Monday, November 17, 2014

Pain Management

I was deeply overconfident.

I know what to expect, I thought. I was going in for a hysterectomy. I'd had abdominal surgeries before. I've had 3 Cesarean sections and an ectopic pregnancy. I've had bone surgeries, dental surgeries, a three hour surgery to my neck. I understand pain - broken bones, labor, strep throat that hurt so much that I couldn't swallow my own saliva. I've spent 2 1/2 days on a morphine drip. The ectopic pregnancy was the worst pain I've ever had - writhing, thrashing pain that had me wishing that I'd pass out from it.

I've got this, I thought.

I did not have it. I had nothing in my wheelhouse to even prepare me for it.

I'm not a wuss. I actually handle pain quite well. It's not unusual for me to take nothing but Tylenol after a surgery. I tend to wake up in recovery saying, "When can I go home?" I walked through ancient ruins and Disneyland with brand new surgical screws in my feet. I was still unprepared for the first, fierce 24 hours after my hysterectomy.

When I woke up in recovery, I couldn't move or open my eyes. All I knew was that my back hurt, I couldn't breathe, and I wanted my husband. I have a "restricted airway" (read: throat that's smaller than normal), and being intubated creates lots of sticky phlegm, so unless I keep clearing my throat, it closes up and feels as if I can't breathe. (My nose is no help; it's chronically swollen.) I kept clearing my throat and calling for my husband, and someone - I had no idea who, but they seemed to be handling me - kept shushing me and telling me that, "There's no Dan here."

Now, I dislike being the kind of person who tells others how to do their jobs (mostly because I hate being told how to do my job). I'm sure that the recovery nurses have handled more loopy, drugged and irrational patients than I have. But here's how I see it: those who are sick or in pain should be handled the same way that small children and the mentally ill should be. If someone's calling a name, ask who it is. "Is Dan your husband?" If I say "Yes," say, "He'll be here soon." If it turns out that, say, you find out that he's a stalker and I live in fear of him, say, "He can't get in here." The whole point is to comfort, not to panic, the subject. Just telling me that he's not there and I should hush is not comforting.

In fact, it was so panic inducing that I later had trouble with him going to the rest room, because he was out of my sight. This is very uncharacteristic for me, and it is not good. Just a heads up.

Before I could move anything, I became aware of more pains, and things began to make sense. I remembered where I was, and why, and realized that the surgery was over. Someone put something in my mouth - I still don't know if it was just a sip of water or medicine, and I said, "Can't swallow."

"Yes, you can." Well, OK, but not easily.

I tried repeatedly to form coherent thoughts, but full sentences were difficult. "Scoliosis. Back hurts. Need to sit up."

"You can do that later."

"After you get to your room, the bed will be more comfortable."

The back pain is still the worst part of the whole experience. I expected abdominal pain, but it felt like the entire three hour plus surgery had been spent in the worst possible position, and my back screamed.

After they took me to my room - and, thank heaven, my husband was allowed to come with me - the first thing I asked the nurse was, "Can I sit up?" I could. "Can I lean way forward?" Yes, I could. "Can I pull my legs up and lean up like this?"

The best thing my first nurse, Rodger, said to me was, "Well, you're going to just love me, because I'm full of all kinds of 'yes' tonight." Oh, thank heaven.

What I really wanted was to straddle the bed like a horse, or a surfboard, with my legs down either side, then lean all my weight up onto my hands or elbows, but I couldn't quite do that. I was worried about putting my weight on the incision site, but Rodger's "yes" meant that I could. I pitched forward and finally got my back to stop screaming quite so loudly. "Oh, much better. Much better."

Rodger was puzzled. "Your back must have really hurt."

"Scoliosis. Dear heaven. You have no idea."

The problem with hospital beds, beach chairs, recliners - anything made for the comfort of the average person - is that leaning back like that puts pressure on the place in my spine where it kinks to the side, and it makes everything hurt. It also cuts off circulation to my left side. I need to do what causes most people pain, and pitch forward. Sometimes, efforts to make me comfortable will have exactly the opposite effect.

The next three days were all about moving just enough to ease the pain in one part of the body in order to experience some slight relief, but it just transferred the pain to another body part, so soon I'd have to move again. The next 24 hours were a fog of frustration and pain. Every time I started to fall asleep those first few hours, the pulse oxygen monitor - the little clip with the red light that went over my index finger - set off an alarm. Apparently, my breathing slows when I sleep, and the machine shrieked if I dropped below 90% oxygen saturation. (I thought it was overreacting. I never got below 82%.) It also went off if the clip got bumped the tiniest bit off center. More than once, I found myself beating the pulse ox clip against the bed rails, wailing, "Shutupshutupshutupshutup!"

For a while, life condensed down to the 10 minutes between times that I could hit the morphine button. Keeping my eyes open was hard. Sometimes, especially if I already feel bad, any sensory input - sight, sound - will result in an overload similar to motion sickness. You can tell if I'm not feeling well when my communication becomes very staccato. My youngest two kids came to see me, and my youngest daughter kept sharing things that happened that night at youth group, and I'd find myself saying, "Sounds like fun. Now sshh. Too many words." Watching my husband walk across the room caused me to throw up.

Morphine, of course, is notorious for causing nausea and headaches, but I couldn't have oral painkillers until my digestive system started working again. My sinuses felt refrigerated from the oxygen tubes, but removing them made the oxygen monitor shriek.

In general, I hate to be touched when I'm in pain. This is hard for loved ones who try to rub my back or my arm. I tend to bark, "Don't touch me!" I can't stand to have collars ride against my throat, so I left the back of my gown untied and unsnapped. It bothered my husband that it sometimes hung, a la Flashdance, off my shoulders. He'd try to "fix" it, and I'd wrestle the fabric away from him. I'd rather wander topless down the hall than have it ride on my throat. Yeah, good times for everyone.

I try not to be, as my sister calls me, "a curmudgeon." I would hear her voice in my head as I cursed the machinery or the drugs. She'd talked to me just before I went in for surgery. "Remember, they're just trying to keep you alive!" I'm actually a usually reasonable and cooperative patient, and when I know that I won't be, I try to apologize. Having to receive shots in my stomach, I warned the nurse, "I hate to have my tummy touched even when I feel good. I will make weird noises. It's not you, and it doesn't hurt."

Asked if the urine in the catch basin in my bathroom was a normal color, I said, "I'm a woman. I normally see it mixed with water. How the heck would I know what shade it normally is?" By day three, I had a bit of a sense of humor back. My nurse made sure my gown was closed over my rear end, and my response was, "Yeah, everybody'll want one if they see mine." Waiting for me to pass gas - one of those post op milestones that every patient has to hit - I said, "I've spoken to my digestive tract about this. It just isn't listening to me right now." Luckily, my nurse found me amusing.

My nurses and aides were pretty uniformly outstanding. God bless them. My husband offered to take a photo of my last nurse, Sam, and send it to my sister "so she'll be jealous." Young, dark haired and good looking, he was also funny and efficient.

Five days later, I'm home, showering, wearing real clothes and feeling more like a human being. Life is much more pleasant and manageable. I'm stiff, slow and in pain. I'm bruised. Sometimes the abdominal gas feels like a weasel loose inside me. Still, all this is doable. Now I've got this.

After I had my youngest daughter (sixteen years ago) I said to my mother, "I tell myself that I'll never again have to be a patient in a hospital. I know that I'm lying, but it makes me feel better." She humored me. Now I just hope against hope that this was the worst it will ever get.

Because I do NOT want to have to readjust, again, what a 10 on the pain scale feels like. (I use now my friend Steven's swear phrase: "Sweet fancy Moses.")

I won't have to go back to a hospital again, right? I mean, I'm done now, aren't I?

I think I speak for many of us when I say, "I hope so."

Tuesday, November 11, 2014

A Fairy Tale Relationship

We frequently hear that fairy tales and popular culture have warped or ruined our expectations of relationships and men.

I will often concede the point. I mean, sincerely, "Twilight?" "Fifty Shades of Gray?" Not only SO NOT romantic, they're not even well written! I never managed to read either in its entirety, even after being urged to do so. Selected passages were enough to convince me to conserve my brain cells and my limited time. Neither is even in shouting distance of my idea of the ideal man or the perfect relationship. (Or, for that matter, even good sex. Eeewww.)

I'm still bitter about the whole "Bridges of Madison County" hysteria. If you missed that (give thanks!), it was the MUST READ a couple of decades ago. After Meryl Streep and Clint Eastwood agreed to be in the movie version, I thought, well, maybe I'm being hastily judgmental.

Nope.

Supposedly, Francesca (I remember her name because there was a huge spike in baby girls receiving the name) was able to endure her stifling marriage and unhappy life only because she had three glorious days with her One True Love. Aside from the fact that I don't buy into the whole ridiculous concept of "there's only one perfect person for you" nonsense, three freaking days? Are you joking? That's not even enough time to have had your first disagreement! Nobody's left their dirty socks lying around, disparaged your mother, failed to notice your haircut, alienated your best friend, spent all weekend watching football instead of antiquing... THREE DAYS? Good heavens! THAT'S your idea of The Love That Will Always Sustain You? Have you ever had a crush on someone, just swooned over them, then discovered that they were a jerk? It didn't happen in the first three days of a relationship, did it? That's just adolescent nonsense! I'm secure that even serial killers could charm you for three darned days!

Yeah; don't get me started.

Sometimes, though, writers get it right. Sometimes the planets (or whatever represents your personal harbingers of karma or good fortune) align, and you get writers and actors who get it right.

This is how I came to be in love with fairy tale characters in a fictional relationship on a TV show.

I've loved ABC's "Once Upon A Time" from the beginning. It's a great rendering of a fun concept. If you don't watch the show, though, this will make no sense to you; either accept that or stop reading, I guess.

The lovely Jennifer Morrison plays our heroine, Emma. Her world is populated by fairy tale characters. They - the writers and producers - seemed to very much want Emma to be in a relationship, but the ones they tested out didn't work. I wanted Emma to be in a relationship; that woman needs to be happy.

I was not terribly impressed when the show added Captain Hook. Oh, great, I thought - they're giving us a good looking, British accented pirate in eyeliner in order to appeal to Johnny Depp fans; it's a cheap and shallow move. When they gave him lines like, "So you've heard of me," I rolled my eyes.

Colin O'Donoghue played the part beautifully; fresh, well imagined, genuine, funny and charming (and, let's face it, he is the best looking man on television). He's also technically delightful to watch as an actor; he never phones it in. Even if he has no lines and is in the background for mere seconds, he's reacting appropriately and deeply. I just didn't think he could save the part from bad writing.

But the writing for Hook wasn't all bad; sometimes, it was inventive and intriguing. I never minded that he was completely mercenary and without loyalty (except to his deceased love, Milah) and that he was over the top flirtatious to anyone female, because he just owned it, without apology.

Then the producers decided to make him a permanent character instead of a guest star, and the writing got steadily even better. They decided to capitalize on his connection with Emma and make him a prospective romantic partner, and it worked. It really worked.

Someone - I'm giving credit to show creators Adam Horowitz and Edward Kitsis - knows how an actual healthy relationship works, and what it looks like. There's the requisite unnecessary drama because it's TV (and that sometimes annoys me), but at its core, the Hook/Emma relationship is authentic and healthy because it's written that way.

Hook puts not only Emma, but her family, first, even before he acknowledges that he loves her. He heads straight into danger, and puts aside his own long held agenda, because it's best for Emma and her family. He doesn't, at that point, even particularly like her father, David - and the feeling is mutual - but he saves David's life, never intending to let anyone know that he had, simply because Emma loves David. There's no martyr attitude, no "look at me!" effort to impress, just doing the right thing because it's the right thing.

After he acknowledges, to himself and everyone else, that he's in love with her, it's a done deal. There's no second guessing, no fall back plan. She and her family will always come first. There's also no pressure; he's very willing to let her return to her first love, Neal, if that is what will actually make her happy, and be best for her family.

(Neal, for his part, does the same. There's a bit of jealousy, but he too wants what's best for Emma, and he's willing to concede that what Emma wants is what's best for her. He'd like that to be him, but if it's Hook, he's OK with that. When Emma's family was in danger and it was nearly impossible to do anything about it, Neal was the one who knew who to turn to, who would leave no stone unturned until the job was done - "Find Captain Hook." It was a very classy way for the writers to handle the whole thing, instead of getting unnecessarily soap opera-ish, or TV talk show slapfest, about it. Mature people behaving maturely is often seen as "boring" TV, but let me assure you, it's actually a great idea. We the audience appreciate it.)

Emma has, at the least, commitment issues. For a man in love with her, that goes from aggravating to painful and back again, but Hook never takes it personally.

Out here in the real world, my oldest daughter is married to a great guy. One of the first ways that we knew that he was going to be a great partner for her, that he actually understood my daughter and what made her tick, was his approach to getting engaged.

Lana, my daughter, has commitment issues. She rarely buys anything without buyer's remorse. She can tie herself in knots over choosing the chicken or the fish off of a menu, then be depressed when it arrives and she decides that she'd actually wanted the beef. Decisions are protracted, painful affairs for her. The more important the decision, the more she agonizes, and the longer it takes. Since she was a child, we've worried that her answer to, "Will you marry me?" would be, "Um... I don't know. Let me think about it. When do you need an answer?"

Craig, her husband, first discussed things in the most general, theoretical ways possible. Then he moved on to things like, "What style of ring do you like?" Then he hinted, for months, it seemed, that there was an important discussion that he'd want to have some time in the future.

She, predictably, freaked out. She didn't dump him, thank goodness, but she agonized. She phoned us for advice, repeatedly. I'm sure that her college roommates bore the brunt of her angst. She worried and fretted.

He never, ever, took it personally. There were no complaints about how she couldn't really care about him if it was this difficult for her, no whining about dragging things out, no jokes about cold feet, no hurt feelings - nothing but cheerful patience. That was when we knew. He gets her. He doesn't just enjoy her company or think she's pretty or want to be married to somebody, he understands her.

When he finally asked the question, he'd given her enough time, space and lack of pressure to sort out how she felt, and why. The answer was not only an immediate "yes," but she wanted the wedding to be in four months. She was busy with her final semester of college and applying for jobs, so my Type A, control freak (and I say that with love) daughter, who hates my taste, turned over most of the planning to me, not really caring what food was served or where the reception was or if there were centerpieces. "If we're married at the end of the day, it was a good day." That's what support and understanding from your partner does.

I thought of that often while I watched Hook. He didn't disappear, he didn't pressure, he just waited. He reminded me of my son in law.

For those same reasons, and because I'm a parent, I enjoy watching Emma's parents. Her mother, as is the way with most mothers, is usually concerned with how Emma feels. David focused on Hook. Over the course of a TV season, David went from outright hostility ("Stay away from my daughter!") and discouragement ("She is never going to like you") to insisting to both of them, as Emma headed into a dangerous situation, "He's going with you. You're going with her." He was the first in the family to say, "I thought he deserved a little credit." When Emma recently emerged between her father and Hook after escaping from danger, David considered it natural that it was Hook she turned to and wrapped her arms around. Slowly, naturally, before their daughter had ever even been on an official date with the man, they started including him in family meetings, family decisions, and even their joint job as sheriff (give that man a deputy's badge, already); in fact, when Emma showed up at the diner looking for Hook, his first response was not, "Hello, gorgeous. Looking for me?" It was, "Did I miss a search party?" Again, making sure that he helps her family is his top priority. Because David sees and recognizes that, Hook and David have developed a relationship that I find delightful.

David recently jumped in to push Hook out of harm's way. Part of that is the quality that makes him a good person and a good leader (after all, he is both Prince Charming and the sheriff), and that's putting others first regardless, but part is the simple fact that he's returning the favor; Hook puts us first, so we put Hook first.

Watching people trying to figure out the balance of "we" to "me" can be funny (or painful). Over thirty years later, we still laugh about a newly engaged friend who said to his fiancee, "Jeannette, where is our purse?" Hook got it right without any stumbling. An example: when he and Emma ended up going back in time - yeah, it's TV - he cautioned Emma repeatedly that they had to be very, very careful, or things could get disastrous. Then, of course, she literally snapped a twig and changed a hugely significant moment. Hook's immediate, gut reaction was to say, "Now, because of us..." Us. There was absolutely no moment of, "I told you so." I know so many people, even otherwise reasonable people in healthy relationships, who would have been unable to resist repeated lectures. "I TOLD you how careful you had to be! I warned you that this could happen! You never listen! Now we have a mess on our hands! After everything I've done for you, you couldn't handle this one simple thing! How could you be so careless?" Not healthy. I also know otherwise reasonable people who would have written a fictional account that way on the theory that conflict and bickering are "interesting." Meanwhile, this fictional pirate calmly stated the problem as a "we" issue and went about the important part, trying to fix it. Genius writing.

Emma's also figuring it out. She's always been deeply defensive. Someone will frequently say something that will cause her to distance herself. Last year, when her friend Regina complained about having to deal with "the doe eyes and the yearning looks," Emma's immediate response was, "I don't yearn." Now, when Regina complained about having to watch Emma and Hook "make eyes" at each other, the defensive response was, "We don't make eyes." We. (It was also cute that she realized almost immediately that yeah, they do.)

It was also while talking to Regina that Emma first verbalized, very casually and naturally, "I trust him." She has deep, intrinsic abandonment and betrayal issues, so trust is no small thing, and considering its existence just part of the landscape is bigger, and healthier, than making grand declarations. "I know that the writers and the actress are aware of what that (trust) means," I told my husband. "I just hope that the character has figured it out." We watched her trust him - with her safety, her family, her feelings - over and over. We watched her send him - rather unwillingly - off to take care of the very pretty damsel in distress in town, when a woman less secure in what his actions would be would never have let her significant other be alone with a pretty, mysterious woman. She's extending that trust to so many things - her childhood, her memories - that indicate that she does indeed know what a big deal it is that she can and does trust him.

Hook (wisely) let Emma take the lead on most instances of kissing. Watching his face, and hers, the first time he recognized that she would not only tolerate but welcome a kiss was heartwarming. Even more heartwarming are the small, non sexual touches - a hand on the arm, a hand held, the bright, instant smile at seeing the glasses Emma wore as a teen. Incongruous moments - watching him use his hook to tenderly smooth down her hood - are funny and delightful. They get it right.

Helen O'Donoghue is obviously a very blessed woman, because her husband wouldn't know how to play a man in love as well as he does if he hadn't felt it. You can write this stuff, you can go to acting classes, but you can't produce the best results without talent and experience.

Every now and then I read someone complaining about the, well, idiosyncrasies of the script. OK, Milah was the mother of Neal. This doesn't bother me, truly. I'm also aware that Hook is a killer and a thief; we've seen him be both. Based on the time and place he's from (he's hundreds of years old), it's very normal. Three or four generations ago, it was both legal and accepted to challenge someone to a fatal duel just because you thought that they were disrespectful. Also, piracy isn't exactly swindling the elderly out of their pensions. I'm not bothered by these things. I mean, I don't recommend wallowing in death and illgotten gains, but nobody's doing that.

If I may, though, be extremely presumptuous and tell people how to do their jobs, even though I dislike that behavior, I'd like to speak to Mr. Kitsis and Mr. Horowitz. I read the interview in which you said, "Our show is a drama. They (Hook and Emma) won't be sitting around watching Netflix and ordering pizza." Respectfully - why not? Let all the drama and conflict and threats be outside of the relationship! Let them have a safe, secure, quiet place from which to go out and fight the world and its villains and problems together. They're good at it. It works for Snow and Charming. It works for other fictional couples on other shows. A happy relationship is not a show killer. Let the audience enjoy some Netflix and pizza nights with them.

Keep getting it right. We'll keep thanking you for it.

So, there it is. I'm thinking that people can take relationship advice from fictional people on a fairy tale themed show; and I stand by that opinion.