HW 22- Illness and Dying Book Part 1

Tracy Kidder, Mountains Beyond Mountains

Random House, 2004

Precis of Chapters 5-6: Doctor Farmer had quite an adventurous and unusual upbringing. His father, known to many as "The Warden" because of his strict ways toward his children led a ship of six kids, Paul being the second youngest. Paul turned out to be very gifted in his intelligence, and even after having a considerably rowdy college life became the very successful doctor and writer he is today. He was able to flourish in an otherwise challenging environment, and eventually Paul came to realize that his true calling was not to simply heal others, but to transform the healing of the less fortunate in Haiti. His studies of Virchow and Haiti culminated in a 6,000 word article about Haitians laboring near the college campus, entitled "Haitians without a home."

Best Line(s):

"Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community."

"The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them."

Thoughts/Questions:

-"P.J." must have truly been gifted, I honestly cannot imagine such a brainy kid coming out of that upbringing otherwise.

-I was really surprised to hear that Paul tried all of this crazy stuff and failed to get straight A's (especially him) for his early college career. I would have thought he would have already been making great strides.

-It sounds to me like this is somebody who really cares about helping people. I hope this doesn't sound offensive, but I wouldn't go to Haiti if you paid me. Paul sounds like someone who is not afraid to get their hands dirty, and that his only satisfaction can come from healing and changing other's lives.

-This is not really related, but I wonder if this were a mandatory read in medical school, if there might be an ethical change on the "dominant" side of this social practice.

Reflection on Today's Presentation

When it comes to today's presentation, I couldn't help but feel uncomfortable sitting up there listening to my mom speak. I wasn't uncomfortable simply because I was sad or embarrassed (of course I was sad but not embarrassed), but because I wondered what people were seeing in me as I silently sat there. I occasionally shifted my eyes around the room to see of any of my peers were observing me. Did they think I was an emotionless robot? Did they admire me for my stability? Were they simply giving me pity? Were they searching for certain reactions at particular parts of my mom's speech? While I felt uncomfortable, I have to admit it felt great, amazing almost, to finally have my peers hear my story. Like I have mentioned on multiple occasions, I feel misunderstood by my peers, and I think that finally having them sit and listen (to my MOM for pete's sake) and nothing more was satisfying in the comforting sense that I know perhaps they now understand me a little bit more. Answering questions after lunch was not difficult at all, in fact it was almost a revelation for me, to question and search the deepest, most painful realms of my thoughts. It is not something I am often able to do, and I am very appreciative that my peers did not hesitate to ask such questions, in fact I commend them for their bravery: these are questions I am not even asked by from my own family. Whether this is out of respect or sympathy I do not know, but what I do know is that those who asked questions today and even those who did not genuinely cared, and I deeply thank them for that with all of my heart.

I am making one edit: I am quite surprised that hardly anyone has mentioned me in their posts. Not that I mean to sound self-centered, but if I were observing, one of the first things I would have asked myself was how I got through the entire thing, why I didn't crumble or currently show signs of being emotionally disturbed, or signs of any traumatizing past? I think part of the reason why is because (and I hope nobody takes this personally) my peers are uncomfortable characterizing me in their posts, for fear that I might read them and be offended in some way. If anyone honestly had any questions, musings or insights having specifically to do with me, let me say right now that by all means, please do. And if you are still uncomfortable putting it up for anyone to read, a personal message will do just fine. I am not, will not ever be offended by how you characterize me.

HW19- Family Perspectives on Illness and Dying

As everyone (in Andy's class) now knows, my mom and I have been through the most extreme of illness and dying situations in the last 10 days of my father's life. Because of this experience we share we are able to talk together on almost the same level about not only my father's illness and dying, but moral values and world views about illness, dying, denial and the medical systems of the world. When I interviewed my mom, I had a good feeling I knew exactly what she was going to say, and not just because I've heard the story, but because I played an active part in it.

The first question I asked her regarded the everlasting battle between allopathic and holistic medical beliefs and techniques. I myself see it necessary to meet in the middle and take the best from both sides, and my mom did not see it any different. While she is a firm believer in the spirit and attitude that comes with holistic methods, she thinks it would be foolish to completely shun the allopathic side of the spectrum. In the end, holistic ways may keep our minds and fortitude alive and well, but there is no denying that in most cases allopathic ways keep our bodies alive, which are essential. She also associated words such as "comfort" and "encouragement" with the holistic end of the spectrum, and words like "security" and "protection" towards allopathy. I found that these were particularly fitting, and made me see things with a different light. I find myself asking if my mom was willing to give up my father's"security" for his "comfort" in his last hours. But I also ask if she was in turn sacrificing his "protection", which probably doesn't apply here because at that point, what protection could the allopathic really offer?

Then I asked a question that I felt was slightly dangerous: if there was any way, ANY way to view the experience in a positive way, what was it? For me the answer to the question is that at the very least, and by this I mean THE VERY LEAST I know what true dying looks like as a filmmaker. But for my mom, whom the experience was the most emotionally intense, was there anything gained from the experience? Her answer was much like what she told everyone today: you learn that you have to be your best advocate, and that the experience, as horrifying and gruesome as it ended up being, brought their relationship together almost at its strongest. Rather than worry about things like taxes or finding work, the two could reconnect, and in addition to their relationship becoming more intimate, much of the tension between my father and my mom's side of the family subsided. She said that IF there was any way that his illness and dying had any positive aspect (not really appropriate word choice but I honestly can't think of anything better to replace "positive", excuse me), it was in the effect it had on their marriage.

In the end I know that my mom and I have this special connection that nobody else on the planet can have, and because of this we seem to be very in touch with each other's thinking. I knew exactly what she meant because I had gone through almost just as much as she did with my father's illness (by this I mean the latter stages). I have to wonder if anyone can ever understand it as much as we do, especially because we did it so differently from how anyone would have treated the situation. Unfortunately even the closest of other family members will never share this connection with us, however I do NOT think it is degrading or lacking of our relationship, just an experience that is missing. Hopefully most of my peers my mom talked to this morning will have gotten as close as possible to understand our story.

Illness at the Emergency Room Wednesday Night! (Insights)

The very first impressions that came to my mind entering and waiting in the Emergency Room (other than "OW THIS HURTS LIKE HELL WHERE'S MY ROOM") were that the hospital (not just the room closest to outside but the actual room I stayed in) were freezing. I didn't have a fever at the time, and although I understand there are machines that need to be in a certain climate to function I could not understand for the life of me why they could not turn up the thermostat.

I also have to wonder why my wait time was so short compared to other sick looking people who had obviously been waiting longer than me. Of course I did not waste a second considering this at the time, but I know I would NOT be happy if I was just sitting there watching people get called in after arriving 5 minutes ago.

I found it interesting that rather than assign me one nurse or doctor, there was a constant flux of different nurses and attendants that I did not know waking me up every half-hour. I also found it weird that no matter how many times I repeated myself, they continued to ask the same questions over and over again. Maybe my view is exaggerated because by 5:00am I just wanted some sleep, but it left me wondering why they couldn't assign me just one nurse who already knew the answers to their questions in addition to where my pain was. Other than this little annoyance I really had no issues with the staff, all who were very friendly and mentally and emotionally dedicated to my well-being.

With regards to the seemingly "magical" nap that I took, I still do not understand what it was that cured me almost instantly. I suppose it has something to do with lifting the mental and physical stress that was on my body before I simply called it quits and laid down. This also leads me to question whether or not the doctors had the greatest intuition- everyone, with great confidence thought that I had appendicitis, and in the end I didn't have that or even an intestinal blockage- just a bad virus. Of course I couldn't really blame them, I WAS showing all of the symptoms, and I myself was convinced I had it.

This WAS my first time ever in a hospital for serious illness, and I have to say the experience was bitter, sweet, and then bitter again. Of course the beginning was bitter because it felt like I had been impaled by a flagpole. After my nap however, I have to admit being "ill" and having people catering to my every whim was actually somewhat enjoyable. This somewhat contradicts what I said in HW17 about no aspect of illness being enjoyable, and in retrospect I was probably angry given the subject matter. If I said being able to watch TV, play games on my iPod and surf the web while I waited for people to give me pillows and blankets while complimenting me about my mood was not enjoyable in any aspect, I would probably dunk my head in the urinal they supplied me. This was swell for a while until the next morning, where I simply had enough. I felt fine, the CT scan confirmed my lack of a serious problem and I was itching to leave. I waited a seemingly endless amount of time for some paperwork to work its way to us so I could leave, and as I sat in my own sweaty pajamas with a huge IV in my arm I found myself listening for hopeful footsteps to approach my room. They wouldn't show up until hours later of course! What if there was another sick kid, who really NEEDED the room who didn't have one while I sat in here like a king?

The actual CT scan was to my surprise quite intriguing. I'll spare you, the lucky reader the less attractive details but it certainly helped one of my problems (if you can guess what that is, if not, I'll leave it at that!). Being immersed in the giant machine was kind of freaky, it felt like I was in some sort of sci-fi film and the laser was scanning alien bacteria in my stomach. The actual effect of the laser ring was a surprise to me. My entire body became really hot and I felt like I couldn't breath (not like I was anxious, but I actually felt like there was a restriction on my lung intake. Overall this was actually fun, and a huge relief afterwards (again, I will stay ambiguous here).

Finally I HAVE to say something about "lunch". It's not like I expected a filet mignon but mystery meat? With a thick coat of barbegoop on it? Uhhhh. Thanks? On the side were some seasoned potato wedges, which were not bad, and cooked carrots. I found it kind of strange that one slice of bread could come in its own package, and that they gave it to me plain and not toasted. Perhaps they were thinking I had some sort of dietary restrictions? In the end, a nice hot cup of tea kept me busy as I waited in the final moments.

Overall, my stay was an interesting experience and I am CERTAIN it will give me a fresh perspective on illness as we go into this unit. Would I do it again? Not necessarily, because in order for it to happen I would have to vomit a waterfall all over again! And besides, I was extremely lucky that I did not require an operation, which would've proved to be an entirely different, not so fortunate experience.

Illness at the Emergency Room Wednesday night! (Narrative only)

Although I realize this doesn't exactly fulfill the requirement to HW19 (which I will absolutely post separately in the near future) I thought this was worth writing about. This post is completely narrative. I will give my insights on the entire situation after they can properly sink in in another, separate post. If this post seems overly long, I apologize, but please understand that documenting specific details will help me write my impressions, observations, feelings and insights when the time comes.

At about 5:00 am on Wednesday morning my stomach was upsetting me. Now I will spare you the less attractive details, but it certainly was not pretty. However, I decided that something as intermittent as stomach aches were not worth missing school for, so I decided to go anyway. I had a fairly good and active day, my stomach aches subsided and a satisfying lunch.

Then it hit me.

Halfway through teaching my after school class I felt a sharp, stabbing pain in my lower right quadrant. I decided that it was probably best that I leave and get some rest (I did have a long day at internship ahead of me). When I got home I tried to lay down on my couch, but could not bring myself to peace. The pain was too much, and at about 6:00 I began considering if this wasn't simply part of my condition, but an entirely different monster. This felt like no ordinary stomach ache, so I asked my mom to look up the symptoms for appendicitis. Low and behold I had all of the symptoms and I made my mom call my pediatrician, a man who I trust very highly as a diagnostician. He thought it was wise that I head to the emergency room, and because I was already considering that myself I obeyed.

The minute I got into the car I vomited buckets worth of food onto the car floor. Personally I find throwing up to be my least favorite sensation of the body. I always feel like I am choking and cannot breath while puking my guts out at the same time. When I arrived at Mt. Sinai Hospital, there were many people waiting to be seen. However, it seemed that I was lucky, because I was called in not very long after I checked in. THEN came the true waiting. I sat in a chilly room on a plastic chair feeling the worst pain I had ever felt in my life, desperately looking around for a sign that I might soon me relieved and taken into a room. Eventually I WAS called into a room for examining where a lovely nurse pressed around my abdominal area. As soon as she finished doing so however, I heaved up more vomit, a seemingly impossible amount at that, and with the addition of the pain and hunger I now had I was simply defeated. They stuck me with an unusually long IV needle, which because I am usually comfortable with needles was not a challenge. They decided that a CT scan was necessary, and perhaps a serious operation to follow that up. After getting tired of waiting for the next step, a decided to try and take a nap again.

When I woke up the world had changed. I was suddenly warm, my thirst was satisfied and there was no stomach pain to speak of. I had not been operated on or even so much as touched since an hour before, and the pain that once put me in serious, unmatched fear was history. My brother called, oblivious to the entire situation and was very worried about my situation. A few friends of mine had also been checking up on me, and I thank them for that. My brother was nice enough to inform the world on his Facebook page, and for once I overlooked my worn out political statement to see what people were saying. At around 1:00am I was given about 1000mL of contrast to drink for my CT scan, which despite everyone's warnings I didn't find to be too disgusting. After another seemingly interminable amount of time I was wheel-chaired to the scan room, where a giant spinning laser tunnel took pictures of my intestinal track.

I didn't get the results of my scan until long after I was moved into my new room on another floor. There many nurses asked me strange questions and I didn't get to actual sleep until around 5:30am. Every so-often I would doze off but nearly every half hour a new nurse came around to ask me the same questions and check my vitals. Finally, the next morning I was met by my pediatrician (whom I had consulted earlier) and my GI doctor. It turned out that the results were surprisingly good, and not only did I NOT have appendicitis, but I didn't have a major blockage either. Because of this, I was finally allowed to eat again knowing that I would not be having an operation. The tray of food they gave me consisted of mystery meat (it somewhat resembled chicken), seasoned potatoes, diced pear, bread and butter and tea. At around 3:00pm I was finally dismissed from the hospital.

As soon as this all sinks in enough to thoroughly analyze it (and after a good amount of rest), I will post another entry strictly focusing on my impressions, observations, feelings, insights, etc.

HW 18 Health & Illness & Feasting

To our family Thanksgiving is one of those times of the year that is simply reliable: we know exactly what to expect. I say this because ever since my Grandmother's house burned down in 2001 (my grand uncle Sandy died in this fire), our holidays and vacations as a family have never been the same. Almost immediately after the fire (this was just before 9/11, mind you) and during the construction of the new house my Grandfather died from an obscure infection. Ever since this catastrophic turn of events in our family it seems like our get-togethers have never been the same. Over many holidays and vacations in the past decade we have seen many outsiders come and go in our intimate family gatherings. Christmas, while it still remains my favorite time of the year due to tradition (mainly the one where I get loads of free goodies) has become bastardized into something reminiscent of an open house where anyone, no matter your relationship with the family are welcome to partake in our most sacred of traditions.

But back to Thanksgiving. I say this is one of the most reliable times of the year because it still keeps true to what made our family get-togethers so enjoyable: the family. The awkwardness of the outsider is rare on this holiday and it is one of the last remaining times of the year where we can just be comfortable with ourselves because we know each other's stories so well. What I mean by this is similar to what I meant in my last post when I said I felt misunderstood by people who don't know that I cared for my father during and after his death. When I meet new people in an intimate environment I usually find myself trying to make an impression, but instead of one that is illustrative of my pain and suffering I end up creating an image of comedy, like I am silly and do not spend time to contemplate the meaning of illness and dying. This of course is false, and although I do see myself as a pretty funny personality I regret that so few people understand my other half. When outsiders are around at Thanksgiving, Christmas or Passover it is inevitable that this will come into play.

Thanksgiving can also be a time of unreliability, as I witnessed that this was the time of year when my father was diagnosed with cancer. Of course I was not informed yet, my mother waited for a more suitable time to tell my brother and I.

This Thanksgiving was a good one, with some of the BEST mashed potatoes in the world thanks to my aunt Karen. This is a meal that is only second to the one I look forward to most: Grandma's Matzoh Ball Soup (which unfortunately I won't be here for this Passover!). This meal was meant for nothing more than to stuff ourselves senselessly, and when desert came I stuck to a modest plate of whipped cream (yes JUST whipped cream. Stop looking at me like that.). Pretty much everyone helped with the dinner (except for those of us who showed up late. Guess who.), and every one of us enjoyed it. Of course there were empty chairs at the table but in the end we were happy to be sharing this holiday with those of us still around.

When it comes to the topic of illness and dying at our table most of our conversations were lighthearted. Not long ago my brother stepped on a toothpick in his dorm room which plunged into the ball of his foot. He was sent to the emergency room when he attempted to pull it out and the outer half broke off, leaving the inner half in his foot. After much operating, the doctors could not get the toothpick out, and he was told it is to stay inside his foot forever. For a drumming performance major at music school who cannot use his left foot or walk at all this is some tragedy! Most of our conversation (which was full of laughter, mind you) was trying to solve the mystery of just how the friggen' thing got stuck up there! He and I tried to play ping pong afterward (we positioned him in a rolling chair that actually worked quite well), and being the skilled player that he is was still able to bat the ball around with finesse. Other than toothpick impalement, illness and dying was pretty much absent from the table conversation. It was a delightful Thanksgiving that will surely be remembered because of this silly incident, and I hope that illness and dying may stay out of the equation for some Thanksgivings to come.

HW 17- First Thoughts on Illness/Dying Unit

The subject of illness and dying is something that I unfortunately know very well. The way I was taught about illness and dying was very simple: we as humans have limited time on Earth and when our time is up, we die and disappear forever. Of course I was never told about the world of nightmarish suffering that is involved in one's death, and the fact that this time may come as soon as tomorrow, but unfortunately I found out the reality by what others may call the "hard way".

When my father was diagnosed with metastatic kidney cancer, I was still 13, and in positively no way did I understand the gravity of the situation. He apparently had it for as long as my life (at least), going undetected until he finally gave in to my mother's demands that he go in for a check-up. This brings up my first issue with the medical system: the doctors are so detached that they sometimes carelessly misdiagnose. My father, who was clearly ill and NOT doing well by any means was examined and sent home with high-blood pressure pills. Go figure.

Over the next nine months I never really felt like he was going to die. I knew it was possible somewhere in the back of my mind but I never came to terms with the idea that this could happen to MY father, a man who was well-liked by everyone and good-spirited. In fact, I will never be sure if he ever thought to himself that the so called "game was up" and that he was truly on the path to death. He had just begun a new art collection titled "Something Wonderful is Going to Happen" as if he were sure that the prophecy would hold water.

When I returned from a week at The Island School in Eleuthera, Bahamas, my mother was clearly troubled. I returned home to find my father in his worst state yet. When I had left for the Bahamas, he had been showing alarming signs of recovery, as if the battle were said and done and he had emerged the victor. Later I learned this was simply his "honeymoon with death", a term doctors use to describe a short grace period before one falls into a state of non-recovery. We had all been tricked. This was crushing in every sense of the word. For a moment something wonderful WAS going to happen, but it was just another deception- it was as if death were saying, "Haha! Good one right! You really thought you had a chance! There is no happy ending here."

In his final week of life I witnessed true suffering. My mother refused to allow him to fade away in a hospital because it felt cold and detached from what was important in his life: his art. I wondered how movies can so shamelessly portray illness in its final stages. Nothing is peaceful or attractive in this image. There is no sense of nobility, no sense of closure. People often think of advanced illness as pale skin, withered limbs and weak voice. This could not be any more false. What I witnessed in those final days was horrifying on levels I cannot even do justice to by simply typing words. In this end stage he could no longer speak, let alone eat or drink water. He was left tongue wagging, short spastic movements, falling in and out of consciousness and occasionally muttering indiscernible sounds. Part of me died that week. To watch him fight bravely for 9 months and then see him completely shattered and undone in such a short time was numbing. Nothing is majestic about illness. Having witnessed this however (my mom and I were the only ones who saw/cared for him in this end stage, absolutely no outsiders or other family) I believe it has had a huge influence on my point of view, and I often feel misunderstood by those who know me, but do not know about this moment of anguish I have gone through. I only hope that this unit can shed somewhat of a light toward those who have (thankfully) not gone through the same experience on what true illness and dying looks like.

And I realize that I probably wrote much more than I was supposed to on one subject, but please understand that this was not easy for me.