The Big Disclaimer: Dear Ones, the takeaway for this little story is not “Jesus is really nice, and He took away my problems because of my faith.” No no. The takeaway is “I was a big sluggard fool who did not attend to her symptoms, and through sheer undeserved stupid luck stumbled across good people who did.” If the trouble passed by, that is no credit to me. Someday the outcome will not be good. That is human life. Jesus is Jesus no matter. On with the show.
My ankles have an extra-Soviet look.
The lower legs have a thick stocky appearance. Back in Leningrad the older Russian ladies all had it; their ankles looked stiff and heavy under their woolly leggings. Retired women in black dresses and kerchiefs kept the infrastructure going; they swept boulevards with little twig brooms, and scrubbed steps, and hauled barrels of building scrap up stairs (and if you stopped to grab a side handle they’d bash you with an elbow). The women were on their feet all day working their abacus at white marble shop counters and impaling little paper receipts on to a metal spike. They stood in packed trams, and bread lines. They stood boiling bed sheets in communal kitchens. On holy days they stood at attention for hours in churches with no pews. These were not flabby sedentary people. So over the years when my ankles got that stocky look, it brought back fond memories of those Leningrad women, who spent their teen years taking apart wrecked trams and rails in dead winter and putting them back together and operating the system themselves after a three year famine with bombs falling all over.
Unlike the Russians, my ankle situation did not come through honest labor. It came from a lifetime of computer editing in a chair. Then a while back, a basic Jack LaLanne deep-knee bend became impossible. Then at our neighborhood hopscotch meet, the hops didn’t feel like a fun lymphatic workout; they felt jarring and wooden. Then, it was hard getting off the floor gracefully. When you visit a masjid and sit on the carpet to chat with the ladies after the service and then go to stand up — those women of all ages just float to their feet like effervescent bubbles in clear mineral water, while my double-handed inverted roll draws wide looks of concern.
That didn’t slow me down on vacation in Eagle. Those stocky ankles hiked all over town all day. But after the trip back, the 13 hours of car / plane / plane / train / bus, away from a Christian culture and all its friendliness, I felt let down and discouraged. Being home in the city itself was fine, and so was being at work. But over the next couple of weeks, every day before dawn I woke up feeling down-hearted, with a sinking sense of foreboding and fatigue. After a good night’s sleep all I wanted was a good night’s sleep.
It felt tiresome to get off the floor and out of my blankie roll, to get down on the floor to said blankie roll at night, to get out of a chair, or to walk down stairs or jump down from the back door of the bus (exit from the rear). When ankles don’t flex or pivot or pronate fully it throws off cushioning and balance. The lower legs cramped easily, and got so restless at work that I’d go lie down and prop them up against the wall. The ankles were looking red and chafed and chapped. (Maybe there were pesticides in the grass, where I walked at the cemetery and golf course to photograph the view?) Then they grew so itchy that to feel comfortable I’d have to run them under hot water.
One Friday at the office we had a big eventful customer service day. People needed direction and help. I ran intereference with scheduling, rooms, deliveries, visitors, and redirecting messages. By 5:00 a silent thought rose to mind: “For Christ’s SAKE, why can’t you people get it together?” That surprising attitude was a sure tip that something was wrong. It was good to take the weekend off and just get some rest.
But on Monday morning, the prospect of hauling up off the floor, let alone facing a work day, was too much. I stared at the ceiling and heard myself say “Oh God. What’s the point? I just want to die in my sleep.”
Then, a threadbare little waltz came to mind. It sawed along over and over, refusing to go away. After a while, the lyrics floated to memory: a hymn sung by sweet Mrs. Kirkland, on an episode of “Tiny Notes from Home”:
I must tell Jesus all of my trials;
I cannot bear these burdens alone;
In my distress He kindly will help me;
He ever loves and cares for His own.
That old chestnut was not even a favorite of mine. The message seemed a forlorn last resort for people alone in little studio rooms, sleeping on the floor in a blankie. Just how did Jesus plan to bear my burden of getting up and going to work today? That thought provoked a lot of annoyance while I tried to languish in peace, forcing myself to not scratch my itching fidgety ankles while that tiresome ditty inchwormed right along:
I must tell Jesus! I must tell Jesus!
I cannot bear my burdens alone;
I must tell Jesus! I must tell Jesus!
Jesus can help me, Jesus alone.
Next an interrupting thought flashed to mind, like a news bulletin: “Cast thy burden upon the Lord, and he shall sustain thee.” A really good Christian would know the chapter and verse. A minimally better Christian would have gotten up and tracked down the quote, but I was too tired to care. Still, this verse and tune did make me wonder. What if I did tell Jesus? Which slice of this whole fatigue pie would I even talk about?
An instant idea dawned: I could tell Jesus through a reliable proxy. I could share the burden now, by walking in to the Urgent Care Clinic and saying “My ankles itch like mad.”
“Golf Course Allergy” seemed a petty reason to trouble the providers down at Urgent Care. But I double-hand rolled off the floor, emailed the office for a sick day, and called the clinic. They booked me a 15 minute slot for 6:30 that evening. A same day appointment! That was a very meaningful stroke of luck. Feeling lighter and more hopeful, I soaked my ankles and went right back to sleep.
For medical appointments it’s a good idea to check in at least an hour early in case somebody else cancels. For a 5:15 arrival, by 4:00 I was standing on a city street packed with commuters, at a busy intersection serving several lines of buses. The scene felt too loud and glaring. It was hard to balance, to turn, to walk a straight line. It was harder to predict and to merge with the rhythm of the crowd. Before I could scramble out of the way, a jogger body-slammed right into me, stammered an apology, and sped onward.
Urgent Care runs on triage. People like me with our own reserved appointments are the privileged ones. We have symptoms stable enough for advanced planning, we speak some English or arranged for an interpreter, we have the technology and skills to make a phone call or navigate to the website for online booking. Any appointment comes with an understanding: anyone who feels worse than I do can walk right in and jump the line. That’s exactly what happened. People with complex medical issues arrived at 6:30, 6:40, 6:41, 6:50, on and on. In the waiting room, each time the name MARY crept up the list to the top of the electronic screen, with estimated wait as 0 minutes, suddenly other names would appear above mine and other patients and their families were whisked in to see the doctors. The wait crept on with a rising level of suspense. Closing time was 8:00. Sometimes patients had to be sent home to try again next day. But in another ray of good fortune, the valiant clinic staff called me in at 8:15 for a last encounter with a hard-worked but resolute vigilant physician.
The doctor scrubbed and gloved up, examining the ankles with care. He shook his head and entered a prescription for ten days of oral and topical antibiotics, and a whole panel of blood tests. “Edema; could be any of several causes. Lab’s closed for the night. Get the blood work in the morning; we’ll take the results, and plan from there.”
“Could this be an underlying chronic venous insufficiency?” I asked him.
“Yes.” He looked regretful as he scrubbed up and left the room.
Well, that could account for the downhearted sinking feeling. Something really was sinking — in this case, my blood supply. What a relief to catch the two buses home, email work for another sick day, and go to sleep.
Bright and early in the morning, a text pinged my phone: prescriptions were ready at the grocery across the street. I picked up the order, drew up a schedule of times for doses, considered heading to the lab right away, lay down first for a little rest, and didn’t wake up until 2:00. That was an interesting sleep pattern that week or so. I would lie down for little breaks with some nice song playing as background. Invariably I’d wake up with a start when the 3 minutes was up and some strident commercial came on. That 3 minutes sounds like a pretty rapid cycle from wakefulness to deep sleep.
At this point, our Orthodox Christian readers might be wondering. Could this have been a spiritual attack? Well, who knows. It would seem that a customized attack would target someone of more spiritual stature. But for the lowest level of attack, maybe a pretty effective message would be “There’s no point in struggling. Stay in bed, and sleep all your problems away.”
Instead, at about 2:00 a very no-nonsense silent intuition demanded that I get up NOW and out to the lab for bloodwork! On the double! Somehow I got myself together, took the next dose of meds, limped off to the bus, and reached the lab for a 4:30 blood test. I limped home, took the next dose, and pitched into bed for blessed comfort and rest.
Usually in the evening I turn off and charge up my cell phone. But instead at 8:00 I was all tucked in, dozing off to a Pimsleur Ukrainian language CD. Once the CD finished, I planned to turn off the player, charge the phone, and go to sleep.
At 8:15, the cell phone (should have been plugged in, mind you, but was not) started ringing. I looked at the number. It was unfamiliar. Probably a robot call. I had no intention of answering. I answered anyway.
A cordial hearty voice wished me a good evening. It was a doctor from Urgent Care. “Someone did call you about your blood work. Right?” she asked.
(Uh… called me? How could results be done already? No, Doctor.)
“Your D-Dimer level is elevated,” she said, with cheerful upbeat calm. “A normal reading is 0 to 0.50. Yours is 0.63. Which is your hospital? Oh — campus? Good. Go now. Report to the ER. Given your other symptoms, the lab result indicates that this might be a deep vein thrombosis. A DVT, or blood clot. People do live, if we catch it right away.” With kind cheerful firmness, she let me know in tactful fashion that if I lay here, and remained alone, I could die in my sleep.
Wasn’t that the goal? said the first thought in mind. In the next split second I looked around the studio room. There were boxes of filing and books stacked all over, because for days I didn’t have the energy or agility to keep the space clear. But I didn’t want people to find me lying here three weeks from now and say “Gee, not only that, but her place looks pretty cluttered.”
More important, here was this doctor, who was not my provider. I was not her patient. At 8:00, she was off the clock. She could be on her way home! But she stayed on anyway, reading all the lab reports. Then, she took further interest in wondering whether the handoff had happened: whether anyone picked up the phone with my results. If she thought it was worth all that trouble, the least I could do was anything she told me. I thanked her over and over, from the heart. She made me promise to get going.
That promise to her got me upright and washed up and changed. I grabbed my insurance card, two forms of state-issued photo ID, the new antibiotics, credit card and checkbook, drinking water (no snacks; some testing needs an empty stomach), cell phone charger, notebook and pen, reading material, rain gear, fluorescent vest, and a flashlight for the trip home again. In 23 minutes flat I was at the bus stop one block away. In 20 minutes more I was checking in at the ER as a Suspected DVT.
On that Tuesday night, the ER was full. All chairs were taken. Just as well; with a DVT risk, sitting around may not be the best idea. So standing in the corner, I opened my Bible for the daily Psalm reading. The book flipped open to Psalm 55:22: “Cast thy burden upon the Lord, and he shall sustain thee.” That was an eye opener. After the Psalm reading I opened my other book, a large anthology of writings by Reverend Billy Graham. It opened to a line from I Peter 5: “Cast all your anxiety on Him, because he cares for you.”
I pondered those two Bible quotes, with Mrs. Kirkland’s hymn rolling along in mind as it had all day. Reading Mr. Graham’s anthology, I set out on a very slow walking meditation all around the back wall of the ER. With occasional breaks for testing in the back rooms with various providers, the walk became a private little Camino de Santiago, lasting for the next 10 hours.
That day, nobody triaged past me. The reception team outdid themselves being thoughtful and kind. Even the security guard was outstanding. This alert patient man monitored the waiting room, and the condition of the patients. He gave parking advice, instructions on finding other clinics, directions to the vending machines. He rounded up stray wheelchairs and offered them to new arrivals who needed them. Gently and patiently he coached a departing Somali family on how to find the rest room, repeating the instructions step by step three times, orienting himself in space and pantomiming the process until finally the family felt confident and comfortable making the trip.
“But sir, we are completely full,” explained the valiant Reception team to a gentleman at their counter. “There simply are no beds. We will call you as soon as we possibly can.”
“This is the kidney stones!” exclaimed the visitor in a Russian accent, pointing to an older man using a wheelchair. “Do you understand how painful he is? We came even with ambulance!” To American ears, this might seem like an overbearing behavior. But in a Russian medical facility, getting the attention of overworked staff could require an assertive and even vehement demand for special or urgent care.
“Absolutely, Sir,” said the receptionist. “It’s written right here in the intake. They are aware of the problem. We will call you as soon as we can.”
The two men, who later turned out to be father and son, conferred in tense whispers. My old-war-horse instinct was to rush over and help. But their help was on the way, and my interpreting days were over. I was here in my new role as patient myself. Mind your business for once, I thought. Give these people some privacy. Pay attention for when the nurse calls you. And yet, me being me, after internal see-sawing pro and con, I finally approached the Russian father at a respectful distance with a contrite bow, hand over heart. “Proshú proshchénia. I beg your forgiveness. I apologize in advance, just in case they call me in first.”
The two men blinked at me. The son leaped up, trying to persuade me to take his seat. “What are you in for?”
“It’s…” The Russian word escaped me. I showed them my angry-looking ankle. “The blood sometimes clots up in a spontaneous manner, forming a blockage in the vein.”
“Tromb!” they exclaimed, making the sign of the cross with a reflexive prayerful whisper. “No! No, if they call us, we will demand that they take you first.” The son sprinted to the vending machine and bought me candy.
As if on cue, the triage staff whisked me right in, ahead of everybody else. Each provider that night was absolutely responsive, attentive, cheering, and gentle. They gave me lots of face to face eye contact, speaking in a clear and calming manner, keeping up pleasant conversation while they monitored my physical and cognitive status. In response to my determination to be pleasant and good-humored, they responded with great good will and humor themselves. There were lots of questions, some over and over (family history, any smoking habits, alcohol, any BREATHING PROBLEMS at the moment?) There were also extra blood draws for whatever lab tests might be called for.
“Sorry,” the lab tech smiled. “Taking a lot of samples.”
“Fine,” I said. “I’ve got another 13 pints. Do I get a cute cartoon-character band-aid?”
“Any recent plane trips?” asked a luminously kind ER resident. “Any extended time in a car?”
“Four plane trips,” I told him. “Two 13-hour journeys, to and from vacation.”
“Ah, I see.” He smiled a little wider, and smoothly racewalked away to consult with the ER attending physician. The ER attending physician came right in. She apologized that the vascular imaging team would not be available until 7:00 am. For a precise diagnosis we would have to wait until then, and meanwhile keep observing my symptoms through the night.
They let me back to the waiting room. By then the Russians had been called in to the back rooms. In my notebook I updated a running record of each provider’s name and title, and what they did and said. Then I kept strolling with Mr. Graham’s book.
A new receptionist came on duty. Seen from the patients’ vantage point over the counter, she wore a neat professional hospital uniform. But at one point when she crossed to the back room, one could see that she wore wonderful elaborate high-heeled cowboy boots. They were a pinto horse pattern in black and white, with lavish feathering fringe and shining buckles.
“In those boots, you are ready for any work emergency,” I told her. “They are simply resplendent.”
“Helps lighten the mood,” she laughed.
At their plexiglass booth office in the corner, there was a changing of the guard. The new guard, like his predecessor, was attentive and deft and unobtrusive, guiding patients and giving instructions. He looked like an interesting young man, someone with genuine caring and presence of mind. He had the cleancut vigor one sees among the LDS missionaries, young men with classic Biblical names who stroll the campus in pairs in nice black suits in all weather. I stepped away from the plexiglass booth, not wanting to distract his vigil. But while pacing in the fresh air near the open doors at the entrance, I thought it would be nice to have some pretext for striking up a conversation with him. There wasn’t long to wait.
“Ma’am, excuse me?” There was the guard, out of his plexiglass and right behind me. “We need to keep that entrance clear at all times. Is there anything I can do, to ask you to step away from those doors?”
“There is everything you can do,” I answered, stepping away from the doors. Then in dismay I realized that my reply sounded very forward. And here I was, old enough to be his grandmother! “That is — no, I meant — you’ve done it all already. I will stand in this corner instead. Thank you, Sir.”
“Thank you, Ma’am. Appreciate it.” He strode back to his post.
The team called me in every hour. Blood pressure, questions about BREATHING (checking for pulmonary embolism?), eye contact and friendly chat (checking for signs of stroke?). After midnight the team measured my height and weight, calculated a dose of short-acting anticoagulant, and administered the blood thinner with a horse-sized staple gun to a generous pinch of my abdomen. This of course led to the rueful thought that if the abdomen were less generously pinchy, I might be in better condition and not in the ER to begin with. “You can administer this injection to yourself,” they explained. “Every day for the next few weeks.”
“Me? To MYSELF? Uh, how far does that needle have to go in?”
“All the way. Or, do you have a partner or family member who can administer it for you? Trusted friend?”
I could just see me knocking at the Wing family next door. “Uh…”
“We can talk about it later,” they reassured me. “The Vascular team will be here at 7:00 am to take an ultrasound. We can let you go home for a while. Get some sleep. Just be back by 7:00.”
It was now 2:10. I went out to talk to the reception staff. “Hello! I’m to report back here by 7:00 sharp later this morning for the Vascular team. Now, I’m a little scared about going home. Urgent Care told me that I must not fall asleep, or be left alone. I understand that for security and confidentiality reasons you are not running a B&B here — but is there an empty corner anywhere in this hospital where I can wait for the next five hours?”
“You can certainly ask Security,” the reception staff volunteered. “That is entirely their decision.”
I approached the plexiglass booth. “Hello? Officer?” I explained my situation. “Is there any place in the hospital where I can stay out of everybody’s way? My check-in here at the ER will be in a little less than 5 hours.”
“Ma’am, I regret to say that our hospitality accommodations are not of the highest order. We are lacking in the usual amenities.” He shook his head. “But you are most welcome to any chair in this waiting room.” By then the whole room was empty.
“Oh! Thank you, Sir! I promise to not block the door.” I looked around. “Would any of you like anything from the cafeteria? I could run down and bring it back.”
“Cafeteria’s closed,” said the team member in resplendent boots. “It opens in the morning.”
“Oh. Vending machines then?”
“We’re good,” said the guard. “Thank you though.”
With five hours down and five to go I sat down to raise both ankles, rotating the feet as a change of pace. Switching books I opened the Bible to the Revelation of St. John. Its surrealistic tone seemed to fit nicely for 2:00 am at an ER.
At 2:30, three new patients checked in. All of them came to tell their life story. One talked to the receptionists. One headed for the security guard for a monologue outside the plexiglass cube. One crossed the empty room to sit right next to the lady in the long dress and head scarf with the jumbo typeface Bible and the rotating ankles. From my seat I could hear the other two narratives (it would add colorful interest to relate the details here, but would not be ethical) while the senior gentleman beside me described the Slain Lamb Upon the Throne and encouraged me to receive laying on of hands with the ever-healing power of the Most Precious Blood. At no point did I feel afraid, but it came as a relief when he simply wandered out the door. The other two men were called in by the triage nurse. To restore some equanimity I got up and stood closer to the plexiglass cube.
“Your gentleman there had an interesting story,” said the guard.
“I had Revelation open on my lap to the Blood of the Lamb, and even I was getting scared,” I admitted. “But you all have so much going on, I wanted to listen nicely and keep him talking, out of your hair and away from the receptionists.”
“You did? I appreciate that,” he said.
Here’s the upshot. Diagnosis: Cellulitis and a lively staph leg infection, plus the chronic venous insufficiency. At 7:00 am, the Vascular Imaging team took a full top to bottom ultrasound of the blood vessels in both legs. “No sign of a clot,” they beamed. “Blood vessels clean as a whistle.” All the lab blood work turned out normal and good; they explained that the D-Dimer rate might simply indicate systemic inflammation. (That is still an important concern to work on). But for the time being the main alarm passed over. For that morning I got to go home, leave the Russians’ gracious candy bar on the giveaway shelf in our building, take my meds, and crash into bed. Later that day I took the notebook and typed out the names of all the providers and staff.
The underlying problem is still there, hobbling some on stiff ankles and a general feeling of being alone and worn down. But two days later, another Urgent Care exam found that the chafing and heat were cleared up, thanks to the antibiotics. Ten days from now, it’s back to Urgent Care for an annual physical; one of their doctors has room to be primary care provider to a new patient. There’s a referral for support stockings and physical therapy. I have to take walk breaks as much as possible, and stand up often. Maybe I’ll write to Mrs. Kirkland and thank her for posting that hymn. A lot of thanks are certainly due to the whole care team.
But, back to our story. Before my ultrasound, before dawn, the Russians came out to the waiting room and joined me near the plexiglass cube. One was treated and resting much more comfortably, both were much calmed and cheered, and they were waiting for family members to come pick them up. They were eager to give me their phone number, and invite me to their Orthodox church. (I did text them next day, but didn’t hear back. I will however attend their church one of these Sundays.) We all shared favorite stories about the Orthodox faith. When their relative appeared, we exchanged best wishes and a friendly goodbye.
I sat down to read some more of Revelation.
A courteous voice came through the plexiglass. “Izviníte. Kák Vy znáete rússkii iazyk? Excuse me. How is it that you speak Russian?” The guard spoke with meticulous pronounciation and textbook grammar.
I jumped up and stepped closer to the plexiglass. The guard and I had a very nice Russian conversation. We introduced ourselves, exchanging our classic Biblical names.
Then to give him time and space I began pacing again in slow drifting circles, memorizing Psalm 23. (Why have I not memorized it before? It’s only 6 verses!) As the night wore on I began murmuring the psalm under my breath over and over like beads in a rosary.
“Here come those ducks. They’re back again,” said the receptionist in the beautiful boots.
I looked up. Outside the open ER doors, in that black hour before dawn, as robins wove a thread of warbling songs in the woods on campus, a family of adult Mallards stood in a half circle. They were listening with interest to Psalm 23. And to think that only yesterday (or no, wait — it was the day before) I was too tired to stand up. Now after a whole circling night of pacing wall to wall, the lack of sleep made me so light-headed that I seemed to be floating along borne on birdsong and time melting along in an eddying steam and the kindness and fellowship and cheer everywhere in this ER.
“THIS place is GREAT,” I exclaimed to the receptionists and guard.