Thursday, December 23, 2010

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.

Sunday, December 12, 2010


I had the wonderful experience this week of having lunch with someone I greatly admire and whom I hadn't seen in 14 years. We were in grad school together back in the dark ages, and she always made me smile, even though we were in a bloody shark tank. She is brilliant--one of the smartest people I know, but like me, she is often loath to bring attention to it.

As we sat together and talked about the time we spent together from 1992 to 1996, we discovered even more things we had in common. Academic faux pas we had made, how we often felt we had nothing to contribute to conversations when we were around certain people, how the cliquishness and back-biting were beyond belief in the magnitude of their cruelty. I walked into the department sight-unseen, coming from an undergraduate college where students were always encouraged to think independently and develop their own interests, rather than groomed to be clones of professors. My friend had been an undergraduate in the department and decided to stay to pursue an M.A./Ph.D. Graduate school is murderously feudal: basically it's indentured servitude, with your adviser controlling your finances and future. If you are unlucky in your choice of adviser, you are pretty much screwed. Especially when your adviser is not the strongest player in the department or field at large. The 10 years I spent suffering there was definitely not the best time of my life, although meeting a certain handful of people and having unfettered time to read and research came closest to making me feel at peace with myself.

I remember writing my M.A. thesis, on a topic that I really loved, and getting wonderful feedback from this friend of mine. Her field was ancient art, which had been my focus for my B.A. Classical scholars tend to be very focused, with photographic recall of thousands of ancient texts. I definitely do not have the same access, nor did my friend. We were quite green together, and having her with me in seminars and lectures was lovely.

She is also 10 years older than I am, and I appreciated her maturity at a time when I was all over the map with myself. My 20's were definitely a lost period in which my adoption baggage was compounded by self-hatred from feeling all at sea in graduate school. The unwanted adoptee advisee.

When my friend and I were talking on Friday, she said that she sees me as more mature (one would hope) but very much the same in terms of my interests, openness, and sunny personality. When I told her that the personality was a mask, she was stunned. She listened to everything that's been going on with such love and support. It felt comforting on many levels, and I do hope it won't be 14 years before we see each other again.

Some comments she made about me being the same have fueled introspection. I've been trying to figure out what parts of myself are molded by my aparents, and which are genetic, from my nparents. Then I realized I forgot a something big, something I often forget: there is also the variable of ME. Some things are just me. I am not a clone of them, just as I had a bad time in graduate school because I refused to be a clone of anyone.

When I was talking to C about the curious way I stand with my right leg out at an angle, it makes sense that I got that from her. She agreed. She didn't agree that she passed along her facility for languages to me. She doesn't believe in genetics for things such as interests and talents. I told her that my aparents aren't into languages the same way that she and I are. She pointed out that her parents weren't either. While I disagree with her about the genetic component of language skills, I do see her point about reading too much into genetics. After all I am a intellectual, latte drinking left-winger who lives in the Bay Area. My nfamily is Republican and conservative, dyed-in-the-wool.

My amom was an English teacher and a stickler for good grammar. Rightly so. I write well in part because of what she taught me, partly because I do so intuitively, and partly because I have done quite an apprenticeship in thinking and writing over the years: from daily writing assignments at my high school that had to be corrected and corrected and corrected, to crafting my Ph.D. thesis in painful increments over five years.

Surrounding myself with smart, witty people was probably also a helpful act. People who love me, warts and all, and who know me inside out. It never stops amazing me that I have such compassionate friends who let me know how much I mean to them. I understand that most all people deserve love, but I just can't get over the hurdle of accepting that *I* am worthy of people's love. I seem to keep reaching for those green figs on the tree that are out of reach rather than enjoying the rich bounty of what I have. Regret and self-doubt are terrible, destructive vices.

I am stumbling around trying to deal with the fragments of myself I've been collecting. I feel like I have discovered increasing numbers of these fragments, sometimes in unexpected places. My current task is to try to reassemble them in a way that is meaningful and helps me feel less anxious and depressed. I know I will never feel complete, and the cracks will always be there, but sometimes imperfection has its own beauty.

Sunday, December 05, 2010


Trust is a precarious thing. I like to believe that I see the good in people until they prove me wrong, protecting myself as much as I can in the meantime. But still, there are people who beg for second chances and trust, but who don't deserve them. They may be wonderful people--with others, but not with me.

Of course, being adopted makes my trust baggage even worse, but there comes a time when enough is enough.

That's all I have. I can only take care of myself, and for now, that's taking as much energy as I can muster.

I think I feel betrayal all the more keenly because I try--although I am not always successful--not to betray others. I can think of some pretty awful things I did to people as I was swimming blindly in my late teens and early twenties, just trying to find myself but not knowing how. Knowing that I wasn't getting enough out of a relationship, or even the right thing. Letting others abuse me, but being passive-aggressive and hurting them back.

I think one healthy thing is that I have at last discovered my bottom line. There are friends of mine who aren't there for me always when I need them, but I know they love and care for me. I trust in their friendship. Then there are those who say they want to be there, but only do so to use me. And they think I don't notice. Well, I do.

I wish it didn't burn as badly as it does. It hurts, but it does feel better in the end to cut people out than to question their commitment to standing by me as a friend, no matter what.

Thursday, December 02, 2010


I am not one usually to run out of words. I have been known to be quiet and withdrawn, but the events of the past two days have truly knocked me sideways.

I have been deeply depressed. This is not news. I have been fighting my health problems and feeling suicidal for over six months. I have been suicidal before, but I usually stuffed my feelings down and made it through by making myself numb. I have lived most of my life appearing cheerful, but feeling like a zombie inside.

On Monday night, I finally decided that if I was going to die, I should tell my brother how very angry I was with him. So I sent him a text that basically said that I was sorry I was born and caused such misery to everyone in my nfamily, but that I had expected more from him. Thanks, but no thanks. He won no prizes for being a gentleman.

Shortly after I sent my text, his wife called me. She had refused to answer an e-mail I had sent her last September, and she had left me high and dry after my visit with her in April, after she moved in with my nmother. I picked up, and she asked if I was okay. I said no, I wasn't. She then said that A (my brother) would call me when he could get out of the lab. I said fine, and then told her that I had been horrendously betrayed, that I didn't trust her, and that basically there was nothing left to say. I hung up.

A called a bit later. He asked if I was okay. I said no. I also told him that I was really angry that he hadn't answered my e-mail in October, or bothered to tell me that he had made it home safely from his tour. He said that he was tired of being in the middle (as if *I* put him there!) and that no one in the family was going to have a relationship with me until C and I worked it out. He had told my cousin to stop communicating with me; I had suspected as much when my cousin stopped responding to my texts and messages. The straightjacket of such an arrangement insisting on complete family harmony made no sense to me on multiple levels: I wasn't doing any of the obstructing, and why can't adults have relationships with other adults without the blessing of everyone on the planet? I brought up how honoring thy father and mother doesn't mean committing murder; where do you draw the line? He asked for some time to think, then said he'd call me back. I answered very sarcastically, "When? Six months? A year from now?" He told me he'd call me the next day, and call our mother that night.

I felt sad beyond measure yet again. I really had done nothing but be born into this family of people I couldn't begin to understand. I wasn't asking for anything more than friendship and respect. I cried, lay in the fetal position, felt more alone than ever, and wondered what in the hell I had done to deserve such treatment. And sadly, this kind of thing is not foreign to me, in love relationships, friendships, and otherwise. You'd think I could find a pattern in myself and fix it, and I've tried, but there is no way I could have created this situation with my nfamily. If anything, my problem is being stubborn and not letting go, but I think I hold onto things for a reason.

So I got the kids ready for bed, took a Xanax to help me sleep, and woke up at midnight with my body and emotions in a knot. I checked my phone and noticed that C had called me. Great, I thought. I am going to get reamed again for contacting someone or upsetting A.

The next morning, I was getting the kids ready for school and saw that C had called again. I couldn't pick up because I was too busy tracking down shoes and jackets and homework and trying to get Tobey to brush his hair. I had an appointment right after I dropped off the kids, and hashed it over on the phone with a friend who is trying to get over a breakup. He advised me to do as he is trying to do, simply to walk away. But I couldn't, I just couldn't.

I got home, arranged myself with Kleenex, a warm blanket, the dog, and the phone, and then called C. She picked up immediately and began to ask what was wrong, why I felt so bad, and what could be done to change it. I told her that I'd been unhappy pretty much all of my life, stumbling through it, never valuing myself. I asked her the three questions I'd forgotten to ask last time: Did she hold me? No. Did she name me? No. Did she listen to Edith Piaf while pregnant with me? No. We talked about how she was drugged for my delivery and doesn't remember anything of it. She was horrified to learn that I'd been in the NICU without a primary caretaker for six weeks; she'd been promised I'd go home with a family right away. She was angry to learn that the agency had lied to my parents about her prenatal care and about my father. She told me about hiding her pregnancy so successfully that she did her whole semester of student teaching and no one noticed. She told me about the day she screwed up the courage to tell her parents that she was pregnant with me.

Our conversation flowed for over an hour. She wanted to know about my parents, my childhood, my experiences. We joked about how we both suck at housework and would rather read books. How we're stubborn and good liars. We compared medications for depression, she asked about my boys, and we talked about how marriage is really hard. I told her that I'd left flowers for her father, and she was happy that I had done so. I asked why he had no flowers while the other family members in the cemetery did, and she said that she kept meaning to do it on her visits, but never got around to it.

At one point she said, "This is a nice conversation. Look, we can talk without yelling at each other!" I agreed. She said that she didn't feel like my mom, but that she would be interested in pursuing a friendship. She encouraged me to call her if I felt sad. I really *want* to talk to her. We do have a lot in common. It was so odd but wonderful to have shoved all the garbage off the table and to be able to interact just as people.

She told me that she had told A that she had no problems with our relationship, but that he insisted on this whole family reconciliation thing. She told me that she'd call him to clarify, and she told me to text my cousin saying that I'd spoken with Aunt C and that she was absolutely fine with him getting to know me. My cousin texted back and said, "Thank God! What a load off." C explained that my aunt and uncle want to approach me, but aren't quite ready yet. I think it's a relief for C now that everyone in the family knows. We can move ahead, take things slowly, and be friends--I hope. I never thought I would be able to say that. It feels wonderful.

A and I are figuring things out. I was so angry, angrier than I had originally thought I was. All those months I fretted about having him back in my life and wondering what I'd done--while knowing I had done nothing except exist. The enormity of his betrayal ripped me to shreds. It will take a long time for me to be able to trust him again, although I really want to get there. I asked him if he'd come visit me so that we can spend time together and reestablish our footing. He agreed, and will hopefully get up this way the weekend after next. My boys are thrilled: Callum said, "I think Uncle A owes me an apology, but then I want to hug him." Tobey just said, "I can't wait to meet him and show him all my Lego. And thank him for Alfie [the Elf on the Shelf A gave the kids last year]."

A assured me that he feels terrible for what he did, and that all of what happened was because of the situation, not because of me. Sound familiar? Oh yes, the situation that *is* me and for which I get punished, over and over and over and over....

But mostly I can't wait to hug him and cry and be happy that he's home safe and sound from Afghanistan. I also told him that he's too Southern and military and has to stop saying, "Yes, ma'am," to me unless he's teasing me as my little brother. I am too young to be "Ma'am."

So things are better, I guess, although I can't decide if this is actually my life or I woke up as someone else yesterday.