Sunday, February 03, 2008

Give and Take

“You never see a hearse pulling a u-haul,” Arvid said today in church, “You can’t take it with you.” His sermon focused on giving. No religion leaves acts of charity out of the accession to the divine—or accession to your highest and happiest self. Another of the ministers read a short essay by Isabel Allende whose 28 year old daughter fell into a coma and died after a year of silence. In her grief, Isabel realized anew the gift of sharing her stories and time and herself and found her daughters soft presence most with her when she gave. What do all of our gifts mean unless we give them away?

After church I visited the gym and read “Les Mes” on the stationary bike. As I near the end of the novel, Jean Valjean reminds me of giving also. A bishop gave him, a convict, the gifts of respect, freedom, recognition, and money which set his soul on a path of charity and growth. He passed these gifts onto those who needed his help on the cold streets of Paris.

I think of the 10 year old child we saw in pediatric cardiology clinic the other day. She emigrated here from the Philippines at the age of four. Born with a heart defect such that the two “great vessels” which take blood to her body and her lungs were switched, or transposed, she also a hole between the two sides of her heart that enabled her to survive, if barely. When she came to this country at the age of four, surgeons here repaired what they could of her heart, given the damage the inadequate circulation had already done. If she had been born here, they could have repaired her heart at birth, letting her live a long life with essentially a normal heart.

In clinic she looks thin and happy, shy and active. She swims for fun and enjoys her friends and school. I almost don’t want to know what her future holds, but once we have adjusted some medications for her pulmonary hypertension and left the room to dictate her visit, I ask Dr. Setzler what will happen to her, “She will get more and more tired and end up in a wheelchair by her late teens. She won’t have the breath or energy to get up and do much. Eventually, she will become home-bound, bed-bound essentially. On hospice. Unfortunately, that phase can last for 2-3 years sometimes, before she dies.”

I wonder if the active shy ten year old knows this about her future. They study the human body in her fifth grade class. Dr. Setzler asked her if she told them about her heart when they learned about the red and blue blood and the circulatory system. She only nods and smiles shyly and somewhat proudly. I wonder if she understands how her heart works. Even with the help of pictures I sometimes have trouble understanding all the shunts and patches and dilations and stents that redirect blue blood to the lungs and red blood to the body, or let them mix enough so that the tissues of the body can survive for a time. I wonder if she has trouble understanding how she has lived this long. And I wonder if she knows how she will die. I wonder if someone could have given her family money for a plane ticket when she was first born and saved her life.

Though most of the patients we see in clinic have repaired hearts or watched defects and live relatively normal lives, we see another patient that day, a four year old, whose life leans inevitably toward a premature end. Her mother speaks Korean and Spanish; my attending speaks English and Spanish. They get along reasonably well in Spanish, but the mother requests a Korean-English phone interpreter because she does not want to miss any of the discussion about her little girl. And she has questions for us—questions about giving.

On her last visit one month prior, my attending explains to me before we see the patient, her daughter looked very ill—end-stage heart disease and pulmonary hypertension, blue and exhausted all the time. He had added some medications but did not have much hope of them making a large difference. He had candidly explained this to her parents. I imagine an agonizing month for them, watching their little pink-bowed girl explore a world she would soon leave, loving her in the moments they had. At this visit, she has unexpectedly improved—not to change the course of her decline, but to slow it perhaps. Her mother, with tears in her eyes, still asks about organ donation. In Korea it has to be set up long ahead of time and she does not want to miss the opportunity to give away the healthy parts of her daughter so that others might live.

In the grief of this mother, and in the grief of Isabel Allende’s loss of her daughter and in the sometimes grief of simply surviving another day, salve for the wounds of living with loss comes in giving.

Jane has just brought me a bowl of homemade stew. On this blustery, drizzly, gray San Diego day, she brings me a gift of warmth and health and time. I try to think of what I can give. I think of the homeless veteran I remember from the Veteren’s day service at church. When the offering came to him, he contributed.

Arvid tells a story of Jesus and his disciples accepting rich offerings for God to the applause of the observers. In the midst of this, a woman in rags approaches and deposits the equivalent of a penny. Jesus tells his disciples that this represents everything she has and therefore more than the wealth of others in the eyes of God.

I try to think of what I can give. I can write. I can heal. I can listen. I can share. I spent a long time with an obese 10 year old and his family the other day. I approached the issue of his weight gently and told him about portion control and healthy snacks and no soda or juice. I tell him about exercise. I offer a few books in case the family (both mom and dad are busy working parents and heavy themselves) needs more structure to create diet plans. As I struggle with my own weight (prednisone induced, depression induced, winter induced, gene induced or some combination) I frame my counseling to him not as a criticism as much as an area where he can make changes to actively improve. The attending later told me that the family had thanked him for the time I spent with them. I can give that.

I gave my car to someone in Mexico I think—perhaps less than willingly, but it helps even to think of theft that way. Thinking of my stolen jewelry in Cincinnati that way, even in the midst of my grief over Michael, softened that pain a little, too.

Bob has just come by to visit on his way to pick up some food. He is short on cash at the moment with an empty fridge. I offer to share the left-over turkey from mom, or the stew from Jane, or the chicken soup from Loraine. As I rattle off the options, I realize how very much I have been given and remind myself of gracious gratitude. He refuses, but appreciates the offers, he says and heads out to get a Chipotle burrito. Given pride, accepting is much harder than giving.

For me, too. I find it very difficult to accept help, though easier perhaps than before my lupus diagnosis.

Yesterday in the NICU, after being up the majority of the night, and sleeping worriedly for the rest of my time on call there, I started to attempt an arterial blood gas collection on the newest and sickest of our babies. When I first heard of the mother arriving in labor with a premature baby (33 weeks, when term is 40) in our near future, I had the charge nurse page the attending, Emily, a resident who just graduated from our program last year and who my heparin drip and I visited in May when she worked in the NICU of the hospital where I spent my ten days as an inpatient. By the time I was attempting the ABG, she had arrived. Under the lights, I sought the tiny vessel in the tiny wrist without seeing the flash of blood which means success.

I saw flecks of light instead, then darkness at the edges of my vision. I asked her to take over the procedure and sat down where I could. The nausea and weakness came over me too suddenly to do anything else. I couldn’t focus and even sitting down I felt like I might collapse. I made it over the nurses’ station and managed to ask one of the nurses to bring me my water bottle. She took a closer look at me and noticed my pallour and diaphoresis (sweating) and got me juice and wet wash clothes instead. They only take care of babies so they didn’t know what to do with a sick big person. I told them I needed to put up my feet and it was probably orthostatic hypotension and that it had happened before. “But it hadn’t happened since before May,” I thought to myself. They didn’t know about my lupus or my strokes. Only Emily did.

When she finished with the baby, someone had gotten me a cot and she wheeled me over on one of the desk chairs. I felt too miserable to feel ridiculous. Lying down helped me after a while. Emily brought me juice and a cookie and asked me about why this happened. I wanted to chalk it up to sleep deprivation and nerves. I had taken my pills that morning, so my stress hormone level should be okay. I had inhaled oatmeal breakfast just before the call to the cesarean section for the premature breech baby boy so my blood sugar level should be okay. I didn’t want to think it had anything to do with the many clogged vessels in my brain.

When I told her my mom had moved to town, she looked relieved. I said she’d moved down here after I got sick in May. After my brother had said, “Shawna shouldn’t be down there alone!” I texted mom to come pick me up. She came in worried a half hour later, by which time I felt better, and whisked me off to home and bed where I slept for a petrified six hours.

I used to feel worse about asking for help, or even about recognizing when I need help. In April, I let my headaches go on for an entire month before telling anyone about them, by which point it may have nearly been too late. I ask more easily now (on some levels). I know when I need help (sometimes). I ask sometimes. Mom says she considers it a gift to be asked for help. She considers it a gift to be able to give to me.

I still struggle with pride, which tells me I should take care of myself. I practice asking for help and feeling graciously grateful for gifts given to me. In frustration at times I still crave complete and total independence. I don’t want to feel obligated to anyone or indebted to anyone. I give with fewer qualms than I take. Taking, I feel exposed. Giving leaves me free.

In a pensive mood the other day, I wrote, “I can bear this when I do not bare. Give me sorrow, grief, work, pain, illness. But ask me not to give you mine. I can bear yours only if I do not bare mine.”

I continue to remind myself to give generously of my talents and time and resources. And I must remind myself that taking enables others to give. And that pride offers no cot or cookies or wet washcloths before a fall. I must remind myself to ask for help, to learn from my teachers, to cry to my friends, to love with my family. I must remind myself to let the world in, so that I can share some of its secrets and wealth with you before whispering into your ear, “Pass it on.”

0 Comments:

Post a Comment

<< Home