Thursday, 21 June 2012

choice

Barely even gruesome and fashionable grellow.

One of the things I've been thinking about is the connection between the choices we make and what follows.

At its simplest I think we all know that terrible feeling that comes with knowing that something bad happened because of something we did. If only I hadn't....gone outside to get the newspaper in the rain in my slippers...I would never have broken my wrist...how could I have been so stupid?!

The if only game is made so much more terrible because we know both the pain or loss of what followed and how (often) the choice we made was so poorly considered. We can beat ourselves up endlessly and irrationally over the smallest dumb things we did, and mourn deeply for some imagined, better outcome.

In my mind cause and effect is a simple linear matter and if I make all the right choices I can blithely skip from one branch of time to the next, avoiding all those adverse events my lack of thought may bring about.

And this basic premise does often hold true. We teach it to kids all the time as a fundamental building block of making sense of the world. Eat your dinner and you will grow and be strong. Get enough sleep and you won't be tired and cranky. Do as you are told and you will be praised, be naughty and you will punished.

There are good and bad choices, and (implicitly) good and/or smart people make better choices and have better outcomes.

So the what if game is also full of guilt, shame and self doubt.

How could I have been so thoughtless to have said that to that person?
Why did I agree to do that thing?
Why did I choose that over the other?
What is wrong with me that I let myself get into this situation?

And very big bad things happening can really shake our confidence in our decision making capacity, the very notion of our ability to choose. It can become debilitating and fill our minds with the consequences of every bad choice we can possibly make.

I don't know how you get past that. Time and a certain amount of denial I guess. The same mechanisms that allow us to jump from our own guilt and shame to judgement of other people's poor choices. As though we've never done the same. As though making mistakes cancels out any entitlement to sympathy, compassion or (most ironic at all) empathy.

As though we've never wanted to be forgiven and understood in all our imperfections.

Overlaid on this is another complicating factor quite aside from the spectre of ourselves as stupid, foolish or bad, and that's the shadow of doubt that our choices actually make a difference anyway. In the absence of a parallel universe to act as a control case, how can we know?

Would my life have been any different, or better, or worse, if I'd said or done differently, would that chain of events cascaded into being even if what I see as the catalyst for it had never happened? Is this story about my choices just a thin veil over the true reality that the only change I can possibly effect in my life is a change I can't even know, let alone control?

Surely it's a mix. Smart choices, considered choices must mitigate at least some of the risks, but they aren't the full story. While I try and regain my trust in the world, my own body, to do the things I expect of it, while I try to integrate lessons learned and try very hard to see more than just danger and risk awaiting me at every corner I will also be trying not to judge myself or others too harshly for succumbing to our inescapable humanity.

I will also be heeding the many wise tweets of my friendly philosopher Alain De Botton (go follow him! He's ace!) such as

alaindebotton
At a certain point a sense of humour shifts from being a pleasant social gambit to being the centre piece of a survival strategy.
21/06/12 4:04 AM

Sunday, 17 June 2012

clawing back

I can't tell you how much I'm banking on this being the last post about human frailty for a long time. I'm definitely ready to move on but since lots of people have been asking and my capacity to respond is limited I'm laying it out here.

It turns out the situation with my wrist was significantly worse than I first thought. The kind of worse it took more x-rays and even a CT scan to properly diagnose. The technical term the orthopaedic surgeon used was smashed to pieces. I kid you not. It's like a jigsaw puzzle he said. We need to open you, put all the pieces back together then screw it down to a T-shaped metal plate, he said. We also need to cut open the other side of your wrist to ...something about tendons rupturing....

To be honest everything after that just kind of blurred and all I could really concentrate on was how fast I could stop all these bone fragments grinding against each other. Why the pain was so awful and so consuming. Why everything felt so wrong. To say I was in some psychological distress would be an understatement. Over and over I relived the original fall. The smashing of the bones, the hospital visits.  The pain getting worse not better. The x-ray images of all that incoherent bone.

So despite my fear of more pain the prospect of surgery the following day was very very welcome. I returned home, did my best impression of happy face for the kids, slept, fasted and returned to hospital the following day and waited while my specialist and his secretary did everything they could to get me a place on a surgery list for that day. When no one had free time my guy agreed to operate on me if he could get a theatre and an anaesthetist. There was a brief up period when he got the former but a major down when it became apparent the latter was not going to materialise. After a couple of hours he sent me home with an appointment for the following day at a small private hospital on the other side of town.

Crushed doesn't come close. I was finding it all very very hard to endure.

Home, cry, toss, turn, fast, wait, drive.

We arrived at the hospital amid the chaos of major building works and, it transpires, a major crane accident. All seeming bad omens to me. I was shunted off to day surgery with my bag, everywhere saying don't keep valuables (can you really be left in a hospital system on your own and incapacitated with no money, ID or phone?), everyone seeming confused about who I was and whether I would staying overnight.

D had to head off to be home in time for afterschool kid duty and although I told him I would be fine I confess I actually felt totally terrified. Alone, in pain, holding my breath for it to be over. And then of course the whole thing started, and then it was over, with nothing in between but fear and pain, discomfort, confusion and horror. A stint in recovery I wish only to forget. An endless afternoon and an endless night just enduring the minutes and hours crawling towards getting better.

I am home and the slow crawl is picking up pace. I'm getting better. The pain has a narrow focus now and sometimes its not much more than discomfort. There is some light not far over the hill and I'm definitely looking forward to being in it soon. I'm almost looking forward to what I am already being warned will be a torturous ride through rehab and hand therapy.

I have to say that aside from the whole how fragile we humans are thing, which is indeed a very big and scary thing, this experience has really given me a big pause for thought about relying on the public hospital system. I grew up with a doctor parent who drummed into us the poverty of the public hospital system, and the importance of keeping out of it. He was also a tremendous snob and like most of what he attempted to shove down my throat I was reluctant to take it all on unexamined.

Thus far in life I've done my best to work with public hospitals where I can and in the main that's worked out fine. I chose to have my babies in the private system, but that was a planned event, so it's a bit different. But I am now fully of the belief that if I had gone directly to a private hospital last Saturday when I fell I may have had my surgery immediately. Even if I hadn't I would not have had the cast removal experience, nor waited for a private consult or needed friends to find me a specialist and get me a referral. No matter what the exact details, there would have been a much shorter time between the fall and the surgery, less pain, less trauma.

There is much to be said about that. The wrongs of that for those for whom private medical care is not an option, my tremendous good fortune that it is an option for me. Complex stuff that's just too complex for my bruised mind today. But stuff that is suddenly very very real to me.

Anyway, that's enough for now. There's healing to be done. And Downton Abbey to be watched.

Monday, 11 June 2012

the full treatment

Crikey. The medical drama!

I did finally improve from the very long running virus/infection/asthma run. I even managed to leave the house on Friday, admittedly to go have medical tests, but I was feeling pretty upbeat about some future good health.

On Saturday morning amid plans for finally spending some quality time with my kids after two weeks of looking at their sad little faces from my bed of doom, I went out to get the paper with Wil, slipped over in the rain and landed with a smash on our stone slab steps. One look down and I knew my wrist wasn't right. I tried to sit up and virtually passed out. The pain was unbelievable.

Unfuckingbelievable.

So I lay there on the cold wet stone, in the rain, in my pjs and waited for the ambulance. And cried and swore. David deposited the kids with a neighbour till my mum could get here (thankfully she was back in the state after her holidays) and came and sat with me. In between my exclamations of pain we discussed sandblasting the front steps.

The ambo arrived after what seemed like forever but was I am informed only 7.55 minutes. Two lovely women who gave me the good drug inhaler that allowed me to passout long enough for them to strap my wrist for transport. Then off to the mercifully close hospital, more drugs, more waiting, more crying, more swearing. X-rays and a diagnosis of a Colles fracture - the ball bit snapped off the long bit of the bone that attached near the base of the thumb. Widely acknowledged to be particularly painful and hard to 'reduce' - the medical term for pulling all the bones back into alignment - a Colles fracture can result in tricky treatment but the doctor is confident she can avoid surgery and all those nasty pins and screws.

So they take me to a resus room and wait for my blood pressure to come up enough to sedate me. By now it's been about 5 hours and I'm stupid with drugs and pain. It takes nearly an hour till the team descends and knocks me out and I wake up covered in plaster. In what proves to be prophetic, the doctor warns me to watch for swelling and the cast getting too tight.

Home.

The realization of what being one handed means.

Can't do up my pants.
Can't cut or spread bread.
Can't open the shampoo bottle.
Can't drive.
Can't pick up a kid.
Can't cook.
Can't do up my bra.
Can't type properly.
Can't pick up washing basket.
Can't carry shopping home.

Back to completely useless in other words. For six weeks.

Sunday dragged along, a mix of sitting around and lying in bed, doing my best to keep the still incredibly sore arm elevated. I let the painkiller regime lapse and by the time I realised how much more intense the pain had become I could also tell that the whole swelling thing seemed to have taken off.

So I headed back to hospital with my mum in tow while the bloke stayed behind with the kids. More waiting. More pain on a steady incline. But this time we had the kind of hospital experience that leaves people looking for redress.

Unlike the day before where the pain and waiting was mostly well explained and accepted as just a part of the process, it was obvious from the get go on this visit that my carers were on the margins of competence.

I can't bring myself to describe the minutae - it seems petty and truly I think in the public health system I'm very tolerant. They have a hard job and a lot of their patients are abusive and self absorbed and I totally get that. I've never had complaints before. But the minute I got into the treatment room and the nurse insisted on taking my blood pressure while i was standing up, every instinct I had wanted me to leave - an instinct I could see my mother shared. (She has taught medicos for most of her adult life, married a doctor, socialized with doctors and medical research scientists - she gets medicine better than anyone I know)

Things went from bad to worse when the doctor finally arrived and made the nurse look like a rocket scientist. She was flustered and indecisive, clear my cast needed to come off but clearly lacking any kind of plan for how to do it. I grew increasingly terrified when it was clear they planned to do this without any kind of sedation.

I watched the virtual comedy show while she tried to assemble the right tools and supplies, utterly failing spatial relations to cut the plaster the right size (oh! Too big! Oh! too small! Oh! Too big!), repeatedly walking across the room instead of wheeling the trolley over to the bed etc. I can barely describe the butchery that followed as she hacked at the cast with a plaster saw, yanked and pulled until she wrenched my wrist so hard I screamed and my mother started to cry.

At this point she went off the get the advice and aid of a more competent nurse who returned with the laughing gas on maximum to knock me out. I don't recall what took place then but I came to covered in tears and hoarse from crying, my mother had been sent from the room after she objected to the presence of a off duty nurse hanging in the doorway watching.

As soon as the bandage was secured the staff all fled and without so much as checking my pulse or blood pressure I was left to go out and catch a cab in the cold. The doctor did say there had been 'a lot of movement' in the fracture when they had taken the cast off (uh, yeah, i did feel that) and that the bones were likely displaced again (though she didn't order an X-ray) so surgery may well be required.

Both mum and I were in shock in the cab coming home, feeling like an assault had taken place, and worse like I had seen it all coming but been unable to stop it. The stuff of nightmares.

So today I'm left wondering what to do next - wait until my hospital appointment on Friday to assess the situation or try and find an orthopedic surgeon on my own? Either way I see more fiddling with my poor traumatized wrist in the near future.

edited to - many thanks for advice and good wishes. a wonderful friend has sorted things for me and I am off to see a specialist tomorrow. very grateful and relieved!

Wednesday, 6 June 2012

in treatment

I've been confined to a sick bed for what feels like forever. Certainly the longest continuous stretch I can recall. There have been some dark times over the last 10 days and I've had to ask for help in ways I'm not used to.

It feels very compromising to say (in tears and on the verge of complete collapse) I can't care for my kids and to expect others to pick up that burden. To see that in the way your kids look at you - to see their worry, their fear, their confusion. It certainly compounds my own morbid thoughts, my guilt, my fear, my desperate need for escape.

So what have I been doing with all this solitude? How have I been dealing with suppressing my black thoughts? I've been listening to the hunger games trilogy on audiobook and watching back to back episodes of the HBO series In Treatment. Thank god for iDevices.

They've both provided me with a lot of thinking material in a time when thinking is pretty much all I can do. I've been weaving all kinds of webs and narratives about the nature of oppression, repression. About the human struggle to be free, about the costs of the struggle, about our chances for success. About how we make sense of it in our own heads, about how we make choices, move forward from the jammed up places we get stuck in.

I was reading something recently about the danger of too much introspection, about how thinking too much prevents us from doing, from being free to create and be happy. I found myself agreeing with it - how could I not? Action is good, creation is good, happiness is good. It's not uncommon for me to be the one in a room saying let's just make a decision and move on, let's just do it!

But watching In Treatment has thrown up the stark contrast, and reignited my fascination, and something much deeper still, with psychoanalysis. This is not my first pass on psychoanalysis, I was 17 when I read my first text by Freud and I can still recall the way my head exploded. The way I felt quite literally that the world around me shattered and everything I thought I recognised was not what I had thought it was.

It wasn't just Freud, or even psychoanalysis per se, but a much larger paradigm that crashed in on the heels of that first text, that first university class. It was a way of looking, a way of seeing, a validation of the work of thinking about things. Peeling back layer after layer of constructed meaning to get to a heart of something, to get to not exactly truth but something so much closer to it than anything I'd ever known.

I also remember a terrible crashing sadness when all that burrowing simply took me to the other side. It wasn't nirvana, or freedom or the end of sorrow or confusion. That was definitely disappointing, there's no denying that. And for many people this in itself invalidates this kind of reflective analysis. What's the point? Why unpack everything if you can't create a more functional whole?

This is one of the central questions at the heart of In Treatment. As both therapist and patients grapple with their various pains and dilemmas - their self destructive behaviours, their inescapable burdens, their false joys, their transgressions, their denial, their anger - there are are moments of tremendous insight. Insights into the very core, the very heart of their existence. And like all things profound, they produce a kind of earth splitting, heart breaking mixture of elation, pain, awe and terror.

Sometimes they run screaming from what they see, sometimes they simply look away until they can catch their breath, sometimes the flash of illumination dies and they can't recapture it. Sometimes they don't want to. Often they focus on their relationship with the therapist as the source of whatever pain or sadness they feel as a consequence of what they see.

Why did you do this to me? Why did you break me open and leave me here bleeding and vulnerable? How can I go on now? You've left me with nothing.

And the therapist struggles with similar questions. Did I break them? What was the point? Can I really help anyone anyway? Am I using the wrong model of therapy, are the rules of how I practice wrong or is therapy itself doomed? Can I go on absorbing these same barrages of emotion from patients who in turn vilify and adore me, who resist and cling? Why can I not fix my own life, free myself through insight?

It's a long time since I've been in this headspace. For over a decade I've been in action mode, making this life. Building layers to keep the core of me safe while I make and care for others. But as I get older, when I am sick, when life becomes more complex I feel increasingly the fragility of those constructions. I'm thinking about those parts of me that have been buried in those layers but I'm also thinking about the parts of me that have become ossified in order to make those layers. The questions I no longer ask, the answers I no longer entertain.

Dense thinking material. It makes the view out my window come alive with threads and connections. With memories. It keeps me from going mad in my confinement. Now to work out what comes next.