Jun 8, 2009

A Kind of Vu ja de

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I bolted upright for a coughing jag that produced little but wakefulness. Reaching for inhalers, I heard myself wheeze. Never a bad time for petting, my cat jumped into bed, hopeful. I coughed again and listened to air rumble through mucus-plugged passages long after I stopped exhaling.

My bronchial tree literally dripped and oozed in excretia that suffocated, like Spanish moss on deep swamp cypress. I inhaled deeply and coughed forcefully. The wet rattle should have produced gobs of goop. I sound like one of my patients.

“Cough,” I encouraged them, “Harder! Cough that stuff up!”  It sounds like such an easy fix, moving mucus from bronchioles to bronchus where it can be hawked up and out. I had no such luck; try though I might. In that moment, I saw my end.

Ever experience déjà vu; that compelling sense of: I’ve been here before? This was vu jà-dé, the antithesis of déjà vu and presentiment of: this is where I’m going.  In the stillness, solitude and silence of the predawn, within the dim dome of a single bulb, I suddenly saw myself: a tiny old woman, ribs protruding, racked by cough. Death by pneumonia; the most common death for seniors. And why not?

“If you can’t sleep because you can’t breathe," I advised, "Or if you are afraid to sleep because you’re afraid you won’t breathe, you need to come in.”  Well versed in sleeping upright during periods of respiratory distress, I knew the subjective difficulty in deciding when to seek medical attention. I attempted to give my patients an objective measure, a line drawn in the sands of seeking help.

After two consecutive days of listening to my barking cough and raspy voice, Dr. Forrester slapped down his pen to ask pointedly, “Have you seen a pulmonologist?”  “Five today,” I croaked, grinning.  “Would you PLEASE seek medical attention outside your own cranium?” he pleaded. His fatherly advice was welcome and wise.

“This is always the dilemma,” I spoke in a halting, hoarse whisper, “When to start steroids? My peak-flow-meter is up 30-points so I think I’m getting better.” “Wait a minute. Didn’t you just say you slept upright last night, for the first time?” he asked. I nodded silently, resting my vocal chords. “You’re not getting better, you’re getting worse. Start your steroids.”

I never think clearly when asthma flares. My excellent deductive and diagnostic abilities are inversely proportional to mucus production. For this reason Kaiser has a policy contrary to the adage, Physician, heal thyself. Were I my own patient, I would chart: dysphonia, laryngitis in the vernacular.

“I think it’s the propellant in my inhalers,” I said. “This only happens when I’m using my inhalers every three hours.”  My physician friends disagreed, shaking their heads, “No, it’s your asthma.”  “But I never used to get this way!” I protested.  During the last decade my asthma worsened or I am less resistant to its predictable cascade when I entertain a respiratory illness. I say entertain because I am a reliable host for a solid month to a series of sleepless snoozes, the song of sleep deprivation, the dancing bacterial follies, a chorus of antibiotics, and curtain calls to a protracted standing ovation by salvation steroids. That’s entertainment! Emailing one’s doctor daily can purport and support a false sense of wellness. He wasn’t here to hear this… the gurgle so aptly named the death rattle.

Sequential nights of coughing fits interrupted by succumbing sleep had wrung all resistance from me. I fell back to my pillow and closed my eyes. I would wake up in the morning… or I wouldn’t. I would open my eyes to my oak tree appliquéd against the sky… or not. Either was okay and no one would know the difference until I was missing from work. The feeling of apathy, complete and utter apathy was astounding.

I emailed my doc in the morning and requested a visit: This is day 12. I need better meds for cough suppression. I have bilateral subconjunctival hemorrhages from coughing; I look ghastly and feel worse.
Later that morning, he examined my eyes, ringed in vermillion.  “You look pretty rough around the edges,” he shook his head. “How long has your voice been gone?”  “I think today’s the fifth day.” I proffered my theory of dysphonia secondary to inhaler propellants.

“Not your inhalers,” he disagreed, “It’s caused by inflammation of your entire bronchial tree including your larynx.” He stretched my steroidal course an additional week and prescribed narcotic cough meds.  “Maybe you should have someone that you check-in with daily,” my Mother proposed, worried and helpless in her island home two-thousand miles away. I had never been so sick, never mucus-trapped to that degree, it scared me and I said so.

A daily telephone check-in when I’m sick. It’s a sound plan and one I resist, as if it signals the end of an era of independence toward something more… dependent.  I hear the longing you have now for a deeper sense of connectedness and interdependence, a friend wrote.  Nuh-uh! I have an automatic way of being called: I do by myself. It is the conversation of a two-year-old. Life does not go well when she rules.

In the evolution of man and society, women have never survived independently without a man or tribe. That we do now or think we can… is an illusion. We are pack animals by nature and no different from the days of Christ, we still live in tribes.  The two-year-old has grown into a content cave woman. Connectedness and interdependence rise solely in my recognition and disassembly of that which keeps me isolated.

A vu jà-dé presents a jarring opportunity to assess one’s course. I have some years before I am that tiny old woman with protruding ribs, racked by cough, and apathetic to the sunrise. I am 2400 air-miles from my tribe and I am surrounded by kin. I can live alone on the ice flow or join the clan.

Welcome to the human race for the grave, one that perhaps produces something meaningful on its way and in its wake. What we remember with relish in the stillness, solitude and silence of the predawn, within the dim dome of a single bulb, will not be our acquisitions but undoubtedly, those relationships of deeper connectedness and interdependence. The richness of life pre-packaged in meaningful