My sister-in-law is a palliative care nurse. She thought we could add Ritalin, an amphetamine often used for hyperactive kids, to the oxycontin. The Ritalin restored Mikhaila’s alertness and had some pain-suppressing qualities of its own (this is a very a good thing to know if you are ever faced with someone’s intractable suffering). But her pain became increasingly excruciating. She started to fall. Then her hip seized up on her again, this time in the subway on a day when the escalator was not working. Her boyfriend carried her up the stairs. She took a cab home. The subway was no longer a reliable form of transportation. That March we bought Mikhaila a 50cc motor scooter. It was dangerous to let her ride it. It was also dangerous for her to lack all freedom. We chose the former danger. She passed her learner’s exam, which allowed her to pilot the vehicle during the day. She was given a few months to progress towards her permanent licence.
In May her hip was replaced. The surgeon was even able to adjust for a pre-existent half centimetre difference in leg length. The bone hadn’t died, either. That was only a shadow on the x-ray. Her aunt and her grandparents came to see her. We had some better days. Immediately after the surgery, however, Mikhaila was placed in an adult rehabilitation centre. She was the youngest person in the place, by about sixty years. Her aged roommate, very neurotic, wouldn’t allow the lights to be off, even at night. The old woman couldn’t make it to the toilet and had to use a bedpan. She couldn’t stand to have the door to her room closed. But it was right beside the nurses’ station, with its continual alarm bells and loud conversations. There was no sleeping there, where sleeping was required. No visitors were allowed after 7 p.m. The physio—the very reason for her placement—was on vacation. The only person who helped her was the janitor, who volunteered to move her to a multi-bed ward when she told the on-duty nurse that she couldn’t sleep. This was the same nurse who had laughed when she’d found out which room Mikhaila had been assigned to.
She was supposed to be there for six weeks. She was there three days. When the vacationing physio returned, Mikhaila climbed the rehab-centre stairs and immediately mastered her additional required exercises. While she was doing that, we outfitted our home with the necessary handrails. Then we took her home. All that pain and surgery—she handled that fine. The appalling rehab centre? That produced post-traumatic stress symptoms.
Mikhaila enrolled in a full-fledged motorcycle course in June, so she could continue legally using her scooter. We were all terrified by this necessity. What if she fell? What if she had an accident? On the first day, Mikhaila trained on a real motorcycle. It was heavy. She dropped it several times. She saw another beginning rider tumble and roll across the parking lot where the course was held. On the morning of the second day of the course, she was afraid to return. She didn’t want to leave her bed. We talked for a good while, and jointly decided that she should at least drive back with Tammy to the site where the training took place. If she couldn’t manage it, she could stay in the car until the course finished. En route, her courage returned. When she received her certificate, everyone else enrolled stood and applauded.
Then her right ankle disintegrated. Her doctors wanted to fuse the large affected bones into one piece. But that would have caused the other, smaller bones in her foot—now facing additional pressure—to deteriorate. That’s not so intolerable, perhaps, when you’re eighty (although it’s no picnic then either). But it’s no solution when you’re in your teens. We insisted upon an artificial replacement, although the technology was new. There was a three year-waiting list. This was simply not manageable. The damaged ankle produced much more pain than her previously failing hip. One bad night she became erratic and illogical. I couldn’t calm her down. I knew she was at her breaking point. To call that stressful is to say almost nothing.
We spent weeks and then months desperately investigating all sorts of replacement devices, trying to assess their suitability. We looked everywhere for quicker surgery: India, China, Spain, the UK, Costa Rica, Florida. We contacted the Ontario Provincial Ministry of Health. They were very helpful. They located a specialist across the country, in Vancouver. Mikhaila’s ankle was replaced in November. Post-surgery, she was in absolute agony. Her foot was mispositioned. The cast was compressing skin against bone. The clinic was unwilling to give her enough oxycontin to control her pain. She had built up a high level of tolerance because of her previous use.
When she returned home, in less pain, Mikhaila started to taper off the opiates. She hated oxycontin, despite its evident utility. She said it turned her life grey. Perhaps that was a good thing, under the circumstances. She stopped using it as soon as possible. She suffered through withdrawal for months, with night sweating and formication (the sensation of ants crawling upside down under her skin). She became unable to experience any pleasure. That was another effect of opiate withdrawal.
During much of this period, we were overwhelmed. The demands of everyday life don’t stop, just because you have been laid low by a catastrophe. Everything that you always do still has to be done. So how do you manage? Here are some things we learned:
Set aside some time to talk and to think about the illness or other crisis and how it should be managed every day. Do not talk or think about it otherwise. If you do not limit its effect, you will become exhausted, and everything will spiral into the ground. This is not helpful. Conserve your strength. You’re in a war, not a battle, and a war is composed of many battles. You must stay functional through all of them. When worries associated with the crisis arise at other times, remind yourself that you will think them through, during the scheduled period. This usually works. The parts of your brain that generate anxiety are more interested in the fact that there is a plan than in the details of the plan. Don’t schedule your time to think in the evening or at night. Then you won’t be able to sleep. If you can’t sleep, then everything will go rapidly downhill.
Shift the unit of time you use to frame your life. When the sun is shining, and times are good, and the crops are bountiful, you can make your plans for the next month, and the next year, and the next five years. You can even dream a decade ahead. But you can’t do that when your leg is clamped firmly in a crocodile’s jaws. “Sufficient unto the day are the evils thereof”—that is Matthew 6:34. It is often interpreted as “live in the present, without a care for tomorrow.” This is not what it means. That injunction must be interpreted in the context of the Sermon on the Mount, of which it is an integral part. That sermon distills the ten “Thou-shalt-nots” of the Commandments of Moses into a single prescriptive “Thou shalt.” Christ enjoins His followers to place faith in God’s Heavenly Kingdom, and the truth. That’s a conscious decision to presume the primary goodness of Being. That’s an act of courage. Aim high, like Pinocchio’s Geppetto. Wish upon a star, and then act properly, in accordance with that aim. Once you are aligned with the heavens, you can concentrate on the day. Be careful. Put the things you can control in order. Repair what is in disorder, and make what is already good better. It is possible that you can manage, if you are careful. People are very tough. People can survive through much pain and loss. But to persevere they must see the good in Being. If they lose that, they are truly lost.
Dogs, Again—But Finally, Cats
Dogs are like people. They are the friends and allies of human beings. They are social, hierarchical, and domesticated. They are happy at the bottom of the family pyramid. They pay for the attention they receive with loyalty, admiration, and love. Dogs are great.