Pink and Smooth

Surprises are foolish things. The pleasure is not enhanced, and the inconvenience is often considerable. -Jane Austen

In early June of 2011, my daughter Sammi had the final endoscopy in a series of eight, each one marking a phase of her six-food-elimination diet for eosinophilic esophagitis. Each scope after the first one — the one that provided the diagnosis — was to test for the effect that a food had on the surface of her esophagus. A negative reaction would look like eczema in that muscular tube running from her throat to her stomach — patches of white, clustered cells, sometimes so thoroughly irritated that long, deep ridges would form, as though the disease itself had run a fingernail down the tissues there. That was the state of things when she had been diagnosed in June of 2010. Continue Reading…

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One Food at a Time

Five years oldThe words “elimination diet” implied, when I first heard them, the opposite of the process through which we put our five-year-old daughter. I thought an elimination meant taking things out of the diet, one by one, until Sammi felt better and her esophagus ceased to have eosinophils coating its walls. In reality, the process worked in reverse. This was what her fifth year looked like: Continue Reading…

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Endoscopy Days

My daughter Sammi was four years old when she had her first endoscopy. Between that first one in June of 2010 and the most recent one in November of 2013, Sammi had more than a dozen endoscopies, each blending into the next, a routine and ritual that she has endured more times than she’s had annual physicals in her pediatrician’s office. She’s had more endoscopies than years on earth or last-days-of-school.

The day before an endoscopy, I always posted a request to my friends on social media to think positive thoughts and project smooth, pink esophageal walls, free from the eosinophils that represented disease. “Think pink” became one cousin’s regular response to my requests, and a local friend whose wardrobe tends toward black and grey regularly surprised me by wearing a pale pink top on endoscopy days, leaving me excusing myself to dry my tears in the bathroom.

Sometime in the afternoon that day-before, the hospital would call us to tell us when to arrive for the procedure. At a children’s hospital, the younger children’s procedures are always earlier in the day, since all children being put under general anesthesia have to fast for eight hours beforehand. As Sammi got older, the start-time for her endoscopies got later, a sign of how long she’d been going through this process.

Most often, we would have to be at the hospital early in the morning. Bleary-eyed but unexpectedly focused and efficient, my husband and I would pack everything we needed before waking Sammi and her sister Ronni. A friend would absorb Ronni into her home and morning routine long before school hours, and we’d drop her off on the way to the hospital. Often, Sammi’s grandmother would be waiting for us in the surgical waiting room, a new toy or fancy notepad in hand to distract Sammi as we filled in paperwork, collected a urine specimen cup for Sammi’s participation in a research study on eosinophilic esophagitis, and waited to be moved to a presurgical hospital room.

endoscopy dayIf Sammi was nervous during this time, she didn’t show it. By the fourth or fifth time, she had begun to remember the order of things, the friendly waiting-room concierge, and the forthcoming afternoon of movies on the couch at home when it was all done. She didn’t seem to dread it. Changing her into the gown and the awful paper underpants frustrated her, but we learned to do that at the last possible moment. Time alone with her grandmother, the TV in the room, and our steadfast cheeriness kept her from worrying.

None of that did a thing for me, on the inside, despite how collected I seemed on the outside.

According to a 2012 study by The Lancet, 34 people per million in the 1990s and 2000s died as a result of being administered general anesthesia. I assume that was 34 people per million surgeries. With every surgery, Sammi’s chance of dying rose ever-so-slightly, statistically-speaking. With every surgery, I became more and more concerned that this would be the one that killed her.

How many chances did she get?

How many chances did I get?

I walked her into the operating room every single time unsure of whether I would ever see her alive again, unsure of what the last words I would hear her say would be. That doesn’t mean that I thought she would die, but that I didn’t know for sure that she wouldn’t.

I sang her to sleep. I kissed her head. I told her I loved her, and I said goodbye.

Endoscopy days were hard. Really, really hard.

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Chivalry

The stories I tell about my daughter — and about my experience as her mother — feel as if they belong mostly to me. For so many reasons, I’ve turned out to be the person who’s handled the majority of her health issues, a role that feels as anachronistic as it does unchangeable. I’ve written very little about Sammi’s sister, Ronni, and perhaps even less about her father, David, except in first-person-plural, the other party implied whenever I write that “we” worried.

When we found out that Sammi’s aorta was the problem, it was a total shock — so shocking, in fact, that David had not come with me to the hospital that day. He’d been visiting his grandmother, who had pneumonia, and as a precaution against spreading it, he’d stayed away from the children’s hospital. My friend Cathy came with me that day. It was Cathy who sat next to me in the consultation room as the doctor explained what a double aortic arch was, and Cathy who looked me in the eye and told me it would be ok. It was Cathy who held Sammi as I called David at work and told him to get out a pen and start taking notes. It was Cathy who stepped outside with me and my woozy baby into the bright, mocking sunlight and steered me toward lunch, breathing, and reason. She was irreplaceable — exactly the presence I needed.

I remember not wanting to tell David, wishing I could give him another day without knowing what was about to happen. Nearly four years later, he had the chance to do that for me, and he did.

***

Every summer since Sammi was two, I’ve gone away for one weekend to the Indiana Fiddlers’ Gathering, a musical festival for traditional string music in a park over the grounds of the Tippecanoe battleground. As an old-time fiddler myself, it’s an opportunity to be immersed in the music I love, to feel the air on my skin in a way that mothers don’t often feel with young children at home. It’s my get-out-of-parenting-free weekend, once a year.

A week before the Fiddlers’ Gathering in 2010, when Sammi was four, she had her first endoscopy. The brusque and busy doctor had emerged from the operating room after the procedure with a glossy page of photographs of Sammi’s esophagus.

“See here?,” she said, pointing to a shiny spot in the photo, “This is something I sent out for biopsy. It could be yeast — that sometimes happens when the kids take these reflux drugs for so long — but it could be something else. We’ll let you know when we get the results.”

David and I squinted at the photo, “What could it be?” I asked.

“Well,” she said, a step away already, “there’s a chance it could be this thing we’re seeing nowadays called allergic esophagitis. It’s a big deal. Let’s hope it’s not that.”

“What do you do about that?,” I asked as she walked another step or two away.

“There’s a complicated diet. Sometimes they can give you some drugs. We have a specialist for it in our practice. Hopefully it’s just yeast.” By the time she finished talking, she had already turned her back to us and was walking away. A nurse walked us to the recovery room to sit with Sammi as she woke up.

For days, I listened for the phone call. My hand was on my cell phone, my ears prickling with the vigilance. On Friday, when I left for the fiddle festival, I told David to get in touch with me if the doctor called with results.

I phoned him on Saturday from my tent, asking “Did the doctor call?”

There was a pause. “No,” he said. “Sorry. Not yet.”

The weekend was soul-enriching, as I knew it would be. I arrived home Sunday, dirty and happy, unloading tents and camping equipment and my fiddle from the car. His mother was there for the afternoon, playing with the kids. David asked me to come up to our room. He closed the door. He said we needed to talk.

“The doctor called on Friday,” he said. “I didn’t want to ruin your weekend.”

Sammi had been diagnosed with eosinophilic esophagitis. It is, we would come to learn, a black-and-white disease: you have it or you don’t. The diagnosis is lifestyle-altering, unclear, prognosis poor, and ambiguously treated.

It was the end of our little world as we were coming to know it. David delayed that end for me by 48 hours. In the days that followed — frantic, drowning days — I knew that he had sat with that knowledge alone, no one to talk to, for two nights.

That was the most gallant, valiant, and noble thing anyone will ever do for me.

If I mention him very little in our story, it is partially because in just that weekend, he did enough for me to treasure him for many years to come.

everything

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Laid in Arms

hospitalDavid, Sammi and I slid into the hospital the morning of her first surgery the way a reluctant toddler comes down a slide. All sorts of practicalities handled, bags packed for a hospital stay, all that remained was the hour of waiting in a room with a baby we might never see again.

If that sounds maudlin, that’s because it was. The risk to this surgery was smaller than most cardiac surgeries, but there is always a risk to surgery. The doctors would slice into my smooth, perfect, luscious baby’s back, pull her ribs apart, and decide which branch of her aorta to clamp and remove. The very thought of it made me weak. And yet, my job was to hand her over to these doctors who didn’t know anything about who she really was. They didn’t know she could sing. They didn’t know how much her four year old sister adored her. They didn’t know about my ambivalence about her for the first months of her life, ambivalence that I worried would make the universe believe that I didn’t want her, after all, and maybe it would take her away from us to punish me for it.

We passed Sammi around the pre-operative room — David and I, his mother, his sister, and her husband. After I refused to give her to a strange doctor to take away, screaming for me, they gave her a shot of Versed, an anti-anxiety drug that made her loopy and cross-eyed. When the anesthesiologist came to take her away, she waved at me as she was carried down the hall in his arms.

Once she was out of sight, I fell sobbing into the arms of my sister-in-law. She and I had never been close, but sometimes, the right person at the right time becomes a lighthouse. She was solid and soft at the same time. I think I fell on her because she was the very nearest person, and all my hold-it-together just dissolved once Sammi was truly and in every way out of my hands.

The details of the day — the waiting, the surprise visit with pastries from David’s aunt, the moment when the surgeon came to tell us that everything went well — these are the uninteresting snapshots of someone else’s life, the ones we look at politely but cannot connect to our own. The universal is in the humanity of kind people when you need it the most. That hug. Those pastries. David’s hand on my shoulder when we learned that they were closing her incision, and my memory flash of his hand on my shoulder as Sammi had been born, with me flayed on an operating table, paralyzed, unable to help her. She’d lived through that. She would live through this.

I couldn’t do anything to keep Sammi alive except to go and find the people who knew how, and to lay her in their arms.

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