Beam me up, Scotty

Life moves along. I wait for my coffee, the shower, meals. TV is boring, books keep me distracted and the internet remains too addictive. It is all a waiting game with the Big Countdown. I'm past the halfway mark and accept the fact I won't be returning to my beloved Pilates for a long time; the majority of movements require your arms so even yoga is out. Muscles are atrophying quickly and I've also accepted I'll just never have Michele Obama arms. I did sign up a personal trainer to maintain lower body strength and have started walking on flat surfaces as much as possible. There is the big buildup to the dreaded lung CT scan and unecessary anxiety rears its ugly head.

CT scans are creepy. My lung CT was done the same day media reported the gross radiographic exposure from one CT (inciting unnecessary cancers from overexposure - further research 29k/72M) and I am now on my 3rd with a 4th likely. The procedure seems benign however when you are inside the machine you are ready to say 'beam me up Scotty' - a revolving scanner rotates around you humming like a whirling dervish. One's vulnerability during ongoing diagnosis diminishes seeking the wisdom of physician's orders, however it all gets down to cost vs. benefit in both $ and health. The shoulder CT eliminated surgery, which has significant health implications especially too many days post injury (1st Dr. error in delay). The lung CT will diagnose cancer, fibrosis or bronchiolitis (the 2 former were negative, amen) and the latter did show inflammation in all lung fields. I'm consulting with a pulmonologist later and this is likely due to the auto immune issue I have, and certainly resolvable. Another amen.

Major debate exists on both the cost of CT machines, reputed to be 30 to 40% more in the US vs. Europe and Asia, and those ordered per capita. Statistics are too easy to quote and I understand there are many variables, yet I do have EXPERIENCE on the healthcare numbers game. More equipment means more tests means more $$$ for business and physicians (if they have a personal investment in scanners/business models). I have nothing against reinvested corporate profit, however when it comes at consumer expense in unnecessary tests increasing ROI that may be unnecessary thus ultimately raising insurance premiums - then I have a problem. You see...you the consumer ultimately pay regardless of how you look at regulation. Because when you are sick, and you don't know how the system works, and somebody tells you a CT scan is necessary (whether it is or not), I GUARANTEE you, you will acquiesce. I did. Our insurance premiums were just raised again for the 6th time in 5 years, with lesser coverage and I have a pre-existing diagnosis. Treasure your health, be thankful for employer sponsored healthcare if you have it, and support health care reform.

Crisis is Opportunity

I returned from San Diego able to move my right forearm - MAJOR accomplishment. I am right handed so eating, wiping, washing is better facilitated. My left upper arm 'stigmata' pain is worsening daily so I'm concerned. My plea to the Orthopedic surgeons office results in a same day appointment only I'll see Rick, the PA-C (see prior post)and once again - here is how medicine efficiently works. An urgent need is responded to immediately, I am radiographed prior to visit, the office runs on time regardless of emergency or volume (think PA's, NP's, licensed nursing staff)there are laptops in the exam rooms where all records and digital films are stored electronically (no paper searching), real time data (symptom) entry. Rick walks in, reviews the prior CT scan, brings up arm x-rays for comparison, evaluates films with me directly, AND, spends more time with me typically then physicians. Not that Dr's don't want to but reality is they are pressed for time and I do not require critical care; ancillary providers also tend to deliver more comprehensive patient education as well they should. I love the guy. Another pragmatist who tells me I will probably be in slings longer (up to 8 weeks) and likely have torn biceps. I get weepy, BUT he give me an order for physical therapy. HOORAY! I start on Jan. 13th. I've also hired a personal trainer to come into my home and hope to get my lower body strength back to pre-injury status. I'm used to this BS by now, Craig and I have a bathing and dressing routine. Can't get mad at him for too long because this is the guy that powders my butt.

When bad things happen to good people it is human nature to ask why. Some see it as a form of spiritual retribution or others as the lay of the cards. People patronize you, give you empty platitudes masquerading as compassion and caring though I'm not rejecting sincere sympathies that are well meaning. Sometimes you just don't need to be told look on the bright side. If you are reading this...get a sense of how the person is doing before quoting scripture if that's your style. However...there is no denying the role introspect plays because you want to negotiate your fate. Often, people return to a religious faith they have abandoned and others make heartfelt or empty promises (whichever way you look at the outcome) to that great spirit in the sky. Regardless, accidents, disease, life threatening events can be cathartic and initiate epiphanies. I also just think shit happens. And when it does, figure out the good and the bad real quick so you can be emotionally and physically nimble if more crap is coming. Retrospect is immediate and prospective lifestyle is promised. So here is where I was going to quote that crisis is opportunity we've all heard about. Per that handy Wikipedia, 'Crisis has four defining events. Specific, unexpected, and non-routine events or series of events that create high levels of uncertainty and threat or perceived threat to an organization's high priority goals. Thus the first three characteristics are that the event is 1. unexpected (i.e., a surprise), 2. creates uncertainty, and 3. is seen as a threat to important goals. Venette[2] argues that "crisis is a process of transformation where the old system can no longer be maintained." Therefore the fourth defining quality is the need for change. If change is not needed, the event could more accurately be described as a failure.' If you look at the the Crisis page there is actually a direct request by Wiki founder Jimmy Wales to understand the meaning, and for goodness sakes, please don't misuse the oft repeated 'crisis is opportunity', as it has been done by folks ranging from Condoleeza Rice to Al Gore. Ouch! I still agree with the meaning, get the threat, sense the fear and hope for the transformation. But crisis is serious and now I don't even think this measures up. It doesn't mean I'm going to start saying my prayers but it does mean I'm going to change my life. Besides, isn't living a life of integrity equal to praying for one?

San Diego Terrorists

San Diego was relatively benign. I felt crappy most of the time however the beautiful home we stayed in and the 7lb Jack Russel terrier were distractions that kept me out of the pity pot. Not to say those days don't happen because self-pity is an engaging and manipulative tool. The 2 friends who had the dubious babysitting role were required to do bathroom duty, thus reinforcing the true meaning of friends. The worst part of the trip was being in the straitjacket to begin with, then strapped in the seatbelt and driving down the freeway at the legal 65mph and having cars speed and weave past you at 90mph (I am NOT lying - I lived there for 27 years) while talking on their cellphone or worst yet, texting. A Hamster (what we call those who live in Belligham) related that to urban terrorism and how right she is. We saw drivers casually go through red lights, stop signs, cut you off, never let you in, honk if you weren't moving fast enough, give you the finger, and Craig once, a 'fucking useless piece of shit (that is our favorite). All behaviors of the arrogant self-important club whose needs surpass all others. The last few years produced a profusion of articles on our evolving and pervasive American entitlement culture. What is this about? It is certainly an unfair generalization but what is the root cause? Poor Mr. Roger's took the hit there for a while, some relate it to greed, others lack of a religious relationship, for some, a lack of or too much education (you know, the common folk vs. the elitists). All you have to do is read the comment threads on any online news source and yikes, this is a spooky society we live in. So hold on to your horses folks and remember, terrorism is everywhere and not just in the face of a jihadist Islamic bomber.

Simplicity

I don't know. Maintaining a daily post in the heat of crisis allows you to express yourself in the moment, but going back may be irrelevant retrospect. It does soften the memories that I thought would be burnished in my mind forever. I am healing daily so I guess this is the lesson of childbirth that either fortunately or unfortunately I never partook of. Oh...why slings and not casts? The fracture location prohibits casting and the humerus just has to 'hang' for weeks so the fractures align and heal. Obviously no movement can occur or bone rubs against bone. Let me tell you - that is PAINNNNNNN!!! The R fracture is worse, jagged with a tuberosity projecting into my muscle. The L fracture is a clean break but the swelling and bruising is significant. After about 10 days Craig yells 'Stigmata' in the shower - an angel has appeared on my arm. We have a good laugh and take a picture. I later find out the muscle in my arm is probably torn because the pain and bruising escalates for weeks. Oh yes, another tidbit. I may have torn rotator cuffs (require surgery) which is only apparent after therapy. If you can lift your extended arm above your shoulder - you are good. Otherwise it's under the knife I go. By now I am immune to these problems. I did realize early on how insignificant this injury is. There are amputees and quad/paraplegics out there and I know I can rehabilitate, so no wah wah for me. There are good days, whiny days and as long as I don't have to listen to the few egocentric friends that we have who are oblivious to anyone but themselves - I'm good. Question: do I come clean with them?

San Diego. Now I have to worry about that. Being out of the comfort of my surroundings, away from my Dr's., in the traffic that I hate and unwillingness to see friends that I had planned on. I look terrible though Craig has really gotten the hang of my ponytail. I have one outfit that I wear: pull on velour pants and a zip up sweater. Will I ever get into my treasured turtlenecks again? I carry around this little Indonesian woven purse my friend Claudia gifted me years ago that now has more relevance than ever. Lightweight, it carries my drivers license, $5, chapstick, and my phone. And of course the good healthcare professional that I am, all my written health detail / instructions are included and those of course are also in my cellphone (hint).

Tuesday AM (1 day post CT) I get a call from my primary care provider, A Physician's Assistant (PA-C). She is a superb diagnostician and I've been very impressed with her care. The arm CT scan showed interstitial pneumonitis, that will now require a lung CT - scheduled out 3 weeks. I immediately look this up online and link it to the immune system problems I've suffered from the last 4 years - though I'm also an ex-smoker. Freakout #2 goes into high gear as I have had this pleurisy like discomfort for months (in denial) and it never seemed relevant to the rheumatologist that I've seen. I don't want to do too much online research or I'll go into high panic and I don't need this now. FYI, healthcare reform requires increased use of ancillary providers that include PA's, Nurse Practitioners and RN's with advanced degrees. To absorb healthcare costs, increase the level/quality of primary care, and reserve advanced diagnostics to specialists (e.g. board certified) medicine (e.g. the AMA) and the American public needs acceptance of these providers in our society, and financing should be provided to develop their numbers, or we are in a shitload of trouble. Baby Boomers meet Medicare. In all the healthcare debate which I followed closely, there were only snipets of this suggestion. Soapbox #3.

I table this latest problem and deal with The Trip. If I don't watch it my anxiety gets the better of me. I can't focus on packing because there is nothing I need beyond The Outfit, The Purse and The Tennis Shoes. Stupidly I do insist on a few extras that occupy nothing but wasted space. Craig has to schlep 2 bags, his briefcase, my laptop all with aplomb. I am double checked by TSA (arm slings), which I don't care about - they are just doing their job. An older couple following me, who appear educated and well traveled, have one of those steel briefcases that upon inspection, reveals liquids, bottled water, pocket knife etc. The woman feigns ignorance stating she just doesn't know what the rules are anymore, they change so frequently. Her husband, who appears to have some kind of mental deficit, innocently states they hoped these items would go undetected. The brilliant answer by a kind, patient and tested TSA bloke - "Well ma'am, Bellingham just sets the standard for restrictions and you are flying at the highest level of safety possible". Don't you love it.

The trip is without incident though I'm paranoid as hell. People want to stare and think WTF, probably also wonder if I'm a victim of domestic abuse (poor Craig) and in general, look away. We use a wheelchair in San Diego which Craig insists on and make it to the car pick up OK. The day has been long and I force him to drive surface streets the 15 miles to his sisters. I should have taken an Ativan.

Reality

You can't be a pussy to have this kind of injury. Nor any other life threatening disease, dismemberment, serious loss or life changing event. Those that have understand. One can empathize but please don't say 'I Know' unless you do. I'm writing this at week 4 and can't tell you how many times I've heard these empty patronizing words. Before 'The Fall' I would have been pissed off, however Lesson 57 allows me to simply say without being confrontive, 'no you don't' (unless of course they do). Now, if someone is referring to all the emotions, behavioral changes and see the light perspective because of the aforementioned qualifiers, I will indeed perform the secret handshake. HOWEVER, I will also firmly state here how moved I am by the love and outreach of many friends and am grateful they think of me in this way. They are generally not the ones saying I Know.

So, week 2 Monday I walked into the Orthopedic & Sports Medicine group I was referred to by Craig's former physical therapist. In medicine: only trust the caregiver referrals because they see the outcomes. Remember the classic line by the surgeon...'the patient died but the surgery was a success'. Cremation is not in my plans yet but before anyone slices me open I want a 2nd opinion. Now here is how a Dr's office is supposed to work. The pitiful sight that I now project has it's advantages. Arms in slings, helpless I tell My Story and the receptionist calls in the RN from the backoffice. Relevant here is the fact the medical group is owned by the hospital that is thus subject to government accreditation standards requiring only licensed staff (e.g. LVN, RN not medical assistants calling themselves nurses) perform direct patient care. Oh, that nasty government intervention that calls for standards not typical in independent private practice unless of course they care - which most don't. I am not yet even a patient but she nonethless reviews my xray films online (another standard of care...electronic medical records, that evil Obama is suggesting), talks to the physician I'm hoping to see and actually tells me to return to the office that very afternoon to see him after my CT.

Peace Health Medical Group runs on time. I am seen immediately for my CT by kind and helpful technicians then return to the office for my appointment with Dr. Holstine. He is an osteopath and board certified in his field. He walks in at the scheduled time, has reviewed my films and now reassures me surgery isn't necessary. The reality is I have to keep the splints on 6 weeks maybe more, can't start therapy until then, may have torn rotator cuffs (later requiring surgery)and full recovery is probably 6 months to a year. I like the honest pragmatic approach but now realize we may have to go to San Diego and I have great fear now of being around crowds of people who may jostle me. After arriving home Craig presses me to make a decision because our friends whose home we are house sitting need to make arrangements for their dog. It is just too damned much for me. I'm freaking out and now finally start to sob violently as I absorb the reality of this injury. I see myself capable of doing less and less. In general, I have The Big Freakout. My good friend Arlene consoles me on the phone and talks me through this and Donna my Guru texts me all evening even though she hates texting. I agree to San Diego but man am I pissed. I refuse to talk to Craig the rest of the night, and silence is the only thing I'm capable of.

I am in a straitjacket. It is insufferable if I think about it. I can't scratch an itch. I have to ask to go to the bathroom. I can't eat. Holding a book is too heavy. I can't put gloves on. I'm afraid to drink even though I'm thirsty. I can hold my phone and turn on the TV. You are reading the words of a classic, wildly impatient, almost Type A personality. Our marriage has been shaky this last year from family and financial issues, Aunt Marge just died and I'm still grieving. This emotionally fragile personality who sometimes sits on the precipice of anger realizes I just have to let all this go. Give in. This isn't any feigned 'let go let god' because I am agnostic. But somehow I just gotta see the light. Craig has been so helpful I can't imagine anyone performing these acts of selfless love unless they truly adored you. He doesn't speak much and since the beginning of our marriage I have to beg him to tell me he loves me. But if you know him, he shows his love through his actions. Some in his life have abused this privilege though fortunately I've had the good sense to always acknowledge him for the benevolent man that he is. This is the meaning of marriage. Crisis is the reality.

Technology is my Friend

DISCLAIMER: THERE MAY BE TMI - BE FOREWARNED. I was going to do a blow by blow daily account of what I was experiencing but it seems trivial. While my emotions ran high and I truly believe I had some emotional breakthroughs - in psychobabble parlance - it is mundane to share those feelings as they evolved. Besides, the devil is in the details. It nonetheless remains necessary to relate the dirt otherwise what is the sense of Two Broken Arms, eh? Ok. Got home Sunday night and immediately felt like I was in a strait jacket with arms strapped to my body - the 4 week plan. Any movement caused excruciating pain so I loaded up on dope and dealt with the sleeping plan. I am a prone 'stomach sleeper' so immediately faced the prospect of 4 weeks on my back. I also can ONLY sit on the toilet and wiping is up to Craig. Eeeew. He positioned me, got my neck in place, pillow under my knees with little pads at my sides to eliminate moving. This position holds true today. Slept OK on drugs and woke up next day...waiting, waiting, waiting for Craig to wake up and 'toilet' me. We're past that now but I still awaken with the sweet plea ... 'are we going to have coffee?' The champ is keeping up with the French Press though he inwardly prays I'll somehow revert to a coffee pot. Don't let that fool ya' though...he would step in for George Clooney anytime on the Nespresso campaign. So...first day I am actually kind of perky, not hungry, planning how I'm going to exercise, and keeping my phone close. Craig heads out to get some supplies leaving me pajama bottomless and hoping I don't have to pee (I do). There is one thing I could do then and now...is hold my phone in my hands, put it on speaker, and get busy. Though texting is my preferred method (have since sent 10,000) I call anyone and everyone to keep busy. TV blows...can't read because book is too heavy in my hands and my precious laptop is inacessible. Mousepad requires reaching and I'm strapped in. Straitjacket. AAAAAAGGHHHH! So the first couple of days are novelty and the excitement of the week is looking forward to my first orthopedist appointment on Friday. We are supposed to go to San Diego on Sunday and I naively continue to plan on the trip though any preparation is beyond my capacity at this point. I have finished my shopping and as usual prior to a trip have the guest room set up with some clothes and items we routinely take though we are minimalist travelers. I have even arranged for a friend to walk me, take me to physical therapy, reorganized social plans etc. Friday finally arrives and as the last patient of the day, have to wait in a very kind but quiet office. Ultimately the Dr. shows up and it doesn't look good. He's tall, good looking, wears velvet pants, looks like a dandy and graduated from UCSD. Remember...I worked there! His interpretation of the x-rays showed another view we hadn't seen (we were given copies on ER discharge) that revealed a tuberosity possibly indicating surgery. Oh, FYI. No casts on these fractures....you just 'hang' for weeks until the bones align and fuse. But the bone fragment sticking out (therefore the subject of my pain all week)might indicate a torn rotator cuff as well as a need for a pin placed surgically. A CT scan was ordered for Monday, I asked for travel approval, and sent on my way. And I mean...receiving this news, absorbing further reality, and oh yes, please get out of the office because it's 4:30 and the office is closed. Then and now, it absolutely amazes me the things people ask you to do KNOWING you have two broken arms, are strapped in, and what part of I CAN NOT MOVE MY ARMS DON'T YOU GET IT do they not understand!!! Craig and I immediately went to the airport to change our flight plans to the next Thursday and off we went. The waiting game starts again. Thank god for my phone, as I immediately called, cried, texted all my peeps. Reality is setting in.

Retrospect

I am going to retrace the events of the last 3 weeks. It is now two days before Christmas, and about 4 days since I can move my right forearm thus enabling me to keyboard. I can literally retrace every second, minute, hour of events up until now because this is a Waiting Game. Plain and Simple. It isn't that I want to savor the challenges, re-experience the anguish of complete surrender, or do a dipsy blow by blow account, rather my hope is to make some sense of this and remind myself of the changes that have occurred as a result - both physical, emotional and intellectual. But just so you know right from the get go and want to imagine how this works...put your arms at your side, fold them in front of you, and this is exactly the position you have to maintain for 6 weeks. It sucks big time.