My sister Christine Ottaway died in 2012 of breast cancer.
I took this photograph at Christmas in Alexandria, Virginia in the late 1970s. I am three years older and made her stuffed toys and puppets for years. The first one was a stuffed snake that I sewed by hand, of brown flowered fabric. My mother was very unconvinced about it, but Chris and I had both longed for the giant velvet snakes at the County Fair. We failed to win one. The snake I made her was only two feet long, but she loved it.
I made the puppet on the left and bought her the one on the right.
It’s lovely to still have the photographs and memories.
For the Ragtag Daily Prompt stable, because maybe love is the only stable thing in an unstable world.
The bones of the great blue heron are so light, that I think it is standing on the floating kelp beds. I’d wish my bones were that light, but that would be osteoporosis. Maybe I could come back as a heron.
The older we get, the more we learn which bridges to cross, which bridges to burn.
What shall I keep?
And shall I burn that bridge before I cross it
or after?
I did not know that was a bridge
I would burn
And I grieve as a I learn
But the sledgehammers and bombs
loosed by the family
have left a bridge
that is all but falling
Into an abyss.
It is stone and old.
It won’t burn, but it barely holds together.
One heavy rock, thrown in the middle
and it will fall
down down down.
What shall I keep?
What shall I let go?
I wonder what my parents think
and grandparents
and sister.
Do they think at all
or do they let go with death
and let joy overcome them
in reunion with the Beloved.
I hope where they are is joy.
It is ok, loves.
It did not turn out well
but people make their choices.
I can’t rebuild the bridge alone
and on the other side they prepare
new IEDs to blow me up
if I attempt to rebuild
or cross.
I keep my children away
from the web of triangulation
and so they are not attached to the land
nor do they play the family games.
I am so glad.
I am still attached to the land
and my dead.
Not the living but the dead.
My sister, my mother, my father
grandparents, uncles, aunt.
All the dead.
Forgive me, but I can’t keep the bridge
going
and I will let the land go.
My children and I will be dead
to those living.
We have family and friends
who are loving and not hating
and not cruel.
I still love my dead and even though the place reminds me of them, they are not there. They are in my heart. I keep them safe and let the bridge and the land go.
It’s about shacks on a lake in Ontario. My grandparents and family built the shacks and I’ve been going there since I was under a year old.
However, my sister died of cancer in 2012 and there was a horrific family battle over my niece. My mother had already died. My father died 13 months after my sister and left the same will as my mother. Unfortunately it was written when I was a minor. I cried when I read it because I was the only person named in it who was still alive. I knew what my father wanted, or remembered what he told me. A will is a will though. I took it to an attorney and followed her interpretation.
Then I was sued by family regarding the niece.
I knew what my father wanted but he had not done it. So I decided not to fight it and handed over half the estate. Because even though my father wanted me to watch over his granddaughter, he had not left me the tools. And she did not want me.
So back to the shacks. It’s the side of the family that brought in all the lawsuits. I have not felt welcomed there nor loved since my sister died.
Part of me is furious that I am being hunted out, unwelcomed, wants our grandparents to curse them.
The other part points out that I have already been hunted out, effectively. I stopped trying to take my children there because I couldn’t tell who in the family was “neutral” (basically not talking to me) or “gossiping” — the rumors re me trying to harm my niece were incredibly painful. I had to let her go.
After my father died I dream that I am issued a huge SUV, black. I am to go pick up three children. When I arrive, two are teens: my two. The third is a toddler. My niece is really the same age as my daughter, but not in the dream. In the dream, they tell me, “You can’t take the toddler. You don’t have a car seat.”
I say, “Can I go get one and come back?”
“No.” they say.
I say, “Please, can I borrow one? I didn’t know I needed it! I was issued the SUV!”
“No.” they say. “You can only take the two teens.
So I took the two teens and left, crying.
I woke up and thought: my father’s will is not my fault. I did the best I could. I followed an attorney’s advice and I tried to do what my father wished. I did not have the tools I needed.
Now my children and I may get an offer to buy our share of the land. My children are ready to be bought out.
I do not know if I am. I feel like this is the last connection with that side of my family, not only the living, but the dead. I love the land far more than the silent living and the cruel living. Why are families so cruel and why do they need enemies so badly? Gossip is a sin, truly, and hurts. Selling my share is saying goodbye to my sister, my mother, my father, my grandmother, my grandfather, my two uncles, my aunt. I don’t mind saying goodbye to the cruel living nearly as much as to my dead.
“amongst those who treat addicts of any kind generally agree that anger and shame help no one and is actively counter-productive.”*
Wait.
I have to think about that statement.
I do not agree at all.
Ok, for the physician/ARNP/PAC, anger at the patient and shaming the patient are not good practice, don’t work, and could make them worse. BUT anger and shame come up.
In many patients.
Sometimes it goes like this with opioid overuse: the person shows up, gets on buprenorphine, and is clean.
It may be a long time since they have been “clean”.
One young man wants to know WHY I am treating him as an opioid overuse patient. “Why are you treating me like an addict?”
I try to be patient. I recommended that he go inpatient, because I don’t think we will cut through the denial outpatient. Very high risk of relapse. “You have been buying oxycodone on the street for more than ten years.”
“I’ve been buying it for back pain, not to party.”
“Did you ever see a doctor about the back pain?”
“Well, no.”
“Buying it illegally is one of the criteria of opiate overuse.”
“But I’m not an addict! I’ve never tried heroin! I have never used needles!”
“We can go through the criteria again.”
He shakes his head.
He is in denial. He is fine. He doesn’t need inpatient. He is super confident, gets work again, is super proud.
And then angry. “My family still won’t talk to me!”
“Um, yes.”
“I’m clean. I’m going to the stupid AA/NA groups! Though I don’t need to. I’m fine!”
“What have you noticed at the groups?”
“What a bunch of liars!” he says, angry. “There are people court ordered there and they are still using! I can tell. They are lying through their teeth!”
“Obvious, huh?”
“Yeah!”
“Did you ever lie while you were taking the oxycodone?”
Now he ducks his head and looks down. “Well, maybe. A little.”
“Do you think your family and friends could tell?”
He glances up at me and away. “Maybe.”
“Your family may be angry and may have trouble trusting you for a while.”
“But I’ve been clean for four months!”
“How many years did you tell untruths?”
“Well.”
Shame and anger. Anger from the family and old friends, who have heard the story before, who are not inclined to trust, who are hurt and sad. The first hurdle is getting clean, but that is only the first one. Repairing relationships takes time and some people may refuse and they have that right! Sometimes patients are shocked that now that they are clean, a relationship can’t be repaired. Or that it may take years to repair. My overuse folks are not exactly used to being patient. And sometimes as they realize how upset the family and friends are, they are very ashamed. And some are very sad, at years lost, and friendships, and loved ones. I have had at least one person disappear, to relapse, after describing introducing someone else to heroin. He died about two years later, in his forties.
Shame and anger definitely come up in overuse illness.
The above is not a single patient, but cobbled together from more than one.
______________________
*from an essay titled “F—ing yes, I’m a fatphobe” on everything2.com. Today there are two with that title. The quotation is from the second essay.
It’s time to write an ending to a story. Let go of those calling me word twister. The ending is dark, sad, devoid of glory. The one who named me twister was my sister. She has been dead a decade. I still miss her except for the calls of money gone awry. The cousins whitewash her and call me twister; past time for me to gently say goodbye. The small bird of hope has sung for ten long years. She lives even on crumbs of cruel spite. She sings in spite of no respite from tears. Quietly in day or night, in dark or light. The hope bird flutters: she’s waited years. I release her now and I drink a soup of tears.
Red Paw puts her elbows on the table and her chin in her hands. “Told you so. Been telling you for 11 years.”
The small child/angel is sitting in a chair that morphs from regular boardroom chair to youth chair as she morphs back and forth.
“Nice job with the chair.” says Red Paw.
The two split and now there is a Small Child and an angel, sitting in two chairs.
Red Paw morphs too, into a bright red angel with a black halo and black bat wings.
The White angel nods and a feather drops. The feathers are bright white. Her halo is made of gold glittery pipe cleaners and attached at the shoulders.
Red Paw’s halo floats and seems to pull at the room.
The Quiet Woman sits in the fourth chair, with a cup of tea. “Anyone else?” she asks.
The others shake their heads.
“We are discussing the diaspora. Is it time to let them go?”
“Has been for 11 years.” says Red Paw nastily.
The small child nods.
The White angel says, “They want to believe what they want to believe. Let them go.”
“T, B, S, C, S, D, A, F, N, C, T, L, K, R and then next generation as well?”
All three nod.
The small child says, “They can contact us at any time.”
“They won’t.” says Red Paw.
“People can change,” says the White angel.
“And do they always?” says Red Paw.
“No.” says the White angel.
“I agree,” says the Quiet Woman. “We are done.” She brings a gavel down on the table, which rings like a singing bowl. The other three blur and melt in to her.
“We are done.”
_____________________
The photograph was taken 2016 or earlier when Halloween was on a Sunday. I dressed up and so did the minister.
An old friend died this morning. She was a college friend of my parents and has known me since birth. I will miss her quite terribly.
She and I took a road trip in September. She had lost thirty pounds, not on purpose. I thought I had better do the road trip while we could. We went from Michigan to visit five households of old friends in Wisconsin. I lived with her and her family for a year during college in Madison, Wisconsin in the early 1980s. She is a beloved mentor.
She also introduced me to all sorts of groups. She has an amazing record collection.
I went with her to see Warren Zevon in Madison.
The painting is my photograph of one of her oil paintings. It is about 3 by 5 feet and gorgeous.
Some diagnoses take months or even years. How can that be?
A patient comes to me with right shoulder pain. His pain is “out of proportion to the exam”. His shoulder exam does not fit with a rotator cuff tear, he has good range of motion, it is weird. I hospitalize him and ask orthopedics to see him.
The orthopedic surgeon agrees with me. It is not a musculoskeletal shoulder problem. We do xrays and labs. We do a chest xray as well as a shoulder xray because on the right side of the body, the recurrent laryngeal nerve goes down to the diaphragm and then returns to the shoulder and neck. So sometimes shoulder pain on the right is referred pain from a problem or tumor or pneumonia at the base of the lung.
His chest xray is normal.
We are having trouble controlling his pain even with morphine.
I call the general surgeon. My patient has some small lymph nodes in his supraclavicular spaces. We actually have lymph nodes all over, but many are hidden deep in muscles or under bone. We can feel them in the neck, the supraclavicular space, under each arm and in the groin.
The surgeon says there isn’t anything large enough to biopsy.
I call the oncologist in the next county. We are too small a rural hospital and do not have an oncologist at that time. I say, “I think he has cancer, but I can’t find it.” The oncologist listens to the story. He agrees. We do a chest and abdominal CT scan and some blood tests. The patient has had his colonoscopy. Nothing.
I send the patient to the oncologist’s bigger hospital. They can do some tests that I can’t. A bone scan and a PET scan.
The oncologist calls me. “I think you are right, but we can’t find it yet. Send him back when there is something to test.”
My patient goes home with pain medicine.
He then calls me every week or two. “It still hurts,” he says. “Please come in and let me do another exam,” I say. “No,” he says and hangs up. I am a Family Practice physician so his partner is also my patient. She comes in and rolls her eyes. “He complains, but he won’t come in!”
At last he shows up in the emergency room and now he has enlarged supraclavicular lymph nodes. The general surgeon biopsies them. It is an undifferentiated carcinoma. That means we don’t know where it is from. We don’t know the primary.
The oncologist says, “Send him down, so we can do the tests again.”
The patient is at home and refuses.
I call the oncologist back. “He’s refusing.”
“Oh.” says the oncologist. “Well, we can treat it with chemo blindly. We can try to figure out the primary and treat it more exactly. Or he can choose hospice.”
Ok, yes, three choices. I call and leave a message to go over the choices with him.
He comes up with a fourth choice: he refuses to talk to me at all.
I call his partner. “Yes,” she says, “He’s grumpy.”
“We are happy to help with whatever choice he makes.” I say.
“I’ll tell him.”
He continues to refuse to talk to me or the oncologist. Eventually he goes back to the emergency room and goes to hospice at the local nursing home.
I tell the oncologist. He comforts me. “Yes, sometimes we are pretty sure there is a cancer, but it has to get big enough to find.”
I am not comfortable with that but medicine is way more complex and messier than people realize. Sometimes it is really nice to have a patient with something where I know what it is AND it can be treated. Appendicitis. Gallstones. Strep throat.
But sometimes it is complicated and can take months or even years. Stay present and keep checking in.
Diagnostic quest.
_____________________
The boat is returning to the water after work in our boatyard. Healed and seaworthy.
I am at a friend’s: she doesn’t have matches.
I am at a friend’s: she doesn’t have bandaids.
“You need a tsunami kit,” I say. “Now!”
My daughter made a tsunami kit for college with a life straw, an emergency blanket, ace wraps and bandaids. A leatherwoman for tools with a knife.
Watching after the earthquake, it’s the crowbar I think of.
It is in my back yard, under the apple tree.
If we have our earthquake, I should be able to find it.
Or if I can’t, you know where it is now.
Please, take it to help someone
if I can’t.
Engaging in some lyrical athletics whilst painting pictures with words and pounding the pavement. I run; blog; write poetry; chase after my kids & drink coffee.
Refugees welcome - Flüchtlinge willkommen I am teaching German to refugees. Ich unterrichte geflüchtete Menschen in der deutschen Sprache. I am writing this blog in English and German because my friends speak English and German. Ich schreibe auf Deutsch und Englisch, weil meine Freunde Deutsch und Englisch sprechen.
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