PE

No, not gym class. Pulmonary emboli. Clots in the lungs that prevent the oxygenation of blood. Really bad stuff I learned about in nursing school but didn't think would happen to me. Then again, why would I think that I *wouldn't* get them?

The week started out well, but in true Kara fashion, here I sit in the hospital at UCSF as a patient--not a nurse, looking through the fog at Golden Gate park, waiting to get permission to get off the cardiac monitor to take a shower. Yep, I need permission to bathe.

I went back to work Monday. I had a fantastic shift with my preceptor from my nursing-school internship. We had a great delivery, with a cute 9.1lb healthy baby boy. The poor mom ended up with a third-degree tear, which means that she ripped almost through to her rectum from her vagina. Ouch! Of course the delivery happened at change of MD/CNM shift, of course it was with a midwife who didn't feel confident to repair a third-degree tear, of course the mom was Hep B+. The baby had to have an immediate bath so that he wouldn't get his mom's blood into any of the injection sites from his initial medications or the blood glucose check (because he weighed over 4000g). I needed 10 arms because by the time the MD started doing her repair, I was already engaged in baby care. The MD called for a gram of an antibiotic to be given IV while I was trying to check the baby's vitals, she didn't think I heard her call, but I did and quoted it right back to her. :-) There are so many tasks to juggle and prioritize; delivery is probably the most stressful time, especially if there is any spanner in the works.

Despite the deluge, however, my beloved coworker and I managed to get mom and baby transferred to postpartum in just over the regular allotted time for recovery. This was great because 1. the patient had an extended repair, allowing for extra time anyway and 2. I remembered how to do my job!

Triage that first night back was filled with patients with severe psych issues as well as pregnancies; I was very relieved to have had a fairly straightforward delivery and not have had to admit a patient who sadly didn't know her own name--and not from substance abuse.

The second shift I took an admission and spent the evening with a lovely couple having their first baby. The census was low, so I didn't get a second patient--which I normally would, and if I had a second admission to do, I would not have been so calm and collected.

I was enjoying the groove and was all set to do another day of training on Wednesday with a senior RN whom I adore. She is intelligent, fabulous, and very laid back. But at noon I started to ache and get the chills. I took my temp, and it was 102.5. I was not fit to be around tender youth, and I abashedly called in sick. Really? Sick on day three?

Thursday I woke up and felt completely drained. I had slept poorly, and still had a fever of 101 as well as shortness of breath. I drove Callum to school, sloped home, and called my MD's office for an appointment. She has told me in the past that because I have no spleen, a fever has to be watched more carefully and I should arrange to see her. I couldn't make it into SF for any of her morning appointments, but was set to see on of the NPs in the office in the early afternoon. I took Finn (my lurcher baby) to daycare because there was no way I could exercise him properly, nor did I know when I would get back from the city. A triage RN from my MD's office called to check in, and she asked if I'd listened to my chest myself. I told her that I thought I detected diminished breath sounds in my right lung, so she asked if I could come in early for a chest x-ray to rule out pneumonia. I said I would, but promptly fell asleep on the couch and didn't awake until just before time to leave for my appointment. As icing on the cake, I forgot I had set my glasses on the floor and stepped on them, breaking the frames. Argh.

So I schlepped to the city, dragged my sorry ass to the office, and collapsed on the exam table. My heart rate was elevated, and I had a low-grade temp. The NP listened to my chest and said that she heard slightly diminished sounds on the right and sent me off for the x-ray. I walked slowly across the street, got the x-ray, and went back to the MD's office to await the results. About half an hour later, the NP told me that the x-ray was negative for pneumonia, but that the attending MD and radiologist thought with my history of clots that I should get a spiral CT scan to rule out pulmonary emboli.

By this time, I was EXTREMELY short of breath, had pain on inspiration, and just wanted to go home to bed. I reminded the NP that she'd told me I could have the CT done the next day. I felt myself pluning down the well of anxiety: I had brought no pain meds with me, I was at the end of my strength, and I had to drive across town in RUSH HOUR to the other UCSF campus for a CT? Now? But she was insistent that the MDs thought it best, and wrote me a note for work saying that I had the flu. She gave me a prescription for pain meds (how in the hell was I supposed to fill this in the next 40 minutes and get the CT, I don't know) and a broad-spectrum antibiotic. I was pissed and felt really angry at this woman--not entirely without reason, it turned out.

I found my way to the other campus and had to park the car in a huge underground lot and climb four steep flights of stairs to get to Radiology. Anyone who knows me IRL can attest that I am an active person. Climbing four flights of stairs is usually not a big deal. And yet I felt with each step I couldn't breathe and wanted to die. Flu, my ass. Chest pain is not the flu.

Got the CT, limped back to the car, and joined the thousands of other people trying to cross the Bay Bridge at 5 o'clock in the evening. Right before I drove past the last exit into the city, the on-duty primary care MD called. She told me that the CT indicated that I had both pneumonia and two clots (those pesky pulmonary emboli) in my right lung, and that I was to turn around and come right back to the ED. Keep in mind that I was partially delirious, not well oxygenated, and very tired. I asked if I could go home first to get some things--I was also worried because my phone was running out of battery. She said that no, my driving in the first place was not such a good idea and that I needed urgent medical care.

So turn around I did, and found myself fast-tracked into the ED. It helps to have problems related to airway, breathing, and circulation. I was admitted, started on antibiotics, and trains of people started to see me. UCSF is a teaching hospital, which is great, and also annoying when you tell the same story to 20 people all in a row. All day. All night. Plus my case is "interesting." You don't want to be "interesting" in a teaching hospital, but that's another story.

The house was full, so I lay on my ED gurney for 19 hours before being moved to my med-surg unit. Now I have a delightful 80-year-old roommate whose health problems eclipse the hell out of mine, but it also sucks to be with someone whose lungs make possibly some of the most revolting sounds I have ever heard lungs make, and who is incontinent. Every hour or two there's a team in here, cleaning up her and her bed. Not to minimize her problems, but it makes it hard to rest when lights are always on and people talking and clanking loudly and flushing the toilet by my bed.

I am on obligatory, continuous cardiac and pulse oxygen monitoring and cannot do much other than go to the bathroom by myself without a physician's order. And I am still sitting here, an hour later, waiting for permission to shower. Great.

My pneumonia appears to be resolving with the huge amounts of antibiotics that have been thrown at it, and I am now on increased dose of anticoagulant, to be administered twice a day. That makes TWO painful injections a day. The boys will be thrilled because I let them help me give myself the shots. Twice a day means that they each get to stab me once. No more punching each other over injection territory, I hope.

So I am happy that I didn't get a clot in my brain, that the clots weren't larger, and that I am not so bad that I am in the ICU.

I am unhappy that the NP diagnosed me with flu (!) and would have sent me home. And that the MD was freaked out by my driving anywhere, but the NP was having me tear across the city and tax myself. Looking back, I think hope that if it had been my patient with shortness of breath, I would have encouraged taking the shuttle, and telling her to wait for the results.

It gets me so mad to think about the flu diagnosis that I must not think about it.

In other news, no less painful or unpleasant than a PE, I finally spoke with my brother A about his plans for visiting me. He had cancelled in December, citing the reasonable excuse of pneumonia, but then after saying he would come in January or February, I had heard nothing more. I get so tired of doing all the work, and I'd decided to tell him that if he was saying he'd come only to please me, not to bother.

I called him with the courage assistance of IV morphine last night to check in after we'd played phone tag for a few days. He was polite and concerned about the PE, and we had a decent superficial conversation until I brought up the visit--except I didn't like to hear that he's not telling his son that the Christmas and birthday presents are from us. Yes! Let's poison yet another generation with lies. But I digress.

Our conversation got back to how busy he is. I told him that I'd been doing a lot of thinking about how one-sided our relationship is, that yes we were raised in different families but we need to be respectful of one another, and that I don't want him saying things to make me happy and then reneging. I would rather have no relationship than one that makes me feel constantly on edge and rejected. He said that he would come the last weekend in February. I asked if he wanted to come. He said he would come. I said that he wasn't answering my question. Sigh.

We will see. I will believe he's coming when I go to the airport to pick him up and he's actually THERE.

Why does being adopted mean that these relationships are often such a freaking mess, and that it's so hard to trust? Ah, that legacy of abandonment.

Then to add joy to this already surreal past few days, the hordes of medical students, interns, and residents either review my medical history orally in front of me or in the hallway, and it's of course peppered with "adopted" "adopted" and more "adopted." The reason I sit here, waiting for permission to shower, is because my body is a Newman body and is giving me Newman problems. But I am not a Newman by Newman standards.

There is no escaping this. Just no way.

The best thing about my hospital experience this time, other than the view out the window: I say I am in excruciating pain and people BELIEVE me. And give me wonderful drugs that make me just that little more relaxed so that I don't have to think about much at all.

Reunion, Part II

Several weeks went by before I dared contact my brother. I wanted to give him space, but my nerves were frayed by the stress of waiting. I knew that this was all new to him, but I'd been living uneasily with it for my whole life. 


I sent off a tentative e-mail to T and received this in response:


Hi K,

We did discuss the situation with C while we were visiting. She told us she gave you up for adoption, there was more to the story than the documents you sent me revealed as far as things being consensual. At this time she does not want any contact with you and would appreciate you respecting her decision. As far as A is concerned, he is still trying to decide what to do. He doesn't want to upset his mother and he has some other stressful things going on right now. I'm sure he will contact you when he is ready and let you know how he feels about the situation. A's father is not aware of any of this and C and A would like to keep it that way for now, I hope you understand. If you have other questions, please email me and I will help as much as I can, but I don't want to ruin my relationship with them either.

T


I wrote a respectful reply, but then felt increasing frustration and anger that my story and identity were being judged and held hostage. How was it that T now knew more about my birth than I did, myself? I sent another appeal:


Dear T,

I have been thinking for a few days about what is most important for me to know. Frankly, I don't think I could enumerate everything in an e-mail or in a telephone conversation. I want to know things about gestures I have, see pictures of C and her family, and hear about the personalities and histories of different members of my family.

I realize that neither A nor C feels able or comfortable providing this information to me, but I do feel that you and I have made a connection and you, better than anyone, can empathize with my difficult position. Likewise, I understand how much you want to support them, and I would not want to jeopardize your relationship with them.

Here is a proposal: if I visit my parents' home in the San Diego area one weekend early in December, would you be willing to meet with me over coffee, just for an hour or two? You could choose a location comfortable for you, and if you want to include A and/or C, that's fine. Or if you want to keep it between us, that is fine, too. I know that this puts you in an extremely awkward position, but there is truly no one else I can ask. I sincerely doubt that J [my grandmother] or B [my uncle] would be open to speaking to me, nor would C want me to contact them. I just can't see myself waiting another 40 years to learn things about myself that nonadopted people know as a matter of course; what A and C prefer is of course in my mind, but I will not sacrifice myself and my desire to know the truth in order to protect them.

To be honest, I cried for several hours after learning that you know more about the infant I was than I know myself. I am a person with feelings, not a clean slate without a past or natural family. This is a painful fact for everyone involved, including myself. I understand that it would be easier on A and C for me just to walk away, but I can't.

Once again, I understand that this is an extremely volatile situation, and that you are in a tenuous position. But I am imploring you, as you have been nothing but kind and respectful of how difficult this is for me. I hope that you won't immediately say no. Please take some time to consider this and the immense difference it would make in filling a dark hole I've been living with every day for 40 years. It's just not a hole I can fill by myself. Believe me, I've tried.

Best regards,
K


A few hours later, I received an e-mail from A:


K,

Sorry it has taken so long to return your e-mail and phone call. I have had a couple of very busy weeks at work and have not had much free time.

We had a nice trip and visit, thank you for asking. After approaching my mother she acknowledged your birth but I do not think she is ready for contact with you at this time. However, I am not against such contact and hope you and your family are well.

I will try and call this weekend sometime.

Thanks.
A

When he did call that weekend, he explained that he was being deployed to Afghanistan in February as physician to a battallion of Marines. A was clearly under incredible stress. He did, however, tell me that he very much wanted to meet me before his deployment. We made plans for me to visit him at his home in San Diego. After C's cold response, I was pleasantly surprised that he was treating me like someone who mattered deeply to him, and had made the point of inviting me to come as soon as possible. I tried to hold back my feelings and stop myself from caring too much, too soon, but it was a difficult battle. A seemed so much like me in the way he respected and treated me. I have rarely met anyone so warm and forthcoming. 

On the appointed day in December, I drove to A's house. I was sweaty and shaking, fearful that he wouldn't like me and that this would be my one and only chance ever to learn anything about my first family. When I arrived, he was outside barbecuing while talking on the phone. I heard him say, "Gotta go, Mom, Kara's here." I felt a chill, knowing that C was on the line. He hung up, then walked up to me, hugged me, and called me "Sister." It was one of the most profound and affirming moments of my life; he smelled and felt so familiar, and it was magical to be in the arms of my flesh and blood. 

Inside the house A showed me pictures of my family: it was strange for the first time to see myself in the people in photographs on the walls. I said to A, "I think I look a lot like our grandfather," and he agreed heartily: "Heck yes, you do!" I noticed that in many photographs C would stand with her weight on her left leg and her right leg sticking out at an angle, like Degas' statues of the little dancer. I do exactly the same thing, and my amom and others have tripped over my right leg for years. I thought it was a singular quirk of mine, but it turns out to be yet another way in which I am part of C. 

A and I drank (a lot), ate a wonderful dinner, and talked for hours. I discovered that my brother and I share so much in terms of our personalities and interest. I told him about the process of searching, my disappointments and successes in life, and how much his acceptance meant to me. He was empathetic and said that while he couldn't imagine what it felt like for me, he thought it must have been incredibly hard. I wept. He held me. I felt comfortable and relaxed with him in a way I've rarely felt with anyone else. We decided not to waste any more time without each other; there were 35 years gone, but the future together lay ahead. 

I cried when I later found out that he was initially equally nervous and worried that I wouldn't like him. It never occurred to me that he might be afraid that I'd reject him. 

The next morning he asked if my aparents would be willing to drive my elder son over, so that he could meet his nephew. They agreed. It was a little bit awkward having them together with A, but I was glad for them to meet. Callum, my son, played with A's son, W. They had a blast running and chasing and riding bikes. A and I talked about how much fun it would be to go camping all together. A hosted a football-watching party that morning, and one of his residents  (A's an attending at the Naval Hospital) was over with his girlfriend. While chatting, I asked how the resident had met A. The guest told me, and then asked me the same. I sighed, smiled, and said, "That's an interesting question." I didn't want to put A in an uncomfortable spot, so I deferred to his lead. A said, "Well, you know, this is my sister. I just met her yesterday." The story came out, A was beaming, and I couldn't have been more proud. He acknowledged me; it was clear that he thought of me as family. 

Our relationship blossomed over the next months, through his being deployed to Afghanistan. He called me twice in the week before he left, saying that one goodbye phone call wasn't enough. He said he loved me. He explained how our relationship put him in a difficult position with our mother, and he didn't know how he would explain me and my family to people when W talked about his cousins. He reassured me, however, that it was his problem, not mine, and that he was in this for the long haul. He told me how much he wished he'd had me around in childhood to protect him from bullies because he was a nerd. It warmed me deeply to feel needed and wanted. 

After he left for Camp Leatherneck, I wrote letters, sent packages, and anticipated and loved getting letters from him. He didn't let me down. I archived every scrap of paper he sent me. I learned that if he died, he had told his wife that he wanted me at his funeral. I cried to feel important to him in a way I hadn't had the courage to hope for. 

Reunion, Part I

The day after I sent the message to my brother, A, on Facebook, I received an e-mail from his wife. 

Hi K,

You have sent a few emails to my husband A about possibly being his half-sister.  We have both spoken to C [my fmom] about this and she denies having another child.  Maybe she just doesn’t want to admit it or she is not your birth mother.  Either way, I would like to know a little more about you.  How did you find out about A?  Do you have a picture of yourself you could share with us?  I know you saw our family photo on facebook, does A look anything like you (he looks a lot like his father)?  A is really bothered by this whole thing and is not sure what to believe so I am trying to find some more information for him.  Thanks and I hope to hear from you soon.

T

Here are our subsequent exchanges:

Dear T,

First of all, many, many thanks for being willing to talk with me. I understand that this is all very strange to you and A, and must seem that it comes out of the blue. I deeply regret causing A and C any discomfort, but this is something terribly important to me. I have been been searching for my family for 12 years, and my adoptive parents are aware and supportive of my search.

I was adopted in Missouri through an agency. If an adoptee searches through formal channels in Missouri, a confidential intermediary system is used. I went through this system; the intermediary twice approached C: once in 2000 and once in 2008. Both times, she was willing to provide limited medical information but nothing else. I did find out that I had a brother, five years younger than I am. This summer with the help of other searchers, I was able to find a match between my information, which included my name "Baby Girl Newman," and the family of W.N. Newman. I am attaching copies of my non-identifying information for you to read; they include a sketch of a family tree because of the spherocytosis. As I mentioned in my first e-mail to A, I have hereditary spherocytosis, which is an added layer of concern (my elder son has it, too) but also of identification. I found out about A from W.N. Newman's obituary, which mentioned C.

I would say that I resemble A in some ways, although this clearly subjective. I am attaching pictures of me and my family so that you can make your own judgments. We have two young boys and very few pics of us as a family, I'm afraid. I've made my profile on Facebook public so you will have access to those pictures, too. I also found some photographs of W.N. Newman, taken in 1954, online at ancestry.com, and I think I look like him, as well.

I would guess that C is still suffering from the aftereffects of having a baby out of wedlock, which must have been incredibly traumatic. It is easier to forget and deny than live with some truths. I have a friend, another adoptee, also born in 1969, whose birthmother took three years to come to terms with my friend's request for contact. C may never agree to meet me, and I must accept this as a possible outcome. But I am hopeful that she will change her mind and that there are other relatives of mine who might be more open to knowing me. I would love to have contact with A, if and when he is able. Please do not hesitate to ask me for anything, more information, whatever is desired. I would of course agree to a DNA test, if that is something A wants.

Once again, T, I cannot thank you enough for taking the time to contact me. It means the world to me that you are willing to go out on a limb and talk to a stranger. I know this must be very difficult for you, as well.

I am available to talk by e-mail or phone, as you desire. 

With great respect,

K

Hi K,

I shared this information with A last night and he is struggling with what to do next. There are a few details listed in the report you sent that do not exactly match the family history as we know it. I think the best thing to do is give him some time to absorb all that he has learned and decide how to proceed. I do believe he will contact you at some point because he has a hard time letting things go unresolved. I also find myself in a difficult position Because I do not want to cause ripples in our family, but you seem like an honest person just trying to find answers so I will do what I can to help. If he decides not to contact you, I will let you know. 

Sincerely,

T

A few weeks later, It was a typical, chaotic Sunday evening in my home. My two sons were distracted from dinner by a thousand things, the dog was pacing around the table hoping for handouts, and I was anticipating the nearing hour of bedtime with unconcealed joy. The phone rang. I jumped up, saw an unfamiliar number, felt my heart catch, and whispered, "Hello?"

The honeyed Southern drawl at the other end said "Hello" back. Then, "Is this K? Have I caught you at a bad time?" I knew immediately it was my brother, and my mind began to spin. I signaled to my husband to take over the circus at the table, reassured my brother that it wasn't a bad time, and escaped to a quiet corner. I was hoping that this call signaled his willingness to get to know me. 

We stumbled through niceties and coincidences. He is a physician, I am a nurse; we both have additional advanced degrees; we both are supernerds. It turned out that one of my closest friends from St. Louis was the sister of one of A's college friends in Mississippi. A told me that he thought that the dark, complicated story involving my birth would make a good novel. I felt frightened and hopeful and ecstatic, all at once. I couldn't be sure this was real. I wanted to know everything about him, and ask every question possible, in five minutes. My voice quavered and revealed my nervousness. I admired A for the courage it took to reach out to this sister-stranger, and for his apparent calm. 

My brother brought the conversation back to the reason for his call: "I have to talk to my mom about this. I have to make sense of it. I want to talk to her in person. I am going to be visiting her in a few weeks. I'll let you know what I think after I get back." We said goodbye.

I was more excited than I think I've ever been, but it was back to waiting. Waiting. Waiting. It could be weeks. The answer might be no. I was too afraid to think of it. 

Searching, Part II

In 2008 my hereditary blood condition, hereditary spherocytosis (HS), caused my spleen to enlarge, my hemoglobin to plummet, and I had to have a splenectomy. Shortly after surgery I ended up with a huge clot in the portal vein in my liver. My whole GI shut down, I couldn't eat or drink, and I was in agony. I spent much of the next month in the hospital feeling like an alien with two IV sites, tubing everywhere, four pumps, and a central line into the major blood vessel leading into my heart to feed me. I was wracked by pain, both emotional and physical. One day I Googled "adoption rejection" and discovered a richness of witty, insightful blogs, written by adoptees. I was excited and enthralled, reading and laughing and crying. Amazed to see things I'd always thought coming out of someone else's brain. I commented and reached out, relieved to find a community of like-minded people at last.

Adoptees are a stubborn lot, and I made new friends who are also search angels. Adoptees rarely take "no" for an answer from anyone, let alone a CI, and the angels were helping me search outside of the CI system. I had new hope, and I truly believed that the CI might have been responsible for my first mother's negative reaction. I couldn't be sure of what she'd said to her, or if my first mother even knew anything about me. I couldn't give up. On and off the angels and I searched, using the parameters of my known last name, my grandfather's recent death, and the geographical region. The angels asked if I was sure of the "Neuman" spelling. "Of course," I naively replied. Who would falsify a name on a legal document? Oh yes, my first mother. Yes, she did.

In the summer of 2009, Kinsolving Investigations found my first family in five days; they discovered and reported that I was really a "Newman." I trembled to have my first mother's name, address, and phone number. To know I had a brother. To read about my grandfather's colorful life in his obituary. I finally felt like a human being instead of a mythical creature. 

Subsequent attempts to contact my first mother, by another first mother and then by myself, proved fruitless. My fmom met me with silence, and the first mother with a calm, "No, I don't think I'll ever be interested." Repeated over and over. I felt empty and demoralized. I still didn't count. I was invisible. I decided to e-mail my brother. Silence. A few weeks later, I found him on Facebook, and screamed out loud. He looked so much like me! I wanted to touch the screen and connect with him. I sent him another message, introducing myself and hoping that he'd be open to talking to me. Then I waited.