February 2010


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I’ve had much reason to consider Dad’s kidneys as we’ve worked our way through specialists, medication options and potential procedures, and I’ve come to think of this matched pair of organs, cumulatively, as the quietly long-suffering wife and mother in the body’s family dynamics. They clean up the messes we create for ourselves, purifying the blood of toxins, and help keep blood pressure and electrolytes in balance. Sometimes, they just get fed up, and their resentment can take physical form, crystallizing into a small nugget of pain. However, once they’ve made us painfully aware of their presence, the kidneys put their heads back down and get back to work as the put-upon lynch pins they’ve always been.

The National Kidney Foundation has a great description of how kidneys work. The fist-sized organs are located just below the rib cage on either side of the spine, and each contains up to a million little nephrons. These nephrons each feature a filtering structure called a “glomerulus,” through which blood passes. Waste products are filtered and passed through a connecting “tubule,” eventually hitting the bladder and then – well, you know what happens after the bladder. According to the website Davita.com, healthy kidneys filter 100 percent of a body’s blood supply every five minutes.

These Type A workers have a spouse, and their partner in marriage, ironically, is the heart – the equally hard-working, pressure-inducing star of bodily organs. These two entities, one the lord of the manor and the other its scullery maid, work in concert to keep us on our feet.

Each is dependent (or, for the fierce individualists among my readers, codependent) on the other for its own well-being. If the kidneys are unable to function efficiently, fluid can begin to back up, forcing the heart to work harder, eventually resulting in congestive heart failure. The resulting high blood pressure, in turn, batters against the nephrons like a storm surge during an astronomical high tide (fellow coastal residents will understand what I mean – for you landlubbers, just know a situation like this ain’t good for anything said tide might hit up against: water always wins).

Low pressure – which happens when we become dehydrated and blood volume decreases – can be just as damaging to both spouses, especially the kidneys. In this case, the kidneys receive too little of the nutrients even these long-suffering servants need to survive. And, with blood flow too weak to force fluid through the nephrons, toxins can begin to back up. This is when we can begin to think we’re in the hospital, when we’re really in our own comfortable bed, and that our son is the nurse we’ve been trying to summon with our plaintive cries of “help.”

Though typically hypertensive – that is, suffering from high blood pressure – Dad has lately been battling the complications of low pressures, as he seems to have become hypersensitive to his blood-pressure medication. Without the medicine, altogether, the pressure remains too high for the kidneys to sustain. But even the slightest dose can, alternatively, send that pressure plummeting if he hasn’t been drinking enough water to maintain a sufficient blood volume.

Analogies help me understand such complicated relationships, so I’ve come to see Dad’s heart and kidneys as one of those old, married couples who struggle on, on their own, each for the sake of the other. You read about them in the paper sometimes. Or, maybe, you see them gently bickering with each other as they totter through the supermarket aisles, with one, perhaps, barking out orders from the seat of a complimentary scooter. They fear calling for outside assistance with the knowledge that such an admission of weakness could well mean the separation that would be as good as – or even worse than – death.

I think of my grandparents, my mother’s parents, when I think of such a partnership – one out in the business world, hauling his family from East Coast to Midwest, several times over, and the other managing children and household. Each, however, remaining devoted to each other. Meeting in late childhood, they became a paired yin and yang in the lives of the family they created together. Meaning only respect when I say this, their relationship was every bit as symbiotic as that of the heart and the kidneys, as neither functioned without the other in mind. At the death of my grandfather, always her own heart’s strongest supporter, my grandmother lingered to clean up the bills and insurance issues before passing herself a year later.

It’s hard to say which of the true loves, heart or kidneys, supporting my father’s own existence will be the first to fail. However, given the current complications (and their recent 88th anniversary as a mutually supportive pair), it’s likely one or the other will be running out of steam sometime soon. And with that passing, the other soon will follow. But such an event is not to be seen entirely in sadness – we should all be so lucky to celebrate 88 years in marriage to a mate that’s helped us clean up our messes, and die within minutes of our true love’s last beat.

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In the spring of 1976, during my junior year in high school, I reached for the stars. The school musical that year was “Funny Girl,” and I set my sights on the Nicky Arnstein role. I actually didn’t do too badly in the singing audition, but those dark-and-handsome, matinee-idol looks the part demands just weren’t what I had to offer, so the role went, instead, to a sophomore who could both sing and smolder (o.k., so he was more Jonas brother than Omar Sharif, but it was a high school production, after all). I, instead, landed the twin roles of Hecky the Cab Driver and Ticket Taker #1, two transporting roles (pun intended) that pulled me just high enough above the general chorus to earn a named credit in the program.

I’m playing dual roles, yet again, these days – those of caregiver and son – in the play that is my father’s life. There’s an added challenge in this new production, however, which I never faced as I attempted to parse the varying motivations of Hecky and the ticket taker – my two current characters often are on stage simultaneously. And, as I seem to be the play’s stand-in director, as well, I only have myself to turn to, when it comes to figuring out which of these two characters should be speaking the lines at any given moment. My biggest frustration often comes from the feeling that I’ve given one of these two roles shorter shrift, at a time when either a son’s compassion or a caregiver’s detached observation would have been the better tack.

Of course, we all play multiple roles in other peoples’ plays throughout our – and their – lives. But I think some people believe the shift that happens in the relationships of parents and adult children, when those parents begin needing help, as a simple role reversal. In other words, we become our parents’ parents. Sometimes this logic goes on to assume this turnabout to be, well, fair play – with the kids now doing for parents what the parents did for them decades ago. In my experience, at least, this argument overlooks a couple basic facts. First, the role of caregiver is inherently different than that of parent, so to call this a simple role reversal misstates what actually happens. And, second, even as we’re caregiving, it’s impossible for we adult offspring to ignore that, while to the outside world we may appear to have taken on the parental mantle, inside we are still our parents’ children.

Now, in the interest of full disclosure, let me be clear that my own parenting experience doesn’t reach beyond housetraining a dog and a couple of cats. So, I’m probably not the right person to make wide generalizations about the experience of being a parent. But, one obvious difference I can’t help but comment on is that – except where a child may have special needs – parents do their job assuming (if they do it right) their role will become easier and less prominent over time. The toddler they’re diapering this year will be handling the bathroom on their own in another 12 or 18 months time. The child they’re reading to tonight will be able to read aloud, themselves, in another couple years. The tween they’re driving to baseball or ballet or play practice will be driving themselves in two years. (O.k., so this one might be more terrifying than uplifting, but you get my drift.)

But caregivers of parents see only the opposite track – from driving to not driving, from reading to being read to, and from bathroom success to depending on the kindness of others to empty the overnight urinal. With decline more likely than accomplishment, this kind of caregiving requires a certain degree of sheer will – in place of hope – to make it through any given day. Professional caregivers – the nurses, aides, physical therapists and others who can help to, at least, postpone a decline – have the added benefit of detachment. Theirs is a job they approach with concern and involvement, but can (mostly) leave behind at the end of the day. However, when the caregiving “client” is also your parent, detachment becomes impossible, and that trend toward decline can lead to a decidedly depressed performance in both roles.

But one distinguishing characteristic of this particular play is that it’s completely improvisational. So, to counter the twin-role challenge it presents to me as an actor, I’ve begun to add some directorial flourishes to move the production from a Samuel Beckett downer to something that falls a bit closer to, perhaps, a Mel Brooks production. Like, wouldn’t it be great to see kick line of visiting nurses emerge behind my father as he makes his way, slowly, from bedroom to bathroom – and I bet the oxygen tubing would make a great prop!

And for my own life, I’m throwing in some Fellini, imagining a dolce vita day when I can merge my two roles back into a single “me.” When Hecky the cabdriver knocks on the door, ready to get me to the station just in time for Ticket Taker #1 to accept my fare for parts unknown. Sure, I may be taking a journey into Neverland with these imaginings, but for now I ask you a favor: Please don’t rain on my parade.

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I live in a town that is said to once have been home to more sea captains, per capita, than any other town in the country. Main Street, on which I live, is lined with the lovely old homes those captains built – many now bed & breakfast inns – creating an ambiance of graceful, yet somewhat wistful, history that has made this town a favorite summer destination for many. A framed list hangs on my church’s wall – the Sea Captains’ church – noting all the captains who once were members of the congregation, along with the names of the ships they helmed and how they died – with causes ranging from “typhoid” to “shipwreck” to “lost at sea,” and, in some cases, even “natural causes.”

So, with all this seafaring history surrounding me, my mind often turns to nautical metaphors. One I’ve just been pondering is the anchor. Anchors are funny things. They hold us in place and help us stay rooted when we have no organic means of rooting ourselves. But, then again, sometimes anchors simply keep us from moving on to better seas.

Sometimes stories can be anchors. Through repeated telling, stories can help us create a web of familial connection and cohesion that might not have any real existence, beyond what we’ve been able to mutually construct as a result of that repetition. My father has such an anchoring story, a story that provided grounding in a reality he wanted, but which was never really, well, real. The story, at this point almost a legend, is built around actual events – the trip he, my stepmother and my then-20-year-old stepsister took from St. Louis to New England to pick me up from the Cape Cod home of my maternal grandparents, the two people who had been my surrogate parents in the year since my mother had died. We were to attend a cousin’s wedding in Cambridge and then meander our way back to what was to be my new home – an apartment in an upscale St. Louis collar suburb.

The legendary aspect of this trip for my father has always been the fact that it was otherwise inconceivable for that many members of his immediate family to spend several weeks’ time in very close quarters without even a single major fight breaking out. It was a wonderful trip, we had no fights and everybody got along. That sentence, or some version of it, almost always has ended his remembrance of that two- to three-week trip, summing up his idyllic remembrance of travelling with his happy family in his 1967 Pontiac Catalina.

Of course, there always is more to these family stories than any single family member’s recollections. For me, the trip represented a voyage into the unknown, for which I had no anchor – or, even, knowledge of whether safe harbor existed. I was just a month shy of 9 years old, and less than a year had passed since my mother had died. I was leaving the two people who had remained a constant throughout my parents’ divorce, my mother’s death and three cross-country moves, and becoming the ward of two people, my father and stepmother, whom I knew barely at all. Once we arrived back in St. Louis, I’d be starting fourth grade at the fourth school I’d been to in a year.  I was quiet and smiling because that’s how I’d learned to survive.

I can’t tell you how many times Dad has told and retold this story, like a personal odyssey, which, unlike Homer’s, was a tale of happy travels bookended by discord, rather than the other way around. And always he ended the story with same summing up – “It was a great trip. Nobody got into any fights, and everybody got along” – while I would stare at my plate, into space or just smile blankly, doing my best to let him enjoy one of the few pleasant family memories he has.

So, during yesterday’s pre-Superbowl visit at his rehab center, I prepared to take myself to my own personal happy place when he started into the ritual retelling, yet again. But I was startled to hear him stop to ask me a question regarding a pretty significant detail: “Was Nonie [my stepmother] with me when I came to pick you up?”

Skipped beat. Followed by second skipped beat. The whole point of the story is that it features a full family.

“Well, yes, Dad. It was you and Aunt Nonie [my name for my stepmother] and Amy. You all drove out together.”

Pause.

“Do you remember Aunt Nonie being with you?”

“Well, no. I don’t really remember the details – but it was a wonderful trip. Nobody got into any fights and everybody got along.”

Which brings me back to anchors. It appears that my father might be drifting free from one of his own personal anchors. I suppose it comes from knowing him so well that the moment had such significance to me – others could justifiably argue that it was only natural for details to slip after more than 42 years. But, for years,  he has used those details to hold his vision of his life together, to tell himself that once he had this thing, this family, where no one got into any fights and everybody got along. It seems his mind isn’t so much pulling up that anchor, but cutting it free.

On the flip side, for the last few days, I’ve begun to really feel what my life will be like without the anchoring presence of my father. He will have been gone a full month by the time he comes back home two days from now, but during that time I’ve been overwhelmed with the details of my own life. I’ve been swamped with work, had a bout of miserable sinus issues and had to deal with wrangling two dogs – my easygoing golden retriever, Bart, and the elderly, somewhat high-maintenance poodle-terrier mix, Beau, I adopted three years ago – into a schedule that also had to accommodate daily rehab-facility visits and doctors’ appointments. Then, last Wednesday, Beau started getting sick. The next day, the vet informed me that his liver was failing and euthanasia was really the only humane option. I sat with him, said goodbye to him and cried a lot.

But, over the next couple of days, I began to realize that I was once again living the life I’d had in my first year back on the Cape, with a dog I could take anywhere and walk with for hours, and a schedule I could mix and match as I pleased, without worrying about 7:15 p.m. dinnertimes and morning toe-dressing changes. I slept in Saturday morning, without having to jump up several times to let an elderly dog rush outside to relieve his aging bladder. And I had dinner out with a good friend Saturday night without having to worry about prepping someone else’s meal, as well. Sunday afternoon, I enjoyed the paper and the fire while sprawling on a sofa that was, for this short while, only mine.

So, I see the possibility of two anchors in motion in the not-too-distant future – one set free by the fraying strands of its aging line, the other pulled up by a combination of deliberate effort and changing seas.

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So, while Dad’s been off in rehab, I’ve been spending some up-close-and-personal time with the big-screen in the living room. The Netflix queue has been all mine, as has the wood stove, and I’ve taken great advantage of this chance to re-own my home.

One of my guilty pleasures has been catching up on the last season of Big Love, the HBO series about life as a middle-class, polygamous family in the Salt Lake City suburbs. I’ve been a fan since the first episode – I’m now catching up on the third season – because of the amazing job it does of portraying the everyday life of Bill Henrickson, an otherwise completely unremarkable business owner and community member, who just happens to have multiple SUV/Subaru/Country Squire-driving wives, and an accompanying brood of children. Periodically, they decide that maybe they need to bring another into their family, a decision reached by the entire collection of husband and wives mutually “dating” the potential new addition. This arrangement, lived out in three adjacent houses in an anonymous cul-de-sac neighborhood, is contrasted against a more traditional community of plurally married Fundamentalist Church of Latter Day Saints members, resembling the one in Texas that was raided last year.

While watching Henrickson as he attempts to broaden his home-supply center business by expanding into the very un-Mormon casino business, I’ve begun picking up on some very unsettling parallels to my father’s life. Like Henrickson, my father is now engaged in multiple, simultaneous relationships with a close circle of individuals, all in relationship with each other, and with whom he regularly spends unclothed time on a scheduled cycle.

Yes, I’m saying Dad is in plural marriage. With multiple doctors.

As hard as this is to admit, there’s just no way around the fact: My father is a poly-doctorist.

I’ve just been an observer as he’s developed this alternative lifestyle, like the across-the-street neighbor in Big Love, who becomes, for a brief time, third-wife Marjene’s best friend. I suppose you could even say I’ve been an enabler, driving Dad from date to date as he’s assembled this multi-doctor family. But, really, I just wanted him to be happy.

It started with his first doctor, the primary (care) doctor in the much-maligned, yet mutually supportive style of relationship that is poly-doctory. After a year of monthly meetings, this first doctor urged him to expand the relationship, bring another in to share in the care and understanding Dad and the first doctor had already established. That’s how Dad came to his second doctor, his nephrologist. As is so often the case in poly-doctory, she brought her own special knowledge and attention, with her focus on those things that so often got Dad up in the middle of the night.

As he saw how easily second doctor became incorporated into this growing relationship, first doctor suggested yet another addition – third doctor was the podiatrist, who worked to keep Dad standing tall and on his toes. Then came fourth doctor, the cardiologist, who understood so well those affairs of the heart that were beginning to slow Dad down.

In fact, fourth doctor was so in tune with Dad and his multiple issues that he was the one to suggest both fifth doctor – the pulmonologist, who may help Dad breathe easier as he negotiates the many tests (and results) a poly-doctory lifestyle raises – and sixth doctor, the vascular consultant, who may be able to help Dad’s toes feel the flow.

Now, you might think this seven-way relationship would raise issues of jealousy and mis-communication among its many members. But, with me as his second-in-command and official appointments keeper, Dad’s been able to maintain harmony in this multi-doctored lifestyle. In fact, I just saw in our latest referral slip that sixth doctor, the vascular consultant, has suggested Dad and his growing stable of brother- and sister-doctors add yet another vascular specialist to their growing family. And all the involved respective mothers would be so proud – you see, they are thinking of dating a surgeon!

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