The end of a professional era

Picture of empty bookshelves

PG: Sad imagery

I never saw Toy Story but I understand that in the movie the toys speak to one another. So I wasn’t surprised when I started hearing banter from my basement office, where I kept a wide collection of toys for child clients who visited. I overheard the toys whining: “We’re bored.”

Normally, I view people as responsible for their own boredom. If I’m bored, it’s my job to find something to unbore me. But this was different: I was the reason for the toys’ restlessness. For three years, they’d had no children to play with.

When I was diagnosed with leukemia, I stopped working with children. It was awful abandoning all my clients without warning. I figured, rightly or wrongly, that were I to become incapacitated again, the adults would be fine but the children might struggle more. So now, when former clients call, I see the adults but I refer children to colleagues.

But first I explain my current health situation, saying something like: “Yes, Ms. Client, just so you know, I could drop dead anytime. Still want to come in?” I know, I know, anyone could keel over at any moment; I just believe my chances of doing so are higher. At least the adults who come in are duly warned.

After three years of not seeing children, three years of the toys’ escalating boredom, and no marked improvements in my dusting, I decided to relocate my toys. Some went to other therapists’ playrooms, some will become Christmas gifts for impoverished Mexican children (thanks Double Ps!), but my toy shelves were not quite empty yet.

There was still the toy to end all toys, the dollhouse. I’d coveted that particular dollhouse for years, so I bought it as much for myself as for my visiting clients. Everyone who came through my office–kids and adults, boys and girls–loved that dollhouse.

In the end, our friend, P., came over with her just-shy-of-two-year-old daughter, and home they traipsed with a good haul, including the beloved dollhouse. I was comforted knowing P.’s daughter was at the perfect age to enjoy the long-neglected toys.

When someone is planning a suicide, or knows she’s dying of illness or old age, sometimes she’ll distribute her prized possessions among her loved ones. Rest assured I have no plans to die in the near future; I just thought the toys deserved some kids. Still, giving the toys away–especially my dollhouse–marked the end of a professional era in my life.

Yes, of course tears were shed. Did you even have to ask?

I couldn’t part with everything, or at least not yet. For now, I’ve kept my life-sized stuffed Grover and my collection of dog-focussed picture books. When I’m ready, I’ll find the right home for my favourite book, Walter the Farting Dog. In the meantime, P. told me I’m welcome for a playdate anytime. I may just take her up on that.

Only some pictures tell 1000 words

A cartoon of Isaac Newton under the apple tree apple falling on his head

Often people ask me where I find the pictures for my blog. Well, dear readers, you can find anything on the internet. Last post, I typed in “The grass is greener”, added “images”, and found many possibilities to choose from. (I suggest you do not search “toy penis images”, however, because your search history will follow you forever.) Then I decide on the one picture that best complements my subject matter. Hopefully I’m not breaking all sorts of copyright laws in the process.

This image search is one of my favourite parts of posting because an image often makes the point clearer. But sometimes finding the perfect one is a challenge. If can’t find an appropriate image, I don’t want to post only text because, well, how boring is that?

With this in mind, I posted a fairly sad picture a while back. J., my voice of judgement and reason, felt a need to intervene. She nixed the sad pix and insisted on only happy images from then on. I’ve been trying, I really have. You may have noticed an increase in silly dog pictures, for example, or other frivolous imagery. But some posts just don’t lend themselves to rainbows and butterflies. If Sadness is okay, shouldn’t sad pictures be okay, at least sometimes? I don’t want to be a downer all the time, but can’t I be a downer every so often?

Even before this, J. had drawn one boundary that I’ve always respected: no pictures of my physical disfigurements. I thought time-lapse photography of the recent bruising from knee to cankle and into my foot might intrigue you, but she forbid me altogether. I guess if you’re not into those graphic medical shows, you might be grossed out. Thus, I will be forced to provide only a verbal description of the progression of my self-inflicted bruises, since I’m sure my words will disgust you less.

Women my age are often concerned about the effects of gravity on specific body parts. Science lovers or not, you all should understand gravity because at some point you learned about Isaac Newton and that apple. ( I’ve since discovered that Newton likely wasn’t hit by the apple but might have seen one falling. I preferred the bonk-on-the-head imagery myself.)

Always the outlier and not caring much about sagging body parts, I choose to obsess about gravity’s effects on my bruised lower body. Since I’m platelet impoverished, when I bruise, I swell, and this swelling has to go somewhere. So, just like the apple, the excess fluid travels down. In the process, a bruise that starts in one place, in this case my knee, eventually spreads throughout my lower leg and foot. Yes, rather than looking like I bumped into a bathtub, I look like I was thrown from a motorcycle.

J. was right: I really don’t need a photograph for you to get the picture. Just envision the current state of my swollen, discoloured leg as a physical representation of my drama queen persona.

Greener grass is overrated

Running shoes face fence, standing on dying grass, greener grass on other side of fence

Have you heard of tyrosine kinase inhibitors (TKIs)? Neither had I until I was diagnosed with leukemia. The discovery of these drugs revolutionized the treatment of CML. Without my TKI, I would likely have needed a ghost writer by now, if you catch my drift.

But I ain’t gonna need a ghost writer for some time yet, according to Dr. Blood. For that news alone, my beloved caregiver deserved the delicious piña colada muffins I brought her yesterday, my thank you for keeping me alive for yet another year. (These muffins were much better than last cancerversary’s raspberry scones, I must say. I think it was the toasted coconut.)

Every three months, Dr. Blood checks the number of cancer cells roaming around my blood. Those nasty cells have been few and far between for a long time now. Upon reviewing my most recent magnificent results, Dr. Blood decided to lower my TKI dose. Since TKIs depress the production of all blood cells, not just the bad ones, Dr. Blood is hoping that a lower dose may allow my body to produce more healthy cells. To use a recent example, I’d lower my risk of complications after a fall if I had more platelets to help me heal.

Yes, I still have CML, but my miracle drug is effectively keeping the illness at bay. If I stop taking my TKI, those ugly cells will become fruitful and multiply again. Because it would be unethical to remove patients from a drug that is helping them, researchers have only studied patients who have stopped taking their TKIs against medical advice. I am not and will never be one of those patients. If Dr. Blood tells me that one pill a day will keep me alive and well, who am I to argue?

You might wonder if I am in remission or if I could go into remission. Dr. Blood has never used the R word with me. Some leukemias can go into remission but not mine, as far as I know. The doctor once told me my cancer-cell counts are so low, it’s as if I’m in remission. (Keep in mind my understanding of remission may be completely inaccurate since I’m a lowly layperson who does not seek out medical information on the internet. Furthermore, my disability pension does not afford me a medical consultant.)

But I have a remarkable ability to manage my anxiety in any situation using my skewed reasoning. I tell myself that were I in remission, I’d spend my time worrying that my leukemia would return. Instead, I can rest easy knowing I’ll always have CML, so long as the CML is well controlled. The grass has to be greener on my side because I’d most certainly maim myself were I to try to climb over your fence.

So for now I’ll continue to amble along, hopefully upright, knowing that at least one part of my medically complex body is responding well to intervention. Now, if I could only get the other medical challenges–the feisty polycythemia, the rebellious liver–in line, I’d be laughing. If I didn’t laugh, I’d cry, which is a-okay too. Remember Inside Out?

 

Annie’s Believe It or Not

Woman falls on icy, snowy sidewalk.

If only I could blame the icy conditions.

Oh hey, yes you, I see you there, check out my legs but don’t you stare. You’ll see my bruises everywhere!

On Friday past, I dragged my shoe, I tripped and fell. What else is new?

Oh my, oh me, I hit both knees. I scuffed my hands, I wet my pants.

[‘Twas pouring buckets up ’til then. What did you think I really meant?]

Those bruises that adorn me now, they’re old and new, black and blue, red and yellow, purple too.

Oh yes, that’s right, they’re small and big, I’m all beat up, oh darn, oh frig. 

And so I say to readers all: Why stand upright when I can fall?

I wish I were not such a mess, I cannot help my clumsiness.

Yes, I have become the protagonist in a heretofore unpublished Dr. Seuss epic. Does Sam ever end up eating Green Eggs and Ham? And will I ever regain my balance?

Thankfully, since we were meeting for coffee, M. was there within moments of my dramatic encounter with the sidewalk. She helped me up, and, once I had my wits about me, she escorted me home. I cleaned myself up and nursed my wounds while she put away my groceries. Then she provided the perfect distraction–good gossip–and she left once she felt I was no longer a danger to myself.

Believe it or not, my bathtub encounter was unrelated to my clumsiness or inattention. In contrast, I’m sad to report my sidewalk fall was completely and utterly my fault. I have always been a klutz, but this propensity for falling is newer. Why is that? I can’t really tell you because I have no idea.

Where is my helicopter parent when I need one? Clearly, I can no longer be left unsupervised, so I’ve decided I’m going to have to hire a manny. (Don’t tell me you need a definition–take “nanny” and go from there.) I figure if I have someone by my side at all times, that person can help me to minimize my danger to myself. He can drive me around and keep me on a short leash. No more monkey bars at the playground, no more bike riding (I’m getting a trike), and walking in only the most comfortable shoes. One critical job requirement is reaction time that is faster than my own. (Everyone has reaction time that is faster than mine.) I will be paying my assistant to scan the environment–those nasty curbs, black ice patches, and random hazards which, I’m learning, are everywhere–and help me avert disaster.

Why not a nanny? Well, I need someone with a little heft to keep me upright. I haven’t been someone you’d describe as “petite” since Grade 1. What’s the point in having a constant companion if she can’t stop me from falling? Plus, think of how everyone will talk if I’m seen hanging out with a young, handsome brute. Hopefully no one will notice my clutching his arm for dear life.

Hindered by a healing hematoma

Yesterday was a momentous day in Calgary: E. was called to the bar. We’ve known E. since she was 14 (14? really?), but now she is full grown and fully employable. J. and I were honoured to be invited to her celebration.

I know this post should be all about E., but of course we need to start with my day, which was spent obsessing over what to wear. You see, I have a huge, ugly, multicoloured hematoma on my shin, and as it heals, my lower extremity is bruised and swollen. It is not pretty.

J. immediately nixed my wearing a dress, fearing I’d scare any small children in attendance. In fact, one little boy ran crying from the room during the proceedings, but I don’t think that was my fault. I decided on dress pants and a blouse, hopefully rendering me passable in the company of sharply attired lawyers.

Two feet with painted toenails with cankles, hard to distinguish between calf and ankle

These are someone else’s cankles.

Then there was the footwear challenge. Thanks to my injury, I have a full-blown cankle on my right leg. What, you’ve never heard of a cankle? In psychology speak, a cankle is a blurring of boundaries between calf and ankle. Chubby people have cankles, but so do people with swollen legs. My cankle is especially attractive because it is black and blue. Until this swelling subsides, my footwear options are limited. My overly casual sandals would have to suffice.

Finally there was the hair. I had booked in with my hairdresser that morning because a shearing was long overdue. He primped and preened me, even liberally applying the hair products I normally refuse. I prayed my nicely coiffed hair would distract people from my other wardrobe failings.

Because the event was scheduled during nap time, and all those difficult wardrobe decisions had exhausted me, I nodded off on the couch before heading out. (I was trying to preempt my sleeping at the event itself.) I often look like I’ve just gotten out of bed, but remember those hair products applied earlier? So much for smartly coiffed hair; after my nap, the right side of my do was completely flattened.

We’d all agree I looked a bit dishevelled by the time I arrived at the event. I could say I was trying not to steal Ms. L.L.B.’s thunder, but really I just looked like I do most days, if a little worse for wear. But I did manage to stay awake through the eloquent and insightful speeches which captured the new lawyer in all her glory.

If I’m honest, my psychologist self is a little jealous of this whole call-to-the-bar thing. I had to write my own speech, commonly called a thesis defense, and squirm through undermining challenges and questions on my insignificant research. I’d have much preferred listening to extensive adulation, with a little mockery thrown in for good measure, wouldn’t you?

Truth is, after years of hard work, Ms. L.L.B. deserves to be so proud of her accomplishments. Way to go, Princess! An exciting and stimulating career awaits. Here’s a nonalcoholic toast–what? no Prosecco?–and a huge Mazel Tov from me. Keep up the good work and you’ll be in Who’s Who Legal in no time.

And I flew happily ever after

Business class seats in airplane.

Did you have trouble sleeping last night because you were so eager to hear about my return trip? Apologies, but I’m trusting you used the non-pharmaceutical tips for insomniacs I provided in an earlier post if needed. Since I can’t imagine the discomfort of hanging on hooks of any kind, I will now take you off those tenterhooks.

When I called the airline the day before my flight, their medical office informed me that, doctor’s orders or not, the company would gladly ferry me through the airport in a wheelchair, but they wouldn’t make any accommodations on the flight without full payment for an upgrade. I found this information both discouraging and stressful, since I did not know how uncomfortable four hours in a cramped seat would leave me, and I had declined those hefty painkillers offered at the ER. I also dreaded asking the passenger on my right if I could put my injured leg on his lap for 4 hours. Seems an intimate request to make of a stranger.

Since my trip had been such a disaster, I needed this story to end well. I decided, despite the medical office’s rules, that I’d still approach the gate agent for help. If I got a similar response, I’d point out, “You realize this note was written by Dr. Brian Goldman, don’t you?” I could only hope this Canadian household name would have some clout. If that didn’t work, I’d have to come up with another strategy that would not involve crying. (Yes, there had been tears. I just wanted you to believe I could cope with stress.) I was prepared.

Turns out I didn’t need to pull the Dr. Goldman card after all. I was wheeled up to the gate before the agent arrived, saw how aggravated she was at being hounded before she was ready, and waited patiently. As the crowds dispersed, I approached. She was initially dismissive of my request, telling me that the flight was overbooked. But when I further explained my situation calmly but concisely, using my best assertiveness speak, she somehow found me a perfect seat in Business Class. She even asked me which leg was injured to spare me putting my elevated body parts into anyone’s face. With this divine intervention, I received all benefits of Business Class seating. I was served a lovely three-course meal (although sadly I had to decline the free alcohol), I never had to stand in line for the washroom, and my every need was met. The flight attendant was efficient and kind and I was in heaven. Yes, literally.

And I got to keep my letter, my only proof of my encounter with my radio idol. I’ll gladly show it to any doubters out there. I don’t make this stuff up.

I’ve decided, based on this experience, which was not perfect but worked out well in the end, that Air Canada has unfairly been given a bum rap. Sure, there are challenging employees in any organization, but there are others who are reasonable and kind. That gate agent saved me tremendous pain and a prolonged recovery. Now I’d better go write her a thank you letter or she may never know how much I appreciated her efforts. I only told her seven times in our two-minute encounter, amidst happy tears.

Star struck in the ER

Cartoon picture of stick figure slipping in bathtub while shower is on

If the “ER” in this post title has set your alarm bells off, I’m impressed by your keen powers of observation. Yes, because I felt I had gained sufficient experience at Calgary ERs of late, I decided to share my medical-crisis wealth farther afield. Why travel if not to assess the medical care at my destination?

My first morning away started innocently enough. I dragged myself out of bed and shuffled to the shower, only to discover that the non-slip mat in the tub was anything but. The mat fled when I stepped on it, causing too close an encounter of my shin with the outside edge of the tub. Yes, it hurt, but I was still unwashed, so I repositioned the mat and tried again. Tragically, since the height of the tub and the slipperiness of the mat hadn’t changed in the interim, I hit a double. By the time I got out of the shower, the swelling was the shape of a hefty piece of kielbasa. Yes, folks, I had an unsightly and painful sausage-like protrusion on my leg that grew to epic proportions despite my R.I.C.E.ing it.

During a quick long-distance telephone consultation, my crisis manager told me to head directly to the ER. Off I trotted, ugly swelling in tow, moving my visit with relatives to the hospital waiting room. I needed to ensure my platelets were high enough to stop another hematoma from taking up permanent residence (been there, done that), and to find out how to travel home safely.

Who was assigned to my case but Dr. Brian Goldman, of the intriguing CBC radio show, White Coat, Black Art. Funny, I had listened to a few of his podcasts on my flight in. On his show, Dr. Goldman is smart and articulate and insightful and he often tackles challenging topics frankly and thoughtfully. And I guess he’s not only a compelling radio personality but also an ER physician. Now that I have first hand experience of his patient care, I’d add that he practices what he preaches. I wonder if others, like me, foolishly tell him that they are his fans.

Although I know Dr. Goldman didn’t need my help, I could have easily directed his assessment and treatment plan because this wasn’t my first rodeo. I needed a CBC from Dr. CBC to ensure my platelets were still high enough to stop the bleeding. If they weren’t, a platelet transfusion would be in order. When the results came back with no concerns, I was let loose.

First, though, I declined the kind doctor’s offer of potent painkillers because they would inevitably have changed my ratings on the now familiar Bristol Stool Chart. If you’ve committed my posts to memory, you already know how complicated the consequences of constipation can be. I didn’t want the solution to one medical problem to create another.

I did, however, gratefully accept the esteemed doctor’s note requesting I be given a seat that would allow me to elevate my leg on the flight. I wondered how the airline would handle this recommendation. I’d love to tell you how things turned out, but I’m going to leave you on tenterhooks. (What an odd phrase, “leaving someone on tenterhooks”. What the heck are tenterhooks anyhow? I looked up the definition but I didn’t understand that either.) Stay tuned, and let’s just say I’ll quell your curiosity next post.

Change is vastly overrated

I’m anti-change and I’m proud of it. I like routines, I like predictability, my only spontaneity is planned. I wish I were wild and crazy but I’m not. Remember, for years I worked part-time at the library. I loved that darn immutable Dewey decimal system.

I appreciate continuity in my health care as well, and I’ve been lucky to see many of my physicians for the long haul. Over time, they get to know my needs and quirks while I do my best to keep them entertained, which is my small way of giving back.

With this in mind, imagine how hard it was for me to go to Dr. Liver’s clinic yesterday knowing he would not be there to see me. [Insert sad emoji here.] Thankfully, to soften the blow, some aspects of the clinic had not changed. I still fussed when the lovely nurse asked me to step on the scale, and, sadly, she dismissed my request that she record her own weight instead of mine, as she always does.

picture of Bristol stool chart, 7 types of fecesJ. and I were led to a different examining room, although you’d never know it since the posters on the wall were identical. Yes, every time we go to Dr. Liver’s office, we are confronted with the poo chart, among other wall adornments. The poo chart helps people identify their #2 for the doctor if they can’t come up with appropriately descriptive language. (Yes, you can buy a mug with this image on it, although I find that notion somewhat distasteful.) I don’t mind the poo chart, but I find the other posters of progressive liver disease a touch unsettling.

My poster viewing was interrupted by the entrance of Dr. Liver the 2nd, whom I had met briefly when I was hanging out in the palliative unit a few months back. Thankfully, Dr. Liver’s choice of back up hitter was a good one. Somehow Dr. Liver 2 recalled every moment of our first conversation. He obviously knows his stuff, and in time he’ll know me. I felt good enough about this visit that I decided to transfer to him his predecessor’s moniker.

There was one moment of doubt, though, when he offered to do an upcoming procedure without sedation. That way, I’d be alert and could drive myself home. My inside voice said: “Is he insane?” But with my outside voice, I easily convinced him that he would regret performing any procedure on me without sedation. I can’t recall my exact words, but it may have been something subtle like: “Over my dead body.”

This interaction brought us back to the harsh reality that our relationship is in its infancy and that we will need time to fully understand and appreciate one another. Thankfully, because of his stellar memory, my new liver healer will retain my preference for sedation for perpetuity. But if he dares to suggest I forego sedation in the future, I’ll be the one you’ll see fleeing down the hall in my hospital gown.

Fear of flying, or crashing?

Man in business suit flying through the air looking terrified

For so many reasons, this is not me.

My cancerversary? Oy vey. Sometimes the anticipation is better than the reality. A potentially lovely walk on a very hot day unsheltered by trees had J. and Jelly panting in no time. And the stop at Annie’s Café was a bust. J. and I agreed that the baked goods didn’t look great, so we passed. Should have gone to Bumpy’s. Live and learn.

Since then, I’ve been furiously trying to finalize plans for a trip to see family. First the bloodwork to determine whether my new chemo had completely depleted my platelets. No, holding steady, so Dr. Blood cleared me for travel. Then the last-minute flight, which wasn’t cheap. Finally a quiet place to crash for the inevitable naps.

J. won’t be joining me because she can’t really bail on the three weddings she’s scheduled. I’ve flown solo many times but I do prefer having my human security blanket along for the ride. Who will open the emergency exits when we need them if not J.?

I don’t have a phobia of flying. I do not stay home or drive long distances to avoid flying. I fearlessly go to the airport, board my plane, and buckle in, but sometimes I get a little shaky after that. I may look like I’m ignoring the safety instructions like all the cool people, but really I’m listening intently.

It’s the take offs and landings, and sometimes the turbulence, that unsettle me. So how do I cope? First of all, I bring a really good novel, several newspapers, and the really hard Saturday Sudoko to distract me. Oh, and if I can watch Food Network, all the better, so long as it’s not Diners, Drive Ins, and Dives. Ugh, just watching that show makes me retain water.

If distraction fails, I talk myself through the anxiety. I remind myself that I’m in more danger behind the wheel of my car than I am on a plane. (Curiously, I forget this statistic when I am driving.) Then, if I start to worry as we approach our destination, I recall that more planes crash during take off than landing. (How do I manage to avoid thinking of this when I am taking off? Beats me.)

And if I still can’t calm myself, I take an Ativan. No, silly, I’m just joshing. Rather, I think back to the one very scary flight I was on years ago. I was returning from the funeral of someone who had died an untimely death. There was a loud noise–an explosion?–and the plane started losing altitude. We did not know what was happening until we touched down safely at the nearest airport. Turns out one of the plane’s engines had kicked the bucket, necessitating an emergency landing. While this was happening, I convinced myself that only a very sick God would kill me after all the suffering I’d already endured that week. I arrived home on another plane without further incident.

Now when I’m feeling scared on a flight, I remind myself that I’ve survived engine failure, and I’m not speaking of my own. Heck, I’ve got leukemia and three years later I’m still alive. Why would I die from a plane crash if cancer hasn’t killed me? Maybe that’s what I’ll tell myself this time if need be. Oddly, I’m comforted by this reasoning.

 

Of course it’s all about me!

Garden stake,

Here are a few important updates: my baking esteem is slowly returning after my successful muffin and bread bakefest yesterday. No sunken middles, nothing under- or overdone, perfection. And yes, I’m still flossing, although I did forget one night this week. I almost jumped out of bed when I realized my omission, but feared having to add flossaholic to my list of addictions. I rolled over and fell back to sleep instead. Oh, and that new chemo? I’ve noticed I don’t seem to need a nap during the day of late. That’s a huge change.

Enough with the self-adulation. I was chatting with some yoga buddies before class the other day, and for reasons I can’t recall, one joked, “It’s always all about you, Annie.” I was a little taken aback or, in psychology speak, I suffered a mild narcissistic injury. But that didn’t last more than a few days.

Of course it’s all about me. Were my yoga friend to read my blog, she’d know I have the garden stake to prove it. I’m sure you’d agree with her assessment, faithful followers. And why shouldn’t it be? Can’t it be all about me sometimes, so long as it’s all about you at other times? Seems only fair, don’t you think?

And I’m not sorry it’s all about me, by the way. (That was an anti-apology, for those of you who are in my Apologizers Anonymous group. I’ve come a long way, baby.) Why does “selfish” have to be a bad word anyhow? Is it never okay for me to focus on my own needs or to ask others for attention or support? Sure my neediness quotient may have risen since the cancer, but isn’t that understandable?

My yoga friend’s comment was timely. This weekend is indeed going to be all about me as I celebrate my third cancerversary. Yes, three years since my diagnosis, three years of excellent medical care and effective chemotherapy, and I’m not dead yet. I could view this milestone as one year closer to dying, and there are times when my thinking strays in this direction, but I’d rather focus on the miracle that I’m still alive. May there be many more cancerversaries to celebrate.

To commemorate this day, J., Jelly and I will be venturing to a beautiful park in the city. We will gush with pride when people stop us frequently to tell us how adorable our dog is. And then we will visit Annie’s Bakery, which curiously I’ve never been to before. How else to make the day all about me than to stop by a place named after me? The day will surely involve chocolate because, well, all celebrations do.

So here’s my response to my yoga friend: Yes, it is all about me sometimes, as it should be all about you other times, and that’s okay. If it’s ever too much about me, I trust you’ll let me know. And if you ever need it to be all about you, count on me to be there.

Have a wonderful weekend all. Feel free to celebrate on my behalf, preferably with chocolate. And remember, if you eat it while you’re walking, you won’t gain an ounce.