The Courage to Cruise

What a wuss I am! There are people who live and work in places that have several feet of snow and ice to get through all winter, and I’m scared to drive down my street. What’s the worst that can happen? We don’t even live on the side of a cliff or the top of a mountain. It’s hard to fall far when you live in a holler. So what if I go into a slide?

My van is over ten years old with over two hundred thousand miles on the odometer. It has a dent on the driver’s side front quarter panel from a hit-‘n’-git driver in Sav-a-Lot parking area. The driver’s door bottom trim sports a big boo-boo from a propane tank bouncing along the interstate highway and stopping on me. I wear a seatbelt and have airbags, so how much harm can befall me?

We’ve got a long way to go to melt the snow with Adam’s latest weather report of 14.4 degrees. We won’t starve, no matter how frozen the holler gets, as our three freezers and two refrigerators are always stuffed to frozen food avalanche capacity. We keep a full pantry, and even have food stored under our bed.

The weather reports say that by Saturday we’ll be warm, but there are some things that just can’t wait that long. We’re down to a partial roll of toilet paper, so I’ve gotta work up the courage to cruise down to some store.

The problem for me is that when I’m scared of doing something, I shut my eyes, and hold my breath, and go really, really fast. This is not a good plan for ice driving. I know there’s a Ford commercial where a blind man drives a car, but I think it’s generally best to see where one is going, especially on ice-slicked mountain roads.

Richard grew up in Massachusetts, delivering baby chicks in all manner of weather. Ice driving doesn’t faze him, except for his worry that someone not as cautious as he is will be coming from the opposite direction on the road. If he feels up to it today, maybe I’ll ask him to go on the provision run. I’d want him to take the van because it has a lower center of gravity than his Bronco II, and he’d mourn the loss of his trusty twenty-year-old steed if anything happened to his ride. But then, I’d worry until he got home because I’m also afraid of being home alone after dark. Sometimes I wonder how I ever ended up in the woods.

My mantra for today will be, “I think I can. I think I can. I think I can,” like The Little Engine That Could. Oh, heck, maybe we’ll just ride to town together, visiting a few friends on the way…

Planning Priorities

Richard’s fond of the phrase “infinite regression of steps.” Before leaving for Atlanta, I had washed all the towels and bed linens used by our guests. While I was gone, Richard had folded all the towels, but couldn’t stuff them into the linen closet with all the extra Christmas crud already in there. I came home to a table full of towels which I couldn’t put away until I cleaned out the linen closet. So began the regression of steps.

I couldn’t clean out the linen closet without finding the storage bin that the Christmas linens go into. I couldn’t find the storage bin until I drove over to the storage shed in which we keep the seasonal decorations, the bin being too bulky to lug across the yard. I couldn’t drive over to the shed without bundling up for the cold. On my first day back from Atlanta, I stayed in my pajamas all day, so I never got to the shed. Who knew that by the end of that day, we’d be in the hospital? And who knew that the next day the roads would ice, making it impossible for me to drive home?

I hadn’t thought to grab a change of clothes or my toiletry bag before racing out the door with Richard. On a previous ER adventure in Louisiana, Terry Sue showed up with body spray and clean underwear for me. Maybe I should have a couple of changes of clothes always in my van, just in case.

I didn’t have Terry Sue on this trip, and all of our local friends were iced in, so I went to Wal-Mart to purchase some necessary items. While there I bought Christmas -colored storage bins on deep discount. At least, this will cut out a couple of steps in the process of storing the holiday décor -- the bundling up and the drive to the storage shed.

Richard slept much of the day. I began de-Christmasing the house when I should have been paying our bills. I’m behind on bill paying and other bookkeeping, so I’ll just have to make myself focus on prioritizing. One, pay the bills. Two, catch up on paperwork. The holiday decorations are beginning to depress me, but leaving them up a bit longer won’t result in our power being turned off – unlike continuing to put off bill paying. I could have used all the down time in the hospital to pay the bills, since we pay them online. But I was afraid to use the hospital and hotel wi-fi connections for transmitting our financial information.

We do know that we have wonderful neighbors. Terry and Denny risked their lives skidding down our road to feed our pets. Shirley and Monty took over from Terry when the weather got even worse. Adam, Josie, Charlie, and Deborah all offered to slide down to where we were to visit and transport us. Mary and Don offered to bring soup. And Sue, an ICU nurse I met only once, through Jack, has been advising me online on handling our doctor issues. It is a wonderful life as long as we have our friends.

Coming Home To Cats

We made it home. We decided that it was a reasonable risk to try to drive home. Adam had assured us that the state roads were all clear, so we knew that the only questionable stretch began where Coker Creek Village intersects with our road. This is exactly eight tenths of a mile from our right-of-way and one mile from our house. We figured that, since we know both householders on this stretch of our road, we wouldn’t freeze to death, even if we spun out on the road.

My original plan was for me to drive until we got to Coker Creek Welcome Center in Murphy’s Corner, and then give Yankee-bred Richard the wheel. Halfway home I got brave, and decided to drive the distance, with Richard as my ice driving coach. I’m proud to report that, even though our road is still a sheet of ice, I steered us all the way home without a hint of a skid.

Our fear of being petless was assuaged upon coming in sight of our front porch. There lay Gypsy, acting like she’s sunbathing in twenty degree weather. When she realized that yonder came her mistress and master, she immediately charged after non-existent beasties and ghoulies. We like having a dog that has pride in her work, false or otherwise.

After Gypsy’s pretend patrol run, she charged over to Richard as he exited the van. As Richard partook of the mutually satisfactory Gypsy rubbing, I proceeded to the shed to check on our ever-aloof cat Buster. There was no cat in sight, but I did hear the unmistakable mournful cry of a cat in distress. I knew this wasn’t the voice of Buster, but I stayed very still and called Buster’s name in that “Here, Minnie, Minnie” tone.

After a brief while, I saw a set of cat eyes peeking at me from a protected corner of the shed. These eyes were not peeking out of a tabby cat’s face, confirming that it wasn‘t Buster. I froze, and a little blue-gray cat came creeping out. It rubbed up against me, moaning for its mama.

About this time, Richard appeared in the shed. I told him that I couldn’t find Buster, but that this cat had appeared. Richard began trash talking to get rid of the intruder. When I reprimanded him, Richard said, “This isn’t a cat exchange; I want my cat.”

Next thing I knew, Richard was inside, announcing that he had spotted Buster, but that Buster wouldn’t come to him because he was spooked. He then announced that he thought we should put some water out for the visiting cat because it may not know our pet’s protocol of drinking out of the creeks. Richard also pointed out that he had put food out for the stray, but that Gypsy had immediately begun eating it. He also suggested that we should put food out in the outbuilding that Buster likes to hide in, just in case…

All the beasts being cared for, I could then concentrate on contacting all those who were concerned about my two-legged beast.

Recovering From Recovery

Richard says he finds it unbelievable that celebrities regularly check into hospitals to recover from exhaustion. He says, if he was a celebrity, we’d put out the word that he’s been released from the hospital due to exhaustion. The hospitalist finally showed up at 1:20 to listen to Richard’s lungs. The problem, according to Richard, is that the hospitalist was so obviously punchy from sleep deprivation; he forgot to instruct Richard to breathe, so Richard’s not sure what good listening to his chest did. I guess the hospitalist just didn’t want to forfeit a billable visit to Richard’s room.

The respiratory therapist came in at 3:00 to give Richard his breathing treatment. He was back at four because he had forgotten to check Richard’s oxygen. This is done by placing a clip on the end of the patient’s finger. Richard is congratulating himself on his restraint in not reacting in his most wicked way when the respiratory therapist told Richard to “Give me a finger.”

Several times, the CNA came for Richard’s vital signs, once having to return within fifteen minutes because she had forgotten her stethoscope in Richard’s room. This is all in addition to the new and improved hospital beds that groan at you every time you move a muscle. This is an indication that the pump is working to adjust the pressure in the hospital version of an air mattress. This may be a necessary feature for nursing home patients and people in comas, but do we really need to encourage ambulatory patients to be so lazy they don’t even adjust their own bodies in the beds? When was the last time a bedsore was reported in a patient who can walk? I don’t object to the feature; I just wish they had a switch for deactivating it.

Richard has begun complaining about the food, declaring that it’s part of a campaign to combat obesity. While Richard was digesting his hospital cuisine, I had a wonderful meal of Veal Rockefeller and sautéed mushrooms delivered to my motel room from a family owned Italian restaurant. As soon as Richard was released from the hospital, Iput him to bed at the motel. When he awakened, I ordered him a really good meal delivered to our room. He was still coughing so badly that he was afraid he’d scare off all the restaurant’s customers if we went out. Since we can’t navigate the roads back to our house until the icy roads improve, we may take in a movie or two while we’re snowbound in the “big city”.

Adam is giving us daily updates on temperature and humidity in Coker Creek. Unfortunately, his latest report was of temperature of 9.1degrees with fifty-two percent humidity. He and Josie also sent photos of the frozen waterfalls in our area, which are beautiful, but don’t give us much hope of passable roads anytime soon. If it weren’t for my fear that Gypsy and Buster will decide that we’re never returning and that they will find new homes, I’d be happy to simply declare the time it takes for the ice to melt as a vacation.

Adam and Josie and Deborah and Charlie have offered to come fetch us, but we may get brave and risk it ourselves. Mary and Don's offer of homemade soup is sounding very good...

Body Art and Not So Smart

Richard has a CNA with a biohazard symbol tattooed on her arm. Thank goodness she was only taking his vital signs. I’m not sure Richard would have let her perform any intrusive procedures on him as freaked out as he was by that tattoo. She says her husband has a matching tat, and he’s jealous because she has more body art than he does. They give each other gifts of more body art for special occasions. Ain’t that special?

When I asked Richard’s nurse to check his chart and make sure his immunosuppressive medication labs had been ordered, she said she had seen the order in the chart. She added that she remembered this because she didn’t know what the test was. Did she have to admit that to me?

Richard’s treating physician failed to round on him (probably because he’s scared of me), but called the room after I finally had him paged. He suggested that Richard should get a primary care physician not affiliated with his post-transplant team. His rationale is that he doesn’t think the post-transplant team would care enough about routine procedures like colonoscopies, and “We’d hate to see him survive a transplant and die in three years from colon cancer.” Once again, he opened his mouth and inserted his foot.

After the huge investment made in transplant patients, nobody gets as much preventive care as post-transplant patients being followed by specialized teams of professionals trained specifically in post-transplant care. How does the hospitalist think Richard has survived for the eight years since his transplant?

Then again, as educated as Richard is, he sometimes says things that aren’t so smart. When I was leaving for Atlanta after our holidays in the holler, I told him that I thought he would enjoy all the peace and quite of our house without any company, and that my absence should add to his tranquility. His reply was, “Oh, you’re just background.” I reminded him of this statement when I got back. He must have thought I wanted a deeper understanding of what he meant because he replied, “You know, like the dishwasher or washing machine.” No wonder he only pays attention when I’m overflowing.

As I prepared to return to the hotel, I pointed out that I didn’t think any of his current nurses were a threat to me when I was away from him, as none of them seemed particularly cute. Richard replied that he thought some of them were nice looking, and he added, “But then, again, I’m sixty-six years old and anything looks good to me.” I guess I won’t get too atwitter next time he tells me I look nice.

I’ve already had to instruct him that a man should never call his woman a big strapping girl. He has also had to learn that women don’t snore, they only breathe loudly; and, while women may pass a bit of gas, they never fart. With such a poor education in the ways of women, is it any wonder Richard was a bachelor until he was forty-nine years old?

Maintaining Memories

Our House in the Holler is Richard’s Tennessee Mountain Home and my retreat from my crazy world. The people of Coker Creek are our people, as are the people we’ve collected along our separate lives and our lives together. Our challenge is to make new friends while keeping the old. They are all gold to us.

We bought our home in the holler without knowing anything about Coker Creek. We didn’t know that it’s in a dry county where beer isn’t considered liquor, but wine is. We didn’t know that the closest mid-sized grocery store is twenty-three miles away. We didn’t know that the closest restaurant is eleven miles down a steep, serpentine mountain road. We didn’t know that the closest ethnic restaurant is a Mexican one that doesn’t serve margaritas or any other alcohol because it’s in a dry county. We also didn’t know that the most exotic ingredients you can buy within an hour’s drive are Americanized Italian, Mexican and Chinese foods.

Something else we didn’t know is how community oriented the folks are and how much we’d be welcomed into their hearts and homes. As conservative as people tend to be here, I was afraid that I’d be burned at the stake. Instead, people seem to find me amusing, and they love salt-of-the-earth Richard. Even though he is so smart and considered a bit quirky in the city, he fits right in in Coker Creek.

I didn’t want to make any more friends. I already feel guilty for not keeping up with the friends I have. Now, here we are several hundred miles from our old friends with a whole bevy of new friends. It wouldn’t do any good for us to run away. We’d still love these people and they love us, so we’d be leaving a part of ourselves behind if we left. And I’d want to continue contact with all of these people.

Richard doesn’t seem to suffer from separation guilt or anxiety. When people are gone, they’re gone. When we move, his philosophy about our former home seems to be, “That was then, and this is now.” I like to drive by and see our former homes and reminisce about our former lives. I also like to hear from old friends, no matter how long we go between visits. Richard wants to close the door and never look back.

He says he didn’t grieve when, at age thirteen, he lost his father because his father had become a part of him.Whenever we’re making memories and I want to take a bunch of pictures or buy souvenirs, Richard tells me that he doesn’t need either because he’s doesn’t have Alzheimer’s yet. Maybe the reason he knows so much is because every experience he’s ever had is stored in his rapid-access memory. I guess my memory and my imagination just aren’t as good as Richard’s.

The only thing we have left of yesterday is the memories; when we turn off the tapes of our memories, we lose that part of our lives. I have had one of the richest lives of anyone I know. I won’t go forward without recalling what came before.

I don’t know how we’re going to resolve all the conflicting emotions plaguing us right now. I do know that we’ll have to say good-bye to Richard’s Tennessee Mountain Home and my House in the Holler unless we can find a way to get proper emergency care for Richard. For a manly man, he’s delicate, you know.

Patient Persistence

How am I supposed to react when the nurse comes into Richard’s critical care hospital room and announces that the pharmacist recommended a change in antibiotics because the first one could affect his heart, and followed with the announcement that Richard’s swab showed positive for Methicillin Resistant Staph Aureous. Now, I don’t think these things are good when one has a normal immune system, but I’m pretty sure they can be extra problematic for people who are on immunosuppressive medications.

I felt worse after talking to Rachel, who encouraged me to check with Richard’s post-transplant care team. I actually succeeded in getting the on-call post-transplant doctor to talk to me and agree to take a call from the hospitalist treating Richard. I felt greatly relieved -- until Richard’s nurse told me that the hospitalist refused to call the post-transplant doctor.

My misgivings were compounded when I found out that the nurse for the night had some experience with post-transplant care and confirmed my fear that the level of immunosuppressive medication in Richard’s bloodstream was not being tracked. This was especially worrisome in light of the fact that less than a month ago the post-transplant team had changed Richard’s dosage because his levels were off.

Richard has had rejection issues in the past, so I’ll do anything necessary to prevent a recurrence. The night nurse agreed to suggest the required lab test to the doctor. I realized there was nothing more I could do until morning, so I went to bed.

Just as I was entering the twilight zone between awake and asleep, Bub called and put Elaine on the phone. Elaine, being a pulmonologist, and one of our very best friends, was not happy with the report I gave her. Upon waking, I went back to the hospital -- armed for bear.

Lo and behold, the doctor with whom I was having the problem was no longer on call. I had to start the whole patient advocate routine with another doctor, who sent a nurse out to talk to me. The nurse was a different one than the one who had helped me the night before. Once, again, I explained my misgivings. Once again, the nurse asked me questions, the answers to which they should be getting from Richard’s post-transplant team.I went to the critical care department manager and pled my case. She reported that the doctor would come talk to me. I made it clear that I had no desire to speak to the doctor until he had talked to Richard’s post-transplant doctor.

Three hours after my arrival at the hospital, I had still not been allowed to see Richard, nor had I seen his doctor. I went to administration, where the hospital risk manager took over talking with me. By this time, I was very controlled, and very angry. Is it too much to ask that our healthcare professionals admit when they aren’t experts on something and make a phone call to the experts -- or transfer the special needs patient to a special needs facility?

One of Richard’s favorite sayings is from Proverbs: He who knows not and knows not that he knows not is a fool; avoid him. He who knows not and knows that he knows not is a student; teach him. He who knows and knows not that he knows is asleep; wake him. He who knows and knows that he knows is a wise man; follow him.

The hospital is a very pleasant facility, with a home cooking cafeteria and wonderful nursing care in CCU, but unless the doctors and administration recognize what they don’t know, I plan to shun them and this hospital.