Life Support

I am preparing to return to work after being on medical leave for nine months. I am excited and nervous, worried that I've forgotten too much, that I will be even worse at placing IVs, and that the crush of responsibility will wear me down in a matter of weeks. Being an RN means that I am the eyes and ears of the MD or midwife when they're out of the patient's room. I have to make quick judgment calls, ask for appropriate meds, and be alert and vigilant for 8 hours straight. I work in a high volume, high risk, high stress unit. Never a dull moment, which is both good in terms of learning and bad in terms of feeling like I am drowning. In my first month on the job I had a patient hemorrhage with an inverted uterus, a neonatal code, several fetal demises, and more than one emergency c-section. I am fortunate that I work with a team of exceptional nurses who support me; I am not completely alone, although there are shifts when we're understaffed and I might as well be. One such time there was no Advanced Life Support RN for the baby, and no resource RN at delivery. I had to dry off and assess the baby, do APGARs, and simultaneously get everything that the MD wanted for the patient (hang new IV bag, get sutures and lidocaine, etc.). THAT made me into a huge stress monkey. Too bad I don't have 10 arms.

Because my job often takes me to the OR, I have to be certified in Advanced Cardiac Life Support (ACLS), which is a fancy way of saying that I need to be prepared to run a code when someone goes into cardiac arrest. I have to recognize ECG rhythms, know which ones are shockable, which drugs to use when in what amounts, and how to delegate and check in with team members to make sure that my orders are being carried out as directed. It is pretty complicated, although there are algorithms to simplify things. I spent the better part of five days trying to remember heart medications and proper treatment for myocardial infarctions and stroke. I spent one day in a classroom going over the algorithms and being coached, and then on the second day, I had my big test, called a megacode.

I am a nervous person at the best of times. Polite people call me vigilant; less polite people call me jumpy. I am a perfectionist with a low startle threshold. I can forget to breathe. You can imagine what being in charge of a megacode did to me.

The tester usually began by asking where the team leader worked and what kind of job they did before coming up with a scenario. I was hoping that I would be asked, so that he could come up with some OB scenario in the OR or labor room involving bleeding out. That I can handle. But I wasn't asked, and my "patient" was a 38-year-old IV drug user, coming into the ER with heart palpitations and dehydration. I had my team put my patient on the heart monitor, checked the rhythm, and ordered an IV start and labs to check blood count, electrolytes, kidney function, liver function, and drug toxicology. The tester informed me that my RN was unable to start an IV, so I had to order an intraosseus (within the bone marrow) line. Then the tester asked me where I worked, and the paramedics and ER nurses chuckled because I had forgotten that toxicology screens have to be checked from urine. Oops. I didn't order a Foley catheter. Then I forgot to shock the patient immediately when he went into ventricular fibrillation. I guess I looked frazzled, because the instructor said, "It's okay. You're doing fine. Remember your algorithms."

I got back on track and passed. It was nerve-wracking, but having been in real codes that were less well handled, I feel as though I can contribute more meaningfully. I hope. Practice and faith in oneself really does matter. And in a real-life situation in the OR or labor room, I would NOT be running the code. Hooray for having three MDs in the OR and a code team to call!

Then I got to thinking about the algorithms. If you follow the boxes and answer questions, things are simplified. You know what to do when, if you constantly reassess the patient and make decisions based on that information. Very few people actually survive codes, but there is a best practice to be followed. That is reassuring.

It made me wish that there were some algorithm to follow when trying to sift through the complicated, clotted emotions that come along with adoption. There are theories (such as the primal wound, and modified Eriksonian crises), and there are examples (such as the interviews that B.J. Lifton published in her books) of other people's searches and reunions. But no adoptions are alike, no adoptees are exactly alike, no first mothers are the same. There is no algorithm for coping: we do the best we can, muddle through, and hope for the best. Sometimes I feel like I am performing CPR on myself, pounding on a chest in which the heart has stopped beating for lack of an emotional home. Sometimes I wish I could give myself epinephrine to give myself a better chance to reset my heart's nonperfusing rhythm.

Over the past few years, I've been given a lot of advice. "Say this, say that, never say that, don't contact, contact now, demand that, ask politely, give more time, show up on her doorstep," and so on. Problem is, there is no script to follow that works for everyone. We all have to write our own as we go. I remember someone telling me not to tell my fmom in a letter that I wanted anything less than her love, and that she had mine. Well, turns out that my fmom isn't the loving kind of person who wanted to hear such words. As she put it, "I feel nothing for you as a child of mine, but you are nice, and if I met you in the line at the grocery store we could have a nice talk. Let's work on a friendship like that." So I am a stranger--that's a given--of no more importance than someone met incidentally while running errands. I will take it, although it wasn't the reception I had hoped for. One step at a time, one step at a time.

Then I sink back into this terrible sense of feeling alone. I have an amazing family, loving friends, and I belong in many ways. I don't belong in my nfamily, at least not yet, and probably never in the way I'd like. How is it that I slipped down a rabbit hole and ended up here, where I can't enjoy what I do have?

Although I become annoyed by people who are so scientific that they cannot begin to understand or process human emotions, I do wish I could pull a card out of my pocket with an algorithm that outlined life support for me in more concrete terms than taking antidepressants, thinking happy thoughts, doing things that bring me joy, and surrounding myself with loved ones. It's these things, oddly, that often reinforce how alone I feel.

In ACLS, there are some rhythms that are shockable, and some that aren't. Can't shock dead, they say. They may shock a flat line on TV, but it doesn't restart the heart. There has to be the right combination of electrical activity, oxygen, circulation, and chemicals for that heart to pump.

Right now, I am not in a shockable rhythm.

ABC. Airway, Breathing, Circulation. Airway, Breathing, Circulation. It can keep you alive, but to what end? What is life vs. quality of life? Oh yeah, there's no algorithm for that one, either.

Demons

I have a wonderful friend whom I had the great pleasure to meet through adoption activism. He is creative, supportive, and very intelligent, although he would blush if I said this to his face or mentioned his name here.

He has been working enthusiastically and tirelessly to put together my Newman family tree. I have ancestors who fought in the Revolutionary War, and in the Civil War. They have lived in the same area of Indiana for close to 200 years. Talk about stability! I've learned about relatives who have committed suicide in various ways. I have seen some of myself in the stories of various lives of my relatives.

Then last night, my friend sent me a picture he'd found of C, her Senior Picture in 1969 that was taken for her university's yearbook. There she was. Pregnant with me. It was the first time I'd seen a picture of her and thought, "Yes, I do look like her." We have the same face shape, eyes, and eyebrows. I still look a lot more like my grandfather, I think, but there was no denying this time that I come from C.

The pain shot through me like an arrow, leaving burning, poisonous residue in the wound. Yes, I look like her. I already know that I share some of her gestures. What others take for granted, I can't. It's not even just that I can't: she doesn't want me to come near her, or ever to know her.

The more that time goes by, I become convinced that she either didn't tell my brother that she doesn't mind our having a relationship, or that she put a different kind of pressure on him. His silence speaks volumes. I cannot even begin to understand how people can treat family this way. He claims that he's upholding the honor of his parents; I think he's taking the path of least resistance and losing out in the process.

To compound my pain, I read some first parent blogs this week, and I noticed that in more than a few of them, their placed kids are all but absent. It's immensely triggering. How can these parents say that they love their children, and then keep them at arm's length, waffle about setting dates to meet with them, or refuse to tell their families about their placed child at all? How can married people with two kids already think it's a great idea to place kids number three and four in order to do "God's will" and provide children to those who don't already have them? I imagine the placed kids feeling betrayed by their first parents, and the kept kids wondering anxiously if and when they might be placed, as well. None of this makes sense to me. It seems so much like adoption double-speak in which the adoptees, as ever, are damned.

I've also been thinking a great deal lately about the burdens that some adoptees bear (which isn't to say that adoptive parents and first parents don't also have burdens, but my concern here and now is for adoptees). How do we get to such a place that our very foundations begin to corrode? Why are we told again and again that our mothers loved us so much they gave us away? It doesn't make sense in any logical way, and then for those of us who find mothers who really don't love us at all, it's a very cruel joke.

I ask, too, how I have descended to a place where death is preferable to almost all other options. I was reading an essay by Howard Kushner about American attitudes vis a vis suicide in the nineteenth century, "Meriwether Lewis and Abraham Lincoln," and was struck by what he wrote about Freud's conception of melancholia and suicide as ineffective, incomplete mourning for traumatic events. For mourners, the world is empty, but for a transitory period--they learn to cope; for melacholics, the world becomes a painful cypher because they have no ego, and thus their defenses to trauma are limited. They are marginalized because they don't have a stable sense of who they are or a way to filter what happens in the world. The unresolved grief felt by melacholics results in chipping away at the will to live, and increased self-hatred and anger at the deserting love object.

Sounds familiar to me. Here I am, mourning what I've lost, being told that I should be grateful and have nothing to mourn, and having my own mother tell me that she wished I had never existed. I am trying to pick up the pieces of me and put them together in a meaningful way, but it's incredibly difficult to forge new coping mechanisms from the ruins of a self that was thoroughly burned to the ground. It is a wearying task, after a lifetime of being bullied, devalued, called ugly and many other things, to find the strength to stand up to C, and everyone else who has tormented me, and yell, "ENOUGH!"

I am angry that I lacked the strength to stop this travesty long ago, and I don't want to let it continue. But it is a struggle, every day, not to give in and find my own peace. Seriously. I have my medication, friends, support, a loving adoptive family, and one ncousin who sees all that is good in me--but it is a tiring uphill battle in a world that sucks.

I have to keep reminding myself not to ask "Why?" and instead ask "How can I get through this?" One minute at a time. One freaking minute.

Dignity

I found a great new magazine in a store when I was visiting my friend this weekend in Santa Cruz. It's called "Whore!: Fast, Feminist, and Feminine." I love this on so many levels I cannot even begin to explain. It had quite a few thoughtful essays, and is definitely worth a read.

What caught my eye immediately, however, was a quote from Johann Wolfgang von Goethe. I tend not to like my husband's people all that much, with notable exceptions, of course. Goethe being an important one of those, along with a lovely group of German friends--all of whom except three live in the US or the UK. Enough said. Goethe wrote, "There is no art in turning a goddess into a witch, a virgin into a whore, but the opposite operation, to give dignity to what has been scorned, to make the degraded desirable, that calls for art or character." That's what's lacking in so much of adoption communication. Dignity and respect. There is not enough love, too much judgment, way too much sniping, and not enough acknowledgment of pain. I was thinking that so little has changed since Goethe wrote this, and it's shameful. Truly shameful.

My time with my friend Thomenon this weekend was wonderful. It is such a relief to be with someone who has known me inside out for 18 years. Who has been with me through thick and thin, who is loyal as hell, and who would take anyone on for me. Who speaks the same academic language that I do, and to whom I don't have to explain all my references. To laugh about our uplifting New Year's Eve in 2000 in which we watched both "Whatever Happened to Baby Jane" and "Cat on a Hot Tin Roof." He thinks I am Maggie the cat, which I take as a compliment. She suffered with dignity. He gave me a knowing nod, and said, "Yep, you're still driven by the literary," when he saw that I keep my subscription to the Times Literary Supplement current. We are both nerds and very proud of it. He prefers the term "intellectual," but I am happy with "nerd."

When I told him about how I have felt therapy wasn't helping me, and that I left each session feeling slightly discouraged, he gave a brilliant excursis on the limitations of empiricism in dealing with trauma, drawing both on Descartes and Stuart Smalley. You can't will yourself to feel differently inside. You learn to accept how you feel and integrate that into your life. Not that it's easy to do, by any means. He also pointed out that all my denial that I want the love of C is self-protection: I may say that all I need and want is my brother, but Thomenon is right. I *do* wish that C loved me. It's a huge wound to have your mother deny you and hate you. And yet that's my reality. I cannot change it. What I can do is try other routes and take care of myself as best I can. Although it's hellish right now, I feel more whole knowing about who I was born to be. While I argue with my brother's statement, "It just wasn't meant to be," because it's a choice, not destiny, I can't argue with how my brother and mother feel toward me. It simply is.

Thomenon and I also had a thoughtful discussion about therapy and how it can create a skewed power dynamic. The therapist is trained, has credentials, and should be there to guide the client through things, but too often they can abuse their position as a pulpit, offer useless advice, or just don't listen. I have friends who I know are great therapists, but there are plenty of them I've seen who became therapists to deal with their own issues, and are driven by insecurity.

I don't dislike my therapist, but I have left nearly every session wondering why I was there. I have seen seven or eight therapists in my life, and the "talking cure" hasn't worked for me at any juncture. I think my problem is that I need to have enough money to see a psychiatrist who is smarter than I am, but I can't afford such a luminary. So I am opting for peer therapy, medication, and retail therapy right now. Not necessarily in that order.

I did feel free to give feedback when I "broke up" with my therapist today, most of which was taken in good spirit. The only thing that truly annoyed me was that my therapist, although I corrected him numerous times over the months, persisted in calling me "Kare-ah." That is not how I pronounce my name, although I recognize that it's the more common pronunciation. I have stopped correcting people who mean nothing to me, because there is no point. When I am polite and redirect people, the majority don't take it in and compute it. It usually comes down to my friends fighting the battle for me, especially in classrooms, because they care more about defending my identity in public than I do. But in a therapist-client relationship, it should be about respect. Seriously. His excuse for messing up, week after week, was that he has a daughter whose name is pronounced "Lare-ah." Umm, okay. But that's not my problem. I recognize that humans make mistakes, but if you have a relationship with me and say my name incorrectly, I will note it if you don't take my correction and apply it. It means you don't give a shit. Yep. I notice, really notice. I used to want to jettison my name, not that I think it's terrible or anything--I like that my father chose it for me--in favor of my middle name, "Jane," which is hard to screw up. And yet I wonder if "Jane" were my given name, would people still eff it up? Probably. I have that vibe.

I have also been thinking about how, inevitably, when people are going through their shit, they tend to make proclamations about what everyone else should/shouldn't do in light of their shit; in other words, they are masking their own shit in pretty demeaning rhetoric. I read blogs and can tell what kind of crises people are having by their blanket proclamations. "Adoptees feel no trauma," yep, you got some. "Adoptees shouldn't say they love their aparents to fparents," umm, does your kid not love you the way you want to be loved? In competition with their aparents, much? "People shouldn't self-diagnose with PTSD, and if they are truly mentally ill, they are 'prohibited' from hurting others." Did someone tell you to move on, so everyone else has to?

That's why I admire people who live their lives with dignity, don't put their baggage on others, and support people where they are, without offering prescriptions or proscriptions. My friend Thomenon is one. My friend Lori is another. She has always taken responsibility for her actions, told everyone about the son who was *taken* from her, wanted him back with a vengeance, and has built a wonderful relationship with him. She told any man she dated that he had another son out there, and they came as a package. THAT is dignity. No excuses, lots of love.

Can't wait to see Harry Potter 7 at 12:02 Friday morning.