January 2011 Archives

I wish that my own experience of becoming unstuck in time would produce a collection of words as memorable and absorbing as those that Kurt Vonnegut used to describe Billy Pilgrim's. That in itself is a cop-out. Fake and lazy. Experience doesn't assemble collections of words, people do. Writers. Authors. Words don't just happen. Left to its own devices inspiration sits there like a pile of dog shit by the curb. It doesn't do anything. Leave it alone and it eventually dissolves and washes into a storm drain. Gone, never there.

My issue...challenge...call it what it is, my problem--fuck that positive spin, this is a damned-by-god negative thing, not some call to a contest, a lesson-ridden metaphorical confluence to be overcome, victory over which will result in a brief spurt of positive growth. It's a problem. There is doubt. Uncertainty. Difficulty. I'm not going to reframe it, I'm not going to recontextualize it, I'm not going to do some New Age personal development hoodoo on it to turn into something fuzzy. You don't grow by making something small and then stepping over it. That is four AM bullshit available on ten DVDs for four payments of $39.95. You grow by hurling your body up and over the jagged and looming peak that's in front of you.

So yes. The problem. My problem is that I am never...here. I'm mostly where I've been, or--especially lately--where I'm going to be. The little green guru in the swamp with Frank Oz's hand up its ass would be very disappointed with me. I wouldn't be able to lift the X-Wing. Never his mind on where he was. Hmm? What he was doing. Hmph.

There's imprecision lurking--I'm supposed to be all about choosing the right word, hip to the difference between "lightning" and "lightning bug"--and that imprecision lurks because the "here" in question isn't spatial, it's temporal. Obviously I'm always here in the former sense. Right now I'm in the recliner at my mother's house, Fight Club is on the cathode-ray tube--I am Jack's wasted life--and I'm typing on my Asus laptop, the little computer with its extraordinary battery life and its overly flexible island-style keyboard, while a few miles away my mother recuperates three-to-a-room and six-to-a-bathroom because, in the end, the place she ended up wasn't quite as bad as it could have been, but still represents a future that may await me, and you, whether we sink into the demagogues' predicted state-run senescence as delivered to us by the dreaded Obamacare, or some other bureaucratic clusterfuck of an elder care system cobbled together for the fractured remains of middle class families. And even that isn't really the issue, isn't really the problem, the problem isn't what's going to happen to me, or to you, the problem is what's going to happen to her, the problem is that her disease will progress, that age is inevitable, and what's going to happen over the next four to six weeks is just a precursor, it's going to get worse, and you see? That's what it's like. I can be sitting here--right fucking here!--and yet not be here at all. I'm in some future of assisted care and immobility, loss of dignity, and the experience of watching someone become truly pathetic. That's a word that's used too often and too lightly. Look it up. It's compassion and sorrow and sympathy all gathered together around a core comprised of the suffering of others.

Right now--temporally--none of that is here with me. There's the computer and the television and a slice of cold pizza in the fridge. But that's not where I am. I've got the knot in my chest from anticipating waking up tomorrow morning and hauling my resistant ass back to the office, and if I work at it a bit I can get a more pleasant vibe from the forthcoming pleasure of sleep, but that's not now either, is it? That's in an hour.

I tried it a bit, on the way home this afternoon, driving south along the 101, with the mountains rising to my left, the sky clear blue and high above me, and I tried, for that five mile stretch, to just enjoy what I was seeing. It worked, for those ten minutes. But then it passed, and I spent some time not looking forward to actually visiting the convalescent home, and while I was there, I looked forward to not being there, the temporal now always just ahead of me, or behind me (which is embarrassing) and so I spend far too much time being elsewhere, and not here, which should, I think, take care of the aforementioned imprecision.

None of which, it seems to be, is anywhere near as memorable and absorbing as Billy Pilgrim. That man had something to say. Those were meaningful experiences. This?

I'm just unstuck.

Inexplicably. But genuinely.

So peculiar.

Such an unusual way to start the day, for me. I felt like a child who'd been given twenty dollars to spend as he wanted and then sent alone into KB Toys, and I wanted to have something else to do with the day, something other than simply going to work. But I didn't, so I took my odd morning glow with me to the office, and did my usual office type things. Not with any extraordinary amount of vigor, mind you. But I was just...content. The kind of state that you want to bottle and keep for later. Maybe sprinkle some on your salad at lunch.

I was glad to have my gladness! And I needed it mid-morning, when the first choice for my mother's post-surgical assisted living arrangements fell through due to four of the facilities' paying residents having the bad grace to all return from their hospital stays on the same day, each in need of a bed. The admissions coordinator at the facility had told us that might happen: paying full-time residents have priority over any Medicare-funded guests. There's another facility in town with open beds, but it's of lesser reputation, which increases my level of concern, due to my mother's particular needs regarding general mobility and assistance. This might mean that I don't get to relax quite as much as I'd planned to over the next four weeks. There's still the possibility of getting into our first choice--a bed is opening up there on Tuesday--but getting that bed will require the intervention of my mother's General Physician. It seems that despite patients supposedly having the right to choose which facility they enter, such places apparently don't like to "poach" patients from each other once they've been admitted. This doesn't make a hell of a lot of sense to me--if the level of care doesn't meet with my requirements, I don't give much of a damn about what effect my desire to go somewhere else has on the relationships between skilled nursing staffs or whether it's a breach of institutional etiquette. But that's how it works.

My mother has a good medical team around her, and a favorable result is by no means assured, but I know that her GP will do his best to get her a bed in the place she wants to be. It's a testament to who my mother is, I think, that she has so many people around her who are willing to extend themselves to make sure that she gets the care she needs.

Which, once more, brings to mind all of the many millions of Americans who don't have such support, who are simply fed into the medical industrial complex and are completely at its mercy. After my mother dislocated her artificial hip picking up the cat (not a particularly fat cat, mind you, just an unfortunate seating angle combined with weakened hip musculature), I happened to be in the room while a hapless technician attempted to rig a horizontal lifting sling to place her on a table for an X-ray. There, on the lifting sling itself, was a clear piece of iconography depicting the exact way that the technician was rigging the sling...surrounded by a red circle with a fat red slash through it. After pointing this out more than once, I finally had to say: "Look, this clearly says not to do what you're doing, so stop doing it. Why don't you go find someone to help you out, here?" Had I not been in that room, the end result would have been my mother being dumped onto the floor and landing on her dislocated hip. The fact that her hip was still dislocated and undiagnosed 24 hours after her admission to the hospital was the result of the ER physician's apparent unfamiliarity with the basic concept of referred pain, and is part of another story. The point of this story is that I've seen enough mistakes made by experts and competent people to know that most patients and their family members put far too much faith in the impressively-degreed and white-coated gatekeepers of our medical establishments.

The way through this unfortunate reality is not found in belligerence, it is found in vigilance and the refusal to equate expertise with infallibility. I have learned to make myself part of the team that forms around my mother with every hospitalization, many of whom she knows on a first-name basis due to the frequency of their encounters. I say "please," and "thank you very much," and I mean it when I do. I remember that nurses and medical technicians are generally hard-working people who are responsible for more patients than just my mother, and that they are usually where much of the real power to provide proper care resides. When things go wrong, I know that the Nuclear Option does not consist of anything other than a steady voice, unwavering eye contact, and a very clear statement of two things: what I need, and when I need it. This I learned last year, when I showed up for a visit following my mother's allergic reaction to her routine IVIG infusion and found her propped up in bed, unconscious, her vomit-stained gown half-off, with a wheezing BiPAP strapped to her face. I need to speak to a doctor. And I need to speak to that doctor immediately. The haste with which the charge nurse picked up the phone was gratifying.

I don't anticipate anything like that this time around, but then I never do. It doesn't make much sense to anticipate things going wrong, because when they do, they always seem to do so in some novel way that I never would have thought of. There are just so many ways, large and small, in which my mother's body can betray her that it seems best to just pay attention to what's actually happening rather than attempt to prepare for what might happen.

And, if I happen to wake up smiling one morning, I keep that for myself, as a gift.

Another one of those days where I end up with all the energy I needed at around 2:00 this afternoon now, when I'm supposed to be going to bed. So I've spent the last three hours in a flurry of computer-based activity, including (in no particular order):

• Designing production schedules for several books
• Setting up a Google Books account
• Revising a document about royalty schedules for authors
• Setting project milestones and an all-important launch date
  

Sounds interesting, doesn't it? Taaaaantalizing, perhaps? Whatever could I be up to?

All in good time, dear reader, all in good time.

As expected, mom was not quite as cheery today as she was yesterday, what with the narcotics wearing off and all. A brief bit of confusion about the exact timing of her move from the medical/surgical wing of the hospital over to the skilled nursing facility that will be her home for the next four weeks sent her into tears, apparently (she hates that). We'd spent a lot of time with the doctor emphasizing that a) she needed to be moved into in an assisted living situation directly from the hospital on Friday, and that b) acute rehab, once the sling came off, would happen after that. Which of course resulted in the doc sending a discharge planner into her room to talk to her about moving her to acute rehab tomorrow. All straightened out when I got there and spoke with yet another discharge planner, but I'm often amazed by the propensity for people--intelligent people, busy, yes, but generally on top of things--to completely forget very specific conversations and set processes in motion that are the exact opposite of what's just been discussed.

I have a great deal of empathy for people who are routinely caught up in the medical system. My mom's a former RN, and sharp, and I'm quick with the thinking on my better days, so between the two of us we're able to muster up the knowledge needed penetrate the Medicare bureaucracy and make sure that she gets the care that she needs, when she needs it. I can't imagine what it must be like for people who don't have the inside track that we do, or who are constitutionally unable to march up to the floor station and politely demand to speak to the charge nurse, or to have a doctor summoned when necessary because the appropriate level of care is not being given. My mom and I make a good team: stuff gets done. If she's upset because there's confusion among the staff, I'm perfectly capable of following the discharge planner into her office while she's on her cell phone, and getting things straightened out. I'm sure that most people just get shuffled through the system, hapless and sick, without an advocate to help them navigate the medical maze.

Because my mother was a medical professional, she's afforded a certain degree of professional courtesy. It's subtle, and it shouldn't be that way, really, but it is, and we take full advantage of it. It also helps that she's not afraid to write letters when things have not gone the way they were supposed to: she's old school, with high standards, and is able to speak the lingo, so when she writes a letter to the hospital ombudsman and cc:'s exactly the right people on the board, things change. They do actually make note of such communication: notes go into your patient file and accompany you on your trips through the system, and I'm pretty sure that my mother's file has the equivalent of a sticker on it that says Do Not Fuck With This Woman.

Which is yet another reason that it's so profoundly unjust that shes been stricken in the way that she has. We shouldn't have to do these things, to make these arrangements so that she'll have the right people around her to help her walk and go to the bathroom and all of the other tasks that I, and probably you, just take for granted, because our bodies mostly do what they're supposed to do. She's only 66, and she's been robbed of what should have been a graceful and active retirement by her clusterfuck of an immune system. It's fortunate that she's always had black sense of humor; often it's the only thing that's been able to see her through an intolerable situation.

So tomorrow she'll move to what she's been calling "the home," which is by all accounts a nice place to be if you have to be in such a place. I'll see her tomorrow there, but probably not Friday, because I have to go down south to have cocktails with my partners and some potential investors.

Which, if you'd asked me six months ago, is not something I thought I'd ever be doing. Funny old world.

No, of course they didn't. But someone somewhere thought it was a good idea. They drew up project plans and had Powerpoint presentations made which explored the improbable intersection of the ice cream and gum-chewing demographics. I suspect this new gum atrocity is related to the proliferation of yogurts with favors like Red Velvet Cake and Key Lime Pie: there's a company that produces flavor essences, and this company is doing business with the yogurt and gum-makers of the world. There's probably a whole realm of horrors that we have not yet seen: Prime Rib yogurt, or the Wonkian Turkey Dinner gum. A wonderful and terrible age we live in.

I am currently fighting a nebulous battle with some sort of sickness. It kind of wrecked my Sunday plans, then retreated yesterday, and now has remounted its assault by hitting me with fatigue and facial pressure. I would rather have two days of knock-down-drag-out viral devastation than this sneaking guerrilla crap. With this kind of mucosal quagmire there's always the possibility of getting stuck on the roof of the embassy while the last helicopter sails over the horizon, leaving you to die buried beneath a mound of used Kleenex and empty Sudafed blister packs. Stand-up fights are superior.

Spent some time in the hospital today, this morning at six AM and then in the afternoon, after they'd hacked off the useless portions of my mother's humerus and replaced them with shiny new titanium and plastic bits. The surgery seemed to go well--which is to say, she survived--and she was very much on Dilaudid when I saw her this afternoon, chatty and hoarse. Ready to do the other shoulder, she said, but that was most likely because the spinal block they'd given her was still working, keeping the pain-beast at bay. I'm sure she'll be less enthusiastic about the whole thing in 24 hours.

Had my first look at potential cover art for the novel today, which was interesting if not entirely satisfactory. I liked approximately 50% of the concept--a promising enough start, I suppose. I've never done this before, and I have no idea what percentage of authors actually end up liking their covers. I'm fortunate to have as much a say in this part of the process as I do (and there are some unique reasons for that), and I suspect that my experience of it will therefore be unusual. But still: cover! Art! For my book. That's some heady stuff right there, which I'd be able to muster up more enthusiasm for were my head not quite so stuffed. Ha!

And that's about all the fingercize I'm going to be able to muster up this evening. Very exciting, I know. But I feel like I've done a small thing, now, and it's the small things that keep me going.

Apparently it's a blog. And it still works! I feel like I've wandered onto the bridge of an abandoned ship, listing at a rotting dock, and found that there's still enough power to light up some of the buttons when I poke at them.¹ Maybe a begrimed radar screen flickers into life, the blurred green sweep leaving dim trails in the half light. Of course, the ship will never go anywhere again, but it's fun to idly flick switches and sit in the musty captain's chair.

How much farther can I extend the metaphor? This far, no farther. The line must be drawn heah!

And while I was away, the year rolled over, giving us a fresh and shiny 2011 to play in. I expect a lot from this year, mostly because I know some things that you don't, which I'll be telling you about soon, but also because last year was such a...what's the calendrical equivalent of a clunker...a turd...a veritable--yes!--shipwreck of a year. (OK, maybe I'll extend it a little farther.)

To be fair, it wasn't the worst I've had, but it was close. It improved a bit starting in August, with the discovery of a whole group of new and fabulous people that I didn't know I needed in my life. So the year did have that going for it, but for the most part I'm glad that it's over, and I can be thankful for that as I peer ahead towards looming successes and known challenges. One of the things I'm going to try to do is kick some life back into this place, mostly because I'm feeling rusty in the word-smithing department. It's like any other skill. You get creaky and stiff if you're not exercising the typing fingers and the bits of the brain that make them go.

So: this is for me, and will be the written equivalent of watching me do the Stairmaster. It will be dull. But at least I'll be stringing sentences together. One! Two! Three! Huff puff puff. Maybe even on a daily basis.

The first of the aforementioned challenges is fast approaching: maternal shoulder replacement surgery, on Tuesday. Routine for nearly everyone except my mother; her medical history is a page and a quarter, single-spaced, and not one of her numerous other encounters with the scalpel has gone entirely according to plan. Her various chronic maladies almost guarantee a long and difficult postoperative recovery, and the chances of something going terribly wrong are much higher than I'd like. But bone-on-bone is very painful, and she doesn't have much in the way of options. Her choices reduce to the certainty of ongoing, sharp and grinding pain, and the near-uselessness of her arm, or the possible reduction of ongoing, sharp and grinding pain and the not-much-better-than-uselessness of her arm. And then, of course, she'll need the same damn thing on her other shoulder, which is also dissolving into an osteoarthritic mess. All of which is set against the relentless progression of a rare auto-immune disease that has already reduced her quality of life to a barely tolerable level. At 66, she has the mobility and weakness of a not-very-spry 86 year old.

I took her to the hospital this morning for her regularly-scheduled IVIG infusion, which should have happened on Thursday but didn't, due to the hospital being out of women's beds. Apparently they get full to the rafters in the first weeks of the new year, as various financial and regulatory annual limits reset themselves. So instead of having one last weekend at home before her surgery and subsequent six-week stay in rehab, she's in the hospital tonight, home tomorrow afternoon, and then back into the same hospital at five AM sharp on Tuesday. I am much more familiar with the layout of Santa Barbara Cottage Hospital than I want to be...these days, I'm there every three weeks for IVIG, and once or twice a year for the medical crises that occur with distressing regularity.

Now I'm sitting in her recliner--the one that I mounted on 4x4s to make it easier for her to get in and out of--paying some attention to Hellboy while awaiting the delivery of a pizza I probably shouldn't have ordered. Stress eating, most likely, but then again, Marty's does make a fine barbecue chicken pizza. The cats that I'll be feeding and tending to while she's having her shoulder rehabilitated are hiding somewhere, having already spied the packed suitcase, knowing with feline certainty that something in their world is about to go horribly different.

As do I. Well, not horribly different. But different nonetheless, with the undercurrent of fear that always accompanies these medical interventions in my mother's life. The complexities of her various conditions make everything riskier, decrease the good odds, and increase my fears. But: hope for the best, prepare for the worst and all that.

That's what I've written this evening. And look at that! Hellboy II: The Golden Army is on next, and here's my pizza. My evening is thus planned. Off into it I go.

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¹Which is entirely different from feeling like it's an empty stage. Totally different vibe.