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What I Have Learned This Week From Anastasia

09 Monday Nov 2020

Posted by Czet in Uncategorized

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Anastasia, benchmarks, Cedars of Marin, cognative disability, corpus calossum, goals, seizures, tuberous sclerosis

Let me introduce you to my eldest daughter, Anastasia.  When she was still a child she was diagnosed as having a congenital disease called tuberous sclerosis.  The diagnosis was slow in coming because her disease is quite rare and today’s medical diagnostic tools had not yet been invented.  It was a difficult time for our family.

Anastasia suffered seizures, mainly petite mal, which she gradually learned to shrug off.  Some were grand mal which galvanized her brother Michał and us, her parents, into action.  Grand mal seizures were life-threatening from falls, choking or the wrong kind of restraint.  Not knowing when to expect such episodes left the family continually on-edge.  Not knowing how best to help our daughter made her parents feel helpless.  There seemed no place nor anyone to turn to, so little was known about the disease and so varied were the ways the disease could express itself.  The doctors needed time and we needed immediacy.

Tuberous sclerosis, it is claimed, is often accompanied by cognitive disability.  This appeared to be the case with Anastasia.  Subsequently, an MRI scan revealed that Anastasia lacked an important structure in her brain.  It is called a corpus callosum.  You may recall that when his brain was autopsied, Albert Einstein was found to have had an oversized corpus callosum.  The corpus callosum is a bundle of nerve structures that connect the right and left hemispheres of the brain.  Albert Einstein had a superhighway connecting the two halves of his brain. We non-Einstein-caliber folk might be more than happy with a few two-lane highways.  Anastasia lacked even a dirt road.  

What this means to me in retrospect is that for much of her young developmental years, Anastasia needed to create and grow her own neural network where one did not exist. It was imperative that the two hemispheres of her brain learned to work together instead of operating as two separate brains vying for dominance.  Just imagine what challenges Anastasia faced. Slow physical growth, mental exploration from one or the other side of her brain, willpower, persistence, selecting something that seemed to work. Testing it. Choosing it or rejecting it. Simultaneously trying something else. Slowly creating a working pathway. Reinforcing it. Moving on to a different pathway.  To me, what Anastasia accomplished, necessarily alone and by herself, approaches Olympic achievement rather than represents cognitive disability. The final result is a series of compromises that we may call a cognitive disability but it is because we don’t have a vocabulary sufficiently discriminating to applaud her extraordinary formative effort and achievement.

Some doctors advised us not to expect Anastasia to live past her teens.  Last week she celebrated her 52nd birthday.  For the past 35 years she has lived in a group home within the amazing community of over 100 disabled persons and their caring and creative caregivers called Cedars of Marin.  As a resident, Anastasia participates in an annual “Individual Support Plan”.  This year her ISP was conducted via Zoom.  Following are a few of the things I learned.

Start on an encouraging positive note when talking about goals.

Anastasia has had a great year and is looking forward to an even better year in 2021. She is in a relationship with Gil and this continues to make her happier and gives her companionship. She and Gil continue to do many activities together that include cleaning, laundry, and helping other residents. She is adjusting to some scheduling changes with the current shelter-in-place directives. Anastasia is a great help to the staff every day.

If you volunteer you can often be assigned the jobs you like.

Living in a group home means sharing chores.  Anastasia took to some, including rolling the several recycling and garbage bins down the long driveway to the street curb for pickup by the municipal services.  She is strong, appreciates tidiness, and is happy about the home’s efforts to recycle.  She took the initiative to help get the barrels out for pickup and now happily handles, by herself, the weekly chore.

Goal – Anastasia will continue doing chores she enjoys which include emptying trash receptacles, helping with dishes, moving bins to the road, and helping with the laundry.

Do For Others When They Can’t. 

Each of the residents is assigned a regular day each week for access to the community clothes washing machines and laundry supplies.  It is their responsibility not only to wash their own clothes, but to keep the laundry area clean and tidy.  Some of the residents find this more challenging than others.  

When Anastasia observed one of her housemates having difficulty, she offered to help.  This was much appreciated by all, and was a far better solution than just complaining.

Express your frustrations appropriately.

At the same time, there are situations that arise between people who live under the same roof that aren’t so easily solved.  In those situations there are peaceful ways to articulate and use your words to express what is bothering you.  It is one of Anastasia’s goals for next year to improve this skill.  Otherwise, what (or who) may be bothering Anastasia, festers inside her.  The offending person has no opportunity to improve his/her conduct.  Instead of a reconciling conversation, conflict can arise.  It is far better to express one’s frustrations early and appropriately, than it is to let them fester and grow toxic.

Goal – Anastasia will seek staff support in managing her emotions.
Benchmark – Anastasia will continue to  demonstrate the ability to seek staff support to improve communication with her peers without anyone getting their feelings hurt. Again, this year she has greatly improved with this skill.

Nutrition.

This comes up regularly on Anastasia’s annual ISP’s but it is a goal she finds worth concentrating on.  

Goal – Anastasia would like to continue to lose weight and exercise more.
Benchmark – Anastasia will discuss healthy eating habits with Cedars Staff and Family Members including portion size and food choices.
Benchmark – Anastasia will continue to walk at least 3x a week.

Always seek opportunities to expand and improve your skills.

Anastasia is a Master Weaver. Yet she has high standards for herself. She works with Staff and constantly seeks ways to improve her skills.

Goal – Anastasia would like to attend a weaving support group and a yoga class on Zoom.
Benchmark – Anastasia will continue to participate in weaving and yoga classes.

__________
I have sometimes wondered upon what metrics will St. Peter determine to open the “pearly gates” when Anastasia, at the appropriate time, appears before him.  At first glance, it seems she has been unfairly disadvantaged. If so, it raises issues of God’s fairness and complicates how any life can be fairly considered. It makes one wonder if the example of the Saints pertain to us. Perhaps we, too, have disabilities that can excuse us for our failings.

I’ve concluded, however, that mercy must be evenly available and justice requires we will be evaluated on the basis of the same criteria.  Otherwise the virtues are nothing more than adjectives, arbitrarily applied to random lives, meaning nothing to our personal goals and aspirations.

We’ve each been given extraordinary unique gifts; gifts the world needs and depends upon, if only we are generous enough to develop and share them freely. We each have our share of corresponding weaknesses and disabilities that make us susceptible to being fearful, self-centered, angry, defensive or otherwise tempted by selfishness.  It is always our decision whom we choose to become, whether our physical bodies or cognitive abilities are more similar to Anastasia’s or to Albert Einstein’s. It’s no easier for either of them… or us to choose a path of admirable living. Nor is it any more difficult.

 Chet has adjusted to the changes in the evolution of his cancer this year.  But there are several ways in which he needs to improve… [See above for guidance.]

Chemo Infusion 2/12—”What, Me Worry?”

14 Wednesday Sep 2011

Posted by Czet in Uncategorized

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accidents, Alfred E. Neuman, amputation, Anastasia, apprehension, ArtsWithin, Civil War surgery, conundra, conundrum, corroboration, ego, embarrassment, epilepsy, fear, fright, helplessness, humiliation, ignorance, infusion room, Losing Control, lost, machismo, medieval cities, nanotechnology, nurses, overdose, pain, papyrus, petit mal, tuburous sclerosis

Dear Friends,

Summary

This week has been characterized, unusually, by my experiencing a series of mental flashbacks of members of my family who have needed medical intervention for their serious diseases.  Not entirely unrelated are the following factoids: • I once had the opportunity to digitize a fragment of papyrus (dating from 3,000 B.C.), that describes initial Egyptian investigations into brain surgery.  • There exist hair-raising stories describing Civil War surgeries in which doctors, recognizing, by then, that speed of operation could minimize shock in a patient, competed against one another in ultra-quick sawing.  Superior surgeons completed amputations in record time—albeit sometimes (and more than occasionally, as a matter of written record)—accidentally lopping off adjoining appendages in addition to intended limbs.)  • Today, molecular and nanotechnologies promise another revolution in medical practice.  Emerging from crude, investigatory beginnings, physicians have progressively mastered knowledge of manifold systems, molecular interactions and interventional techniques.

Yet for all that comforting reality, I wish I had a bit more of Alfred E. Neuman’s attitude of “What, me worry?”

Details

One weekend of my life I will surely never forget took place in the early 1970s.  My eldest daughter, Anastasia, was but a toddler.  She suffered from petite mal seizures of unknown etiology, for which she took liquid medications. On my way home that Friday I stopped by the pharmacy to pick up a fresh bottle.  Typically during a petit mal, we’d observe Anastasia suddenly stop whatever she may have been doing.  A glassy-eyed unfocused stare would come over her face for 10 or 15 (?) seconds as her body and limbs took on an uncontrolled rigid jerkiness.  Seconds later, all the symptoms would disappear in a flash.  Anastasia would appear to be slightly disoriented for a second.  Then, she would blithely return to whatever it was she was doing before the epilepsy struck her.  But on that weekend’s Saturday morning, her mother and I watched one of Anastasia’s fits with horrible fascination.  It had a longer duration than usual and was less controlled.  Her body and arms swayed according to what appeared to be a macabre dance choreography.  She was obviously more discomfited during and after the long episode.  She seemed tired when she came out of it; seemingly, an eternity later.

What followed, of course, were urgent calls to doctor’s offices, hospitals, emergency rooms and pharmacies.  (Communications have improved a lot over the past 40 years.)  I was a callow father in my early thirties.  I had no idea of the import of the innocent question that, in desperation, I blurted out after an otherwise frustratingly futile phone conversation I’d been having with a pharmacist: “Might there be any significance in the fact that Anastasia’s medicine is typically orange in color, but the bottle I picked up on Friday is raspberry in color?”

There was.  As it turned out we had been, all unknowing, coaxing Anastasia to swallow a medication five times stronger than the dose prescribed for her.  Accidents happen.

For those who have not met Anastasia, I should explain that the story of this accident ends well.  She recovered from the overdose quickly (as toddlers do).  Weeks later the genesis of her petit mals was definitively diagnosed as resulting from a disease called tuburous sclerosis. Doctors predicted that Anastasia would live into her teens; but that we could not expect her to survive longer than that.  This coming November, our family fully expects to celebrate Anastasia’s 43rd birthday! Although disabled, Anastasia’s is a joyous and cheer-filled life.  She works as a weaver in a sheltered workshop (and would gladly sell you some placemats, table runners, or other woven goods she and her colleagues are so proud to create).  It surely looks as if she may outlive me!  Predictions, even medical predictions, don’t always come true.

In my Cancer Clinic, I wear a wrist bracelet with my identification.  Even so, as each new bag of medications is attached to the IV pole, the nurse asks me to state, aloud, my name and birthdate.  When particular drugs are being prepared for infusion a second nurse is summoned to witness my answers as to my identity, and to corroborate that the medication being injected into me is the one that has been prescribed for me and not another patient.  This procedure should console me… save for the fact that I know that such a regimen would not have been put into place had there not been prior experience of mistakes being made.

When I appeared at my Cancer Clinic last Friday it was to be “unhooked” from my fanny pack with its 48-hour continual infusion.  I was greeted cheerfully by the attending nurse who said “You’ve been here before [and presumably know your way around].  Go on in, and get comfortable.  Someone will be with you in just a moment.”  Confidently, I strode down the hallway but quickly found myself in a warren of physician’s offices and small specialized laboratory rooms.  I’d clearly gotten lost and didn’t belong there. Abashed, I retraced my steps and eventually found my way to the infusion rooms.

I’ve got a pretty good sense of direction.  I didn’t even get very lost in the wonderfully crooked streets of Rome or Milan, or the anti-parallel ones of Krakow.  [In the case of many Medieval Cities, the central nest of alleys and narrow lanes are not merely artifacts of geography or topography, but were intentionally designed to confound and confuse intruding marauders who might have penetrated the outer perimeter walls of the city.]  So I was curious about having gotten lost in an office building… until I realized that, quite possibly (read “likely”), I didn’t really WANT to get to the infusion rooms.

Although culturally endorsed, its actually contrary to some deeply imbedded genetic code to admit Fear.  Yet, for the past two days, on the run-up to only my second full days of chemotherapy, Monica noted that I’ve become increasingly apprehensive.  I’ve felt it, too.  I’m in the best of care and am possessed of the most competent academic and clinical advice about my condition.  My chemotherapy is administered in sterile and professionally controlled circumstances by experienced and exceptionally well-trained nurses.  But despite these rational understandings, I’m afraid!  …of mistakes;  …of possible pain;  …of the integrity of my body being violated by incisions and needles;  …of poison;  …of my cancer;  …of ignorance and the helplessness that comes from it;  …of, perhaps, losing control;  …of potential humiliation;  of… of… of.  [Its worth noting that these fears all relate to the ego.]

The mischievous face of Alfred E. Neuman mocks me with his iconic motto: “What, me worry?”  Sure, me worry.  And for good reason.

Its counter-productive to deny Fear.  The machismo attitude comes from a desire to appear invincible to whatever it is one fears.  But to the extent denial or machismo dulls Fear, it can be harmful.  Nor, evidently, is rational analysis effective at dampening this primal instinct.  Fear is a complex response upon which depends survival of individuals (and, indeed, species).  Possessing Fear we can instantaneously respond to dangers, seen or felt.  Fear prepares our body physically, mentally, and chemically to respond to a challenge.  Fear heightens our senses and alerts our defensive attitude.  Therefore: “Fear is our friend.”

Nevertheless, I feel embarrassed to admit to Fear particularly when I know, full well, the proper actions to take, and know that I WILL take them.  [Isn’t Fear unnecessary under such conditions?]  In addition, I am intensely conscious of what an extraordinary gift it is to have access to and to receive the care I’m undergoing.  [Doesn’t Fear denigrate such an undeserved gift?]  I am intellectually confident and, indeed, certain (as can be) that the treatment I’m receiving will rid me of my cancer.  [So why be Fearful at all?]   Yet, Fear exists.

My relation to Fear seems to be another conundrum and paradox.  I’m becoming increasingly aware of living with such conundra.  But despite the awkwardness I feel about feeling Fear, I am very grateful that this core instinct is not diminished in me.

I am frightened.  I’ll go.  But I’m right to be wary.

Chet

Related

• About CEDARS (where Anastasia lives) and ArtistWithin (where Anastasia and her friends, the weavers, illustrators and ceramicists sell their goods to the public) — http://www.thecedarsofmarin.org/articles1.aspx
• About MAD Magazine and Alfred E. Neuman — http://en.wikipedia.org/wiki/Mad_(magazine)

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  • On Thanksgiving Day, 2020 2020/11/26
  • What I Have Learned This Week From Anastasia 2020/11/09
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