Working Again (Repurposed)

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According to http://www.takingcharge.csh.umn.edu/enhance-your-wellbeing/purpose/life-purpose/why-life-purpose-important:

  • One of the common features among people who live with a purpose is that they are able to find meaning in the things that happen to them. Andrew Zolli, author of Resilience, describes these people as being able to “cog­ni­tively reap­praise sit­u­a­tions and reg­u­late emo­tions, turn­ing life’s prover­bial lemons into lemon­ade.”

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Back when my mother, Alberta, was in rehab, I arranged for her to have a phone consultation with Dr. Steven D. Farmer (http://www.earthmagic.net).  Dr. Farmer is a spiritual healer, psychotherapist (retired) and shaman.  My mother has no interest in anything esoteric, woo-woo or  otherworldly.  But as a former psychotherapist, I knew Dr. Farmer would know how to speak to my mother in a way that would be both  encouraging and therapeutic. I also knew that his shamanic abilities could reach those esoteric parts of my mother that needed healing and support.

Dr. Farmer talked to my mother about  her purpose– her role with her patients and her family.  It was a very helpful and much needed conversation.

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  Dr. Victor J. Stretcher, author of the book “On Purpose” states

  • When you see the data about the elderly who have little or no purpose in life, and how quickly they get sick and die, you realize how important it is for an elderly person to repurpose their life toward something bigger than themselves.

Although, I had referred most of my mom’s patients to other child psychiatrists or pediatricians–a handful of parents kept calling, sending cards –asking when they could  make an appointment.

I don’t think my mother anticipated how  going back to work would affect her.  Her patients have given her a huge gift.  Because of them–she has not only repurposed herself but she has also reclaimed her self esteem.

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Getting to Know You

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My dad was mischievous.  Even when he was seriously ill and in treatment for non-Hodgkin’s lymphoma–he was mischievous.  My twin sister and I used to take him to chemo and radiation therapy–daily.  It was a difficult time, but in hindsight it was also a great time because we got a chance to get to know each other–differently.

 

 

I remember once driving my dad home from the grocery store– I had the radio on and was listening to Bon Jovi.  My dad turned to me and said, “I didn’t know you liked this kind of music.  There’s so much I don’t know about you.”

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Later, when we got back the house, my dad started to make an elaborate  lunch.  My dad loved to cook.  He then set the table for 4 instead of 3.  “Someone  else joining us?” I asked. “Oh.  Just a friend I met… who speaks Italian.”  At that time, I was obsessed with everything Italian. I had even learned to speak Italian  in college.  So, of course, I was excited.  I started thinking about the fabulous possibilities of this mystery guest.  “I’m gonna be the next Mrs. Ferragamo or  Mrs. Gucci,” I thought to myself as I planned an elegant, yet simple wedding.

 

 

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Then the doorbell rang.  It was my dad’s new friend–an elderly,  Ethiopian man.  My dad introduced him as Mr. Wollo.  “This is odd,” I mumbled.  My twin sister, Akwelle, giggled. We all sat down for lunch.  My dad then told this old, odd man, Mr. Wollo, all about me and my interests.  “She looooves speaking Italian.  She loves to cook.  She loves to paint. She loves photography. Why don’t you say something in Italian, Koko?” my dad said to me  as he opened his eyes up super  wide.  I growled something incomprehensible, even to me.  Then I stormed from the table and ran up to my room and devoured a party size bag of plain M&M’s.

 

 

By the time I went back downstairs, lunch was over.  Mr. Wollo was long gone. Then I yelled at my father, “What was your plan here with this crazy lunch!? Have you lost your mind?  Mr. Wollo is even older than you … and… he’s… hideous!”

 

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My dad was laughing loudly by this point.  Coughing even. “You take things too seriously. Your temper tantrum was priceless, though. It was all a joke. No big deal. But if you change your mind, I am sure Mr. Wollo is free tomorrow,” my dad said as he continued laughing his biggest laugh.  I was too upset to appreciate the humor.

 

 

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Late last night, when I was helping my mother get to the bathroom (for the 4th time), she suddenly started laughing.  She was walking very, very slowly and said, “I’m a comin’.  I’m a comin’.  I might be a little slow and the coffee might be cold when I get there, but I’m a comin’.”  Then she really started laughing, coughing even–with tears in her eyes.   By this point, she was pretending to hold up a cup of coffee as she moseyed along in her fuzzy, pink, skid-proof socks.  We were both laughing!

 

 

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I mention all of this really as a reminder to myself that even in difficult times–there’s still always something to laugh about.  I am able to appreciate that now.  Ultimately, this whole experience– with my mom’s stroke and recovery– is a chance for us to get to know each other–differently, and to keep laughing.

 

 

Marching Orders

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My mother, Alberta,  likes having a schedule. Before her stroke, her life was highly routinized. She was always up by 5:30 a.m.–at the office by 7:30–home by 3:30–dinner was by  4:00– and at 4:30 she was always watching  Judge Judy.  Her nightly  bath was at 6:00  and she was in bed by 7:00 p.m.

 

 

Once our mom left the inpatient rehab facility, she soon started outpatient rehab 3-4 times a week.  This routine of physical therapy, occupational therapy and speech therapy was grueling– but our mother needed something to do.

 

 

 

 

I appreciated speech therapy the most. The speech pathologist  was the first (and only) person who explained the nature of our mom’s stroke to us.

 

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Frontal Lobe – Front part of the brain; involved in planning, organizing, problem solving, selective attention, personality and a variety of “higher cognitive functions” including behavior and emotions. 

The speech pathologist informed us that the area of the brain where our mom had her stroke (frontal lobe) governs sequence, organization and memory. She explained that speech is more than just verbal ability. It is all about how we see ourselves in space. It was the first time anyone mentioned how the brain damage from the stroke affected how our mom perceives and misperceives herself and others in the world around her. As a result of the stroke, our mom is much more impulsive and restless.  And she has no filter for her thoughts. If she thinks the food you made is bad, she will not sugar coat it. She tells it like (she thinks) it is.

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The speech pathologist, however, gave us tools and cognitive exercises to kick-start our mom’s brain back into appropriate action. We were also encouraged  to get a (paper) calendar so that our mother could anticipate her daily schedule and routine.

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The speech pathologist explained that we all need awareness (a sense of ourselves in time and space) to effectively function in the world.

 

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When our mom first started outpatient rehab she was in a wheelchair and was using a right sided hemi-walker to stand up, sit down and shuffle from place to place.  Midway through rehab, our mom started using a 4 pronged cane to walk.  We were also told to “ditch the wheelchair.”

 

When outpatient rehab (4 months) was over, the discharge advice was:  Keep walking. Walking boosts brain function.

 

In Search of an Acupuncturist

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David Crow’s “In Search of the Medicine Buddha” is one of my favorite books.  It’s about an acupuncturist, David Crow, who leaves his acupuncture practice in San Francisco to study Tibetan healing practices in Nepal.

 

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When my mom first had her stroke, I knew acupuncture could help her.  The problem was finding an acupuncturist who made house calls.  When I found one who did–the next problem was convincing the nursing home/ rehab facility of the value of such a service. Long story short, they were not convinced.  The medical staff would not even allow our mother to leave the facility for acupuncture treatment. My sisters and I had to wait (3 months) until our mom was home before she could be treated by the acupuncturist.

 

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When the acupuncturist, Matt Brookman (http://www.brookmanacupuncture.com), first came to our house, he asked our mom about her concerns.  Our mom said she was “miserable” and wanted to feel better.  She was in a lot of physical pain and was mentally drained. The main concerns my sisters and I had centered around our mother’s emotional state–plus her insomnia, excessive night time urination and anxiety. The acupuncturist  evaluated our mom by looking at her tongue and checking her various pulses.  The acupuncturist then explained that the meridians of the body he would be working on for stroke recovery are the same meridian points  that affect emotional balance.  A win-win for us!

 

 

According to The Academy of Classical Oriental Sciences (www.acos.org):

  • A meridian is an ‘energy highway’ in the human body. Qi (chee) energy flows through this meridian or energy highway, accessing all party of the body. Meridians can be mapped throughout the body; they flow within the body and not on the surface, meridians exist in corresponding pairs and each meridian has many acupuncture points along its path.
  • The term ‘meridian’ describes the overall energy distribution system of Chinese Medicine and helps us to understand how basic substances of the body (Qi, blood and body fluids) permeate the whole body. The individual meridians themselves are often described as ‘channels’ or even ‘vessels’ which reflects the notion of carrying, holding, or transporting qi, blood and body fluids around the body.
  • Practitioners of Chinese Medicine must be as knowledgeable about these meridian channels as the Western Doctor is about anatomy and physiology of the physical body. Without this thorough understanding, successful acupuncture treatments would be difficult. A practitioner of Chinese Medicine must know how and where to access the qi energy of the body to facilitate the healing process.

 

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Matt, the acupuncturist, also prescribed  Chinese Herbal Medicine for our mother. Matt ordered the herbs for us.

 

 

Our job was to cook the herbs in water and give them to our mother in the form of a tea twice a day.

 

 

Matt’s acupuncture treatments along with his prescribed medicinal tea have proven to be crucial components in our mother’s recovery.   And Kookaburra is happy because she finally has a new boyfriend!

 

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First Night Jitters

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Once we got home, my sisters and I had to figure out how to get our mom out of the car, down a few steps, onto the walkway  and into the house– in a wheelchair.  At this point our mom was unable to maneuver steps well.  The therapists at the rehab facility told us to remember, “right foot up, left foot down.”

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But the rain made walking more complicated.  We had to figure out another way. For some reason we thought carrying our mom in the wheelchair was the easiest option to get from A to B.  It was a clumsy mess.  But– finally we got her to the front door and eventually into the house.

 

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Once inside, our mother was in a state of total disbelief.  It was like she was returning from war or prison.  We were  prepared for the little things like getting rid of the floor rugs and making sure we had plenty of pull-up diapers and wipes and even a bath lift and shower chair. But we were miserably ill prepared for the emotional aspect of our mother’s return. We were each experiencing a sort of PTSD.

 

 

I kept waiting for my own emotional meltdown.  I busied myself by spending time with Kookaburra.

 

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The therapists warned us against installing a stair lift to get our mom from the first floor to the second floor.  They said stair lifts promote laziness. Instead they suggested bumping up the stairs.  That first night–it took us two hours to bump our mom up those fourteen steps. We were all exhausted.

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My sisters and I divided our time with our mother– giving each other breaks to avoid burnout.  I chose the night shift.  I crazily thought this would be easy.  That first night was easy.  Our mom slept like a baby.

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A Change of Plans (Leaving Rehab)

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My mother was hospitalized for the second time in rehab due to extreme stomach pains. She had stopped eating and lost a lot of weight.

 

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By this point, she was no longer taking Lisinopril (high blood pressure medication). Her blood pressure had actually  normalized thanks to an Ayurvedic home remedy–a cup of hot water with a teaspoon of honey and 5-10 drops of apple cider vinegar each morning before breakfast.  But she was still taking Aggrenox (a blood thinner) and Lipitor (for cholesterol-even though she did not have a cholesterol problem).

 

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Initially, the Emergency Room doctors thought our mom’s stomach pain was due to gallstones. The scans, however, showed no gallstones. Nevertheless, they still wanted to do  exploratory surgery to make sure. The surgeon in charge said she did not feel comfortable operating on someone who was already compromised by stroke.  She said her gut instinct was that our mom was having a poor reaction to the Lipitor.  The surgeon was very concerned about our mom’s elevated liver enzymes.  She immediately discontinued the Lipitor believing this medication was causing  the problem.  The surgeon explained that  Aggrenox is often paired with Lipitor because (for some stroke patients) these drugs work synergistically– even if there are no cholesterol issues. However, she said, “Not all drugs are effective for all people. Some can do more harm than good.”

 

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One day after the Lipitor was discontinued, our mother started eating again.  She was then able to go back to the rehab/nursing home.

 

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Although our mom was eating– by this point she had completely given  up on her physical therapy.  She even resorted to falling asleep in the PT gym.   She was becoming increasingly more despondent and depressed– repeating over and over that she would never get better. The therapists kindly explained to her that recovery takes time.  My mom’s Occupational Therapist even gave her a pep talk for encouragement. She responded by telling him that we (her daughters) had abandoned her.

 

 

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After 3 months in the nursing home, our mother was an emotional wreck.  She could be laughing  one moment, then suddenly  crying the next. She was confused and disoriented. She even said she wanted to die.  She also spent hours perseverating on nonsensical themes.

 

 

 

I was afraid our mother would not survive another week  in inpatient care.  Her initial plan was to stay in rehab “until I can walk,” she said.  But we needed to change plans.

 

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It was time to bring her home. The social worker at the facility then started the 3 day discharge process.  The social worker  arranged for continued outpatient speech therapy, occupational therapy and physical therapy at a different facility.

 

 

 

On a rainy day in late April, my sisters and I  nervously brought our mother home.

 

 

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A Sort of Déjà vu

 

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My mother, Alberta, arrived at her new inpatient rehab/ nursing home by ambulance. She  had only one bag carrying three medications (Aggrenox, Lipitor and Lisinopril) from the hospital with her.  She was wearing a hospital gown, socks and pull-up style diapers.  My mother had grown so weak and frail during her  hospital stay that she had completely given up on any attempt at  using a toilet. This is when her nearly 9 month dependency on diapers started.

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My mother was hospitalized twice while in the nursing home.  Once was for a Urinary Tract Infection.  I later learned that “most of the residents get UTIs because they wear diapers.” The time when my mom got a UTI was when she was left in her urine soaked and waste laden diaper until morning.  The night staff  was mostly interested in sleeping, not working.  Although my mom called for help with the call button, no one came. Unfortunately, the night staff was also not well educated about the different needs of the different residents.   A more effective approach would be to train the staff about what it means to have stroke.  Or what it means to have Parkinson’s. Or what is means to have Dementia.  Regardless of the condition of the residents, the true missing component of the night staff was compassion.

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The daytime nursing staff at the facility was great.  They were always busy–but for the most part–they were kind, caring and attentive. My sisters and I practically lived there.  The daytime nursing staff even knew our schedules.  My older sister Aellyn was there from the early morning hours until about 9:45 am when my twin sister and I would arrive.  At around noon,  my twin sister and I would leave the facility, go to the office (and mostly refer patients to other psychiatrists).  Then we’d go home for lunch, walk Kookaburra and then return to the nursing home and stay until dinner when our older sister would come back and stay until it was time for our mother to go to sleep at around 8:00 p.m.

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My mother had daily Physical Therapy, Occupational Therapy and Speech Therapy.   My mother appreciated all of her therapists.   But she particularly adored her Speech Therapist and her Occupational Therapist.

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From the moment I saw my mom’s Occupational Therapist I had a strong feeling that I knew him.  It was  an unusual experience– but not an unfamiliar one for me.  I had a feeling like this once before when I got extended eye contact with Ricky Martin.  Yep, that Ricky Martin! It may sound odd, but I think different realities/past lives must sometimes overlap and something like a bleed through happens.  Did I seem familiar to my mom’s Occupational Therapist?  We’ll never know for sure.  But one time, it kind of seemed like maybe, perhaps he did remember our romance in 4th century China.  He was assisting me and my twin sister in the bathroom with our mother when suddenly our mom was about to fall over on me.  I stabilized my mom. Then I noticed hands around my waist and a thumb gently caressing and stroking my back.  It was the Occupational Therapist!  I turned around– he  was intensely blushing and his beard was all fluffy.  When I later told my twin sister, she said, the Occupational Therapist was just acting and reacting from “plain animal instinct.  Nothing more.”

 

7 Nights to Go Crazy (Hospital Horrors)

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The morning after the E.R. visit, an MRI revealed that our mom did  indeed have an ischemic stroke.

Types of Stroke (from http://www.strokeassociation.org):

  • Ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87 percent of all stroke cases.
  • Hemorrhagic stroke occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs). But the most common cause of hemorrhagic stroke is uncontrolled hypertension (high blood pressure).
  • TIA (transient ischemic attack) is caused by a temporary clot. Often called a “mini stroke”, these warning strokes should be taken very seriously.

According to the neurologist, in addition to the ischemic stroke, it was also clear that our mother  had been having  mini strokes (TIAs) or infarcts on the right side of her brain for sometime– all contributing to her  left side weakness.

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FYI:  In order for  insurance to pay for  any kind of inpatient rehabilitation, a patient is required to stay 3 nights in a hospital.

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Initially, our mom was on track to stay the 3 nights at the hospital.  The neurologist even anticipated that she would need only 2 weeks of inpatient rehab after that.  But because of one hospital related blunder after the next, our mom’s stay was extended to 7 nights at the hospital.  Things got so bad that my sister, Aellyn, decided to stay overnight in the hospital room with our mother.  Our mom experienced everything from poor sanitation, to medication mishaps to insane roommates,  to a broken bed,  a broken toilet,  insomnia, severe diarrhea, severe dehydration, blood pressure spikes and drops, difficulties finding inpatient rehabs (that would accept patients from this horrible hospital) and no weekend doctors on duty to help.  The no weekend doctor part was the most egregious. Can you imagine a hospital with no weekend doctors?  The day (and night) our mom experienced severe diarrhea, my twin sister, Akwelle,  had to threaten to call 911 to get the E.R. doctor to come up and care for our mother.  “Well, the only  doc on duty is in the E.R. right now. And he’s busy with E.R. stuff,” said Nurse Amber.  “If you don’t get that doctor up here, I will call the police and they will do it for you,” said  Akwelle to the Nurse Supervisor.  Those were the magic words because  Dr. Emergency Room came right up!

 

The hospital stay took a real toll on our mom.  By the end of the  7 nights, our beautiful mother, Alberta, was broken.  She was physically, mentally and emotionally drained.  She had aged at least 20 years in that one week.  She begged us to get her out of there.

 

Finally, on the 7th night, we were able to get our mother into an  inpatient nursing home/ rehabilitation facility.

 

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At the E.R.

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On the walk to the Emergency Room,  our mother kept insisting that she was ok. My twin sister pointed out a penny on the sidewalk. “See there.  Pick it up. That’s a good sign,” said our mother.  She then said she was going to tell the E.R. doc that she injured herself falling the night before.  But when we got to the E.R. my twin sister, Akwelle, immediately told the E.R. receptionist that she thought our mom was having a stroke.  Our mom was rushed to an examining room.  “Code Red:  Stroke,” was announced over the loud speaker.  My mom was allowed only one visitor in the examining room. My twin sister stayed with her while I sat in the E.R. lounge.

 

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I started  thinking about how earlier in the week, at home, I had seen a little white cloud in the house. It was slowly floating, rotating like a wheel through the breakfast room.  “Was that a sign of something bad or something good?” I thought.   I had also seen this weird lady at the grocery store. She  had this thin cob-web like string  coming from the top of her head.  It moved with her wherever she went.  I could not figure out where it originated.  I blinked my eyes several times but I still saw it.  I must admit it–every once in awhile I do see unusual things.

 

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Back in the E.R. waiting area, I finally decided I should just go back to sit with my mom and twin sister. I figured the E.R. check in people were not keeping track of which one of us (twins) was where anyhow. This worked out perfectly. The E.R. doc was talking to my sister outside the examining room.  She said the Cat Scan showed no bleeding on the brain but she said she was concerned because clearly our mom was either having  a TIA or a real stroke.  She talked  about a drug called tPA (tissue plasminogen activator) that she could give our mom.  “But, I won’t– because there’s only a short window to give this drug and if your mom had a TIA last night and then another one today, then that window has closed.  It is too dangerous. It could even  kill her.  There is no way I am risking that.  She will have to stay here overnight for observation,” she said.

  • tPA or tissue plasminogen activator (from http://www.strokeassociation.org):
    The only FDA approved treatment for ischemic strokes is tissue plasminogen activator (tPA, also known as IV rtPA, given through an IV in the arm). tPA works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. If administered within 3 hours(and up to 4.5 hours in certain eligible patients), tPA may improve the chances of recovering from a stroke. A significant number of stroke victims don’t get to the hospital in time for tPA treatment; this is why it’s so important to identify a stroke immediately.

My twin sister and I went into the examining room to sit with our mother.   She was eating a turkey sandwich.  “You should go home.  I am fine.  Pick me up tomorrow. Go home and walk Kookaburra,” she said.

 

Blizzard Warning

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I had a bad feeling something big was about to happen. Every morning since Christmas, I’d been waking up wondering if my mom was going to wake up too.  Then the blizzard announcement came.

 

 

The predicted storm was alarming to most people.   For me, it came at a good time.  Since the beginning of January, my mom had developed an odd rash all over her face.  It was getting severe.  I thought maybe a few days at home would do her some good.  Plus, I thought it would give me time to do some research in my handy dandy book on Ayurvedic home remedies.   I had to figure out what was causing that rash.  Maybe it  was  caused by  troubling thoughts?  I even thought she might be depressed.

 

 

I first learned about Ayurveda (the Science of Life) when I was a sophomore in college. I had just formally declared  my concentration in International Relations instead of pre-med. Initially, I had planned on becoming a Dermatologist.  I had this weird fascination with pimples.  Then my mom showed me a few of her medical journals.  The pictures were graphic.  My mom said, “Bet you didn’t know pimples could pop up in all sorts of places-not just the face?!”   After that,  I decided, International Relations was indeed going to be my major.  Anyway, I was taking a Russian Literature class and was seated next to my loud, obnoxiously catty friend Eric.   He started saying snide things about  this girl seated in front of us.  He thought her hair was “way too long” and she should “not be wearing that sweater with those pants!”  The girl turned around to look at stupid Eric.  I apologized. The girl was Mallika Chopra.  We soon became fast friends.  She told me all about her dad (Dr. Deepak Chopra) and his books on the mind body connection and Ayurveda.  Those books changed my life!   Ayurveda is one of the world’s oldest  healing systems.  It is based on the belief that health and wellness depend on the balance between mind, body, and spirit.

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I knew there had to be a reason for my mom’s rash.  Was this skin outbreak her way of grieving?

 

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Lucille and Alberta

In August 2015, my mom’s older sister, Lucille,  died.  Coincidentally, Aunt Lucille had suffered a similar stroke nearly 10 years before my mom.  My mom and Aunt Lucille had a special bond.  My mother often talks about how Lucille was the one who encouraged her to go to medical school.  At the time, my mom had been feeling low because the schools she wanted to go to were not accepting women.  Aunt Lucille did some research and found a medical school for my mom.  She even got her an application.  When the acceptance letter arrived, my mom asked Lucille to open it.

 

Lucille opened the letter and read the good news.  My mother was washing dishes. She  was so excited she broke the glass she had been washing and severely cut her hands. Lucille angrily rushed my mom to the hospital. She feared my mom had now ruined her chances at going to  medical school.

 

 

 

Also, in early January 2016, my mom’s very  dear friend from medical school and fellow psychiatrist, Dr. Frances Cress Welsing,  had a stroke.  My mom, my twin sister Akwelle and our cousin Janice (Aunt Lucille’s daughter) went to visit Frances in the intensive care unit.  When we got there, my mom was totally shocked to see  her friend on life support. My mom was speechless.  But once we got home, she would not stop talking about it.  The next day we got the news that Frances had died.  My mom was very sad.  This is when my mom’s rash started getting  really bad.  I’d never seen her so upset, not even when my dad died.

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The weekend of January 23, 2016,  we got 28 inches of snow.  A blizzard!  Monday evening after the snow had stopped falling, my twin sister and I had a marathon of shoveling snow in the front and alley areas of the house.  My mom took her nightly bath and afterward said, “Good Night.” About 30 minutes later, my sister and I heard a loud thumping noise from my mom’s room. We ran upstairs and there was Mommy on the floor with her legs folded under her. My sister said, “What happened?” My mom said, “I just tripped over the humidifier. It’s nothing.  Good night!”

 

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The next morning, my mom said she thought she might have the flu.  She said she was going  back to bed.  I noticed  she was stumbling again while walking up the stairs.  When she got to her room, there was a very loud thud.  It actually shook the house like an earthquake.  My twin sister and I rushed upstairs once again.  Our mom was on the floor, but this time she had trouble getting herself back up.  That’s when my twin sister insisted that we go to the Emergency Room.  My mom said she just needed a nap.  But my twin sister  said she was going to call an ambulance.  My mom said, “No!” Then my twin sister cleverly said, “Why don’t we go to your doctor’s office.  He’s in the building next to the hospital.  The streets are probably clear over there.  Let’s do that!”  My mom said yes.  The next task was all mine–driving through all that crazy snow!   I did not stop for any red lights. I just kept on going– praying I would not crash.  Thankfully, we were the only people on the road.  Finally, we got to my mom’s doctor’s office.  There was a note on the door, “Due to inclement weather we are closed.”  I had already parked the car in the parking garage.  But, the ER was just in the next building.  So we walked.

 

snow