Keep Breathing

 

It's been a week since my tilt-table test. Finally heard from the neurologist today. I'd be a lot more pissy about that delay, but the doc was so amazing that he won my heart.

Monday is my day off, so I was sleeping in when the phone rang. The doctor had a cancelation and there was an opening this afternoon, if that wasn't too short notice. I made "Joanne" her repeat the appointment time and the doctor's name several times so I could get the information in my phone through bleary eyes. Got up. Had a much-needed shower, and found socks and underwear without holes in them, (for Mom.)

During my meditation this morning, I noticed the economy of breath. Breath is balance. We take away, and we give back. I breathe in life and breathe out what I don't need. The air that comes into my body dissolves into elements my body can't function without. The air that leaves dissolves into elements that support the life around me. In a real sense, each in-breath is a new birth as my body is renewed and restored, and each out-breath is a new birth as the world around me receives the gift of my life.

These are the things that drift through your mind when you are sitting quietly in the morning with a cat in your lap and your mind on... well... breathing.

Morning chores, yada, yada, yada, take out the trash, gas up the car, drive across town, and register at the Clinic to meet yet another new doctor. Drop the "Specialist" co-pay which could have purchased me a ticket to a decent musical at the Opera House, and make my way to the waiting area for Neurology. 

Find a respectfully remote chair, (will I ever be around strangers again without thinking about "safe social distance?) 

Breathe.

I sat in my comfortable chair, feet flat on the floor, hands folded across my lap, palms up, "like a beggar's bowl," my priest used to say. I was facing a window, and tried to find a soft focus for my eyes by gazing at a smudge on the glass, but soon, that seemed kind of fake to me, like an old white guy in his first yoga class. I noticed that I was breathing smoothly, though my heart was beating hard enough to notice. On either side of me were elderly couples - sick men and the women who loved them, from what I could tell - with two cell phones and four canes between them. I found myself wondering how long they had been together. What was it like to be so old and so connected to another person? I was jealous, sitting there alone on a gray Monday morning. I flicked my eyes over to steal a look at them, and imagined what they looked like when they were young and beautiful. When they were filled with life and lust and couldn't wait to put their hands on one another. The old man on my left slipped from a doze into a dream and his cane clanked to the floor. His wife put down her phone rolled her eyes at me, and stood it back up beside him, without a word. The wife on my left excused herself to go to the rest room, and her tall husband, the one I could see had once been a dangerously handsome man, sat quietly drumming her purse with his fingers.

I breathed in the air of the corridor. The faint smell of new carpet. The sound of sneakers moving in the hall. Perfect temperature. Out the window, I could see pairs, almost always pairs of people walking from the parking lot to the Clinic doors. Some were arm in arm. Others just side by side. Husbands and wives. Mothers and daughters. One pair was almost certainly a granddaughter and her grandma. Very few had the professional feel of client and caregiver. I took them in, glad I had decided to give up on the whole "gazing softly into the middle distance" schtick. I would have missed all the love making its way across my world.

A smart, efficiently friendly lady called "Robert?" from around the corner, and I joined her for the short walk to room 3. We celebrated the liturgy of the exam room, vital signs, list of medications, medical history, why are you here today? Then she did something unusual. "Dr. S is a tall slim man. He rarely knocks, so don't be startled when the door flies open and there he is." It struck me as an exceptionally thoughtful thing to say, and I wish I had remembered her name so I could thank her.

Then came the time of contemplation between the nurses interview and the appearance of The Doctor. All patients know this interlude. We read the posters. If we have a companion, we smile quietly at one another, or sneak a quick squeeze of the fingers if we're feeling especially anxious. I chose to sit quietly and breathe, (once I had checked out the weird little acrylic model of a brain on the writing desk.)

As I breathed in and breathed out, I became aware of the others who had waited here. I breathed in their anxiety, and breathed out comfort. I breathed in anger and breathed out acceptance. I breathed in relief, and breathed out hope. I imagined people after me breathing in the light I hoped to leave. Then the door flew open and Doctor S appeared. 

He was indeed tall and slim. If it's not too much of a cliche, he was kind of birdlike. He spoke quietly and with few words, as if he respected their value. He did not meet my eyes for a long time, making me wonder if he might not be a little autistic, or at least painfully shy. His gaze landed on the laptop beside me, and it quickly became obvious that he not only did not know me, but he didn't know my case, nor even the neurologist who had met with me in December. We were both quiet for a long time. He read. I looked at the little plastic brain then noticed that my heart was not beating nearly as hard as it had been in the waiting room.

We talked about my life, first the most recent events, then reaching back to the days of radiation, chemo, and my first fainting episode, almost 14 years ago. He was quiet for a long time, reading test results and radiology reports. He asked some more questions and I added some more information that I had forgotten - fainting after exercise - losing control of my left hand - blurred vision in the right eye like looking through a broken, dirty window. More quiet. More breathing. I realized that he and I were now sharing our breath in this little room. He was a detective, interpreting clues. I was, what, a crime scene? Whatever I was, we were intimately connected in that room, and I became aware that he had been there with me for well over half an hour. 

I soon learned that during that silence, he was researching  head-and-neck cancer, radiation, and scarring of the carotid arteries. Also orthostatic hypotension (getting dizzy when you stand up) and its relationship to the other two. I sat their trying to be a patient patient, while he was becoming a better doctor. He had me lay down on the exam table and took my blood pressure. It was dangerously high. Then i stood up. Any problems? Nope. He took my blood pressure again. It was dangerously low. 

We went back to our chairs. "Well," he said, and this is my first memory of meeting his soft, blue eyes, "you are complicated." He explained that nobody had been able to give me any answers because my equation had so many variables in it. There is the orthostatic thing. The radiation thing. The blockage thing. The exercise. The meds. It's hard to know which knob to adjust first. He offered a couple of things.

Keep doing the things I am doing. Keep exercising. Keep drinking water. Get up slowly. Sit down when you feel shaky. Wear compression hose, which chicks find irresistible, by the way. 

He also wants me to track my own vitals every morning. Weight. Heart Rate. BP. He suggested I get data during the day, too, especially before and after exercise. 

And finally, he got on the internet and found a "neuro-vascular surgeon" - who knew there was such a thing? - who could give me a reliable second opinion on treatment options. 

I looked at my watch. This specialist had just spent an hour with me. I told him how much I appreciated that. His eyes immediately went back to the floor. "Well... you're complicated." I had a distinct feeling that Dr S kind of enjoys the complicated ones.

So, I have next steps. I have another appointment. I have action to take. I have the OK to exercise and instructions to track my workouts and my body's response to them. I have something like hope that I might actually be able to run that marathon next spring. And I have a whole bunch of stuff that I didn't have when the phone rang this morning.

We are all breathing, all the time. I tell my classes, "It's the first thing you did, and the last thing you will do." Today, I breathed in life, and breathed out... well... life, actually. I was born and born again with every breath. I received an inheritance and left a legacy with each puff in and out. Jesus talked about being re-born and the Eastern traditions talk about being reincarnated and I wonder if the three of us aren't all talking about the same thing? We all live and die a thousand times a day. Our breath reminds us, not only how much we need the world around us, but how much we are composed of the elements of that world. Likewise, the world is composed of the breath, the cells, the poop, and finally the dust to which we return to become part of the next living thing that inhales or digests or absorbs us. Our lives are finite. But the Life of which we are a part goes on and on. 

Today, I met a guy who couldn't look me in the eye, but saw things inside me that a bunch of other doctors had missed. I met a handsome man who guarded his wife's purse like a family heirloom. I met a wife who loved her sweetheart too much to point out that he had fallen asleep in public, dropped his cane, and was drooling just a little bit. I met a nurse who warned me about something weird ahead, and I met a whole lot of people looking out for one another on a gray Monday afternoon. 

All-in-all, a pretty good day to keep breathing.

Tilt!

 I  never was much of a pinball player. Dad never let us go to the arcade at Kennywood because he said it was a waste of money.There were a couple of machines in the back of a store in the little town where I went to college, but more often than not, I set off the dreaded "Tilt" alarm and lost my quarter, just as my wise father had predicted.

If you have never played one of these old beauties, just know that if you tried to manipulate the ball by jostling the table a little too aggressively, the "TILT" light would flash on, and thenwhole game would shut down.

That's sort of how the tilt-table test works. They tip you in just the wrong way, hoping they'll be able to see what happens when your brain says, "game over." So, I guess mine was a success.

I'm gonna try to remember yesterday's events, but the images are pretty foggy, so don't hold me to them. I'll try to keep the dramatic embellishments to a minimum.

I woke up around 3:30. These stress tests always seem to happen at god-awful morning hours. Consequently, the sleeplessness that precedes them starts that much earlier. I was allowed to take my medicines, thyroid and grandpa's crazy pills, but you have to fast so you don't get sick all over the expensive equipment. I skipped my morning coffee, for safety's sake.

Sophie and I meditated for about 45 minutes, then we did the Wordle and the Connections puzzles. Checked the bank account to make sure the pre-payday balance was still in the black, and it was. I had to laugh. Last week, I got a note from the hospital, informing me that my share of the cost of this test would be a little over $1600. I didn't dare tell them how slim the odds were of either of us ever seeing a check that big with my signature on it.

The test was scheduled for 8:00 AM, and my instructions told me to be there 30 minutes early. If you know anything about Nicholasville Road in Lexington, you know that waking up 5 hours early for an 8:00 appointment on that nightmare of a road doesn't give you nearly enough time. I pulled into the parking lot of Central Baptist Hospital at around 7:50 with no idea where I was supposed to report on this labyrinthian campus which I had only visited to bring my then fiancé to chemotherapy appointments. Mercifully, I was nowhere near the cancer center. 

I was a confused traveler, lost in a strange forrest.

A couple of lovely fairies in blue scrubs helped me to find the registration office. I had a vague sensation of having been in the same room with Debrah when she was alive, but couldn't be sure. The lady who registered me was very sweet. Asked if I'd like to pay anything on my balance, and when I said no, she suggested I wait for a final decision from the insurance company.

I was pretty distracted when she gave me the directions to the stress lab. Something like, "Go right out the door, turn left, then left again, and the elevator is right there. On the third floor, you'll go left - you have to, because there is a wall on the right, then you'll go left and left again, and the lab is right on your left." Thank you, ma'am. I wandered into the hall, hoping for lots of signage.

"Bob? Bob, is that you?" A pretty little fairie in scrubs caught up with me and gave me a hug. After a few coffee-deprived moments, I recognized Krissy, a girl who used to work at the Y. She is now among the friendly little blue spirits who wander the halls of Baptist Hospital rescuing lost travelers. She pointed me toward the elevators, which I'm almost I remember being on the right, and wished me good luck.

A short ride to the third floor, and a bunch of left turns put me at a set of open automatic doors. About 3/4 of a mile down the hall, a lady with a clipboard called out to me. "Robert?" Turns out she was my nurse, and had been alerted by the forrest spirits that I was stumbling along the path in her direction. I do not remember her name, so I'll call her Renee. She was very kind, like all the folk in the kingdom, and of exceedingly good humor. She laughed and joked as she asked me to strip off my shirt, shaved my chest, and stuck little electrodes all over me to monitor my heart through the test. She asked all the questions to make sure I had followed the instructions in my email, and put a blood pressure cuff on me. My pressure was exceptionally low, which i attributed to all the magic creatures I had encountered on my way to the lab. Then she told me that a nurse named Allison or Adrienne or some such thing would be in in a moment to insert an IV.

With that, the door opened and a little guy with a rapidly receding hairline and a kind face entered and introduced himself as my nurse, Stephen. Renee laughed. I was so accustomed to being confused by this point that I just took it in stride.

Stephen explained the test, used lots of acronyms, and stuck the IV in my arm. I make a habit of always complimenting the skill of anyone who sticks me. I think it relaxes them, and that can't be bad. Stephen's stick was about a six out of ten, I flinched a little, but at least he hit the vein on the first try. "Well done," I said. "Thank you." He seemed relaxed. Another happy blood-letting on my permanent record.

One detail sticks out from our conversation, "After we tilt you up, you may feel light-headed, or even faint during the test. Don't fight it. You are strapped in solidly and you won't fall. We're trying to measure what happens to you when you have an episode. If you pass out, we'll stop the test and put you down." Now, in horse country, the phrase "put you down," is not one you want to hear from a veterinarian, let alone an RN with slightly above-average phlebotomy skills. I made a mental note not to pass out under any circumstances. 

This is where the fogginess starts. I'm flat on my back, strapped down with three wide velcro belts, and Renee took a baseline blood pressure. 104/58. That is so much lower than normal for me that it made me wonder if I had messed up my meds the night before. Little did I know how strange things were about to get. 

Somebody pushed a button, and the table tilted up to 80°, just a slight backward lean. Blood Pressure: 64/44. "Holy Shit!" It would not be the last time I sullied the forrest air with foul language. "How can I still be alive?" Suddenly, my fairies seemed a lot more professional and serious. There was no sense of panic, but I definitely had their attention.

My vision started to blur in my right eye, the side where they found the blocked arteries in my neck. When I closed my left eye, it seemed as if I were looking at the world through a broken window with jagged shards all around the frame. A sharp pain seized the area around my eye, and i started to feel weak. Renee continued monitoring my blood pressure every three minutes. 

 62/42

58/42

60/46

I'm copying these numbers from the report. I don't remember hearing them. I just remember being terrified by them.

They asked me to keep talking and describing what I was feeling. My tongue seemed to thicken and my mouth was having trouble articulating to make words. At one point I told them that my brain was feeling "wooly." I told them about studying diction in acting class and about how Martha had looked after me during my cancer treatment. I told them how bad I felt about not being a good husband. "Oh, fuk. Excuse me, Miss Renee. I'm sorry I said that in front of you." I don't know what I told them after that.

The last reading on Stephen's report says, "50/? - unable to hear a diastolic #" 

And that's when they decided to put me down.

The aftermath is like a medical montage in my memory. Blood pressure readings returning to normal. Stickers being removed. Shirt back on. A forest nymph with a wheelchair rolls me to the front door. She tells me I can take the shuttle or walk to the parking garage. I start walking and realize I have no recollection of where I parked my car. The garage seems a long way away, and it is much colder than I remember. Find the garage. There is the elevator. Pick a floor. The panic button on my keychain sets the horn off. My car is definitely not on this level. Lean out over the rail. Yes, I think it's below me. I should absolutely not be leaning out over this rail. Down the stairs. Find the car. Yeah, a designated driver was recommended, but not required. I really should have lined one up. Send a text to work. Test is over, going home, need subs for my classes. Cancel personal training clients. Loving support from the team at the Y. Start the car. Holy shit. I hate driving in parking garages. Out on the street. Goddam Nicholasville Road. A Yankee must have engineered this traffic pattern. Past campus. Jaywalkers. They have no idea the risk they are taking. Uptown. Parking spot. Front door key. Sophie, vocal and confused. And I pretty much slept until suppertime. 

I don't know what they learned from this. I guess it confirmed that I wasn't making it all up. I'll hear from the doc soon I'm sure. Meanwhile. I feel fine today, and am heading back to work. A nice splash in the pool will do me good.

I prefer the company of geriatric water nymphs over blue fairies, any day. 

At least they've never threatened to put me down.

What Did Horatio Know?

 
It's pretty easy to make fun of New Year's resolutions. Even the people making them don't take them seriously. And when you've lived enough years, the new ones start to look an awful lot like the old ones.

The best of them are forgotten by Groundhog Day. Why bother?

I think there might be a couple of reasons. 

I grew up in a river city, and even though I never spent any time towing barges like my brother-in-law, Cap'n Don and his boys, I've envisioned my life to be like a river for many years. There are currents to account for, channels to follow, locks to negotiate, cargo and shoreline to protect, and lots of stuff floating by that may or may not be worth paying attention to. Why not check your equipment now and again? Renew your training. Update your charts. Review the regulations. There are plenty of surprises that you can't foresee. Why make your own bad luck? Take your bearings. Look around. How else do you know what needs fixing? How else do you know if you are off course?

So before meaningful changes in the way I pilot the Good Ship Pennsy, it makes sense to me to take a walk around for an inspection. Everything shipshape and Bristol fashion? Or is there a little too much poop on the deck? 

First stop. How's the body holding up? Well, there are problems, just like you'd expect in any old tug. The heart is steady, if a little concerning. The arteries have started demanding more attention than I'd prefer. Nobody has been able to explain why I get dizzy so often, why I faint so easily, or why my important parts of my body seem to stop talking to each other from time to time. I will be investing lots of hours and dollars in the medical-industrial complex in the coming months. The tests and scans and diagnostic engineers haven't found anything life-threatening yet - so I'll stay the course. Keep falling down. Keep getting back up.

It isn't all bad news, though. I'm carrying a little less weight than last January. Around 10% less. That's good. Eating better food. Also good. I've started running a couple times a week again, and that feels terrific in my legs and in my spirit. Learning to bang on the heavy bag, which is improving my stamina, my upper body strength, and the way I imagine my arms look in the magic mirror I have in my bathroom. I have a crazy dream about running a marathon (#3!) before I turn 65 next year, and I'll need to crank up the intensity considerably in 2024, but I like the training plan I'm on. Again, stay the course.

Next stop. Time to check a little deeper. How's the mind holding up? How's your brain, old boy? I'm happy to report that it's not too bad. I found a splendid therapist this summer, and he is helping me to put a lot of things into perspective. I have a better sense of what matters to me than I have had in a while. Exercise, therapy, and meds are working together to keep me on a fairly even emotional keel, even with all the medical drama. I seem to be able to write and think and teach and make people laugh at a professionally acceptable level, and those are the ways I need my mind to stay strong. Just between you and me and the Internet, losing that strength is my greatest fear, but I've noticed no signs of serious trouble so far. I mean, I do the "why did I come into this room?" thing a couple times a day, but I haven't dropped any babies or started any fires or anything newsworthy yet.

So, Pennsy. How's your soul? 

Now, we're in troubled waters. To be honest, she's sprung a few leaks, Cap. 

What do you do when the old answers just don't patch up the holes anymore? I don't remember ever having any serious doubts about God. Then one stormy day I opened up the cabinet where my good, Christian life-vests used to be, and all I found were some discarded face masks and a half-empty bottle of hand sanitizer. And a note from God. "IOU one lifeboat." 

No. It is emphatically not "well with my soul." these days. Remember that old hymn?

When peace like a river, attendeth my way,
When sorrows like sea billows roll;
Whatever my lot, Thou hast taught me to know

It is well, it is well, with my soul. 

It was first published in 1876 and written by Horatio Spafford. The story behind it is horrifying. According to this article in Wikipedia...

Horatio Spafford 1828 - 1888 

This hymn was written after traumatic events in Spafford's life. The first was the Great Chicago Fire of 1871, which ruined him financially. His business interests were further hit by the economic downturn of 1873, at which time he had planned to travel to England with his family on the SS Ville du Havre, to help with D. L. Moody's upcoming evangelistic campaigns. In a late change of plan, he sent the family ahead while he was delayed on business. While crossing the Atlantic Ocean, the ship sank rapidly after a collision with a sea vessel, the Loch Earn, and all four of Spafford's daughters died. His wife Anna survived and sent him the now famous telegram, "Saved alone …". Shortly afterwards, as Spafford traveled to meet his grieving wife, he was inspired to write these words as his ship passed near where his daughters had died.

I mean, holy shit. What a horrible story. What an incomprehensible response. You're a better man than I am, Horatio. 

Though Satan should buffet, though trials should come,
Let this blest assurance control,
That Christ hath regarded my helpless estate,
And hath shed His own blood for my soul.

Life's waters need a vessel that can navigate both billowing seas and peaceful rivers.  I want a map I can rely on. I want it to be well with my soul. 

But, it ain't.

For me, be it Christ, be it Christ hence to live:
If Jordan above me shall roll,
No pang shall be mine, for in death as in life,

Thou wilt whisper Thy peace to my soul.

I know that this should inspire me. I want to be more like this faithful, grieving husband and father.

But, I ain't.

My soul needs some attention. The kind of attention a marathoner gives to climbing hills or a boxer to slipping a jab. The kind of attention a frustrated old man gives to his to-do list so that the important things don't disappear into the cracks between "where are my goddam keys?" episodes. 

So, here is my 2024 resolution: after a lifetime of praying at God, I am going to spend some time every day just listening. Not reading or watching inspirational videos or blogging or practicing speeches or lectures or sermons or whatever other busy-ness I've been doing to paint myself into this spiritual corner... just listening. 

I don't know what I expect to hear. I guess I sort of expect to be surprised. I just know that something is missing. I do a lot of good things in my life. I teach and inspire. I give things away. I try to treat people with respect and honor their dignity. I'm a good scout, all-in-all. But in some, instinctive, lizard-brain place that I can't wrap up in ideas, let alone words, I know that something is being neglected. There is something in the water that needs my attention. 

And Lord, haste the day when the faith shall be sight,
The clouds be rolled back as a scroll;
The trump shall resound, and the Lord shall descend, 
A song in the night, oh my soul

I'll let you know what the river tells me.