Thursday, April 9, 2009

Mothering

Relationships with our mothers can be complicated, and mine is no exception. Our past 12 months have been challenging owing to illnesses, schedules and the 600 mile distance between our homes. Through the help of a wonderful therapist, I understand the dynamic between myself and my mother – intellectually – but the emotional part still struggles to keep up. The funny thing about therapy is that it helps me understand the past but not how to navigate aspects of the future.

For example, my father recently left me a message on Facebook (of all places!) that my mother was going to have a bone marrow biopsy for a chronically low platelet count. Based on fuzzy memories of my heme-onc rotations, bone marrow biopsy = cancer until proven otherwise. I google chronic thrombocytopenia looking for answers and a differential. That’s the default setting on my brain – back to logic & science & evidence. I also pick up the phone.

“Hi, Mom. How are you?”

“I’m fine. I’m supposed to have this test tomorrow in the hematologist’s office.”

From the tone of her voice, I can tell she’s on the verge of being unhinged by the test – not the potential diagnosis – although to her credit she’s been through early breast cancer (DCIS) & a course of radiation.

“Dr. Bone Marrow is very reassuring that the test is not a big deal.”

“Mom, you need to ask for Versed & lots of it.”

Flashback to standing at the bedside in the wards of the Navy Hospital. My face is hot as the blood is rushing to my toes in sympathy for the 6’5” man who is howling as the team of physicians are drilling into his pelvic bone. Flash back number two is in the OR with our heme-onc attending as they are putting his 8 year old patient with ALL to sleep. He readies the biopsy tray with classical music tinkling in the back ground.

“You don’t need to be pain.” (Thus my reason for being in therapy in the first place: the complicated dance of daughter nurturing mother. Once again the choreography takes off before I’ve even got my shoes on. )

“How do you spell that drug?” She asks.

“V-E-R-S-E-D.”

“OK, I’ll ask.”

She leaves me a message the next day thanking me. She and her doctor have decided to schedule the procedure in the interventional radiology suite with conscious sedation. She’s still somewhat unhinged by this. She wants to know more about conscious sedation. This time our exchange is mid-day by e-mail.

MWAS@gmail: It will be like your colonoscopy. Probably some Versed and monitoring.

MOM@gmail: OK. They have me scheduled for Friday with the radiologist.

MWAS@gmail: Talk to you later. Love you, Mom.

Post procedure was anti-climactic. She did well, and had glowing things to say for the radiologist and his nurse. With my father on the phone, some more piece of her puzzle slide into place. Mom’s been losing weight unintentionally for several months. She also has a low white cell count. She feels fine, otherwise. We all dance around the big C - and it leaves me wondering if that’s mom and dad’s doing or the doctors until they have a diagnosis. Intellectual mind whirrs through the differential: leukemia – maybe a chronic form like CML, viral infection (that’s the pediatrician in me), or some type of autoimmune problem like rheumatoid arthritis which runs in our family. There could be other reasons, but my adult medicine is rusty and inexperienced.

Emotional mind is reeling. Oh Crap! (and several other expletives) As much as I want just intellectual mind to deal with this, the therapy that’s trying hard to integrate the two aspects intervenes. I feel lost – not sure who is supposed to show up – the intellectual nurturer or the emotional daughter in need of her own nurturing but afraid to ask. To be continued….

11 comments:

  1. Hang in there, MWAS. It sounds like you are giving your mom what she needs right now, which is the loving support of a daughter and the gentle guiding hand of a doctor in the family with her best interest in mind.

    My own mother was diagnosed with lymphoma when I was a freshman in college, many years before I would become a medical oncologist, and that was very emotionally complicated. I cannot imagine adding to that the intellectual aspects if I were already a physician. (She remains in remission 19 yrs later, in case you are wondering. :))

    Hope the results of the bone marrow bx are good. I will keep fingers crossed for you and her.

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  2. Complicated is right. Right there with you, MWAS. Keep us posted. They don't teach you how to handle this in medical school. Hugs.

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  3. I, too, have a complicated relationship with my mom. Your description of the intellectual/emotional selves is perfect for me.

    What I've discovered, after some therapy for this whacked out relationship, is that it's better to have a bizarre relationship than no relationship at all.

    I think you are doing exactly what you should do. Be there, accessible, for medical insight but mostly daughterly support and love.

    It sounds trite, but I'm putting your family on my ever-growing prayer list. Can't hurt, right?

    Peace, sister.

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  4. Tempeh, Thanks - very weird position to be in right now and from far away.

    KC - you're so right -never a class in med school about coaching your own family through their own medical ups and downs.

    FD - I'm honored to be on your prayer list - and I'm coming to that same conclusion about the wacky family - better some than none at all!

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  5. MWAS, thanks for sharing this complex experience and reflection with us. I'm with you in spirit on so many levels! Rooting for you - T. (Anesthesioboist)

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  6. My mom and I had a touch and go relationship until my last year of residency. For some reason things started to click and our relationship improved. Eight months after I finished residency, my mom died unexpectedly at the age of 59. I thank God our last year together was not contentious! I still will need years of therapy to process everything I endured with my mom, but at least I don't have the what ifs to deal with.

    I say if you can, keep working at your relationship with your mom. 6 years after her death, I still miss her and mourn all the milestones she will never witness in my life.

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  7. I recognize what you're going through; I am beginning the same dance as my parents are developing various ailments which need ever-increasing interventions. I suspect that we'll find that our comfort level in dealing with our parents' medical issues is much like that of dealing with our children's issues - sometimes we'll want to pull out every credential we've got, on other occasions we'll be there primarily as emotional support, and most of the time we'll fall somewhere in-between. My thoughts are with you.

    A

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  8. I'm sorry you have to go through this difficult time! I think being a physician actually makes this sort of thing easier, since you have the knowledge to understand completely what's going on and to help your mom make good, informed decisions. If you had no medical knowledge, you'd probably be much more uneasy.

    This way, you can do things to help instead of just standing by (like making the Versed suggestion). Your mom can feel more comfortable knowing she can trust your input and knowing you can translate the complicated, potentially scary medical information.

    It is strange and unsettling when a child has to take on this type of role in a parent's life. I guess it's part of the normal progression, but that doesn't make it easier.

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  9. Thank you all for your support - it means a great deal. I find I'm walking so many fine lines right now - trying to make enough medical suggestions without overstepping, keeping up with the various updates without amping up anxiety, working on this relationship and trying to make something of it while trying to keep my mom's feeling in perspective. Thanks again! MWAS

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  10. My husband is a veteran of many BMB. They hurt but it's over quickly. Getting anesthesia turns it into more than just a quick visit.

    When you get to the point where you've been spending more time than you'd like with doctors and hospitals sometimes the quick poke is preferable to the medicated half-day ordeal.

    Low platelets/blood counts weren't ever his symptom, so hopefully your Mom has something less involved!

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  11. Just support your mom like a friend and don't overanalyze stuff. I've noticed my American friends overanalyze every aspect of their relationship with their parents and blame all their faults on it...sometimes treating the relationship just like a casual friendship is better. If your mom says something inflammatory, don't be like a teen and freak out; deal with her like any other adult. Anyway I wish the best health for your mom.

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