Little Victories

There's always one more insight

2007-10-24T18:09:41Z

So yesterday I was explaining to a mental health professional how I came to be in her office--that is, about the accident and its aftermath. She said, "So when you broke your elbows, you weren't engaged in risk-taking or dangerous behavior. You were doing something perfectly safe and ordinary. Do you think that has something to do with your anxiety and fear of making decisions?"

. . .

Huh.

A late entry in Blog Against Snap Judgments Week

2007-08-10T01:18:31Z

In pursuit of doing something about the emotional issues left behind by the Stuff I Haven't Managed to Finish Describing Here (I know, I know), I went to the local behavioral health services and signed up for treatment. Counselling. Whatever seemed helpful. I was assigned a case manager, but didn't really know what to do with one of those, and hadn't met her before this week, when I got a call from the clinic office.

My case manager was no longer there. For the time being, my case would be handled by the slow-talking, kind of disorganized-seeming woman I was now talking to on the phone. Let's say her name's Ann, though it's not.

Since I still wasn't entirely sure what a case manager did, I didn't think much more about it. I was scheduled for an appointment this morning with the psychiatrist who'd done my evaluation last month, for a followup. Smart woman; I looked forward to it.

But her office called yesterday. She'd been transferred; I'd be seeing another doctor for my followup. (Those of you who are thinking this may not be the best way to treat an anxiety problem are probably onto something.) The new doctor was fine, but not as oriented toward being a therapist as the previous one was. Her job was to assess the effect of the medication I'd been prescribed, refill, change, or remove it if necessary. She asked what other treatment I was pursuing, and I explained that I'd sort of fallen through the cracks so far, but that I thought I'd be directed toward group therapy by my case manager. As we left her office, she suggested I ask if my case manager was in right then, to talk about individual therapy, rather than a group.

The receptionist called Ann, and said yes, she was in, and would see me right away. So I went out into the atrium, and found Ann coming to meet me.

She had some kind of disability--her walk was uneven, her eyes didn't track quite right, and her face had the asymmetry that comes from some facial muscle or nerve problem. She'd left her office keys on her desk, and had to knock to be let into the office area. She still spoke slowly, as if her sentences were being rationed.

I told her what the doctor had suggested. She told me that, in the system, clients had to attend group therapy for a month, to prove they were commited to the process, before they could be assigned to individual therapy. But that was okay, Ann said. She'd get me into a group, and I could meet individually with her in her office afterward.

It was like being asked to the prom by a guy I wasn't interested in. All I could think was, this is a bad fit, this is a waste of her time and mine. This is not the person who can get me to dig down to the root of my fear of decisions, work, conflict, mistakes, failure, mortality.

Then Ann told me that in 1969, when she was twelve, she'd been diagnosed with a brain tumor, a big one, deep in the tissues in the brain stem area. Her doctors told her family she would never speak well, if at all, never be able to walk, would probably die. She died on the table a couple of times during surgery.

In my lap was a copy of Norman Doidge's The Brain That Changes Itself, a survey of discoveries about neuroplasticity. It was the book I'd brought to read in the waiting room. I'd wondered as I read if I would have had the determination and courage the patients in those cases had, to come back from something that should have been a life sentence. I doubted I could be that kind of person.

The kind of person sitting in the chair in front of me offering to help me.

Ann believed that, when she died during surgery, she saw and spoke to God. He offered to answer seven questions for her, any seven. One of them, she told me, was, "Do you really send people to hell forever?" Ann's god told her he never sent anyone to hell. Nothing he'd made deserved that. God forgave everybody. But some people couldn't forgive themselves; they created their own hell and lived in it.

I made a judgment about Ann based on the way she looked, and moved, and talked. It was wrong. Did she make a judgment about me? Did she see me and think, "There's nothing wrong with her. She has everything, all the advantages. She doesn't need my time and experience"? Maybe she did. If so, she overcame hers faster than I did mine.

I will try very hard to live up to my new case manager's faith in me. I will probably make stupid snap judgments about people again, but when I do, maybe I'll notice and second-guess them.

And I'll work on learning to forgive myself.

And I awoke and found me here

2007-06-07T18:16:44Z

Let's see--when we left our protagonist, she was in a hospital bed watching things blow up and fall down on TV.

A last, I hope, note on that: Watching the Towers go down was bad. Watching the Towers go down over and over and not being able to leave the room or even move to a chair that didn't have a view of the television was, frankly, hell. I think I did finally talk someone into either turning off the TV or pulling the curtain around my bed. But I still can't watch that footage.

I was in the hospital for several days. Abbott Northwestern made me feel safe, secure, and confident in the whole getting-better process, which is important to the actual getting better. The only difficulty was that as long as I was on dilaudid, I couldn't keep anything in my stomach, and they wouldn't release me until I could. We collectively figured that one out, though, the staff and I.

When they let me go, I took up residence in Bets and Adam's spare bedroom. No commercial airlines were flying; even if I could have caught my flight home to L.A., there was no flight to catch. This saved me from trying to figure out how I could fly from Minneapolis to Los Angeles alone, with luggage, while unable to use my arms.

I remember only some of the help and workarounds and necessary compromises involved in getting me through the rest of my stay. Bets kept me fed and clean, and kept track of the medical stuff. Geri S. kept me company, made lists of names and contact numbers I needed, ran errands, and was basically my arms. Both of them dealt with the airline, trying to find out when and under what terms I could fly home.

I developed pretty great abdominal muscles, because I couldn't use my arms to raise myself from lying down to sitting up. I couldn't hold the phone to my ear; in order to use the telephone, I had to set the receiver on the arm of the couch and hold it there with my face, my ear to the speaker. I could, eventually, bend my left arm enough to get the contents of a fork into my mouth. That was a good moment.

(I did my half of a pitch meeting during this time by doing that thing with the phone. Will was live in the conference room at SciFi Channel, meeting with a couple of the producers, and I was contributing via the conference room speakerphone. At my end, I was in my pajamas, sitting on the floor of the spare bedroom with the cordless phone pinned between my ear and the side of the bed, my arms crossed over my stomach in matching powder-blue slings. There is justice in heaven, by the way: We got the gig.)

Then my friends Jim and Dee, from L.A., called. They were in Minneapolis visiting their daughter, and were also stranded there. They'd heard about the accident. They suggested we go home on the same flight, so I'd have someone to look after me on the way. Oh, whew--another insuperable difficulty supered.

Yeah, this is pretty much the story of a whole lot of people providing tremendous amounts of help for no reason except that they could. To say that this is worth noting and remembering is to say that it's cold at McMurdo Station in July.

So I could go home. All I had to do was go to my followup appointment with the orthopedic surgeon, who would tell me how to proceed from there. I'd see if he had recommendations for a doctor in Los Angeles I could go to. I'd get a copy of the surgical report, and any other necessary documents to ensure continuity of care.

The surgeon took the old dressing off my arm, looked the incision over, and put a new cast on. He gave me the names and numbers of some orthopedic guys in Los Angeles, though he wasn't sure they were taking new patients. And out at the front desk of the surgeon's office...they wanted to be paid.

I think I'd heard "Renaissance Festival/workman's comp" repeated often enough that I'd come to count on it. I'd never hurt myself on the job before, so I had no idea how it worked. But I wasn't an employee of MidAmerica Festivals. I'd worked there for seven summers, adding value to their multi-million-dollar asset. But I was a contractor. I had no claim on them or their insurance. When the surgeon's office staff inquired of them, that's what the Festival office told them.

This is where the story takes a turn, you see.

Until this point, my experience would have been just the same if I'd had a regular job, with an HMO as part of my benefits. I would have been broken, but repaired, and the bills would at this point go to the insurance company. There'd be paperwork, hassles, co-pays, items contested, et cetera. But those are things doctor's offices understand, and consumer assistance groups sort out every day.

No, that was the day that the sentence, "May I see your insurance card?" became one of my triggers for anger and anxiety.

I never once--not once--went into a medical facility for treatment and heard at the desk, "Do you have insurance?" Over forty million people in the United States without health insurance, and the question was always, "Do you have your insurance card with you? May I see your insurance card?"

That question came to sound like, "You don't belong here. You don't have the necessary prerequisites to get care and become well. We don't even know how to think about a person as Other as you. You are not on our list of questions."

Every time, I'd have to say, "I don't have insurance," and every time it felt more like a confession of failure and weakness. And almost every time, the person on the other side of the desk would be at a loss for what to do next. There were procedures, but he or she had never needed them. Not because uninsured people didn't get sick, but because they never came in to be treated.

I gave my contact information to the person at the surgeon's front desk. I would straighten this out, I said. I had the name and number of a business person at MidAmerica Festivals. I was sure it was just a matter of talking to the right person. Meanwhile, the bills would come to me in Los Angeles.

My mighty support team got me packed, and promised to mail all the things that couldn't readily be managed on the plane. Jim and Dee picked me up and took me with them to the airport.

Geri had given me a huge stuffed platypus, the color of a lemon and the size of a king-size bed pillow. Very cheering...and one of the most practical tools I had during the first phase of my recovery. In the waiting area, on the plane, in the packed and chaotic airport shuttle to the parking lot, I kept the platypus upright on my lap and folded my broken arms around it. It was my portable soft surface. It cushioned jolts and vibration and ensured that, when my arms were tired, I'd have a safe and comfortable place to let them relax.

Air travel, even with the planes back in the air, was like trying to flee the country ahead of an invading army. Flights were limited, and there was too big a backlog of stranded passengers to get everyone where they needed to go when they needed to go there. Everything was crowded. Every space I was in threatened my arms on both sides. I clutched that platypus to my stomach and made myself as narrow as I could, and dodged, and when I couldn't dodge I led with my hip or my shoulder.

The crowds made every space ten degrees hotter. The parking lot shuttle was so crowded with people and luggage that, though Dee and Jim had managed to make sure I was one of the people sitting down (if I stood, I couldn't hang onto anything to keep from falling), there was barely room for my feet in the aisle. I was terrified that someone would bump into me, trip over me, drop something on me. I felt like glass--except that glass doesn't sweat.

I'd been safe and secure in the hospital. That was over now. The shuttle was my notice of payment due.

But then I was home. Jim and Dee brought me to the apartment, to Will, who I'd wanted to see so much for so long. They didn't stay; they'd been away from home a long time, too, and besides, Will and I probably wanted to be alone.

I was home. Everything would be different now. Everything would be all right. And I was sitting on the living room couch clutching a giant stuffed platypus for comfort, and my arms were still broken, and I still didn't know what I was going to do about that or how to find out what to do or how to pay for it when I figured it out or how long things would be like that, painful and uncertain and unsafe.

I lost my temper. I don't remember what it was about. But in the first hour after I got home I lost my temper at the person I love most, who'd spent the last weeks alone and afraid and unable to know even as much as I did about what was happening and when it would be resolved. After weeks of being polite and thoughtful and even funny to strangers and friends, I lashed out at the person who means the most to me.

Yes, I know how that works. It's perfectly understandable. It's even normal. No harm, no foul. If someone else were telling me this story, that's what I'd tell them, too. But, you know, what I said about remembering pain? I remember that one. And sometimes I think it can't feel bad enough to pay me back for having done that.

Welcome to hell, kids. Here are your accordions.

(To be, I regret to say, continued.)

Rewind: anecdote

2007-06-06T18:35:56Z

Will reminded me, in the comments on the last post, of a part of the story I'd left out.

Back to the Renaissance Festival, just after the accident. Someone found Safety Services to take me to First Aid. Two Safety Services guys arrived with a RennFest ambulance: a two-wheeled wooden cart designed to be pulled by one person and pushed from behind by another. (Usually patrons hired one of these carts to haul them around the site, but I think Safety Services had the option to comandeer one if they needed it.)

After hearing an account of what happened and what appeared to be wrong with me, the guys poured me onto the bench seat (I might have been a little inclined to pass out) and set off across the site to the First Aid building.

And as they went, they cleared pedestrians out of our path by shouting, "Make way! Make way for the new owner of the Festival!"

Laughing didn't hurt at all. I still love those two guys, whoever they are.

This is how it started.

2007-06-05T06:59:39Z

Two months ago, a friend came to visit. She couldn't stay more than a couple days, so we did what one does in these cases: talked almost nonstop every waking hour, trying to catch up.

One of those conversations was in the kitchen. She sat at the little desk where the phone is, and I stood leaning against the counter, probably paused in the middle of doing something kitchen-y. I don't remember how the segue went, how she led into the question. But she asked for the story of how I broke my elbows.

Her son and daughter-in-law had been sort of intimately involved in the immediate aftermath of the elbow-breaking incident. They took care of me, put me up, solved a thousand emergency problems. But my friend had the story only secondhand, and wanted to hear some of the details, since she knew pretty much everyone involved. So I began to tell her.

As I did, I stiffened up. My voice was flat and harsh. I clutched the edge of the counter behind me as if the floor might disappear and only that counter would keep me from the drop. My stomach threatened me with dire things.

Everything I told my friend happened six years ago. Old news. All over now.

Until I think about it, or try to talk about it, or see or hear things that remind me of it. Then I get to be a time traveler. I get to revisit the last quarter of 2001, when I slipped and the wheels came off my life.

Saturday, September 8, 2001, around 12:30 pm. I was following a gypsy act into the Feast of Fantasy at the Minnesota Renaissance Festival. We'd been warned that someone had spilled water on the wood floor. But I had rubber-soled boots, and I was right behind someone else, and I was concentrating on the effect of the entrance.

I don't remember slipping, really. I remember being on the floor, and Lorraine asking, "Are you all right?" I knew I wasn't all right enough to perform, so I scrambled up and got out of the building, quick, before I got in the way of the show. I felt...funny. Not dizzy, exactly, but as if I shouldn't try to stay on my feet because that was going to stop working any minute. I lay on one of the wooden benches in the courtyard. The master of ceremonies made worried noises over me. I couldn't figure out what it was that made me feel so strange.

Everyone else had a much better view of the damage: my right elbow was swollen to the size of a baseball. By the time Lorraine and the band finished their show, I still didn't trust myself to stand up. I'm not sure who summoned Safety Services from across the site.

The nearest hospital was St. Francis in Shakopee. I hadn't been in a hospital in over a decade, or a doctor's office in many years, either. I'm a writer. I'm self-employed. I could afford food, rent, utilities, and taxes--the things that keep you going day-to-day--but I couldn't pay $300 a month for individual health insurance (the ballpark for coverage I'd seen advertised around that time), with a thousand-dollar deductible. Cheaper just to pay for the office visit when I had the flu, and since I was very healthy--no chronic health problems or conditions, a stainless steel immune system--it was a reasonable gamble.

Now I was being brought into an emergency room in a wheelchair. Could I have a different pair of dice, please? Because these aren't the ones I was playing with yesterday.

I think they asked at the desk about insurance, about payment. Now I know the questions, the protocol, the answers they need, the language they ask in. But then I didn't. I hadn't had anything to do with the healthcare system in years. The people who asked me the business questions, who expected me to provide sensible answers, were almost literally not speaking a language I understood.

I learned it eventually. But...well, imagine taking your IBM Selectric into the shop for service and finding that there was no longer any such thing as a typewriter, that in order to come home with something that would print letters on paper, you had to answer the salesperson's questions about how much memory you needed, and whether you had wifi, and if you needed the tower configuration with the high-speed DVD burner.

And you have to do it in spite of never having seen a home computer except maybe in a movie. And the people asking the questions have been living with that technology for years, every day, and it doesn't occur to them that you have no common language.

That's what dealing with the business and billing side of health care providers was like, for me.

Someone told the folks at the St. Francis ER admitting desk something about the Renaissance Festival and coverage and liability. Something got written down about that. It was enough to get me care.

"On a scale of one to ten, how would you rate your pain?" the ER nurse asked.

"I'm not sure. Four, maybe? And I'm really cold--I can't stop shaking."

She piled heated blankets on me and injected me with morphine. She explained modern pain management strategies: that you start medicating for pain before the brain really starts to register it, because it's easier to keep a lid on it that way than if you wait until you really, really want the morphine. What she didn't say was that she knew I was in shock and as soon as the fuzzy edge went off it, I'd be able to assure her the right number was about eight or nine.

The x-rays were tricky. Hard to get the right, multiple, angles on a joint you don't dare flex too much. The technician was irked that I couldn't help more. But he got his shots at last.

The pointy projecting bone of my right elbow--I think it's the olecranon fossa--was snapped off.

It's odd, the things I do and don't remember. I don't remember who was at the hospital with me. Lorraine, definitely. Betsy? She was with me later. But was she in Shakopee? I remember being polite and well-spoken to the hospital staff. I usually did that; it was one of my reflex coping mechanisms for crises. People will help you if they like you. You'd think I would remember which of my friends were there.

I got a prescription for percoset which we filled at Target on the way...

...home. I couldn't go home. I was in Minnesota, and home was in Los Angeles with Will. The next best thing was Lorraine's place in Wisconsin, where I'd been visiting. I was too broken for a two-hour car trip.

But a bunch of us had planned a sort of slumber party at the Radisson in Bloomington that night, and the suite was reserved already. The bedroom became my sickroom for the night, disarranging everyone's sleeping arrangements. I slept intermittently, braced and padded with pillows to keep me from moving my arm.

The next day Betsy and Adam took me in. They moved me into their spare bedroom, and Betsy proceeded to mastermind my treatment plan. She got me an appointment to see an orthopedic surgeon at the hospital where she was an administrator, got me through the admissions process, once again said words like "Renaissance Festival. Liability. Workmen's comp."

I was going to need surgery. The orthopedic doc would open up my arm, put the bone tip back in place, and fasten it there with a stainless steel plate screwed into the surrounding bones. He explained this to me as I lay in the hospital bed. Then something prompted him to look at my other elbow, the left one. He ordered an x-ray of it.

It was broken, too. Just a crack, not enough to require surgery. But I'd have to wear a sling, and not use the arm.

I went into surgery on September 10.

The next morning I woke up in my hospital bed--well, "woke up" being relative, since the anaesthetic hadn't worn off yet and I was on a dilaudid drip--to find the TV on at the foot of the bed, and the nurse telling me and the woman in the next bed that someone had just flown a plane into the World Trade Center in New York.

Oh, bad drugs, I thought. I'm never doing these drugs again.

To be continued. I can't do this for very long at a sitting, I'm afraid.

You gotta start somewhere.

2007-06-05T01:39:04Z

If you're here, it's because you decided you wanted to read about how I got kind of, um, broken, and what I'm finally trying to do about it. If you didn't decide any such thing, there's probably a typo in that search string, dear.

Journaling is, they tell me, a recognized therapeutic technique. LiveJournaling, complete with animated userpics and mood icons, could be the way to go for us pixel-stained technopeasant wretches in therapy.

Heh. I'm in therapy. Well, that's a start.