Category Archives: Family

SeoAh Day

Spring                                                                   New Shoulder Moon

20180408_123029Yesterday was a SeoAh day. After breakfast we went to the King Sooper and picked up food for Thai/Korean Chicken Soup and a shrimp/rice noodles dish. SeoAh knows exactly what she wants, picking among the produce items carefully, smelling the spring onions and the leek. On the leek, “I can use this.” So into the cart it went.

She bought me a cafe latte at the instore Starbucks, but while we were drinking our coffee she admitted, a bit sheepishly, that she actually prefers instant coffee. When we went past the InterMountain Rescue Shelter, “Rescue the Rescuers” booth on the way out of the store, she wanted to know how she could help them.  She’s missing Murdoch.

Back home she made me an instant version of rice cake soup that was surprisingly good. Gonna take a picture of it and pick up some more at H Mart next time we go to Jon’s.

20180408_182234After Kate’s shower, SeoAh helped her with her hair, combing it out. Kate’s improving, gradually. She starts P.T. this week or the first of next. Tomorrow morning we have a nutritionist consult to discuss a weight gaining diet for her. She was already petite, but post surgery she’s become even petiter. Charming, but she’d feel better with a few more pounds for stamina.

In the evening we took SeoAh over to Sushi Win in Evergreen. She loved it on previous visits as a sushi connoisseur. Seafood is her favorite protein, having grown up close to the Korea Strait which joins the Yellow Sea, the East China Sea and the Sea of Japan. Xi, a Chinese waiter, took this picture of us there.

Attenshun!

Spring                                                            New Shoulder Moon

uface me

Good conversation yesterday with friend Bill Schmidt. He turned 81 on Friday, a birthday call. He’s deeply involved in a business, UFaceme, (picture above), writing code, doing statistical analysis, using pitch decks to secure investors. May we all be as vital at his age.

My phone call with him took place at the Final Approach, the food court at the cell phone lot for Denver International Airport, while I waited for SeoAh’s text. She flew in from Atlanta yesterday to stay with us until Thursday. Her English has improved significantly and we chatted easily on the way back from the airport.

creative commons license
creative commons license

Been wondering for a while why I’m so damned exhausted. Caretaking seems to demand far more of my psyche than my body. The various chores I do, by themselves, are not physically onerous. Washing dishes. Not hard. Doing the laundry. Not hard. Running the vacuum, picking up. Not hard. Grocery shopping. Not hard. Taking Kate to medical appointments, handling the tasks with her that being one-handed makes difficult. Not hard. Feeding and managing the dogs. Not hard. The sum of them all? Makes me, as evening approaches, short of emotional reserve and wanting to flop in a chair. Why?

decision makingWell, a reason occurred to me. Decision fatigue.* This involves the affective cost of constantly making decisions. The theory suggests that we have a limited amount of attention and choice-making each day. Sleep restores it, but as we make decisions our decision making ability depletes, often quite rapidly, leaving us emotionally drained and less than crisp in whatever we’re doing.

How does this apply to caretaking? All those not hard things each require a certain level of attention and decision making. Do I wash the dishes now or do I wait until after supper? How much laundry soap do I use? Which setting on the machine? Is it time to vacuum again? Does this stuff need to get put away? Where does it go? Why isn’t Rigel eating? What can I do to help her? What’s on the grocery list? Do I need to get gas? You get the idea.

Though none of these things individually are hard, many of them are ones that Kate takes care of in the normal division of labor in our relationship. That means I don’t have settled, habitual ways of handling them that bypass decision making. Over time I would gain those, figure out a way to include all of them in my day without having to find the detergent, measure it, wonder how long the cycle takes. But for now each of them requires a flood of mini-decisions, each of which drains energy.

Just writing about this makes me want to find a chair, flip on the TV and zone out for a while.

*decision fatigue refers to the deteriorating quality of decisions made by an individual after a long session of decision making.[1][2] It is now understood as one of the causes of irrational trade-offs in decision making.[2] For instance, judges in court have been shown to make less favorable decisions later in the day than early in the day.  wikipedia

 

We’re Living in a Post-Dishwasher World

Spring                                                                  New Shoulder Moon

Visit to Lisa, our primary care doc. Kate’s post-op. Biggest issue is weight loss. Contributing factors: nausea, lack of exercise, Sjogren’s, especially a sore mouth sensitive to sharp food and spicy food. Good news, shoulder pain seems gone. Which was a big reason for the surgery in the first place. Lisa showed us pictures of her Izzy, a labradoodle puppy. Very cute.

After that we went to Plato’s Closet, a second hand clothing store. I’m still dressing my Colorado persona. Bought several flannel plaids, ten, I think, for less than the price of one new one. Good brands, too. I was gonna ask the help if Plato’s Closet was a play on Plato’s Cave, but decided against it since it seemed unlikely any I encountered had ever heard of Plato.

20180404_17503020180404_174842We drove on into Denver, Colfax Avenue (sort of like Lake Street in the Twin Cities). To GB Fish and Chips. Their motto is “In Cod We Trust.” This is one of Ruth’s favorite spots and yesterday was her 12th birthday. We had a nice visit with her and her phone. Gabe was there, too, out of the hospital after septicemia, but still on IV antibiotics. He looked a bit exhausted.

Earlier in the day Rick came out from 1 Stop Appliance. The A team at last. He figured out what’s wrong with it. The main computer board and a computer board for the inverter were both shorted out. Significant since they were just installed Wednesday of last week and Monday of this week.

samsung-built-in-dishwashers-dw80j7550us-64_1000
looks like an alien

Rick noticed water splashes along piping near them, then showed me corrosion both on our old main board, which he had brought, and the new ones. Problem. Since to look at a dishwasher it must be pulled out, that means it’s disconnected from the water and electricity. You can’t run it and look for leaks so it’s necessary to use secondary data.

He took pictures, muttered. Then he told me Samsung might condemn it. Sad. Now we’re condemning dishwashers. What’s next? Sofas? Toasters? Shoes? I hope they do condemn it. It’s nothing more than an expensive drying rack right now. If they do, they either buy it back from us or give us a new one. Either one is ok at this point.

Ironically, I found this article just now from the Atlantic on April 3rd:

Doing Dishes Is the Worst  This is now an empirically proven fact. Dishwashing causes more relationship distress than any other household task.

 

Life Extenders

Spring                                                                  New Shoulder Moon

bunnyus“I’m a doer.” Kate said this yesterday. Yes, she is. So much so that we often referred to her as the energizer bunny. Jon’s divorce, Sjogren’s and arthritis has made doing difficult, often downright painful. The combination put her in a tough place psychologically; but, it feels now, for the first time in a year plus, that she’s going to push through it. As Winston Churchill said, “If you’re going through Hell, keep on going.”

shoulder reversalWe had her first post-op appointment yesterday and got to see an x-ray of the new appliance. This isn’t hers, but it’s an accurate representation of what we saw.  As this image shows, the ball of the shoulder is now where the socket used to be and the socket where the ball used to be. This reverse total shoulder uses different muscles to power the arm, the deltoid in the main. It also reduces pain more for certain patients though I’m not sure why.

Seeing the screws, poking out from the ball, seemed strange to me, but it underscores orthopedics as the carpentry of medicine. Sawbones. The multiple uses of the inclined plane. Thanks, Archimedes.

These surgeries, joint replacement, aren’t perfect, but they’re way better than doing nothing. My knee, for example, is not the knee I had when I was 40, but it is pain free and I can work out without contorting myself. I can’t stand for long periods of time, but I can stand without pain. Kate has two artificial hips and now an artificial shoulder. Pain reduction is a primary benefit of all these procedures and it’s usually pain that leads to them in the first place.

peasantsWe often talk about folks for whom physical labor is key to their job: trades people, movers, utility workers, lumberjacks, mechanics, farmers, even physicians. Prior to joint replacement as an option, they had to suffer through the pain or stop working. Imagine what it was like on the frontier to have debilitating hip pain, a shoulder that would no longer move above a right angle, a knee that buckled under pressure. Or, in the middle ages, for peasants. Soldiers. Domestic servants.

bionicsIt’s likely, for example, that Kate’s years of lifting babies and young children led directly to the arthritis that ruined her right shoulder. That’s the Schneider hypothesis since the sort of dysfunction her shoulder displayed is most common in women.

These are life extending surgeries, making it possible to live, rather than exist. I imagine that soon bionics will be more generally available and will complement this sort of procedure, perhaps making up for atrophied muscles which are a common sequelae of joint problems. All this is part of the glass half full view of the future.

 

 

Recovery Now

Spring                                                                          New Shoulder Moon

20180401_0632072
this morning

The new shoulder moon has gone from new to full and over the course of its transition Kate’s new shoulder has begun to heal. Still a long road ahead but her pain is better, her overall spirits, too. She still has some nausea, which is tough for her because it makes her very uncomfortable. On the whole though her recovery is on track after those first four days post-op.

The routine of caregiving has become easier. I’ve learned how to alter my routine so it makes things simpler for her and for me. I even did two loads of laundry yesterday. Now, this may not seem like much, but Kate is a laundryhead and as a result it’s something I’ve done only rarely in all our years of marriage. Before we were married, yes, but she likes laundry. General picking up, cleaning up, something we might both do, is now my responsibility so I just do it. Cooking and shopping are mine now; as is doing the dishes, though I hope our very expensive dish drainer will actually wash the dishes, too, after Monday.

Kate’s has two post-op appointments this week, the one I mentioned on Monday at Panorama Orthopedics and Wednesday with Dr. Gidday. By the time the new shoulder moon wanes her recovery will be well advanced.

 

Recovery under the New Shoulder Moon

Spring                                                                           New Shoulder Moon

recovering-please-waitKate has slept well, mostly, her first two nights home. She’s controlling her pain with tylenol and the occasional tramadol or vicodin. She had a bout of nausea yesterday; but, unfortunately, that’s not really unusual. Her weight is up, thanks, she thinks, to good intravenous hydration in the hospital. Prior to surgery she’d had trouble keeping water down. She’s on the mend.

Can’t say the same for our *%$!!** dishwasher. Not the drain pump. Maybe the sump pump? Nope. So. Computer boards. 1 of 2. We have to order them, can’t get them by Wednesday. Oh. That means, due to 1 Stop (ha) Appliances mountain schedule, Mondays and Wednesdays only, that we’ll not see a working dishwasher until April 2nd which is the date of Kate’s post-op appointment with her surgeon. Grrrr.

10002012 05 01_4261Snow. While the rest of the nation east of the Rockies has been pounded with storm after storm this land of ski resorts and mountain passes has been dry, one of the 14 driest winters in the state’s meteorological history. Last night though, maybe 9 inches of heavy, wet fire dampening snow! Welcome.

Our little hippie dog Gertie has recovered from her long, strange trip over Sunday with her usual resilience. Tail wagging and happy. Gertie is a good role model for how to handle adversity.

The view out the window here in the loft shows snow covered solar panels, flocked lodgepole pines, a white Black Mountain, and a pastel blue/white sky. Peaceful.

 

 

Finally

Spring                                                                            New Shoulder Moon

dictionary.com
dictionary.com

Finally. Kate’s home. An iatrogenic problem. Squared. The surgery was the first culprit, of course. A surgeon cut into her. An anesthetist put her into a drugged sleep. New, unfamiliar elements got installed, in her body. Lots of insults. Why surgery is not ever to be taken lightly.

Recovery, then. In the newer, fast paced, get’em out of the hospital mode, the gold standard is one night, then back home or wherever. Knock back the pain. Make sure the gut’s working, pass gas and you win the prize, get some discharge instructions and Bob’s your uncle.

However. If the pain is bad, so are the drugs. In this case dilaudid. A powerful narcotic it apparently upset Kate’s sensitive stomach. She couldn’t keep food or water down. But the pain. More dilaudid. You see the problem here. This is the second iatrogenic cause.

homeostasis concept map
homeostasis concept map

Sometimes, the treatment can rival the presenting complaint as a source of pain and discomfort. Medicine is as much art as science, a truth not always palatable to consumers who want certainty in matters critical to life. I know I do. But, it’s a fool’s desire. The human body is far more complex than we understand. Just look at all the new information about gut microbes as an example.

To my non-medical mind the biggest issue is the interdependency of all the body’s organs, systems. Poke one, many respond. It’s like trying to repair a car while the engine’s running. So, I’m grateful that the folks at Ortho Colorado stayed in the messy and confusing twists as Kate’s body tried to recalibrate. It did. Joy, to mention a word from a few posts ago.

Suspended

Spring                                                               New Shoulder Moon

Still not home. I went over yesterday after lunch only to find Kate struggling to eat a bite of a bacon sandwich. She couldn’t keep that down, water either. Extremely unpleasant for her. Kate hates nausea.

ok, maybe not this quiet, but still...
ok, maybe not this quiet, but still…

When I went in yesterday, the busy M-F buzz of the hospitals had disappeared. There were fewer cars in the parking lot, a guard at the concierge desk, the Ortho small cafe closed. Nobody bustling about guiding patients, taking preop folks back, people with canes or walkers stayed at home. On the third floor, patient rooms, only a scattering of folks remained, three that I counted on Kate’s wing.

It’s disconcerting to have Kate in a place that feels emptied of its vitality, just when she’s having trouble. Being in a hospital over a weekend is not something you choose.

Meanwhile, after a full Sunday of lying around stoned, looking pretty damned unpleasant, Gertie’s tail wags furiously (normal) and she ate. Back to normal after a trip to the late ’60’s. Kep sniffs Kate’s side of the bed.

20180323_075536_001On Thursday, the day of Kate’s surgery, I left Rigel and Gertie outside while I was at Ortho Colorado. Staying outside that long, several hours, is unusual for them. When I let Rigel inside, she ran to the couch, jumped up on it, jumped in the air a couple of times, then flopped down into her usual position. Ah.

(Rigel yesterday hunting for voles.)

I hope Kate comes home today. Having her in the hospital, uncomfortable, makes this whole process feel suspended. When she’s home, I know her shoulder will be recovering, right now its her system adjusting to the insults of surgery. Not where we wanted to be right now, but what is.

Relieved

Spring                                                                             New Shoulder Moon

Update. Just spoke to Kate. Feeling much better. Home after lunch sometime. I’m heading in around noon. Relieved.

Kate Still At Ortho Colorado

Spring                                                                            New Shoulder Moon

Kate, costumed for Purim
Kate, costumed for Purim

Kate had break through pain yesterday and nausea that they couldn’t control well. So, she’s still at Ortho Colorado. Plenty uncomfortable, but problems that seem, at least to me, manageable. Unpleasant sequelae from the meds and the cutting. I imagine she’ll come home today. Still convinced this was the right thing and that her care has been very good.

A strange sense of exhilaration with all the changes occasioned by Kate’s surgery. I find myself whistling on the way into the hospital, generally feeling good. It’s as if the additional load is something I needed. Weird, eh?

As also happens in these situations, often enough to be predictable, a lapse in the daily routine led to Gertie consuming a substantial number of Kate’s thc edibles. My fault. Gertie is, right now, pretty stoned. We had a similar incident with Kepler a couple of months ago and he slid down the stairs, looking confused. Apparently all mammals have a cannabinoid system and cannibis receptors. Gertie seems very unhappy, I imagine because her left leg makes her unsteady to begin with and the mary jane? Adds to it.

Beloved community dr-martin-luther-king-jr-quote-beloved-community-09.16.15-v2-1800Beth Evergreen has reached out to us in several ways. Individual members have offered to bring food or otherwise help. Leah, the executive director, called, wanting to know if we needed anything. Several folks from our mussar group responded to my e-mail on Thursday with love and concern. For both of us. A thought that keeps going through my mind: beloved community. Christian churches aspire to this, Beth Evergreen achieves it. I’m proud to be a member of the congregation.

One other thing I noticed. Both Kate and I were worried about her dying during surgery. Why? Well, it happens. Rarely, but it happens. Jeff Glantz, a member of Beth Evergreen, had a successful operation to remove a malignant brain tumor, then four days after surgery, he died. This was a couple of weeks ago. Jeff’s situation was on our minds, too.

I mention this because neither of us owned up to this concern until the surgery was over. By not talking about it before, by letting the death taboo keep it hidden, we lost a chance to console each other, to go a little deeper into our relationship.