September 7th, 2006

LL

Update, Tennis, The Knee, Football.... way too much!

As I watch the U.S. Open and wait for a dreaded meeting with a patient and his elderly mother, to talk about DNR (do not resuscitate) or even, hospice, I thought I would update my journal. The time never seems right, but it is so satisfying. So here goes....

Cardiomyopathy, dilated, with a low ejection fraction and increasing difficullty just getting through an ordinary dialysis without oxygen desaturation, feeling very bad, taking a 911 trip to the ER from the dialysis clinic.... arriving last Monday with a K+ of 7.8!!! No wonder he didn't feel good! No dietary indiscretion. No nopales! (cactus.... pure potassium, nearly and a folk remedy, but not for those with chronic renal failure.) Could he be having a bowel infarction without pain, diarrhea or acidosis?
And, if he is, he's not a surgical candidate. Oh the subtleties.... and in Spanish, and with denial. What a lovely mental adaptive mechanism is denial. Denial is why I almost never write anything for Damned Dialysis, the great patient support network via Live Journal.

Well, we are finished with denial, his and mine. I asked that a Spanish speaking social worker and priest talk with patient and mother, who hovers over him, with love!, but like he was at his first day in school. At 11:30, I will find out: 1) How much progress was made toward coming to grips with the reality of where we are. 2) What his latest LVEF is. It was 27%, and he should be able to live with this a while, but it seems more like it's 17-20% I do not like this part of being a doctor! I do not like trying to figure out what is best in a bad situation. I'm angry at god! Yeah, it's all part of the job. He, the patient, has had 4 or 5 years he wouldn't have had without dialysis. All we ever do is buy time anyway, but mostly, we don't think about it. It leads to existential depression.

I feel better, for the moment. I understand the dynamics of what is played out in my own mind anyway. It's part of the job. Tennis, football, self-pity.... part of the escape!
LL

My Knee.... Hah!

Andre Aggasi juist retired with a disc problem. Poor Samuel will soon be exiting this world with an irreparable heart. What the hell am I complaining about?

I can walk. I can get out of my very low Porsche, and stand up, and after a few steps, walk, seemingly, normally.

Tennis was how I hoped to improve my love life. Before I ever had one. When I was about 9 years old. In Chicago. At the park district. For 50 cents, or maybe a dollar. The public park gave you instructions and one new tennis ball, I think. Taught you how to keep your eye on the ball, bend your knee, switch your grip, and behave!

It was later on, after having learned the basics and seeing JANE RUSSELL, and discovering that in high school, the letterman's sweater seemed to be the key that unlocked the door to the cheerleader's heart, and realizing that I couldn't make it in the he-man sports, like football and basketball, I put my energies into that.... for Chicago, sissy sport, tennis. I got the letter. The team got the city championship. 32 years later, I got the cheerleader!

I guess it worked out, after all! Lin, with a pretty mediocre, old, tennis player, Capitola, CA, August, 2006 (photo by Gil Sharon)