The Waiting Room

Having a fifteen year old daughter is like living with a sarcastic kitten: clever, irrational, prone to napping, and reflexes that would put the average gunslinger to shame. It’s odd having a kid that is not only useful to have around but also intermittently more capable than me. Early phases of parenting involved a mutual acknowledgment of my superior strength and intellect. These days the only reason that I’m worth listening to is the fact that my collection of mistakes is fairly unbeatable. If, in the past, my instructions were couched in principled consideration, these days it’s mostly just stories about my comprehensive experiments in the various types of upfuckery that can break bones, hearts, and compact cars.

For Stella’s 15th birthday this year, she chose to spend the day at a waterfall with some close friends and then to have some grilled cheese sandwiches dipped in tomato soup. I’m deeply relieved that “low maintenance” is a heritable trait. So far, one of the things I appreciate the most about my daughter is her taste in friends, even if they are a bit more mature, clever, and talented than me. Teenage energy is a lot of fun. It’s like a combination of immortality, hair die, disbelief in consequence, and experimental orthodontics.

As the teen girl squad settled into the basement sleepover phase of the celebration, Tiff and I headed to bed, somewhat mystified by the pattern of squealing followed by loud thuds. Were they playing corn hole with bags of mulch? Having a pillow fight with wet pillows? It was a mystery until morning, when over waffles, they explained that they were spinning on barstools until “everything turned the same color” at which point they threw themselves onto some mattresses and camp pads they’d spread out on the ground and rolled around until things made sense again.

*Aunt Lois, Tiff, and the Teen Girl Squad*

Most of my friends know that Stella’s middle name is Firefly, but not everyone knows that it came down to a coin toss between Tiffany and I. We had Stella at home and in the circus of chaos that is life with a newborn, we failed to let the government know about her for quite a while and her middle name remained ambiguous for those first few months. Either Maris or Firefly depending on who you asked. When we finally were sitting in the car outside of the courthouse and had to commit to one or the other, we flipped a coin. Heads, I win with Firefly, tails, TIff wins with Maris. I lost the toss. Tiff was moved enough seeing how sad I was at losing and we decided to go with Firefly after all. Tonight on the solstice, fifteen years later, as I watched her dancing through a recently cut Indiana hay field amidst thousands of fireflies, I still feel good about the choice. Tiny miracles are still miracles.

We have spent quite a bit of time traveling by van for the last 20 years. Between van 1 and van 2, we have logged over 350,000 miles in a big noisy box. We have slept in all kinds of improbable places and I love having a big turtle shell that the whole family can hide in. And while it’s hard to beat waking up in some remote beautiful landscape, a lot of the nights in the van are just place to sleep on the way to somewhere else. For these in between times, you can't beat a friend’s driveway as a place to bed down. You don’t have to unpack anything but you get all of the comforts of a clean bathroom and a nice living room. Sometimes you even get homemade fajitas and strawberry shortcake. On our way to Indiana, we stopped off at the family Darko’s place in Lexington to break up the drive and enjoyed making yet another night of memories together. I also woke up in the van to the unique version of crazy brief thunderstorms that characterize a Kentucky summer. Between the deep rumble of thunder and the stroboscopic lightning, I briefly thought I was back at burning man but I didn’t seem to be wearing women’s underwear and most of my recent memories made sense.

We were headed to Indiana because my mother recently found out she had a grapefruit sized tumor on her left adrenal gland that needed to be removed. After 20 years in medicine, and after the covid earthquake permanently cracked the foundation of healthcare, I no longer trust hospitals to reliably take care of loved ones who have been freshly incised and sutured back together. Nurses are overworked in ways that most mortals can’t comprehend and hospital administrators as useful as “thoughts and prayers” for the most part. It’s deeply saddening to watch our healthcare system collapse from the inside. Sometimes, as a doctor in our current medical system, I feel like the proprietor of a run down third world hotel: “The electricity is on between 4 and 7 and the working toilet is on the third floor. You gotta pay cash in advance”.

The country of Medicine has it’s own culture, vocabulary, and cuisine. As doctor, part of my role is always to be a tour guide for visitors. Doctors, nurses, and the rest of the medical crew do care about their patients for the most part. But they don’t care in the way that most people are used to. In most of society, caring for someone means attending to their happiness, whereas in medicine, we’re not so concerned with happy as an outcome. Alive enough to complain, that’s plenty good. It can actually take quite a bit of work to get a patient well enough to complain, and patients don’t know about all the stuff that happened when they were unconscious.

So, for relatives who are being hospitalized, I have my camp pad, my sleeping bag, a bunch of snacks and a stack of books to read. Not that I know anything about surgery. As a doctor whose specialties are emergency medicine and psychedelic therapies, the only expertise I have is crises, both real and imagined. When things are going according to plan, I don’t have much to offer, despite my parent’s blind faith in my medical omniscience. Mainly I translate doctor and nurse talk into English and function as a slightly more demonstrative call bell for the patient.

As we made it into downtown Louisville with its giant bridges and disparate mix of riverfront architecture, we navigated the increasingly complex union of 3 interstates and 2 bridges. From overhead it looks like any extension cord that I have attempted, and failed, to store in an orderly fashion, and driving it feels like playing Mario Cart. Currently they have one tunnel and one bridge closed which means a lot of traffic is diverted to an exit west of town where they get back on the interstate the wrong direction to get to their original destination. I did get to see a semi plow over a median through some grass thanks to a poorly marked detour. Me and the kids finally arrived at the hospital feeling like we’d survived an epic quest and were immediately subjected to the bonus round challenge of parking near a downtown hospital with a 10 foot tall van. We eventually found a sketchy pay lot with a minimum of rubber gloves and needles on the ground.

With Tiffany out of town at the country’s largest gathering of psychedelic medicine practitioners or “Burning Nerd” as I like to call it, Stella (15) and Jude (10) were enlisted in the hospital vigil with a promise of unprecedented screen time and some dried mango. However, after traveling for two days and enduring the Mad Max turnpike, we were informed at the hospital entrance that no one under 12 was allowed in. Certainly there are times, after a heavy night at chipotle, where I consider Jude to be a genuine biohazard. But this felt like one of those conspired reality shows, being forced to decide if I was going to protect my mother from medical mismanagement or leave my son in a camper van over at fentanyl corners. Oddly, while I was trying to make a plan C with my father, hospital receptionist waved me over and said, “They just now changed the rules again, now it’s ages two and up. Here’s your visitor stickers.” I left like I’d passed some kind of test to see how much patience I have for healthcare policies made by idiots.

*Me and what I’ve accomplished with a good psychiatrist*

I do really enjoy having the kids with me for challenging times these days. They are laid back, funny, enjoyably strange, and old enough to be genuinely helpful. Navigating a new hospital is easier with six eyes than two. The kid’s main goal was to deliver my mother a gift they had picked out, which was a small rubber triceratops that sprouted startling pink tumors when squeezed. Kids growing up with doctors have odd ideas about humor. “Ha, ha. Funny tumors,” I imagined them thinking. So weird.

We arrived just a little before they took my mother back to surgery and she was in good sprits like normal. My mother has a zen like curiosity and acceptance when it comes to life and I frequently wish I was more like her. She seems to never get sick. Between growing up on a farm and spending 50 years as a nurse, she has a different threshold for “hard” or “stressful” than most humans.

I have a close friend who often says that life is lived in the times between. Sitting in a waiting room with my father and my children felt like that kind of living. Sometimes being stuck waiting for the future puts you squarely in the present. The surgery was expected to last two hours and at two and half hours we finally got a phone call from a nurse in the OR saying “Your mother is doing fine but the surgery is taking longer than expected.” This helped allay my fears very little. There are very few times in medicine that something unexpected is something desirable. After another hour, and during the only 2 minute period my father ever left the waiting room for some coffee, the surgeon came out to talk to us and let us know that the tumor had been attached to the large vein leaving the kidney necessitating removal of the kidney and leading to a decent amount of blood loss. (One liter, or about 15% of her total circulating volume of blood). But she was getting a transfusion and would be moved to a hospital room soon.

We live in an age of miracles. If this had happened to my mother when she was a young woman, it could have easily been fatal. It’s so hard to remember what a luxury it is to live in a time and place where someone can be cut open, put back together, and get blood safely, all while unconscious. It was only a couple of generation ago that this would have been unthinkably futuristic.

My mother has had a sweetly curious and objective attitude about the whole thing. Before surgery, while she and I were walking around their property in Indiana, she likened it to pregnancy. She was curious about all of the changes in her body that were happening because of the tumor, but also excited to have it gone. After she awoke from surgery, and had sometime to settle back into the conscious realm, we told her about losing her kidney, and she was sad to lose a part of herself that had been with her so long. I have a deep respect for her ability to be simultaneously objectively curious and emotionally engaged in life’s odd turns.

The combination of my my mother’s robust health and my concerns about medical errors and hospital acquired infections led to her doctors recommending discharge after a one night stay. Hospitals are places where miraculous wonders occur. But once they do, you should get the #@%& out of there. Everyone there is either sick, or just spent time with someone who is sick. Hospitals are the inner city of bacterial life. If a bacteria grew up and survived in a hospital, expecting to win a fight with it may be deadly. While there may be a risk of complications from surgery, there is also a risk to just breathing in a hospital that is hard to quantify.

Studies have repeatedly shown that patients recover quicker with fewer complications when they have a view of natural settings. At my parent’s house, set on a low hill in Indiana, my mother was able to sit comfortably before windows showcasing the many trees and flowers that they have planted over the last 20 years while basking in natural light and having access to fresh air and the food that she is used to. It also gave her access to her grandson who desperately needed her to help him beat the legend of Zelda on her Nintendo.

We stayed on a few more days while my mother convalesced. I got to spend a lot of time biking and walking around in southern Indiana; quiet Mennonite farms with their horses and buggies, redwing blackbirds zipping through cornfields, orange tiger lilies and periwinkle cornflowers lining the edges of cattle pastures. Sometimes when I return to places from my past it feels like I can see the present in new ways. I can see how existing as both father and son simultaneously is probably a rare phase of life and that I should let myself make as many memories as I can. I also see a playfulness and curiosity in myself that has weakened due to either age or responsibility. I have always assumed that I would be immune to the inflexibility that seems to accompany aging, but I can see how it is necessary at times to provide the support needed to the generation before and after myself. I feel fortunate to have the health and capacity to support the people I love. I also see that we can become the roles that we play in relationships. Sometimes this is necessary, sometimes it is just easier to look outward than inward. As always, I want it all. I want the wisdom of my parents, the capacities of middle age, and the playfulness of my children.

I used to skateboard here 30 years ago, now onewheeling. Sometimes futuristic toys are pretty cool.

Turtles All the Way Down