Wednesday, April 29, 2009

Snuffed but not forgotten: Ignatius, the large, dead fibroid

After an MRI and a couple of weeks of indecision (fear), I scheduled a uterine fibroid embolization (UFE) for August 18, 2008. The target: an 11.7 cm by 16.2 cm by 13.9 cm fibroid dubbed Ignatius, perched like an conquering emperor atop my uterus—incidentally flattening my bladder into a pancake with a slight bulb at one end. If I seem to disappear into the ladies' room excessively, Ignatius is the cause. There isn't much bladder to my bladder.

The UFE went according to plan, although my system is still a little confused. I had spotting in January, light periods in February and March, and, to date, a delayed one in April—a delay which has made me feel lousy and in perpetual PMS mode, achy, tense, and cranky. Crankier than usual.

I've felt a little better since the UFE, but not dramatically so. I'm not surprised Ignatius didn't strike me as the type who would "go gentle into that good night." I was supposed to have a follow-up MRI in three months, but put it off until it was past eight months later, that is, until Tuesday, April 21, 2009. The question: How much had Ignatius shrunk without its blood supply?

I went to a different place at Northwestern Memorial Hospital than I had for the first MRI, and there was virtually no wait. The moment I'd completed the forms, I was called and shown where to disrobe by a no-nonsense, humor-impaired nurse. I'd barely touched the seat of a chair when I was called by the technician.

Before we could begin, she had to check my fit in the MRI equipment. I arranged my arms, the left one not too bent because of the IV, in the traditional pose of a corpse, she pushed the button, and in I slid.

Partway in the slab's movement stopped, leaving me nose to ceiling with the machine and nowhere to go.

I could feel my heart and breathing rates accelerating, as though gearing up for a full-blown panic attack. Once, many years ago, I'd had a closed MRI scan on my head (the problem: a persistent sun-induced migraine) and at first had thought it was not so bad. About 20–25 minutes into it, however, I realized how completely immobilized and trapped I was. It, too, was a tight fit, and it occurred to me that if an atomic bomb fell, I did not have enough leverage to get myself out without help. Suddenly, it wasn't so easy to breathe deeply.

You must admit that, despite the irrationality of the idea I'd survive a nuclear weapon attack only to die trapped in an MRI scanner, at least I was practical about my lack of means of escape.

At this point in my reminiscence, the technician, as though reading my mind, assured me that my head would be out (partly, as it turned out—I was still nose to ceiling with the tube, but if I rolled my eyes up I could see the room behind me. She backed me out, fitted me with hip pads, fussed some more, and put me back in.

Previously, I'd been given orders not to breathe/to breathe through noise-blocking headphones, which worked well. This time, however, I was given earplugs to block the noise. I didn't breathe or not breathe on command, however, although I thought I was following her muffled instructions pretty well. Surprised that she hadn't noticed how many times I had asked her to repeat herself (which she may be used to, as English is not her first language), I told her that I'm hard of hearing. At that, she left the earplugs hanging uselessly and most uncomfortably out of my ears; still, they didn't cause nearly the discomfort that the wedgie I'd managed to give myself just before I had come into the room.

And so I spent approximately 30 minutes trying to ignore the wedgie and to breathe in and out on demand. At one point the technician backed me out again to have me center myself better, but on the whole I thought it went well.

She had a different opinion, which I soon heard about.

The moment she retrieved me, she began to berate me for not requesting the larger MRI scanner. (Honest, I don't not do these things on purpose.) With the smaller scanner, it took longer, she said, and it was harder on me and on her. She told me the name of the machine to ask for. As if I had not gotten the point the first time, she told me a dozen more. When she returned me to the no-nonsense nurse, she said the same thing to her a half dozen times (the nurse: "Oh . . . hmmm."), then she wrote the name of the machine on my paperwork, lest I forget.

I had a distinct sense of, "I don't ever want to see you at my machine again [until you've lost 100 pounds]."

Of course, I'd like not to have any more MRI scans, which would solve her problem and mine.

After getting dressed (an important step given the that the next stop was at another building), I wandered over to Doctor Atomic's area, where I picked up a pager and sat in an area where I was the only woman among the middle-aged men. One flipped his way through a selection of reading materials from his briefcase—the Financial Times, Fortune, Money. I wanted to ask, "Say, you don't happen to have Scientific American, National Geographic, or the Utne Reader in there, do you?"

Soon an elderly woman came along and asked a more casually dressed man if she could sit next to him. He agreed warmly, but returned to his own reading even as she tried to strike up a conversation. She asked him how long he'd been waiting and mentioned that she lives nearby. After she finished a cup of coffee, she asked him where she could throw it out, and he gallantly took care of it for her just before he was called in. After that, whenever she heard a pager, or a staff person came to the door, she thought it must be her turn. When they called a nonfunctional pager number, she struggled to read hers. just in case And, wouldn't you know it, she did have one of the nonfunctional pagers. A number was called, and she had to ask if it was hers. She reminded me a little of my dad in his old age, when he thought always that he must be next. I used to think it was a form of self-centeredness peculiar to the very young and very old, but now, especially since I've lost some hearing ability, I wonder if some of it is simply compensation for sensory deficits—you can't hear and can't see well, so you worry that they called you or buzzed or lit up your pager and you missed it. That, combined with heightened respect for time, can make elders seem impatient. We all have to be mindful of how we interpret and judge the actions of others.

My pager buzzed next, and I left [soldier of] Fortune to his capitalist dreams (there I go, interpreting and judging). I talked to the nurse for a bit, then waited for Doctor Atomic. I'd met him twice before, the day we discussed my previous MRI images and the day after the UFE, when he came in with a resident to make sure I was still breathing and resting uncomfortably. When he arrived this day, he shook my hand and methodically went through my symptoms, some of which I didn't remember. Frequent urination—mildly improved. Bulk feeling—mildly improved. Lower back pain—mildly improved. Bloating and gas—wait, had I said that? I must have. By now, I was feeling badly that the procedure didn't appear to have been a resounding success, so I assured him that the symptoms I couldn't remember were much improved.

We turned to the before/after images. Seen at a comparable angle, Ignatius has shrunk from 13 centimeters to 12 centimeters, or just one centimeter. It's still large. It's still making a pancake of my bladder. But, as Doctor Atomic noted, we'd done what we wanted to do—we'd killed it. It's just a solid gray mass on the screen, with no blood supply. It's dead, Jim.

Now I have two alternatives, which means I have only one as a hysterectomy short of malignancy is not an option for me. The other, Doctor Atomic suggested, is a laparoscopic myomectomy, in which Ignatius's remains would be cut up and removed laparoscopically. Because of my weight, an abdominal myomectomy isn't a good option. Doctor Atomic said he would consult with Dr. M, a gynecologist, and let me know if he thought the laparoscopic approach might work for me.

And so on Monday, the 27th, Doctor Atomic called to tell me that Dr. M had seen my images (now there are two men who have been exposed to the more elusive bits of my reproductive system), and he thinks a laparoscopic myomectomy would do the trick for me. Yesterday I called Dr. M's office and made an appointment for June 16.

Truth to tell, I'm less nervous now about another procedure than I am about taking another two-week medical leave in this unforgiving economy and environment. You might think that, in troubled times, people would be more supportive—after all, we're under the same pressures in the same leaky boat. Difficulty can bring out the best in people, but I'm also seeing how it can bring out some undesirable qualities, too—including defensiveness and inappropriate competitiveness. Two weeks of leave may open the door further to attack, and who knows what I will find when I return?

Why do I get the feeling the late, unlamented Ignatius is laughing at me even as its remains weigh heavily upon my mind—and my bladder?

Monday, April 27, 2009

Limitations

As I grow older and forgetful, I realize that my memory isn't failing. Nearly everything I ever knew is still stored. It is only that it's more difficult and takes longer to access. Twenty years ago the name of my kindergarten teacher would have come off my tongue instantly, even automatically. Today, if you asked me who she was, my slower processor would have to do dig through nearly 48 years' worth of accumulated files, and I might hesitate for few moments. I may even appear to have forgotten her name altogether. But it's still there, under the detritus collected over many years. My processor works sluggishly in the background until it does find the data at 3:00 a.m., by which time I have forgotten why I was trying to recall it. Or, at 6:00 a.m., as happened recently, in a dream I hear the name, slightly distorted, of someone I have not thought of in nearly 30 years. My processor burped it up randomly.

Although I don't know much about either the human brain or its favorite toy, the computer, I believe that how they work is based on similar principles. Mechanically, they are different, but in some ways their ultimate functionality is the same. Walking on land, swimming through water, flying through air—no matter how it's accomplished, it's a form of locomotion that moves you from Point A to Point B. And so it is with human and electronic minds—both store, both access, both process, both calculate, both communicate. Surely by now science fiction writers have touched on every conceivable integration of human being and machine from sentient computers (HAL 9000/2001: A Space Odyssey) to computerized humans (Roger Corby/Star Trek) and, of course, androids (Data/Star Trek). The question is: Do computers think like humans because that is the only way of thinking we know and understand? Will the next revolution in human thought come when we discover other ways to perceive, compute, and think? Or are we married forever to one way because it is the only one we can imagine? Is our own thought, and the electronic extension of it, limited by our design?

My brain is like a computer whose hard drive is full, whose memory is faulty, and whose processor is failing, and life is like a program. If X, then Y. Everything, no matter how complex, could be reduced to choice. Events may be cumulative, but at each step there are choices and events that determine the next choices and events that determine the next, running parallel to one another, for the duration of each creature's life—and potentially beyond, because what we do and have done affects other humans, other creatures. We're in the program, so it's hard to see it from a detached perspective. We live on the plane of our existence, not above it.

Somehow this reflection brought me to the rescue of Captain Richard Phillips from Somali pirates.

As we know, under orders from President Barack Obama to do what was necessary if Captain Phillips were in "imminent danger," Navy SEAL sharpshooters killed the three remaining pirates, the ringleader having already given himself up. It was a reasonable plan that was well executed and, most important, successful.

But it might not have been. If any one of a number of things had gone wrong, the results might have been quite different. Captain Phillips might have been killed, which would have been a tragedy for him, his family, and his friends, and a disaster for President Obama and the Navy. Even if the mission had simply failed to retrieve Captain Phillips, we'd be asking hard questions about what went wrong and why the world's strongest and most advanced military couldn't rescue an American citizen from a handful of thugs. Obama and his administration would still be haunted by the mistakes made and trying to reestablish the public's trust in their leadership. If A happens, Captain Phillips is retrieved. If B happens, he isn't. If C happens, he is killed. Imagine all the branches that would lead to each of those outcomes, and all the branches that would stem from them. That's how life works, or at least that's how we see it. It's all about possibilities, probabilities, and choices.

Perhaps that's why virtual reality, games, and role playing are so popular. Unlike life, there are no real consequences of going with choice A, B, or C. In a "Somali Pirate" game, Captain Phillips would not be real, and neither would be the choices, decisions, or blood.

But the world is real, at least it seems so to us, and so is the program, faulty as it and the hardware and the operating system may be.

Still, I wonder how many worlds there are, and how many ways in which to perceive them. We'll never know as long as we are trapped within our own limitations, which prevent us from escaping them.

Tuesday, April 21, 2009

Listen to them, children of the night . . .

By day, Chicago's Loop—the downtown business district of soulless, gleaming glass-and-steel towers interspersed among blackened vintage relics—bustles with activity. Elevated trains and buses disgorge city-dwelling office and store workers by the thousands, while commuter trains haul in warm bodies from the suburbs. Dishes and glasses clang in restaurants bars, while takeout containers and cups are filled. Delivery vehicles block streets and alleys. Lines form at government agencies, post offices, and banks. As the morning wears on, families and tourists vie with workers for sidewalk space and bus seats. After 10:00 a.m., the shoppers appear. At lunchtime, those can spare a few moments pour out of their office buildings seeking lunch or bargains or to run errands. And between 5 and 7 o'clock in the evening, the process reverses itself, with mostly urban young people staying behind for after-work conviviality and theater- and opera-goers appearing at select restaurants in the theater district and surroundings. Later, temporary lines form at cab stands as each production lets out.

Such is dawn-to-dark life cycle in downtown Chicago.

Despite the drinkers and diners, the theater and opera attendees, and the less studious of the new wave of art students roaming the streets, much of downtown Chicago consists of near-dead zones after late office hours. In some areas, you may be surprised to find yourself the only person walking on that block, or that you're sharing it with its mostly unseen homeless residents. Often, they're not the homeless you meet during the day, asking for money outside the train stations, stores, and restaurants, who disappear with the changing shift. To me, they seem to be the hardcore homeless. Several years ago, when a visitor and i left a pizza restaurant around 9 o'clock, one of these hungry-looking men stopped us to ask not for money, but for our leftovers, which we turned over to him. He clearly needed them more than we did.

Most suburbanites I've known are uncomfortable being downtown after the streets are no longer crowded with their kind. From a practical standpoint, they don't want to miss their express train or the next one because after rush hour (really three hours) the trains just don't run very often. The later it gets and the fewer trains there are, the farther away the suburbs recede. There's more charm in being at home in the bosom of one's family and in the comfort of one's home than in being pursued by gaunt homeless men who want what's left of your pizza. When someone tells you he or she is from Chicago, it's likely they mean that they work in Chicago during daylight hours but rarely have seen the city after 8 or 9 o'clock at night. There's safety in distance and numbers.

I didn't watch the television series Beauty and the Beast regularly but did see enough episodes to know that it captured a mood of urban darkness and danger at night, real and perceived. Contrast that setting with the perfect and dreamlike pastel houses and manicured lawns of Edward Scissorhands, in which the improbable castle on the improbable hill, where evil seems to dwell, could represent the suburban fear of the urban unknown.

Years ago I thought of writing a story or even novel about the city's life after dark, when shifts change from the white-collar desk jockey to the cleaning crews who toil overnight on carpets, cluttered desks, acres of glass and flooring, and countless counters and toilets. As one group leaves and the other arrives, and darkness settles in, the atmosphere changes. With fewer people on the street, the sense of unease and danger increases, a sense exploited in the 1989 Batman film, in the scene in which Bruce Wayne's parents are murdered after a night out.

But I didn't. I've never lived a suburban life, nor have I cleaned toilets at night or been a shift worker at a place like UPS, picked up by a special CTA bus, nor have I been a denizen of the streets, nor have I spent any time on Lower Wacker Drive except passing through in the safety of a taxi or a friend's car. I would be writing something that simply wouldn't be true to life, unable to balance the light against the dark, or to capture the mood. It would be an obvious fake.

Whether I'm at work or at home, at any given hour, night or day, I can't conceive of what is out there. A couple of months ago, the police broke up a dogfight in progress, with even seasoned officers shocked and sickened by the brutality of the scene they found. This week a puppy mill was busted. Then there are the endless reports of child and animal neglect and abuse, spouse beatings, gang fights, robberies, rapes, murders—the list goes on and on and on. And it's all happening within a few miles of the mostly serene lakefront scene out my windows. Only the people who confront these horrors every day—police, firefighters, social workers, and others who are on the front lines out there—could capture the true-to-life, complete picture of the city's good, bad, and ugly. Although I don't retreat to the suburbs, and I have had a few scary moments confronting reality, still here I am, looking out at life from a vantage point well away from it, a zone of relative safety. And I am too old, too comfortable, and too frightened to leave it.

Sunday, April 19, 2009

Dream: Flying fish

I was on a small ship in a small sea, like the Mediterranean but colder. I sensed that it was turbulent, and then noticed concrete bumpers everywhere. Strangely, my ship never hit them. I was afraid, though, because I knew that if I fell into the water I would die almost instantly from the cold.

An enormous fish leaped out of the water and flew by. Later I would tell someone that it was airborne for 300 to 400 yards, although in the open water (with the concrete bumpers) I had no way to judge distance.

The fish continued to fly around, each time landing a bit closer to the ship. After I woke up, I realized that its landings in the water never created enough disturbance to rock my ship, nor did the turbulence I had sensed, although they should have. Even more than that, I was struck by the intelligent, malevolent expression on the fish's face as it looked intently at me on its flybys. This was no fish, but a sentient force for evil.

Again I felt my awful fear of the icy water even as the fish looked knowingly at me.

Tuesday, April 14, 2009

Dream: Flight and the face in the mirror

When I first became aware, I was Ronald Reagan, I was flying a plane, and I was being told to jump. At first the oddest part was being someone who was very old or dead when I knew that I, whoever I was, was in my prime.

When I looked down, I saw only inky blackness—not the glimmer of even a light, not the swell of even one shadow. How could I be expected to jump into the void? If I didn't, how could I land the plane in the void?

And even though I could see nothing, I felt the plane descending into the darkness.

Once a beautiful young woman, I was disfigured now and had no face, just scar tissue where my face had been. Still, I dreamed of loving and being loved. One day I risked entering the anchorite cottage, where I would be able to see myself as I had been—and perhaps I hoped someone else would see me the same way. This magic came at a dear cost, although I was uncertain what it was. As miserable as I was, it seemed that the reward was worth the price.

I looked into the small wall mirror and saw myself with a face, even a beautiful one, but I felt more puzzled than joyous. It was mine, yet not mine. What had been the risk of seeing it? Why could I not stay in the anchorite cottage and enjoy the illusion of having a face forever?

A man, perhaps a couple, came in. Maybe this was the man I loved or could love. He or they did not notice me. Without the mirror, I saw that my illusory face was no more. How could that be? It was supposed to appear in the anchorite cottage, but perhaps that was the curse. I had had one tantalizing glimpse, and a dream for the future, and that was it. It was the end of hope.

Monday, April 6, 2009

Relativity

Who would have guessed that a couple of links to my humble rumination on the virtues of the physical act of writing would draw so many visitors from so many places? Instead of agonizing over human foibles and behavior and worrying about why things are the way they are (imperfect), clearly I should focus less on writing and more on the tools of writing.

I jest, of course, although in the past few years I have begun to look enviously upon those who have a definitive set of tools they carry about with them, tools that seem to imbue their unseen labors with physical substance and reality. It might be someone with a bucket, brooms, and brushes, or with a hard hat and tool belt. It might be a musician with instrument case in hand. Or it might be someone like the young woman I saw on the bus with her “Art Bin,” no doubt bursting with all kinds of fun colors when opened.

At most I have a notebook and a pen/pencil case (pens, pencils, correction fluid, erasers, sharpeners, glue stick, scissors) to define me. They’re tucked away in a bag, and they are things that anybody and everybody uses in their home or corporate office. Oh, I have colored pencils and markers, too, but in my hands magic doesn’t flow from them, just childish scrawls.

That I like the substance of things is evident from the clutter I’ve accumulated since my 2003 move, after vowing to clean up my act and my place. I think I’d prefer a neat, uncluttered space, but somehow being surrounded by dusty books, paper, pens, and pencils makes me feel real.

March was a difficult month. I was busy with work to the point where I couldn’t think, and then I noticed more and more that time is slipping from me. Evenings and weekends are becoming shorter with each passing day that brings me closer to the end. Even an hour for lunch seems more like a half hour. Before, I could find time to be bored. Now, there’s not nearly enough time even for just a few small pleasures. When I’m sad (too often), I kill time by sleeping. When I’m happy (rarely), sleep is a luxury. And, perhaps because my body senses that spring is not that far off, something drives me to feel that I cannot afford the time for it.

My timeline is finite, after all, and I’m moving along it at what seems like a greater speed as I approach the end. Like a needle running along the grooves of a record, life started out in wide, slow circles. Now as it approaches the blank inner circle where the record ends, the needle seems to travel faster and faster over the shorter and shorter circles. I don’t know how long the music will last, only that it will end in silence.

And, right now at least, I’m not ready for the final note. There is so much left, or perhaps very little.

Time is relative in ways that even Einstein could not explain.

Sunday, April 5, 2009

Blast from the past

My brother sent me these photos, taken September 1988 in Pennsylvania at the Altoona Railroad Museum, Horseshoe Curve, and an overlook point. I don't know if this last is from the time I slid and rolled partway down the mountain until the brush caught me.