Requiem for a Dream

One of the joys of renting a home is unpredictability. A year ago the owners of our rental divorced. We initially feared liquidation, but they reassured us things would continue as usual. The husband gained custody and decided to use our back room as an office for his internet music business. His business partner worked on cleaning up the room and we removed the few things we were storing there. I should explain that we rent the downstairs of an older home. There is a mother-in-law apartment upstairs which is also rented. A paper thin door with a connector room adjoins the laundry room which is next to the stairs to the apartment. For the last two months there has been a stranger in the next room every day until 7pm. As we eat dinner and spend time together in the evening, he can hear our every word. I have an irrational fear that one day I will open up the door to find a dozen people in movie theater style seats eating popcorn and eavesdropping. There would have been little personal interest until a few months ago. Life was falling into place- I was days from completing the most important test of my life and Ryland was almost potty trained. The rain had come again, and Adam was out kayaking. I heard the shrill beep of my pager as I walked to my office. “Husband on line- emergency” Shit. Adam’s voice was like a stranger. “Alan is missing and presumed dead. I need his girlfriend’s phone number.” I immediately had the impression that this was no time for questions so I asked if he was alright and found the information he requested. I told him I would pick Ryland up and he could do what he needed. As I tried to finish the afternoon’s work, I realized how dire the situation was. Adam worked the night prior and did not sleep before going to the river. He was with Alan and one other friend, a good natured and green twentysomething. Adam was the trip leader. Late that night, the details of the event were recounted between drunken sobs. In the coming days I sought to figure out what it meant. I first witnessed the world of kayaking 10 years ago. I came to understand the camaraderie and flow state in the water. I have seen the pain of loss and gone to funerals of those forever frozen in youth. There is a duplicity between the glory of conquering fear and the mortality of a pin with no exit. It was not until Alan died that I realized how close these were. He was a very capable kayaker paddling within his skill set. If the day went a different way, I could have easily gotten another call. I love my husband as he is, a kayaker. But when people remark that a kayaker “died doing what they loved” it is difficult to swallow. There is nothing romantic or glorious about death. Losing a family member in their prime is unredeemable and unforgettable. Whitewater remains an unforgiving mistress but the call of the siren is inexplicable. I remain hopeful that when the call is silent, my kayaker will return home.

The other side of the rabbit hole

People often ask why I run distance. A comment about masochism or stupidity usually ends the conversation. But there is more to it. Running takes on a very hypnotic quality after repetitive pounding for several hours. The meditation of motion is all consuming and excess fades away. Medical education is repetitive pounding as well. Looking back, my perspective is changing. During medical school and residency there is a strong feeling of inadequacy. The whole process seems unnecessarily difficult and cumbersome. The socratic method (fondly called "pimping" in the medical community) is the cornerstone of learning. It is at best a challenge and at worst humiliating. The sleep deprivation and workload pounds at one's soul day after day. There are sacrifices and bargains to struggle through. I am finally sleeping and eating on a regular schedule. I no longer doze off during movies and have not had a migraine in two months. I realize now that the small parts of myself I gave up over the years were replaced with the qualities of a physician. Making life and death decisions at 4am will never be easy. The rigors of training make it possible to function during times of severe fatigue or uncertainty. Having enough reserve to finish the race requires discipline. The more mental and physical strain one is willing to endure, the more polished and sleek the results. Apparently there is life on the other side of the rabbit hole.

Summer of our discontent

Each summer my mind wanders back to the Catskills. The summer I spent at Omega changed me in many ways. Freshman year of college for many teens is shocking. My shock was not in the lack of structure or rules. I was used to that after years of living with my dad. I always managed to wake myself up, make my lunch and attend school. After classes I studied and filled my time with extracurriculars. I continued this in college and discovered I could make good grades, volunteer, and participate in dance and yoga. I struggled with the social interactions. I was isolated at home. I moved in to a dormitory filled with 500 other girls. I had no idea how to embrace that. I struggled socially through the first year. I made a few friends and spent weekends in the suburbs with my boyfriend. In the spring my mother asked what my summer plans were. The notion of returning to my father’s house was abhorrent. I applied for a seasonal job at the Omega Institute for Holistic Studies.

Omega was several hours drive from my childhood home. The job was rudimentary work in the kitchen. It was part time employment and required living in a tent for the season. After a sigh, I accepted and packed camping gear into my geo storm. Mom offered to drive with me and help me settle in. I knew nothing about camping, so I consented. As we pulled up a brawny man with an unkempt beard stood at the entrance. My mother rolled down the window and said “My daughter is here for the work-study, man. Can you hook her up? She’s kind of shy.” I grew red with embarrassment and wondered why I brought her. He directed us to our destination as it began to pour rain. Great.

After the tent was assembled and my mom left I looked around in the rain. With tears in my eyes I realized I was alone. I went to the dining hall and began eating by myself at a large circular table. In a few minutes a bouncy girl my age approached me. “Anyone sitting here?” She asked. Without waiting for an answer she sat down. We had an intense conversation about freshman year and vegetarian cooking. As time passed, others joined us. Suddenly I was not alone. People flocked to Omega for different reasons. One girl recently lost her brother. One was hitchhiking across the country and needed a place to stay. Others, like me, sought refuge from the depersonalization of a large university.

Over the summer there was drama. An 18 year old began dating a 40 year old cook. There was a ban against skinny dipping in the lake. A staff member contracted Lyme disease. We all decided to vigilantly spend evenings in the sauna to sweat off ticks. I grew to love having friends drop by my tent without knocking or invite me on meaningless errands off campus. The Omega staff were proud of their eccentricities and soon I was too. I returned to Pittsburgh in the fall with a new lease on life. I was ready to open up, to lead by example, and to choose my own path.

Some like it hot

The first time I heard about Bikram yoga I was living in the temperate Southeast. The notion became more appealing amid a harsh New England winter. The temperature had not reached double digits in several weeks when a Bikram studio opened. I decided to check it out. In reading the website, I realized Bikram was a little different. The concept is facile: 26 poses performed with meticulous precision in a room heated to 105 degrees. I left my 62 degree home with the idea that at least I would be warm for 90 minutes. I paid at the desk and entered the “hot room”. The crowd was not the usual middle aged female crew I was accustomed to. Scantily clad women sized me up and beefy men glistened with sweat. I was red faced before the class started. As class began, it dawned on me that this was the step aerobics of the twenty first century. The teacher yelled at us like a drill sergeant for the entire 90 minutes. The forms were precise and there was a feeling of competition and jockeying. I love yoga because it frowns upon the competitive edge I fostered for most my life. It reared its ugly head in Bikram. After the class was over, 4 degrees felt refreshing. Overall, not a bad deal, but now that spring is here the hot room has lost its allure.

The son also rises

I was in my call room at 3:45am. I had been asleep for a few hours during the tail end of a heinous 24 hour call shift and woke up to more contractions. I better use the restroom, I thought. I stood up and my water broke. In retrospect, I should have expected this. For the last few days I had been experiencing painful contractions. I timed them the evening before and they were occurring at 7-8 minute intervals. I was only 36 weeks, so I shrugged it off. This could not possibly be labor. But there was no denying what had just happened.

I generally am in control and have a plan, but this situation caught me off guard. I called for a second opinion on the matter. Adam was sleeping with his phone at bedside these days. His years of EMS had been good training for a panicked phone call at 4am.
"My water just broke. What should I do?" The answer should have been obvious. Before he could respond, I was telling him to meet me in the call room. "No, no, just meet me in the birthing pavilion. No, actually, just meet me here." He told me to get a grip and call my attending, then head to the birthing pavilion. Of course, I had not packed a bag yet since I knew I would not deliver this early. He assured me that he would pack some belongings and food and be there in 30 minutes.

Next, I made the phone call no attending physician wants to get in the pre-dawn hours. "Um, hi, my membranes just ruptured and I'm heading to the birthing pavilion." My attending was very nice and offered to come in. We negotiated that I would take phone calls and he would come in if there was an emergency. It was only a few hours until my colleagues arrived.

At the birthing pavilion, I was met with suprise. I was ushered into triage and the resident came to examine me. She told me we needed to do a pelvic exam to assess for membrane rupture but changed her mind as she saw the puddle of fluid I was sitting in on the stretcher. I was placed in a birthing room and given a few hours to see if labor would commence on its own. I was only one centimeter dilated. Pitocin was started when this failed to occur. I was consented by anesthesia "just in case" but was convinced that I wanted a natural birth. Adam came but I sent him off to retrieve our camera and more supplies. I started having painful contractions but was so exhausted I just laid in bed, resting with my eyes closed in between. The nurse took this as a signal that the pitocin was under-dosed. By the time Adam returned I was cowering in pain, crying and begging for an epidural. After the epidural I was comfortable, and by afternoon I was fully dilated and ready to push. This was fortunate because I was having late decelerations, a sign that the umbilical cord was wrapped around baby's neck, cutting off oxygen. Any longer and I would have been taken to the OR suite.

Ryland was born at 5:16pm. He weighed 5lbs 2oz. He did well for the first hour or two, but then I noticed his hands and feet were cyanotic. His body temperature had dropped to 35C (95F). He was rushed to the NICU for warming. In the midst of this situation, I got more shocking news. My mother was en route to New Hampshire. I had spoken with her earlier and we decided it was best for her to wait two weeks to visit. She told me she respected that and understood. I got the phone call asking for directions, and telling me she would be at the hospital at 2am. I told her this was unacceptable and gave her directions to my house.

The NICU team placed Ryland on IV fluids for the night so that I could get some sleep. I had gained infamy during the day as "the resident who's water broke on call". He did well overnight and was released from intensive care the next day.

We made it home and my mother left.

The birth was far from the controlled, natural experience I envisioned. But I have no complaints and I'm happy to have Ryland here, safe and sound.

The Grandfather

July 1, 2009 was my first day as a neurology resident. It was Adam's 30th birthday, marking a new decade in our life. It was also the day I lost my father figure.

My grandfather was a simple, practical man. He taught me to swim in my youth. I spent endless summer days at his resort, splashing in the pool and eating ice cream. My brother would ride the lawnmower with him on an endless expanse of green. He worked hard but loved coming home for a good dinner and chocolate cake for dessert. Before we ice skated in the winter, he would walk out on the ice to make sure it was solid. He came to all my ballet performances and handed out our gifts on Christmas day. The summer before I turned 16 he bought me a turquoise Geo Storm. By then the resort was a retirement community and my grandparents were furiously trying to sell the last of the condos. Grandpa always had time to patiently endure 10 mile per hour laps around the development as I figured out how to drive.

When I brought home the man I intended to marry, my father did not ask him one question about himself during a five day trip. Under my grandfather's roof Adam was drilled with questions about his plans for the future, what his parents did, and his hobbies. Adam came prepared and soon after Grandpa was an enthusiastic fan of kayaking videos.

As he became sicker, I grew to admire my Grandpa even more. He was first diagnosed with prostate cancer in 1985. It was in remission until 5 years before his death. Illness stripped away the fire that inspired a juxtaposition of love and fear in those closest to him. The most stark features of his soul were exposed. His stubbornness was apparent when he insisted upon being the patriarch at my medical school graduation. My father had cancelled at the last minute. By then the cancer was eating through his ribs and pelvis. He left the auditorium after my name was called and walked off the pain in the bright meadows of the VA campus. He never hesitated to tell me how proud he was of me.

I saw Howard a month before he passed. He knew he was dying and we spoke frankly about his wishes. Ever practical, he said "Just cremate me and throw my ashes out the car window. I won't know the difference." We talked about finances and I assured him that I would care for his wife, should her life exceed her means. He had no regrets and told me he was ready. He was scared of the pain, but not of dying. He wanted Grandma to travel and enjoy life after he was gone. As I pulled out of the driveway, I looked back at his skinny figure, baggy clothing hanging off his once robust physique. I knew I would never see him again.

I called my father that night to tell him it was time to get on a plane and say his goodbyes. Unfortunately, he was not ready to face the truth. He never got to see Howard off. Later he told me he could not believe he went so suddenly. We had a strange memorial service at my childhood home. Howard's twin brother could not stop sobbing. Other relatives made meaningless chit chat. My dad kept repeating the lyrics to a country song when others expressed their condolences. "Well, life's a dance. Sometimes you lead, sometimes you follow." My grandmother refrained from getting drunk until after guests left, then we kicked back martinis and she cried on my shoulder.

Howard had many characteristics that I treasured. He worked hard, pulling himself from poverty with a meager 11th grade education. He was brutally honest. He loved simplicity and found contentment in a good meal or a job well done. He was my father figure, and I miss him.

So this is the new year

I'm not enthusiastic about holidays. The notion that one can designate one day and announce that everyone must celebrate and have fun is ridiculous. Against this usual belief, for several years Adam and I had a New Year's tradition that we thought will last forever.

I met Adam in late 2001. We exchanged stories about New Year's Eves gone wrong. In 2000 I was wishing the world would end. But I was far less despondent this year. Adam told me of his plan to have a New Year's Day dinner, complete with ham and black eyed peas. He argued that it was the perfect unclaimed holiday. After all, everyone was home and hungover. They were ripe for food and good conversation. I planned to come as a sort of second date, but at the last minute fielded a desperate call from my former restaurant manager. I negotiated terms for working a shift including a free meal for two. I stopped by Adam's house to check on the progress and break the news. He was marinating ham in coke and chopping collard greens. I told him I would take him out to dinner to make it up to him.

The next year we were living together and decided to make the dinner again, complete with several vegetarian additions including risotto and collards sans ham hock. We had friends over and learned to love New Year's Day over the next few years. Upon moving to Johnson City, we tried to carry on this tradition. It was much less successful. We had a group of friends by this point, but they were all home for the holidays. Awesome, I thought, there are so many people I would like to get to know. We secured 8 guests, bought food, and started work on dinner. One by one, every guest cancelled within 2 hours of arrival time. We were left with a 12 pound ham, 10 cups of collard greens, and a complex. For the next year, we panicked every time we invited someone over for dinner. Are they going to show up? We vowed never to celebrate New Year's again. We now enjoy a quiet evening at home. It might be hard to get collard greens and black eyed peas in New Hampshire anyhow.