I haven't seen each other for four years, since she moved East from Reno. She was my best friend at church and helped me through some truly gnarly times, so I was just delighted to see her again. it appears to be mutual! She gave me a very brief tour of Amherst and Northampton, both of which are so charming you could just go into sugar shock, especially after the dreary lack of architecture in many Reno neighborhoods. All the houses here look like something out of a children's story or a Christmas card (if it were winter); gingerbread trim, fantastic roofs and chimneys, lawns so green they look painted.

Deirdre said that for her first two years here, everything she saw made her exclaim, "Oh look, how cute! It's just so cute! How can everything here be so cute?"

We went out to dinner with Deirdre's boyfriend Skip and her daughter Morgan. Afterwards, Skip drove us around so I could see more of town, especially the Smith campus. (Deirdre had shown me Amherst College and UMass Amherst earlier.) Then we went back to Deirdre's house, which is as charming as everything else around here. We sat on her porch and drank tea and caught up on each other's lives, and i admired and patted, when the animals allowed it, her dog and three cats. They are, of course, very cute.

I also called my cousin Val in Amherst and made arrangements to get to her house on Wednesday. I haven't seen her since her brother's funeral two years ago, and I'm looking forward to spending time with her under happier circumstances.

Tomorrow I'm going to wander downtown -- nearly everything's within walking distance here, another plus -- and check out the shopping. Deirdre tells me that one of the yarn stores here is the largest in the country. Bwah-hah-hah! I hope they ship!