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Wednesday, August 29, 2012

Food May be Hazardous to Your Health

Her head was down, lost in a puzzle, her usual way of passing a silent meal. She had decided on an easy meal of beans on toast (an old favourite from her childhood) but had jazzed it up with a fancy salad dressed with fruit and nuts to assuage her guilt over the otherwise canned meal.

He ate in complete silence as always. Sometimes, if he doesn't like the meal and is too polite or just rendered mute by the disease, he will be as quiet as death, not moving, not speaking, not eating. It is what dining with a ghost must be like.

Tonight he was happy with the meal, if not the salad. She had been sure to make the toast fairly soft, knowing he can have difficulty with very chewy food now. The beans were easy for him.

He started to cough. Parkinson's patients can have a great deal of difficulty swallowing as the disease progresses but he has had little trouble, eating ravenously at times and putting on weight in recent months. He has never had trouble swallowing his pills either, often gulping down a handful all at once.

But there is that cough. Nearly every meal makes him cough at least a little. She is so used to it that she barely acknowledges it anymore. She tries not to be annoyed by it because, to her jangled nerves, it sounds like he is forcing it sometimes like a small child vying for attention. But she knows he is not capable of such manipulation.

She lifted her head as the cough seemed to worsen, this time sounding loose and rattly. He rose from his chair to head to the washroom to spit out his mouthful but the cough rendered him too unsteady to go more than two steps. He was going to vomit on the floor, she was sure. Now on high alert, she ran to the kitchen to grab a basin, ordering him harshly to stay where he was. The coughing was now uncontrollable. Mucous was running from his mouth.

She ordered him to get down on his knees because he was buckling and in danger of collapsing. She had to assist him down as he seemed deaf to her instructions.

He was now retching loudly but was still breathing and making sound, both good signs that there was nothing stuck in his airway. He just needed to cough up whatever was stuck in there which she thought must be a small piece of pecan from the salad.

A second later he keeled forward landing with his face in the bowl. To her horror she could see he was unconscious; his eyes were open, tongue lolling out. Assuming the particle of food must now be blocking his airway she grabbed him around his waist - no easy task with an inert body - and summoned her learning from a first aid course taken decades ago. The abdominal thrust, as it is now called, was what she attempted, thrusting up into his diaphragm as well as she could in this very awkward position. Nothing. Again. He spluttered, coughed and spat into the basin which was now bloody from a gash on the bridge of his nose from falling flat on his face. All that appeared in the bowl besides lots of saliva was a very small, soft morsel of toast, hardly enough to cause such a fuss.

She assumed the punch in the stomach had dislodged the food but as she thought about the episode throughout the evening she knew that he hadn't really been choking beyond all the loud spluttering and coughing. Remembering a horrifying film shown during her first aid course, she understood that someone choking cannot speak or breathe. In this traumatizing film, the mother of the family simply collapsed and died in front of her useless family members after several minutes of silent but wild gesticulating. Michael was not at all silent throughout the attack. Could there have been a cardiac event causing him to lose consciousness? It was during a conversation with one of her concerned children later in the evening when she concluded that he had probably lost consciousness from a plummet in blood pressure. He had gone rapidly from sitting to standing to kneeling on the floor with his head down, all within a few seconds. His damaged autonomic system, that has caused a similar though less dramatic episode in the past, was probably not capable of making the quick adjustments required to stabilize his blood pressure. But at least the relaxing of the muscles while unconscious stopped the coughing and retching. 

He had little memory of the event later in the evening but seemed visibly shaken. So was she. His face maintained a pallor all evening and he was more withdrawn than usual.  His blood pressure was very high but by morning had dipped wildly again. All that morning he was more confused and lethargic, still overcoming the shock she assumed.

She has resolved to keep meal times more tightly controlled. That dinner had been delayed by a late telephone call but otherwise she always tries to have the meal on the table by 6 p.m. at the latest. Any later than that and he loses interest in food as his medication wears off.  5:30 at the latest in future. And she will never leave him to eat unaccompanied. She must always be within earshot from now on.

There was a moment when she thought this was the ugly end. There hadn't even been enough time to call an ambulance; it was all over in seconds. She probably should have alerted someone other than her children but we all know how a hospital stay would have worked out. It seemed more prudent to keep him calm and quiet, sitting right next to her all evening. There is a visit to the neurologist very soon so she will broach the subject.  She is doubtful anything can be done. Just more vigilance. Maybe more medication.

*Frans Snyder, The Pantry, circa 1620.

Thursday, August 23, 2012

29 Hours

Twenty-nine hours. Tuesday morning to Wednesday afternoon. A blazing trip down the highway to Toronto to visit two of my kids. Eight, nearly nine hours of driving. Two hours back and forth on a train from my son's home in the extreme suburbs to my daughter's home in the heart of the city. Seven hours spent in bed, most of them asleep. A lot of walking. A lot of talking. A lot of fun crammed into a small space of time, all of which now seems like an improbable dream.

But I did it. I finally screwed up my courage and hit the road. I will do it again even though the fallout has been somewhat severe, but not nearly as bad as I expected. Ativan to the rescue once again. I had hoped to wean Michael off his three days on this strong medication but his anxiety was quite severe after I returned so I am taking it slowly. A debrief from our caregiver was positive - no calamities - but it was obvious from the complete withdrawal upon my return that my absence had been felt. Slowly in the evening his body softened and his glassy-eyed silence was broken. By this morning Michael slumped again, another brief - thank goodness - but disquieting rigid withdrawal.  He is better now, more than twenty-four hours after my return. All in all, not too bad.

I have turned the corner and will most likely try another such journey in the near future, though I won't stretch the time to more than one night just yet. Maybe a daring thirty-six hours next time.

My joy was loud. The visit with my kids was, of course, wonderful, but the drive was nearly as much fun. I whizzed my way down the highway with my music blaring, stopping only for bathroom breaks and strong coffee. I discovered I have cruise control in this new car, a novel phenomenon for me. Let me say that I love to drive. I love a stick shift. I love being in control. But I thought I'd give the technology a try since I have it.  I set it for about two km/hour slower than the lowest posted penalty speed, 120 km/hr - a mere $95 fine if caught compared to the $10,000, instant vehicle confiscation and license suspension for 150 km/hr.  Having learned my lesson a few months ago after receiving my first ever speeding ticket I was trying to behave despite my lead foot. I set the speed then tentatively removed my foot from the gas. What an odd sensation. The car seemed to have it's own mind and my job was simply to sit back with my hands on the wheel. The tachometer sat rigidly in one position and my speed never wavered no matter what the terrain. It took me a while to adjust to not being in full control even though I knew I could override the system at any moment to pass or slow down. Joyful Joyce seemed to take charge and wanted to make her own way forward with me as passenger.

I drove past places where I have friends. I briefly entertained thoughts of dropping in on a few. How nice it would be to have that freedom but, even if I'd had their contact information on me, my time was severely restricted and Joyful Joyce needed to get me home.

So instead I spent my time singing, breaking into hormonal menopausal sweats to sexy music, and observing cars. I can add a new fact to my overly generalized list of purchasing tendencies in our society.  Where middle-aged men like expensive convertibles and young men like souped up cars, women of a certain age seem to go for wildly coloured subcompacts, present company included. My hot green little gem was matched by shimmering blue and bright red vehicles of a similar ilk, mostly all driven by women probably wearing Birkenstocks or at the very least therapeutic orthotics in their shoes. These cars are a bit like those sensible shoes but with a big sparkly bow, or like wholesome brown bread with a sticky, sugary icing. We're trying to be wild and free of our responsibilities but cannot shake our deeply rooted sense of duty. I wondered if my sensible sisters in subcompacts were also breaking free for a much needed vacation, listening to loud music on their solitary adventures.

Friday, August 17, 2012

Vincent and Me

I communed with a great man today. A friend and I paid a visit to the National Gallery to take in the exhibit entitled "Van Gogh Up Close." It focuses on his years in France, the last four years of his life as it happens and, it seems, his most productive. But it was also the time when mental illness most overwhelmed him, killing him in 1890 through what appeared to have been a messy suicide. He was only 37. He spent much time in hospitals and then an asylum after a breakdown in 1888 when he famously chopped off an earlobe, all this in the wake of a nasty argument with Paul Gauguin. These final years of his life were spent fighting despair, depression, paranoia and hallucinations.

And yet, as I wandered through the exhibit humming Don McLean's "Starry, Starry Night," I was uplifted. Such light amid the torment. There is a sense of peace and serenity emanating from these masterpieces; obviously Vincent's art was a soothing balm to a tortured soul. As I inspected the details in some paintings, I was struck by a seemingly random splash of colour that had no discernible shape or meaning or, in another, a very unusual choice of colour. They almost seemed like mistakes but it was more likely that my strong sense of order and sanity wouldn't let me see their meaning.

I eschewed the headphone tutorial. I didn't want to be distracted from my own response to the paintings. I may go back and use the aid, but for my first visit I wanted no one else's perspective or interpretation to influence me. I knew enough of his life to just drift through the exhibit unaided.

Halfway through my wanderings I was hit by an intense sadness, especially after reading some quotations from his letters where he admits to his madness and his efforts to hang on to sanity through his art and his connection to nature. Clearly he failed, ending his life so violently. The demons overtook him.

But what a testimony to the breathtaking brilliance of his mind he left behind. What wonderful proof of the sanity deep within him even though his life was spinning out of control. What a soothing balm for me to recognize that no matter how wild and crazy a person might seem on the surface, deep inside there is a soul that is anchored and safe and untouched by the maelstrom.

All this is comforting as I contemplate a road trip I am planning to take next week. It will be my first overnight journey away from Michael in many years.  I informed him - perhaps unwisely - of my plan a few days ago but will not mention it again until the day I leave. Already the madness is quietly manifesting, though, of course, he cannot articulate his worries. Telling him or not telling him, I've learned, makes no difference to his reaction when the day comes. He might go over the edge, inflicting his own internal damage upon his person, his own symbolic disfigurement. But deep within I must trust there is still a little place where the real Michael hides untouched, creating his own spiritual masterpieces.

I have realized finally that this disease will probably hold Michael in its clutches for many years to come and I must take a night off if I can. Up until now I have kept going believing that this could not possibly continue much longer, that I could hold on until the end, sparing him the further agony of even brief abandonment. But recently a switch has gone off in my brain with the understanding that I must go if I am to survive this long-term sentence bestowed upon both of us. I am blessed with a gifted and competent caregiver in whose hands Michael will be lovingly looked after. She may have a big job; the worst may happen. But come what may, I must hang on to the notion that despite all the madness and confusion, Michael's soul will remain unscathed.

I took Michael up to the local soccer field tonight where his old buddies were playing a game. He arrived with a spring in his step and walked without falling once. He tossed down his cane, announcing he was going to warm up to play. I quietly told him he could not participate in the game. He glared at me, refusing at first to believe me, but he gave in and watched from the sidelines instead, running competently for the ball when it was kicked out of bounds. A masterpiece of movement. The air was crisp and clean, nearly autumnal. But it was the sky that amazed me. It was truly a starry night with a paintbox of deep blues. I felt as though Vincent himself were reassuring me that all would be well.

Vincent Van Gogh, "Starry Night," 1889.