Baby Steps

Baby Steps By Lanny Arvan I’ve been putting off writing this piece, afraid either that I wouldn’t be sufficiently open in what I have to say, putting too much of a glossy coat on, or saying some things that are painful and wondering whether doing that is worthwhile. It’s easy enough to procrastinate under normal circumstances and when in addition you’re taking some serious narcotics that can help you get to la-la land if you want, the temptation is that much greater. But in spite of the drugs I’m not really too spaced out, so putting the dagger into that excuse and it being Monday morning, the time to start on things, I have to get this piece out of my system. Here it is. Sometimes I choose not to engage. People who know me, especially the people who work for me, may be surprised by this. But in particular when I travel, whether on the plane or waiting for the next flight in the terminal, I’ll put up an invisible barrier, book in hand, sending out an unmistakable signal – if you want to schmooze with somebody choose somebody else. I’ve put in my time (at whatever meeting or conference I’ve attended) or on my way out of town I’m making mental preparations for the meeting and that prep for the activities once I arrive clearly is more important than anything that might come up in the moment while en route. So while I don’t walk around with a “Do Not Disturb” sign, you get the message, don’t you? The not engaging is an act of arrogance begat by a lack of courage. I find it difficult to talk with someone about other than superficial things when not armed with a reasonable sense of where that person is coming from – liberal or conservative, religious or atheistic, in favor of online technology or not, and on and on. Pushing ideas around with someone else who is essentially a blank slate, well, that is a strange thing to be doing. I can only recall two flights I’ve taken where in essence I talked the entire time with the person sitting next to me. On one of those the conversation was about race car driving, something I know absolutely nothing about. It was friendly enough and it did pass the time. On the other, the conversation was about teaching “design” and doing so in studios rather than in classrooms. This one was close to the mark of my own professional work, but still I was the follower in the conversation and that made it ok. It’s a short list and beyond it my travels either happen with colleagues, where there is already considerable background and knowledge, and then the biggest issue seems to be whether to talk about work or rather about anything but, or I travel by myself in which the cocoon I’ve erected serves the purpose of keeping me insulated and so I get to dust off my old mantra – travel is the only way I can get any fiction reading done. ***** Last week the choice to engage with the world or stay safe within my little universe was hoisted on me through some unusual circumstances. I’m going to relay those in chronological order as it will help to understand my mindset. 4/28/2009 1 My family drove up to Ann Arbor, Michigan on Friday the 8th to spend a weekend with a variety of relatives in celebration of my brother’s 50th birthday. (The past five years the poor guy has had the misfortune of 9/11 being his actual birthday, so we had the party on Saturday.) My brother is the division chief in Endocrinology and he invited his whole unit to this upscale buffet, along with a bunch of folks from the neighborhood, and of course the various family members. Right before the guests arrived my brother and I played some “real ping pong” in his basement. In this case, “real” means there was effort and concentration and unlike how we might play if we’re with the kids. He beat me both games but the scores were respectable. I had sweat dripping off my brow by the time we concluded. There’s nothing like meeting all these guests whom I had never met before while feeling hot and sweaty, and less than perfectly composed. The party itself was from four to seven, dinner with wine or beer or soft drinks, and then some of the neighbor guests lingered for a while longer. I’m guessing that the place completely cleared out around eight. After that there were some family games and banter. And then perhaps around ten or so, the others had all gone to bed and my brother and I, while noshing on peanuts in the shell and a flavorful hummus the caterers had brought, had one of our conversations, this one mostly about family and career. We can both talk up a storm if we’re so inclined and didn’t disappoint in this circumstance. Eventually, it starts to get late and I say its time to hit the hay. So I trundle up to bed. Supposedly we’re sleeping in my nephew Tim’s room (Tim is eight years old) and when my brother got Leslie (my wife) and me set up in that room the day before he went out of his way to alert us about the sloping ceiling that aren’t very tall in some places and if we weren’t careful we’d bonk our heads on it. It’s funny how it is the risks you weren’t alerted to that do you in. And I’ve got to make the circumstance clear. Because everyone else was asleep, I didn’t turn on any lights. Not infrequently, I’m the last to bed at home so often gently find my way upstairs in the dark. That’s not a big deal. But it’s not so shrewd to do this on alien territory, especially in an older split level house, the style that my brother and his wife favor, with its many nooks and crannies and idiosyncrasies in design. As it turns out, there is a step down into this room, a step I had not anticipated, and so I fell, a hard fall that made a loud thud. That startled my wife and she woke up with a scream. My brother who was going to the bathroom downstairs heard this. When he got to the bedroom he found me writhing in agony on the floor. He and my wife started to talk about what they should do about this and he asked whether they should call an ambulance to take me to the Emergency Room. I tell him to hold his horses, maybe if I have a few minutes to calm down the pain will subside and I can get up off the floor. In those few minutes I discover mostly that I’m not going anywhere but also that if I keep the left leg rather straight, it’s ok with the pain not too bad, but if I flex the leg at all it starts to spasm and that is excruciating. Ultimately, my brother does call for the 4/28/2009 2 ambulance and some fireman show up first. A few minutes after discussing the circumstance they splint my leg. (My brother told me later that was his idea. Here is to his medical education.) My stereotype is of wooden splints, but that is dark ages technology. Everything I’ve had during this experience (two immobilizers in addition to the splint) has been with Velcro and the rigid rods to keep the leg from flexing are situated inside a cloth that is by design comfortable to the skin. The splint puts the lie to the economist’s paradigm – sometimes we’re better off when operating under a constraint. How they got me out of Tim’s bedroom and downstairs to the gurney, all three hundred plus pounds of me, over a very narrow set of stairs, still boggles my imagination. They slid me onto a bed sheet and doubled that, then grabbed from the various corners. I was airborne and frightened I would fall again. But I didn’t. These folks were really good at what they do. Then on the gurney they had to do it a second time to get me into the ambulance, because my brother’s house has a lot of steps and is not wheelchair accessible. My wife decides to ride in the ambulance and my brother drives along in his own car as we head to the Emergency Room. We were planning to drive back to Champaign late Sunday morning and now the issue was, just what are we going to do, stay with that plan or stick around Ann Arbor? We didn’t know the answer to that at the time but in case we were going to drive back, it was pretty clear that my wife would be doing all the driving. So as the admission process concluded and they wheeled me back to the Emergency Room, Peter drove Leslie back to the house so she could get some sleep and then he returned again to see me, ultimately going home a second time at 2:30 AM. The accident itself happened around 11:30 PM the night before and I reached the hospital bed in a hallway berth adjacent to the Nurses Station in the Emergency Room right around 1 AM, which I know because as I was laying there I could stare at a clock that was overhead and in plain view. David Bromberg on the album Demon in Disguise tells the story about how Jerry Jeff Walker came to write the song Mr. Bojangles, while in jail. “Jerry Jeff wasn’t there on no research project.” Well, I don’t know much about doing that sort of research project either, but I can say based on that one Saturday night lying on the bed and listening to other patients scream their heads off, sometimes cursing, sometimes crying and saying absolutely horrible things, that an emergency room is a rather gruesome place and quite apart from anything that ails you, the ER can create a sense of unease, just by being there. Though I did close my eyes from time to time, I didn’t get any sleep. Mostly I think I worried about whether to stay in Michigan and get surgery there or to go back home. Until about 4 AM I didn’t see a doctor and didn’t get any treatment. I had been told that they’d sneak me in for an x-ray, but no such luck. All they had done at my request was to give me a urinal and pull the curtain, so that while I was right there out in the hall, I could do my business in relative quiet. It was an interesting applied research question how to 4/28/2009 3 get appropriate access to that urinal, with an immobile leg and shorts that didn’t have a zipper, another example of necessity giving birth to invention. From over hearing some of the various nurse conversations, I got the impression that certain patients were hard to deal with and they’d rotate personnel at such patients depending on whether that had been a success or not. I also got the impression that patients were queued up on more or less a first come first serve basis and unless something life threatening was happening in real time (a stroke victim was admitted while I was lying there) staff were allocated by that queue. So I didn’t feel a grudge that it took so long to see the doctor. I felt absolutely miserable lying there. But I had to admit there were a lot of other people in the ER who were equally miserable (or worse). That said, when the doc did finally come around he asked whether I had x-rays already (so one wonders whether in the ER the right and left hands should shake once in a while) and then he did an exam around my kneecap area – does this hurt? – where he concluded that it was likely tendons or ligaments and not a broken bone, but I should still have the x-rays to confirm that. I believe he offered pain medicine, which I declined, then when I learned it was Tylenol, I accepted. I didn’t want to be groggy later in the morning when a decision would have to be made about whether to go back to CU or not. After the x-rays were taken, I got more attention. The doc came back and confirmed the good news - there was no broken leg and then we talked through the bad news. It seemed that the right strategy was to get me functional with crutches and then we should drive back that day. As sensible as that sounded, I had my doubts, though I didn’t articulate them. I didn’t know whether I could do crutches. I didn’t know whether I could get into our car. And I didn’t know whether I could tolerate the entire drive back. Those doubts notwithstanding, we now had the shape of a plan and we began to implement. The doctor convinced me (ex post this was definitely the right thing to do) to take some real pain medicine and so I soon had some Vicodin, which has been my main pain relief since. And some crutches were ordered for me to try out at the appropriate time. What was supposed to be a half hour or forty five minutes, to let the Vicodin take good effect, turned into an hour and a half, perhaps longer. When we actually tried to test the crutches, it was a complete disaster. My leg started to spasm before I was completely upright and the pain was so great that I insisted in lying down again. In other words, we didn’t really try it and left that for later. I started to think about having the surgery done in Michigan – the family could drive down that day and I’d join them sometime after the surgery, but how would I get there and what would happen during the interim? That didn’t seem like an answer. But I didn’t seem able to stand up. What was the alternative? Around 6 AM I got a hospital phone and called Peter’s house. Nobody picked up and I got the tape. So I left the message and called back later. After the fact, I learned that my 4/28/2009 4 cousin Arlene who lives with her family in North Miami Beach actually did pick up the phone, but she didn’t realize I was in the ER and hence thought I was responding to a call from the outside rather than making a call to the house. She hung up because I was responding. Not a big deal in the grand scheme. I called back about an hour later and got my brother on the phone. I told him to come and get me. As I learned later, I had already been released. By the time my wife and my brother did show up I had made another attempt with the crutches and this time I was able to stand and take a few steps. But I still wasn’t sure whether I could get into our car and if I couldn’t do that, who was I fooling? Somewhere in the 7:30 AM to 8 AM time frame, there was a crew shift. I got both a new doctor and a new nurse. Both were instrumental in getting me home. When my wife, brother, and I discussed the alternatives with the doctor he reframed the problem from one of torn tendons that couldn’t be repaired without surgery to a different problem, that of intense pain, and if the pain could be managed then the recommendation of the earlier doctor could be implemented. He informed us that there were still many levels to ascend in terms of pain medication and he proceeded post haste to make that climb. Ultimately I got two shots of Dilaudid for the pain and Darvon as an anti-inflammatory. I also took more Vicodin. I think for many people the Dilaudid would have put them to sleep. But I remained pretty much awake during the whole deal. I recall hearing the doctor from across the room talking to an orderly who was concerned about my high dosage of mediation to the effect – he’s a big guy; the drugs don’t quite work the same way on him; they’re not putting him to sleep. Based on this experience my current view of how medicine manages the patient’s pain is like a pan balance, where on one side is pain and the other side there is medication. When the pain weighs too much, then add some medication to the other side to see if that balances. There is no a priori right answer to where the right level of medication should be. It’ determined to achieve this balance. And in this particular case, they were preparing me for a long car ride. That second shot of Dilaudid was for the road. The nurse, who was a real sweetheart, and quite overweight just like me and therefore, I believe a little bit more sympathetic to my cause, helped make the transition into the car so I never did use the crutches for that. Instead, I backed up into the car, resting my weight on my hands and sliding along on my butt, ultimately stretched across the middle car seat, which I used like a sofa lounger. The width of the car (a brand new Honda Pilot) is just sufficient for me to be comfortable with left leg straight out and with my back upright and leaning against the passenger door. Both my sister Marlene and at least one of my cousins, though I’m not sure if it was Anicka (my cousin from Denmark) or Arlene (the one from Florida) who warned my wife to make sure the car doors were locked, lest I fall out of the car when the passenger door I was leaning on swung open. 4/28/2009 5 I came to understand that I was released from the hospital, though I wasn’t really ready for it. I didn’t know how to use the crutches and I was completely immobile. But it was the best alternative to leave then and so that’s what we did. The seating arrangements for the drive home were a little unusual. One boy, who had to climb through over the luggage and other stuff, sat in the way back. The other boy sat in the “shotgun” seat in the front. At the various pit stops, they rotated. I stayed in the car the entire trip, but really wasn’t too uncomfortable. After the previous 10 or 11 hours, the drive itself was kind of easy and uneventful. ***** One of the things about an incident like this is that it sheds light on some inefficiencies in the American Medical System. There was no way for the medical record of my experience in the University of Michigan Medical Center Emergency Room to be shared with the folks at Carle Hospital here in Champaign-Urbana. We hand carried the x-rays, which they gave us when we were discharged in Ann Arbor. Likewise, the Michigan ER room had to do a full patient history on me, rather than pull something out of some database (to which I had given them prior consent to pull). Taking a medical history is a comparatively minor thing and in this instance that didn’t really matter (but one can readily envision many other circumstances where that sort of thing would matter quite a bit). However, going through that ordeal in the ER at Michigan and having that count for naught in being treated in Urbana really broke both me and my wife emotionally. It didn’t help that it was a Sunday. A lot of the problems would have been side stepped if the accident had happened during the work week. When confronted with inefficiency of the above sort, the natural tendency is to game the system. Wearing my campus level administrator hat, I dislike the gaming; it makes the system seem not just inefficient but inequitable as well. However, as a consumer in need I’m certainly not above gaming myself. In this particular case my wife, who is now President of the PTA at our younger kid’s Middle School, is pretty well connected with a bunch of parents from the Primary School days. One of these connections is with a family where the husband is one of the top cardiologists in town while the wife is someone she took early morning walks with for a period of time --- till they moved. So we called them from the road (though we needed another friend to come to our house, find the phone number that was listed in the old Primary School contact book that my wife (shrewdly) has kept) and then my wife talked it through with them about what we should do and who would be best to do the surgery on the leg. They recommended the orthopedist then on call, a young guy and one with a strong reputation. And they called ahead to the emergency room at Carle, to let them know we were coming. I’m really glad they did that. When this episode is a little more behind us, we need to get them a really nice present. My wife headed straight for the Carle Emergency Room, once she got off the interstate from our trip. Our plan was something like this. First we had a family friend meet us 4/28/2009 6 there. She would take the kids home, get them settled and reacquainted with our dog, Ginger, and make sure they were ok for dinner. This would allow my wife and I to be at the ER earlier and hopefully get everything else done quicker. We were both dogged tired and looking for some time to relax with the understanding that the situation was under control. Second, while we understood that we had to again go through the ER process, we hoped that the attending physician would agree to let us be seen by the orthopedist on call who would then have me admitted to the hospital. The surgery might happen the following day. And as for the post-op, we’d deal with managing that after we had a good night’s sleep. Even now, it seems to me that what we expected was reasonable and not outlandish. But that is not how it played out and you may have guessed (correctly) that we were severely disappointed in our expectations. Instead, this is what actually happened. There were no spots in the ER whatsoever, so when we were eventually seen by the attending physician, that happened in the lobby. Indeed he had been called by our friend the cardiologist and my situation had been generally made known to him in advance. He did a cursory exam of me, looked at the x-rays from Michigan in such a quick way that he couldn’t possibly have seen what is in them, confirmed that my tendons which connect the quadriceps to the knee cap had been completely severed, and then informed us this was elective surgery, to be done on an outpatient basis. After a few minutes of discussing that recommendation, he clarified what he meant. If I ever was going to walk again I needed this surgery, so in that sense it was not elective. But I didn’t need that surgery immediately. It could be scheduled at their convenience. They’d do the best they could on this, but it wasn’t like a heart attack. So he set out to have me sent home and passed the baton to the social worker, who would arrange for the services I needed to get home. One was a wheel chair, where I could extend my left leg in a supported manner. The other was an ambulance that could accommodate me in the wheelchair. My wife and I, completely spent at this point, didn’t take this news well at all. Listening to my wife on the phone both that evening and the next as she talked with potential providers of service for us, it had become clear that the situation had gotten too hard for us to manage, with the immediate issue how to get this 300- pound man, bound into a wheelchair, into our house that was not wheelchair accessible – every entrance had steps. And I, for my part, had a different worry. I was still lying in a gurney at this point and that seemed to have more support for the leg than a wheelchair. I didn’t know if in the wheelchair, I would sit comparatively pain free. If it was going to hurt a lot in the wheel chair, what kind of solution was that? The social worker acted as if we had choices to be made, but really there weren’t any choices. The next part was a bit surreal. When the wheelchair came, I had to be tested with the crutches to be able to transfer from and to the wheelchair. I flunked the test and the people attending to me got angry and said I couldn’t go home unless I knew how to use 4/28/2009 7 the crutches and how could I have possibly come into possession of the crutches without knowing how to use them. I was tempted to curse back at them. Tell them I didn’t want to go home at all and if it wasn’t for the stupid stinginess of the HMO, I would have been admitted to a hospital room that evening and bypassed all this other nonsense. But I didn’t do that, perhaps because I knew if I did I would have completely broken down and gotten into a crying jag. They may not have known that nor may they have known of my actual experience in the UM Emergency Room. So they tested first and taught second, a pedagogy that most would agree is not the ideal. I submitted to the training (again, no real other alternative) I got a barely passed, definitely not an inspired performance but it was good enough to allow me to go home and more important for me to sit in the wheelchair and see if I could tolerate it. That part turned out ok. The driver of the wheelchair van was a very nice guy and ultimately very helpful to us. But he had the “wrong van” in the sense that its design didn’t anticipate my outstretched leg and so it was a bit difficult getting me in, turned face forward, and strapped down for the ride home. But after a fashion we managed. Getting out was a lot easier. There was just more obstacle, but it was a biggie. From the air, Champaign-Urbana looks billiard-table flat. But from the ground and sitting in a wheel chair, I had to confront steps to the house, no matter which entrance was chosen. We tried to tilt the wheelchair with me in it and roll it up a step. That was a loser and completely unsafe so we abandoned that plan but stymied with no other. We were just outside the house, almost there, but it seemed like an insurmountable hurdle to finally get into the house. Ultimately, the driver called a few of the his buddies who work for the same outfit and together they got me into the house in a manner similar to the way those fireman got me out of Tim’s bedroom, except instead of lying on a bed sheet, I was sitting upright in a chair. Once inside the house, the got me on my feet and with the crutches they stationed a person in front of me and in back go me and I slowly move to my study, which has a recliner that has served the dual purpose of acting as my bed since I’ve been home. ***** To a certain extent, the story starts here. All that came before is really background, a lot of set up and information that is necessary to understand what happened next and why I chose my title, Baby Steps. That day started on a good note – I had a sound sleep the night before. Although there was the leg to deal with, I felt refreshed. That was definitely a plus. I think I came to the realization that morning before my wife woke up that this was going to be a long haul thing and my attitude going through it would matter a great deal. There clearly were legit reasons to be depressed (for example, I was still in the same clothes I wore when I played 4/28/2009 8 my brother in ping pong, with no prospect of a shower any time soon), but that didn’t feel right. I wanted to deal with this in a more constructive way. And I really wanted to help Leslie, my wife, out of a rather impossible hole, to manage my situation although it seemed so difficult, so hopeless. I didn’t have any big ideas on just what to do, but if any were to come along I’d make sure to take them seriously and follow them to the hilt. Leslie, who did get some sleep but definitely not enough, had no such epiphany. And she had a difficult problem to solve with no obvious solution in sight. I had an appointment to see the Orthopedist at 11 that morning, but with no known way to go from the house into the car and if we couldn’t do that, well then we obviously couldn’t take advantage of the doctor’s help. The guys who helped us the night before couldn’t do an encore appearance. The company they worked for had responsibility for getting patients home from the hospital. But they didn’t pick up folks from their home to deliver to the doctor’s office. (Arranging for this type of transportation is one reason to live in a nursing home and actually the Social Worker did suggest that instead of coming home on Sunday night I go into a nursing home. But I rejected that out of hand, not because it would mean being with a bunch of geezers overnight, but rather because I thought my needs differed sufficiently from their other patients that I would not be well served.) Leslie did try to call the fire department and see if she could get some off duty fireman to do this work. She was certainly willing to pay them – whatever it cost to get them to do the job and told the dispatch person she spoke with something to that effect. But she didn’t get a very encouraging response. She was told to try elsewhere. I think she did make a few other calls, but no luck with any of them. Then fate started to intervene. She got a call back from the dispatcher that some firemen would be at our house around 10 to help load me into the car. A firetruck pulled up right outside our front door. Those guys helped us immeasurably. We didn’t even give them a tip, having been told that was not permissible. We’ll have to make amends some how. The main deal these guys helped me with was to walk down the three steps from our “mud room” into the garage. At the time, this was scarier than riding the worst possible roller coaster. I had not control of my left leg at all, I was certainly far from agile with the crutches, and as we all know the bigger you are… But with these guys there I had enough assurance to try it. I was shaking and sweating profusely when I finally got loaded into the car, but now we could make the doctor’s appointment. The appointment was at the new Sport’s Medicine Clinic on the North side of I-74 and I would say it set the tone for a very positive day, one where both Leslie and I began to see we can live with this thing. It was raining but the entrance way to the place has an awning that we could park under. Leslie went inside to get help getting me out of the car and into the wheelchair. She came out with a man and a woman, neither of whom look like they’re in the business of helping big guys do transfers like this, but the man turns out to be the doctor and I believe the woman was his nurse. After a somewhat awkward transfer I get inside and though it was still about 25 minutes early for my appointment, 4/28/2009 9 the doctor saw me immediately. Even in a small town like Champaign-Urbana this type of royal treatment just doesn’t happen. That phone call to the cardiologist the day before was beginning to pay dividends. The orthopedics doc, Dr. Bane, is a very likeable guy, with a down to earth style and at least in our case a willingness to listen to the patient. We asked some questions about the injury and the surgery, but it turns out that most of our concerns especially those that Leslie expressed, were about transportation and particularly about how to get in and out of our house. The docs’ answer was simplicity itself, a perfect use of Paul’s Law – get on your butt and move backwards in a crab-like manner, propelling yourself with your arms. It wasn’t an elegant solution like walking down steps with crutches, but it was do-able, because it seemed pretty safe, even if it was laborious and time consuming. This was the idea I was looking for. Coupled with the fact that our steps to the garage are from wooden boxes that are movable, we now had a way to get in and out of the house. I would treat that house entry as a seat and then use my butt from there. When I tried that when we returned home after we had done all our medical visits that day, I crawled all the way to our main staircase and then climbed one step, then another, and yet a third, and was finally elevated enough that I could stand up and use the crutches. Do-able and helping me to be self-sufficient. Our next appointment after the session with the Doc was with his nurse, where we learned that we were bypassing normal protocol (which apparently is slow) so that the Doc could do the surgery the next day. But there was a variety of pre-op activities that would have to be done, some of those could be completed by the nurse herself, even if that was a bit unorthodox for them, but the rest needed to be completed at the main clinic, which is where the Emergency Room is in a facility located separately from the Sports Medicine Clinic. This meant more transfers into and out of the car and it meant we had several additional interviews with other people, at each station of the pre-op process. When I do engage in a social setting I’ve got my own fairly unique schtick, which is basically about telling a lot of reasonably bad jokes, but not of the canned variety. Rather most of these are word plays that are developed in context. I’ve been doing this sort of thing for such a long time now, so much so that I no longer understand where the ideas for the word play come from. But I do know that most people seem to react well to it. It solves the dual social setting problem of showing that I’m listening, and putting the person I’m talking with at ease. I’m not going to bite them. At worst, I might make them wince by coming up with a real bad one. I was aware of this type of engagement in the interview with the nurse as well as later in the day, with one of the pre-op nurses. My wife knows this behavior very well and I was trying to send her the following message without explicitly saying it --- if I can be telling all these bad jokes, life itself can’t be that bad. It’s hard to have this sort of creativity without being upbeat in side, even if the humor itself is a bit ironic. 4/28/2009 10 I felt the need to be “on” during the whole interview process and after the day had concluded I convinced myself that I had experienced a sustained adrenalin rush that really helped me execute this type of behavior. There was another positive that happened – I got more confident with the crutches and was able to execute some transfers with only minimal help from my wife and nobody else’s assistance. Leslie remarked several times that day that I was really improving with that. Managing the physical work of transfer was equally important to keeping an engaged approach in conversation. Both together contributed to the sense of do-ability and that we could get through this. ***** The surgery was the following day and it was at yet a different facility, a place not far from our house where the recovery rooms are like hotel rooms. I did get to stay overnight, justified by the need for a pain pump. I had the full attention of a single nurse that night (at least it seemed that way to me) who woke me every 90 minutes to give me more medicine. The pain was horrible, but it didn’t last and I was able to go home Wednesday afternoon. I’ve been there since. I wish I could say that I sustained the high level of behavior I had on Monday, but there has been some reversion back to a little less optimism, a little harder to get along with. This is partly because I’m so dependent on other family members to get normal stuff done and I’ve not yet figured out the most satisfactory way to manage that dependency. I can hear myself being bossy at times and am not happy with my own tone after the fact about that sort of thing, but I don’t seem to be able to prevent it while its happening. That’s something to work on. And there are also some issues that bother/scare/disturb me, most of which resolve around taking a No. 2. We don’t have a good solution for it. While waiting for my leg to heal enough that I can sit on a toilet, I’ve been eating very little. Part of that is the pain killers suppressing my appetite, and another part of this is knowing that the long term solution entails taking off a substantial amount of weight. There is no time like the present to start on that effort. But I’m sure I’m going beyond the sensible steps in this direction and that is motivated purely by this fear. With a preoccupation toward those type of thoughts, its hard to maintain the engaged banter posture. And now I’m under doctor’s orders to be a couch potato, so I’m hanging out a home, and not dealing with a lot of different people. I understand that for the wound from the surgery to heal, the couch potato approach is the right one, but for my emotional well being, it probably would be better to get out of the house. C’est la vie. We’ll get there, eventually. 4/28/2009 11