Monday

I'm tired today. It hasn't been a spectacular day... lots of things to whine about. One of my favourite patients probably won't last the night; one of my docs is pissed because I requested a change of assignment (she's not very busy and I get bored), there are too many little kids with cancer... this wasn't a good day to be an oncology nurse. It doesn't help when I get an idea in my head. You know when that happens? Something occurs to you and you can't stop thinking about it, and suddenly everything makes sense in relation to that one random thought that happened to take hold. Today the random thought was that I should be more present for my children. Maybe I am not entitled to take this much credit for their future outcomes (maybe nature has more weight than nurture), but I managed to convince myself today that they will turn out to be deadbeat junkie tax evaders if I don't stop working full time. Luckily, I came to my senses fairly quickly and now I'm still employed, but I'm vaccilating in the quality-time-versus-quantity-time debate. I declined a daycare board meeting tonight because it seems wrong to be out of the house for one of the three waking hours of their day that I am actually available. Of course, serving on the board of directors for the daycare also assuages my guilt at being away from home becuase I can claim it's all in the name of making sure they are in a nurturing and loving environment when I am not with them. Truth be told, they are probobly nurtured more effectively at daycare than they would be if I was home with them... I have neither the patience nor the creative energy to be a stay-at-home parent. I depserately envy those who do, but I cannot honestly count myself among them. I firmly believe I am doing them a favour by farming them out to professional caregivers during the day. Why did I choose to have children, you ask? Some days, like today, I have no answer. I mean at least we haven't done the live-in nanny thing (although I have suggested it), or the boarding school thing, we are taking responsibility for our offspring, but really, are we doing them any favours? Would it be better to have a present mother, however bored, short and miserable, or one less present but happy because she felt more fulfilled by a career which challenged her in the way parenting should but doesn't?

Oh, well. I found a lucky penny today. Maybe something exciting and faith-restoring will happen tomorrow.

Grownup

Somehow, and I'm not quite sure how, I ended up a married woman with two school-aged children.

One minute, I was drinking my face off in university, even before the days when I realized I might need some way to support myself if I ever wanted to move out of my parents' house. Fast forward to newlywed time when I thought it would be nice to have a baby to snuggle. Somehow, I (we) produced not one, but two, and fed and nurtured them through the Parasite and Merely Dependent stages. Now all of a sudden I am done with babies and we somehow made it to the Early Independent stage. We are the parents of two People who are individuals with preferences and opinions; People who no longer depend on me for the most base necessities of life (a productive nipple and nice firm sleeping surface).

We have moved from the basic necessities, up the hierarchy of needs to some slightly more complex ones. Now they can feed themselves, if the food is available; that is, they can shove it into their faces. No, now, I'm thinking of things like role-modelling and boundaries and safety. Somewhere, diapers (cloth or disposable?) and bumper pads (death trap or cute nursery design?) turned into "don't talk to strangers" and "eat your vegetables". In between was the please-and-thank-you and be-nice-to-your-friends stages, but my memory of those months seems to have gone the way of the Pampers. Gripe water has been replaced by bandaids as absolute essentials.

I think I first realized I was a Parent the day I licked my finger to clean off a spot on Aimee's face. I remember my mother doing that to me and how much I hated it. I swore I would never... but there I was, instinctively, grooming my child. Probably even earlier than that, I remember one incident where I was in the middle of doing something and my newborn daughter started to make hungry noises. I wanted to finish, but by the time I had (two minutes, tops), she was practically inconsolable. I vividly remember the epiphany that day, when it dawned on me that I really don't come first anymore. I am on hold until my kids are sorted out (slight exaggeration, for heaven's sake I managed to get a degree in there somewhere, but still, you know what I mean. I am choicelessly depended upon).

And now, we are at a stage of life where they can, independently, propel their lean little bodies down the street on the two-wheelers that they chose, (no more fat little baby legs), and fix themselves cereal and choose an outfit for the day (usually one, in Jack's case at least, that confirms in living colour, his heterosexuality). Somehow, the responsibilities of the parents of a school-ager seem so much more ominous than those of an infant. When you are a new parent, every decision is fraught with risk (will I harm his chances of going to Harvard if I have this one drink?), but the stakes seem even higher now, and the consequences more serious (if I let him play with that kid, will he end up stealing cars and doing drugs? Will she end up being a snotty little brat like that one? Will they get beat up at school if they don't have Nikes? Am I capable of teaching them how to stand up to bullies/peer pressure/poor choices?). And I can see they are only getting steeper (if I lend him the car tonight, will some drunk asshole run a red and make him an organ donor?)

After Jack's independent little adventure last weekend, I can see that the day is coming where it may not be so easy to rest assured that they are safe at any given moment. Maybe it's a good thing that the decisions we make as new parents are, in the grand scheme of things, so basic. It's a way for parents to break in slowly, let them get used to their role before thrusting upon them more weighty decisions. That way, there is plenty of training for the "how do I tell him my grandson is a spoiled brat?"-type questions.

My main hope for my kids is that they end up being productive, likable members of society. I want them to have the skills to make good choices. And failing that, I want them at least to be clean. Thankfully, they are now capable, if not willing, to groom themselves. I shouldn't need to wipe their faces in public.

I think I will use this post as a sort of time capsule, so that in a few years, when "wear your bike helmet" has turned into "use a condom", and the intervening years have disappeared into the ether, just like their infancies, I will have a record of my inner Parenting Turmoil. It will never go away, I am learning that now. I suspect it will evolve as the challenges and the stages evolve. I would like to think, though, that I will be able to avoid performing whatever the equivalent to wet-finger face-washing is for a given age or stage. We'll see. If I have figured out one thing, it's that I can make no promises. Or predictions.

Further

...to Superstitions.

I have noticed that the locker room door at work, which is supposed to be locked at all times, is more often unlocked when I have gone to the effort of getting out my key. If I just try the knob, it is always locked.

I believe in lucky pennies. The last two I found were indeed lucky...I found the first the day I got a call for the interview for my current job. I was desperate for a new job and I found a penny and my friend asked what would be my idea of luck. I told her a job interview, and I got one that day. Oh, and I was offered the job on my birthday. My most recent penny was found shortly before I won a donut from Tim Hortons.

If I mention something out loud, the opposite tends to come true. At the conference I went to a couple of weeks ago, there were door prizes. I told whoever was listening that because I had recently won a donut from Tin Horton's, I wasn't due to win anything. But sure enough, I won a nice box of 4 mini-bottles of wine which I then carted all over Toronto. Of course, this doesn't always work. I tried it with my last cup of Tim's coffee, hoping for the plasma screen tv, but all I got was "Play Again". But it happens enough that I am starting to say things aloud to protect myself from the opposite.

Also, when I forget to throw my book in my bag and therefore have nothing to read on the bus, I never meet someone I know to talk to. I get company only when I have a really good book that I am dying to read. Or when I am grumpy and it hurts to be polite.

Kids hurry when you are actually running on time, and drag their feet when you are late. The bus comes early when you are running behind, but late when it's -40C and you forgot your scarf. In my clinic, the two x-rays missing from the 40 in the envelope are the only ones I really need.

You get the idea. I think there is a larger force at work here. Don't you?

Runaway

I went to a conference today, and although I felt a fair amount of guilt at abandoning my husband with the kids on a Saturday, I chalked it up to professional development and went anyway. It was interesting and useful and everything, and when I came home, it was to an empty house. There was a note that said Trevor and the kids had gone to friends'. I headed over there.

These particular friends live on the next block, with maybe a dozen houses between us, around a corner. In fact, if you walked through our back yard, climbed the fence, and walked though that neighbour's yard, you would be almost directly across the street from my destination. I, needless to say, walked over (aside from wasting $1/litre in gas, it meant we could both drink).

This is a family with whom we have become quite friendly. Our boys are about 6 weeks apart in age; we have similar interests and jobs and toys. The kids are in the same daycare. We often spend Saturday afternoon and evening sharing playtime and a meal. And a few bottles of whatever.

Tonight, when I arrived, it was a nice day, and the kids were in the back playing. Trevor was clutching a beer and looking pale. I asked how his day was, figuring it was a routine single-parent day with the monsters. He subtly suggested I come in the house so he could relate a story. Oh-oh, I thought.

Apparently, this was Trevor's second beer, and he looked as if he deserved it. I was already feeling guilty, so the fact that he was drinking on the evening before a proposed 12 mile run gave me cause to believe that this was a story of concern.

It turns out, that when it was time to go to our friends' house, Jack offered to call and tell them they were on their way (the telephone is a novelty, Jack having recently acquired enough understanding of manners to earn the privelege of using it). He spoke to Mrs. Friend, and reported that since he could run as fast as Dash (from The Incredibles), he would be over shortly. Trevor loaded a few bottles of beer into a backpack and put it on Jack. Trevor fussed around and loaded some stuff into Aimee's backpack, put the appetizer he had made into a bag, and organized everything to leave the house.

When he ws ready to leave the house, he called the kids. Aimee dutifully and promptly reported to the front door and put on her shoes. Jack did not.

Trevor called. Jack remained absent.

Trevor looked through the house. Jack was nowhere to be found. Keep in mind that Jack is 5, and in this age of abductions and predators and other horrible things, has never been anywhere without a parent or close caregiver.

Trevor looked in the back yard. No Jack.

Trevor polled the next-door neighbours. No one had seen him.

Trevor started to worry.

Trevor ran to the corner and looked. No Jack.

The neighbour got on his bike and rode the other way to check houses on the other side. No Jack.

Now Trevor was getting frantic. A few minutes had passed and several more loud hollers into the depths of the house produced no Jack. He desperately asked the next-door neighbour if he could leave Aimee there and she told him to go. He jumped in the car and drove around the block to our friends' house. No Jack on the way.

He pulled into their driveway, ran in, and practically yelled, "Is Jack here?". There was Jack, at the top of their stairs, looking down at Trevor, blinking innocently.

Mrs. Friend took one look at Trevor and realized what was wrong. She said, "Oh. You didn't know he was here." "No," said Trevor. "I didn't". Jack had run, like Dash, around the bay to his friend's place, made it unseen into the house, and was playing innocently inside while his daddy panicked.

Jack got a bit of an earful from his hysterical parent, and is, as a result, temporarily not speaking to Daddy.

Trevor returned the car to our driveway, reported to the neighbours that Jack was safe, collected Aimee, and walked over to the Friends', where he proceeded to drink beer quite rapidly while his heart rate went from "charge the paddles to 360" back down to normal.

Mr. Friend, who walked in from the grocery store at the same time as Jack strolled into his house, figured Trevor and Aimee were right behind. "I heard the clink-clink of beer bottles and there he was," he said. "I was glad he'd brought beer," he added, winking.

By the time I arrived, Trevor had stopped shaking. He told me the story. "We'll laugh about this tomorrow," I said.

"Not likely," he said, and opened another drink.

The whole event lasted less than ten minutes. Trevor just sighed again, across the room. I think it will be longer than a day before he can laugh about it. The little monster.

Recovery

Bone marrow or stem cell transplants are brutal. First the patient gets chemo (with nasty side effects) to induce a remission (which would bounce back into disease without further treatment). Then, when they are in remission, they get drugs (with side effects) to make their bodies produce stem cells. Then, their stem cells are harvested via a gigantic IV needle and a complicated machine over many hours. Then, they get more chemo, twice a day, to completely destroy any bone marrow they have left, and I think maybe radiation, too. Then they get their stem cells put back in and they wait and hope. They need to be on an isolation ward for weeks until their bodies have some immunity back. When they are discharged, they need to stay within a certain (close) proximity to the hospital for 100 days, in case a fever or something develops, because any little sniffle is literally life-threatening. Often, all this doesn't work. Sometimes there are complications which cause pain, or recurrence. Lots of times there is infection. Some don't make it out of hospital. Sometimes we wonder why people allow themselves to be put through it all.

Last fall when I worked in chemo treatment we had this patient to whom I often administered chemo. He was about 21 and had something (I forget exactly what) that earned him a stem cell transplant. When I saw him, he was about three months out from his transplant, and battling complications left and right. He came in twice a day for IV antibiotics and painkillers. He was bald, and he was sick. He was always smiling, though, and we had good conversations about the books he was reading while he waited for his endless treatments to finish. By the end, he could practically hook himself up, he'd been though it so many times.

I thought about him a couple of weeks ago. I wondered how he was doing. I almost looked him up on the computer, but for confidentiality reasons, we really aren't supposed to unless we have some specific care-related reason to. I asked a few people about him, and someone said they though he hadn't made it.

I saw him today. I had to do a double take, I almost didn't recognize him. He had hair. He was upright, not hunched and pale with pain. He wasn't even wearing a hat. He had a little meat on his bones. He looked fantastic. He looked cured. He said he was doing really well. He was still smiling.

I didn't have time, so I didn't get much detail, but seeing him doing so well really made my day. I felt better all afternoon to know that he made it. I might be buoyed by the success stories all the more because my heart breaks for the patients who don't make it. I guess that's why they allow themselves to be put through it: this patient has a chance for a real life, changed by cancer, but richer for it.

Caffiene

In yet another personal semi-triumph of willpower, I went without coffee today for the first time in many, many years. I love coffee. Let me impress upon you the magnitude of my sacrifice. I love coffee. Why would I torture myself so? A new masochism? No, just the fear of aging.

Yesterday, I completed this questionnaire: http://www.agingresearch.org/calculator/quiz.cfm

Try it. It is quite scientifically-based and it gives a good analysis of your life expectancy. Out of 100 potential years, my lifestyle, genetics, etc. suggest that my life expectancy is 93.8 years. Not bad. I eat reasonably well, I don't smoke, I live in the 'burbs, I'm not prone to stress, I have good genes. My "problem areas", however, are too much coffee, too much chocolate, and probably too much alcohol. The authors preach moderation over abstinence, so I took it somewhat to heart when they suggested I could replace some of my coffee with green tea. No voodoo, no claims of immortality, just the suggestion that I might live better, longer if I cut back. I guess the days of teenaged invincibility are over.

Coffeelessness wasn't that bad for most of the morning. The tea prevented the headache. But by the afternoon, I started to feel a bit twitchy. I started thinking almost obsessively about coffee. I had a doctor tell me to get a cup if I started to seize. I felt compelled to tell everyone whose path I crossed about my coffeeless day, with poorly-concealed, probably misplaced pride. Somehow, I made it through supper without a seizure, and without a coffee. I don't even think I was all that bitchy, although you'd have to ask my family.

I have rationalized my decision not to go cold turkey. Besides the fact that I love coffee, I was chatting with a patient today who has been given the choice to have chemo or not. He has a few months to live, at best, and the chemo may give him another couple of months, but the side effects may make those months miserable. It's all about quality of life. I told him he needed to weigh out the pros and cons and decide if he would rather have more time, or better time. This goes back a bit to my blog of yesterday. The more I think about it, the more I realize that despite the pain, the depths to which we sink when we are mourning, the good times are worth the risks we take when we love enough, when we give enough to hurt that badly.

So, needless to say, I am drinking a coffee (and eating chocolate Easter eggs) as I write this. Today, I glimpsed a tiny corner of insight into addiction. I know the risks, but I have decided that I would prefer to live a shorter, more caffeinated life. I have made my peace with it. I just hope my delicious salvation will let me sleep tonight.

Memorial

There was a memorial service on Friday at work, to remember patients for whom we have cared and who have died. It was a nice time to reflect on the work we do. I mentioned to one of the doctors I was going and he told me not to. “Never go to a patient’s funeral. It’s too hard to stay objective”. I told him it was good for closure. Often we see patients every day or week for months and months, and one weekend they are admitted to hospital and then they succumb, and we never see them again. Often the first we hear of it is when we happen to see their name in the obituaries.

I had another doc tell me recently that she doesn’t read the obits anymore because it’s too sad. There is no doubt that it is sad. I told her, though, that we need to take comfort in the fact that we help these people through their final days. We make them more comfortable, we help control pain and shortness of breath and bleeding. We preserve function and help patients to keep their dignity and stay in their homes as long as possible, if that’s what they and their families want. The knowledge that what we can and do accomplish all that should, in turn, give us comfort. Often when we see patients, it is known up front that we will not be able to cure them. But incurable does not mean untreatable, and there are things we can do to the last days to help.

The remembrance service talked about public grief and private grief. There are certainly patients that I miss, and am sad about when I hear that they have died. Once I hear that the death was peaceful and comfortable, though, it’s the family that I grieve for, not the patient. The patient is cured, then. It’s the task of those left behind to carry on with life in the absence of that person. For most of us, in North American society, once the funeral is over, the public display of grief is no longer socially acceptable. But anyone who’s ever lost someone knows it takes a lot longer than a few days for the acute sense of absence to subside.

In the depths of it, the finality of death is so unutterably sad that we wonder whether the whole effort of life is worth it. We feel like there is no point in being happy, in being human, if it risks this despair. It’s a physical sensation in the gut, or the heart, or the head. That is the private grief that can go on and on and on. Days or weeks later, after the funeral, there will be a moment when we want to make the bed, and call to the person to grab the blanket on the other side, and they aren’t there. Months or years later, we’ll suddenly hear a joke that we think they would like, and think, “I’ll have to call her…” It starts all over again, like scab ripped off and the bleeding starts again. That is the private grief they talked about at our remembrance service.

As health care professionals, we need to keep in mind that we are entitled to grief, both public and private. To be open about it is frowned upon. Doctor Number One, above, eliminates the risk of grief by not attending funerals. Doc Number Two chooses not to read obituaries. Sadness and the acknowledging of tragedy (because it is tragic, no matter how old or how sick the patient was, to those left to feel his or her absence) is dangerous for us, because there is a risk of reduced objectivity, and the treatment we provide may not be optimal if we can’t be objective. But it is impossible to treat, to interact with people without giving up some of that objectivity. It's the only way we can make decisions about treatment. Although our capacity for that giving is bottomless, I believe, we need to recharge our stores every once in a while, by acknowledging the losses and the grief. That’s why the memorial was so valuable. It gave us a safe and acceptable place to demonstrate our public grief, and the message we received was that it’s ok, necessary, in fact, to be sad, to allow ourselves the private grief.

Personally, not professionally, the service had me thinking about recent and imminent losses. My grandmother in November, my great aunt, last week, half a world away in South Africa, my (dad’s) dog who is kind of fading away before our eyes. It’s not so much the person lost, as the understanding of the effect of the loss on people left that make me sad. We cope, we carry on, but we can’t deny the exchange that has occurred with every contact. We gave, they gave. They received and we received. It is inevitable and unavoidable, the contact, the exchange, the loss. The comfort comes in the fact that the person carries on, in fond memories and funny stories. That may, eventually, help to mitigate the physical sensation of loss when they are gone, or to provide an outlet when all you want in the world is to talk to them. But we can’t minimize or ignore that we miss them. It’s what makes us human.

So beans to the doc who won’t read the obits. I admit there is less at stake for me, since I am not prescribing treatment. I am giving less and so I have less to lose if it should fail, but I want the closure. I want to know if it was peaceful and if we were able to help them. Knowing those things helps to reinforce the faith that what I do is important and not futile. It gives me the strength to come back tomorrow and do it again. It helps me to know that when the time comes and I have to face a more personal loss, it will be easier let myself grieve.

Progress

There is an old school near where I work. I pass it on the way home. It had to have been built a century ago. It is a three-storey brick building with what might either be a bell tower or a housing for an air raid siren or something. It is huge and old and it exudes character. It has been vacant for quite a while; months or years before I started working there. There was a for sale/for lease sign on the fence for a long time. Then one day, there was a sold sticker over the sign. Cool, I thought, someone bought it. It would be a good place for a clinic or a homeless shelter or a hospice or something. It was probably pretty cheap, considering how long it had been vacant.

Last week, I saw construction activity going on and then as my bus passed it, I saw a wrecking ball going at it. An excavator has been picking up the debris and loading dump trucks with it. I was really disappointed. (Jack, however, was thrilled by my description of it and asks for updates daily)

There's something about a half-demolished building. It can either signify new beginnings, or the end of an era. I guess it's back to Gramma Betty's glass-half-full outlook. I look at this place, where probably generations of kids learned the times tables and the alphabet, and it's literally being bulldozed in the name of progress. So far, they have taken off the classrooms on either side of what looks like a central hallway. The bell tower is still standing. You can see the classroom doors, all gone now. Once, if you were walking those halls, they would have opened onto industrious little kids poring over a spelling test, maybe a mischevious little boy dipping the pigtail of the girl in front of him into his inkwell. Now, they open onto thin air. The chalkboards are still on the walls that remain. I would like to get close enough to read the ghosts of chalk that they must still sport.

How hot would it have been on the third floor in mid-June? How many kids gazed longingly out at the playground as the clock seemed to go backwards? How many decibels would the collective shouts of years of 3:30-on-the-last-day, years of September back-to-school-grumbles be? How many spitballs flew? How many apples given to teachers and how many indoor recesses on rainy days? Schoolgirl crushes, friday night dances, field trips. And who needed a gymnasium when you trooped up those three flights a few times a day? What is your fondest elementary school memory? Generations of kids did that there, too. Lofty aspirations and blinding disappointments. How many times did the dress code change to adapt to the lengths of girls' skirts? How many times was the national anthem sung between those walls? God Save the Queen/King?

I guess the Principal's Office is gone (I always capitalize that phrase in my mind). I wonder how many former pupils, once scarred there as naughty children waiting interminable minutes for their strapping (and disciplined more by the thought of it than the actual event itself, if it even happened), pass by now, and subtly feel a weight lifted from their shoulders to know that that particular chamber, fundamental to their Formation (in whichever way it formed them) is gone. I wonder if the halls still smell like that combination of chalk dust and lunch and books and mimeograph and kid that every elementary school once shared; I think, I hope, that those smells are such a part of the fabric of the place that the smells of exhaust and rain and the city would not take root, despite its years of vacancy and its current state of doorlessness.

I wonder what they will build on the site. It's not going down easily, it is solid brick. I hope some of it can be recycled. I wish I had gone to look at the building when it was for sale, posing maybe as a prospective buyer. I wouldn't have the first clue what to do with it, but it would have held stories. I like the idea of a hospice, where people could go to die peaceful deaths, when they choose, away from heroic measures that prolong agony. A re-comissioned school would be a good place for a hospice. I imagine painting walls and refinishing floors, and thinking about all the bean sprout experiments that started on those window sills, or seeing a stain on the floor where some terrified five year old threw up on the first day of kindergarten before a kind teacher cleaned him up and gave him a hug and it was all better, or finding a name carved into a wall by a kid told to stand in the corner for being disruptive. I think there would be good karma there for the dying.

I guess this particular demolition has me thinking about innocence lost. Generations of kids learned the Three Rs there, not knowing yet about wars and cancer and disfiguring car accidents and epidemics. They were trust personified. All they knew of the big bad world was that if you dipped a girl's pigtail in your inkwell, you might get the strap. There was no terrorist threat. There was no crack, no twelve-year-old prostitutes, no gang shootings, no abductions. No 9-11. And even if my twenty-first century six-year-old hasn't been faced with those things directly, yet, the fact that I can't imagine a time when I would let her walk the 500 metres to school unaccompanied by an adult is proof enough that she is affected by those unfortunate by-products of "progress", at least indirectly.

I want whatever they replace this building with to have some merit, some consideration of what came before it. I hope like hell it won't be a parking garage or a strip mall. I guess I will hold on to the thought that the spirits of those Blank Slates, those bundles of Opportunity, the kids that spent the best years of their lives walking those halls, will infuse whatever ends up on the site with their innocence and that it will turn out to be a glass half full.