Friday, April 29, 2011

Septic Shock Newsletter Part III

There is no place like home!

Sharon returned home from the hospital late yesterday morning. She spent much of yesterday afternoon resting. She gets happy and weepy over the spring flowers.  She slept well last night and remains afebrile today (max temp of 99.6), which is a great relief. She is taking ciprofloxacin for her infection and oral pain medications for her continuing flank and bladder pain related to her large kidney stone and/or the large plastic pipe (stent) that is in place. She still has bilateral pleural effusions (Water in the space between lungs and it’s lining, the pleura).  She is sort of like an insulated thermal cup.  With the fluid and infection it is very important that she maintain her “pulmonary toilet.  This is a process of coughing, and positioning herself to assure that her lungs drain, get lots of air and do not become infected.  She practices inhaling deeply using her inspirometer, which she named “Steve, Too” after her brother who is an  unrelenting and effective advocate that this breathing stuff is a priority activity.  Fortunately, it fits in with great yoga techniques too and is good for all sorts of ailments. 

Today she was eating meals at the dining room table and had  visitors and calls. Her appetite is good and to raise her serum albumin and iron she has relaxed some of her eating practices (Happy meat and plant based diet).   She appears to have lost most of the extra fluid that she accumulated during her illness. People are not as inclined to call her “lumpy” or “sausage girl”. I am not sure anyone was ever brave enough (except mayber our children) to ever call her that really.   It appears that she will not need to take more diuretics at this point.  During her last day in hospital her body decided to sweat — a process called diaphoresis. She sweated at least a liter of fluid off in what she says was like the worlds longest hot flash. No one is entirely sure of the mechanism for this but at one point Sharon said that maybe her body was wise and decided it needed to increase the loss of fluid or alternatively, her body was responding to seven solid days of adrenaline. When they were all pondering this she said “I don’t know, I have been a little stressed”. This was met by silence and then followed by a hearty laugh all around.

Sharon and friend Margaret Caudill-Slosberg were reflecting on life in the hospital and she wondered about what could be learned from a qualitative study of the language used and names applied to a patient as a reflection of how sick they are. Sharon says she was called honey, sweetie and dear for 4 full days and only when she was mostly out of the woods and on the road to recovery did people begin to use her name. Maybe this is something woordle or the like could illustrate — if not for science at least for fun.

It is hard for her to be home and not be involved in all the things she normally does here. She is a slow moving guest trying to keep her whims within reason and yet not forget to ask for help. I am deeply grateful for all of the offers of support and help with grocery shopping, garden clean up, and dinners. On day 3 of Sharon’’ illness I came down with an impressive sinusitis and upper respiratory infection which has been annoying and persistent. Perhaps I have been stressed. Sharon likes to have me around for naps being someone seldom inclined to take them otherwise. We turn into a puppy pile (with cats).  We have not had to send Natalya out with a bow and arrow yet due to the largesse of our friends and family. Morgan has even offered a mercy visit home next week sometime.

Tomorrow morning, Sharon has an appointment with Dr. Nisbit, the urologist, to discuss surgery to remove the stones in her left kidney. Based on our meeting with him yesterday morning prior to Sharon’s discharge, its possible that she might have the surgery next week. We will continue to make updates available on the blog and please feel free to share them with others and leave comments and suggestions. Good articles, books, podcasts or entertainment shows are all of interest. 

Understandably our friends are shocked to learn of our latest adventure. They just turned away for a moment and next thing they know the whole shooting match has gone crazy.

Stay in touch, thanks for your kindness to our family and enjoy the spring.

Tuesday, April 26, 2011

The Septic shock newsletter Vermont

Part II

The Good News continues. Sharon is no longer on any intravenous medications, and she no longer requires any supplemental oxygen. In fact, there is even talk of her going home tomorrow, but we are not holding our breaths yet! She had a shower earlier, which she was able to handle by herself, and she is walking independently—though slowly—around her room, showing more strength and stamina than she did yesterday. Everyday another body system seems to come back online, allowing her to dispense with a tube or monitoring system.  She said that the shower reminded her that a physical body can be a source of pleasure particularly if you add warm water.

Natalya and I came into visit Sharon this morning, and I am back this afternoon, while Natalya is studying. Natalya has been taking care of all of the animals at home and many other household chores.

News flash! Dr. Rousse, the hospitalist taking care of Sharon today, just stopped by to chat. All systems look good, and he plans to discharge her tomorrow morning, assuming no setbacks overnight. Sharon’s platelet count is now normal, her lungs sound good, and her albumin—a major protein in the blood stream that reflects liver function and nutrition—is up to 2.6 from 1.9 yesterday.  Her white blood count went up a bit today, but there are no longer any “bands,” a kind of white blood cell signifying acute infection. Sharon has less pain today and less edema in her legs, feet, and abdomen.

Sharon keeps editing my words of enthusiasm, commenting that although her edema is better she will continue to take some diuretics over the next week or two.  She says that she feels a bit like a “tide pool” or estuary, and that has been at high tide for awhile.  In fact, while we are cheering how good she looks, she notes that she feels more bloated than she when she was 9 months pregnant and that she feels decidedly bovine.  Yes, she is thankful that her pain is diminished, but she has spent the last 7 days with at least a couple of major events involving what felt like a Mac Truck driving over her, some howling, and a lot of morphine. She experienced the first few days semi-consciously and, therefore, finds such optimism an act of great faith.

All your offers of support and encouragement are greatly appreciated. She does want to note that the number of people who say they have also had kidney stones suggests that someone needs to do an epidemiological study.

That’s it for now. Hopefully, the next update will be issued from home rather than the hospital.

Gib (with commentary by Sharon)

Feel free to comment on the blog site and Sharon will get the comments or via email.

This is the picture we put on the wall of Sharon's hospital room


Monday, April 25, 2011

The Septic shock newsletter Vermont

Posting from Gib
"It’s been a rough week for us in Vermont, but fortunately it is now much better.

Last Tuesday (19 April) about noon, a large stone in Sharon’s left kidney—Sharon has a history of kidney stones—moved so as to obstruct the flow of urine from that kidney into her left ureter. That blockage caused an infection in her kidney, which later that same day spread to her bloodstream, producing a condition known as “sepsis.” This in turn resulted in a drop in her blood pressure and the loss of fluid from her blood vessels into the surrounding tissue, a condition known as “septic shock.” Sharon underwent emergency surgery early Wednesday morning to open up the blockage. This was done by inserting a small plastic tube—a “stent”—from her bladder through her left ureter to her left kidney. Although the stone wasn’t removed, the insertion of the stent allowed the infection in her kidney to drain. After surgery, her blood pressure remained unstable for several hours, and the hospital staff worked heroically to keep up her blood pressure and prevent further complications of septic shock. By Wednesday night, her blood pressure was reasonably stable, but she remained critically ill. Thursday through Saturday, she gradually improved, and by Saturday night she was well enough to be moved from the intensive care unit to the medical ward at the hospital. On Sunday, she continued to improve and was able to stand unsupported and do most basic tasks by herself (eating, washing, dressing). Fortunately, it does not appear that any of her organ systems sustained any significant long-term damage, and she should recover fully from her ordeal, although it will take several weeks for her to be back to normal. She will still need surgery to remove the stone, so that a similar event doesn’t recur. This surgery will probably take place in early May.

Today (Monday, 25 April) Sharon’s condition continues to improve. Hooray! She has no fever, her blood pressure is normal and stable; her platelets (important for stopping bleeding), which had been low, are increasing; her white blood count, which is indicative of infection and was very high, is closer to normal levels; and her lungs remain clear, although she has some fluid in the space between her lungs and her chest wall. She is now eating (and enjoying) solid food and is up moving around to use the bath room. All indicators are positive at this point. The foci of treatment at this point are keeping Sharon’s lungs clear and free of infection, reducing the edema fluid that she accumulated during her crisis, and reducing her pain and discomfort from the kidney stone.

This afternoon, I am well enough to contribute to the narrative with Gib. I think of this as the septic shock newsletter and there are a few themes:

1. First hand experience is updating my medical knowledge. All things are connected. The theoretical interactions learned in medical training about fluids, electrolytes, platelets, infection, shock, are amazing. Personally experiencing these terms from my bedside while floating in a spiral fog will take awhile to absorb.

2. The body exists in the moment, in here and now. I crashed into the moment with identical body time, thought time, and emotional time via severe illness, and I am stunned with gratitude.  The kindness of my brothers and sisters-in-law, Abdi & Hassan Iftin in Nairobi (see post about this story! Abdi escapes Somalia) , Gibs' family, and friends such as Mel and Rodney Reis, who knew  what was happening and kept track of our crazy course with support and encouragement is overwhelming.  I kept sending out little messages via Gib saying "hold us in the light," and the notes came back and they helped.  Wednesday night I believed I would live, and I listened to the weekly webinar on "the body" by Clarissa Pinkola Estes in my ICU room.  I had dreams about that community of people and their support that night, and it was a rich source of connection between before and after. (See Sounds true: Clarissa P. Estes and The joyous Body

3. In keeping with "health through imagery" (Health through imagery) I have commented on and critiqued all pictures around me, and people have been very patient with me.  The images in our environment matter-- I have asked Gib to link to two favorite pictures. First, is the trio of barn swallows (Hirundo rustica-- thanks, Mom, for a name I would never have known otherwise) sitting on the strand of barbed wire at evening time. I hope to donate it to NVRH  when I leave here. It would look so good on the wall in my hospital room.   Tres Barnswallows

Second, Ecola Bay State Park and the Oregon Coast. This is a favorite -- the sea air, the sunset, the sound of water on rocks, and wind comes fresh and fully to mind.  Ecola Bay, Oregon Coast

4.  It only hurts when you don't laugh. I have named my spirometer (the little plastic toy-like object for maintaining lung function) Steve Too after my brother Steve, who calls each day to remind me to BLOW BLOW and Blow.  Natalya left me with a drawing on a white board with numerous sayings, including "Never give up never surrender," and humorous greetings from our pets.

My husband is amazing.  I knew how sick I was by watching his face.  His wonderful and even his most irritating trait have wound around each other  into an indistinguishable collection.   He has done so much to help me survive and want to survive than I can say.

I shall leave this to Gib except for the last line about him.'
Love to all"

Sharon (and Gib)

Sunday, April 10, 2011

Our voices our stories: Abortion


First Person: Your Voices, Your Stories

“I wish we could offer each other the kindness of respectful listening.”

In 2008 the radio program "On Being" (formerly "Speaking of Faith") asked listeners to write to them about the topic of abortion.   I was moved to respond and now they are updating and re-airing the program they have selected among the comments offered, and mine was posted on their main page.  Check it out.

Our voices: About abortion and how we talk to each other

Moreover, not long ago, Jane Flink sent me this story as part of a conversation we had on the topic of abortion.  One of the wonderful things about it was that I had no idea what her opinion was and so I had to listen carefully and open my mind.  Another wonderful thing is that the story is full of forgiveness.  That is always a good thing when important issues are being discussed.  So, I include a link to her short story.  It is excellent and its is called "God has a good idea"

God has a good idea: Many voices of women

I believe that we must move the topic of abortion back into dialogue, particularly among women of all ages and tell each other our stories and what is in our hearts.  It is a topic so laden with emotional meaning  and political significance that it has become unspeakable.  This sense of danger is often a sign that an issue has become wholly symbolic and is no longer connected to real peoples' lives.  Reductionism has occurred and this is a great pity because polling from many sources show that almost 80% of people agree while only 20% of people are in conflict. This is where the media and our fear of conflict collide to make a difficult situation worse.  I think there is more agreement and forgiveness than we know.


Thursday, April 7, 2011

Paths- Abdi flies - escape from Mogadishu

Abdi and Hassan Iftin in Kenya
This is in the category of one the most gratifying things I have done.

Late last fall I was introduced to a young man living in Mogadishu Somalia by a Public Radio program called "The Story".  It was an episode from a series called "Messages from Mogadishu," and he was reporting as a covert citizen journalist, known only as Abdi,  he was risking his life to tell us about life in Somalia.

I was moved and left with a fierce concentrated activation.  I wrote to the radio station to thank  Dick Gordon and his staff and I offered to help Abdi in some way if I could. I didn't have anything specific in mind.  Abdi and I were connected by email and began a conversation that continued through the early winter and by Christmas it included our  middle school science class who helped to create video messages for him which we put up here on the blog.

I enjoyed these email conversations  enormously. We ranged across all sorts of topics and in time others were included to enrich the conversation.   But at the core there were four of us -- Abdi in Somalia, his brother Hassan in Kenya,  my friend Ben Bellows in Nairobi, and me.
We evolved from a loose social connection, to a a bi-continental learning group, to a kind of family and then, ultimately, a swat team.

Abdi's messages were becoming increasingly alarming despite his understatement and wry humor.  He was getting direct warnings and veiled threats.  His pictures were galling, dismemberment, fear in every mundane act.   It seemed inevitable that his luck would run out even if no one discovered his reporting for the international media.

By early March he decided he needed to leave Somalia and it seemed wise. The four of us went into full alert.  We researched and explored the options until we had Plan A and B.  We had to be very careful about the information that went to Abdi would not put him at greater risk.

Together we created an underground railroad, a freedom path, a logistical machine.

For nearly two weeks it was an obscession.  I followed his steps through the streets of Mogadishu  and I could taste the danger. The three of us on the "outside" were exploring options and determining what could work -- constantly on the phone or email updating our information. Then we decided on Plan B and were making specific dates when we learned that Abdi's house had been bombed. Forunately, he was shaken, but alright.   Hassan was beside himself and I got the call at a rest stop in New Hampshire, and Ben was on the road in Africa Our messages zinged back and forth between continents. The four of us fretted through the details and moved the dates up for an urgent departure.  I had butterflies in my stomach representing little mementos of his real fear and loss.

And, last week our collaborative logistical machine delivered. It picked up that young man and delivered him free of the war.  Last weekend he made it to Nairobi his voice was filled with amazement and joy.  As we waited and then heard he was safe I kept getting rushes of excitement and the urge to run around in circles.  I am very proud of all us and I break into spontaneous smiling every time I am think about it now or hear from one of them

Please listen to the audio link from "The Story" where Abdi and Hassan tell Dick Gordon and Cori Princell in a live interview at the BBC studios in Kenyaabout the details of his escape .

Listen -- The Story: Abdi flies from Somalia

Now every day he doesn't have to wonder if he will see some awful thing or lose his life. What he has seen is unimaginable.

He has been "given" (and made for himself) the chance to start again.
It is amazing and giddying and overwhelming to be part of a fresh start.
Lord knows that starting again is a great chance and there are thousands of young people all over the world that deserve the opportunity.
But it is not fair. If his life had not been hijacked Abdi would be miles along by now in his path and so would his brother Hassan. they are smart, talented and extraordinary young men.  I know that if my children had to start over again at 25, I wouldn't only be grateful, I would be frustrated too. Being a refugee is actually not a fresh start because you cannot legally work or go to school. It is simply a chance to be safe-- which is not simple and it really matters.  We celebrate this first step in his fresh start but have no illusions that the way forward will be easy. 

Abdi shared a picture he took of his mother on the day he left.  She is one of the heroes of this story.  Her love and courage is breathtaking and an instinctive act of normal motherhood. I am glad to say that yes indeed, he has been able to call her and tell her he is safe.

Abdi and Hassan's mother
I hope when you hear this tale that you will be reminded to leap sometimes.  Don't talk yourself out of doing something kind and maybe a little different.

If you want to learn more about Abdi or Hassan or contribute to their fresh start, all well wishes, seed funds, or connections are welcomed.  Check out additional episodes of their story at APM "the story" in "Messages from Mogadishu"-- messages-from-mogadishu.   It is well worth it.  

Peace and thanks for letting me share this big moment


Tuesday, April 5, 2011

Paths and transitions-- Symbolic but not always serious

" When you come to a fork in the road....Take it " 
--Yogi Berra

A good reminder about choosing our path by contributor Jane Flink  

Friday, April 1, 2011

Path series & transitions- a gift contribution -- #2

Contributed by Julie Hansen
Julie: Sharon, I like the paths blog. There is a poem that Emma wrote that I thought of it right away.  
It's a gardening poem about growth, but the growth is life as well as flowers. 
Sharon:  I do like the poem and a lot. I look the liberty of adding in specific pictures to illustrate ideas that came to mind... the amazing face of the female snapping turtle-- ancient, wise, kind, fierce and a four season series that I have always loved.

Female snapping turtle works to fit through fence into field on her way


I can see you now,
eyes closed and arms full
of flowers, still dripping dirt,
roots lolling around your fingers,
as I look out through the kitchen window.

You told me the names of the flowers once,
but I can never recall them,
and I suddenly have the urge to ask
you what they are,
because I don’t want to keep forgetting.

Your glasses have slid
down your nose just a bit,
and it makes you appear much older
(perhaps older than I’d like
to admit you are).
I can see your mouth open,
sighing with the strain of age,
as you stand to survey your work.

You take a breath, eyes gazing,
a sense of accomplishment draped
across your squinting eyes, and your half-open mouth.

I can see you now
lean the rake against the tree,
the sun dipping into the mountains behind you,
and I commit this image to memory, because I am terrified
that one day I’ll forget it.

       ---Emma Hansen

Female snapping turtle makes her way across a field, close up
The path through the woods from the garden in all seasons- a circle without ending that always includes renewal