No, It Doesn’t Get Old

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One evening, almost exactly four years ago, I went out to dinner alone with my nine year old daughter, Sammi. Her older sister had religious school from 6pm to 8pm, and sometimes, I couldn’t bear to drive home, cook something, try to get Sammi to eat quickly, and then scoot back out the door again. The local Thai restaurant was easier, and besides, just a month earlier, I’d been left awestruck when Sammi ate an entire plate of pad woon sen in that very booth.

Six months earlier, she’d undergone major cardio-thoracic surgery to move her meandering aorta away from the places where it was smashing her esophagus nearly closed. Before that surgery, an adult portion of any restaurant meal would spoil in the fridge before she could finish the whole thing; she’d sit at a restaurant, fidgeting and chatting, the bite of tofu speared on her fork going cold. Mealtimes were frustrating slogs through her inability to swallow.

Even once the cause had been discovered and her aorta gently moved to the side and sewed to her sternum, eating was still slow and frustrating for her and us. We’d sent her to feeding therapy, a white flag waved at the eight years of labored eating that had conditioned her to chew slowly, fill her belly with water, and avoid the kind of dense food that would help her grow. Over the entire summer, once-per-week therapy over her lunchtime seemed to do little to help her regain the ground she’d lost. I waited for the growth spurt that didn’t come.

Then, one November day at the thai restaurant down the street, I mentally planned for her leftovers to go in her lunch the next day (and the next, and the next), only to look across at the plate of mild glass noodles and vegetables to see it slowly emptying. By the end of the evening, I was so excited that I took a photo of her empty plate and texted to my husband, my mother-in-law, my parents, and several friends. Continue Reading…

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Being a Child

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More has been written about Atul Gawande’s book Being Mortal than on most other books on medicine and health, combined. It was reviewed in the New York Times, The Guardian, The Wall Street Journal, and dozens of other newspapers, magazines, and other publications large and small.  Its study of how the medical profession handles the process of dying — whether that process comes at the end of a full life or far too soon — has changed the national narrative. Doctors are coming around to the idea of supporting patients on their own terms as the end draws near, a concept which, to many, seems antithetical to their oaths. After all, are they not charged to “do no harm?” Gawande’s Being Mortal forces the discussion and redefinition of “harm.”

In an early chapter of the book, he writes that there are two kinds of courage. “The first,” he says,  “is the courage to confront the reality of mortality—the courage to seek out the truth of what is to be feared and what is to be hoped when one is seriously ill. Such courage is difficult enough, but even more daunting is the second kind of courage—the courage to act on the truth we find.” As he shares the stories of his own patients — choosing between risky surgery and an uncomplicated but speedier end; finding ways to maintain autonomy as they age; managing varying levels of discomfort while remaining lucid and cogent — it is clear that all the scenarios where his courage to “act on the truth we find” are predicated on the first courage to “seek out the truth of what is to be feared.”

In other words, there can be no action toward healing without first determining how his patients define healing. Continue Reading…

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Contrast This

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About six weeks ago, I tripped over a bolt jutting out of the floor of my garage and landed, head-first, on a spare car battery. It became clear within a few hours that I had a whopping concussion. In the impossibly bright lights of the emergency room, a friendly young resident told me she was considering whether or not to give me a CT scan.

“It’s just how tender your skull seems to be,” she said, puzzling it over. “I’m a little worried about whether you’ve fractured it, or whether there’s any bleeding in your brain.”

“What are the reasons for and against it?” my husband, ever the pragmatist, asked her.

“Well, if we did it and found out she has bleeding, we’d definitely keep her overnight, just to be able to check her regularly and get another scan in the morning.”

“So, why not do it?” I asked.

“Well, it’s a lot of radiation, is all…hang on a minute,” she mused, paging through my chart. “How old are you, again?”

“Forty-four, last week,” I told her.

She did what looked like some mental calculations in the air above her, then recommended that we do the CT scan. When pressed, she explained that the cancer risk comes about forty years after the exposure to radiation. By then, she calculated, I’d already be pretty old. It was a worthwhile risk, given the math. Continue Reading…

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Listen to Us

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This poem, by Shel Silverstein, always made me sad. When I was a little girl, I had an audiocassette of him reciting it, and his warm, avuncular voice is the one I hear in my head when I read it.

The Little Boy and the Old Man

by Shel Silverstein (1930-1999)

Said the little boy, “Sometimes I drop my spoon.”
Said the little old man, “I do that too.”
The little boy whispered, “I wet my pants.”
“I do that too,” laughed the little old man.
Said the little boy, “I often cry.”
The old man nodded, “So do I.”
“But worst of all,” said the boy, “it seems
Grown-ups don’t pay attention to me.”
And he felt the warmth of a wrinkled old hand.
“I know what you mean,” said the little old man.

It’s hard not to feel heard. Little children sense that they’re being ignored even if they can’t express it well. They may do other things to get the attention of grown-ups: break something, have a tantrum, or find other ways to force that grown-up to take notice. Old men may quietly do what they want, or give up entirely, but they have an understanding of who they were when they were young men — that they ignored their elders, that they paid less attention than they wished they had, and the empathy they have might lessen that feeling of sadness. These are expected responses.

But what about women? Continue Reading…

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I’ll Hold Two Hands

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I have two nurturing, empathetic daughters. Both went away to overnight camps this summer and came back with appropriately maternal nicknames. One daughter was affectionately nicknamed “Nancy,” a name her camp friends said sounded like someone’s mom, because she greeted her friends each morning with “did you sleep well?” The other daughter, equipped with a bag of crocheting, another bag of butterscotches, and sipping a can of ginger ale, felt called to wake her friends in time for class in the morning; they called her Grandma.

I glowed with pride when they told me.

Because their loving natures make them muse regularly about what it will be like to have their own children, I feel full approval to imagine myself as a grandmother, someday. My grandparents were not a part of my life, but my daughters have been lucky to have two grandmothers and a grandfather, giving me a window into all the choices I might have someday about how to conduct myself in those magical, far-off years. I have thought often about the way I want to behave. After all, becoming a grandmother does not end my tenure as a mother, nor as a wife. How to proceed? Who will I be? Continue Reading…

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