Sleep Apnea

Obstructive sleep apnea is caused by loose tissue (turbinates, tonsils, uvula, soft palate, etc.) blocking the airway. The problem appears during sleep because that’s when everything relaxes, and it gets worse with age because that’s when everything relaxes more. There are five treatments: tracheostomy, surgery, dental devices, weight loss (if the patient is fat), and a breathing machine called the CPAP. Trachestomies are for when nothing else works. Surgery and dental devices aren’t terribly effective, and surgery also has some curious side effects like making the patient talk like a duck and drop food from his nose. With another surgical method, the patient’s jaw is broken and pulled forward throwing his teeth out of alignment. I’ve already had two sleep-related surgeries. One was for a deviated septum, the other for the same thing plus chiseling bone from my sinuses and tissue from my turbinates. Without the second surgery, I couldn’t have gone as long as I have without a CPAP.

The CPAP (continuous positive airway pressure) does pretty much what it sounds like it does: it pumps air down one’s throat continuously so the airway remains open. How much air varies. Most machines pump a steady amount, but I have a “smart-PAP” that adjusts from a low of ten (cm H2O) to a high of sixteen. Sixteen is one shit-load of air.

The patient wears either a mask or a fat cannula. The first mask I tried created a pressure sore on my nose, and the next three leaked, so I’m using a cannula. The problem with both masks and cannulas—even when they fit—is that they occasionally allow air to escape, especially when the patient turns over. This requires a certain delicacy of movement and considerable adjustment and readjustment throughout the night. Otherwise, the wind that is supposed to go down my throat is blowing loudly across my face or into my eyes, creating the risk of an eye infection.

I try to think of my CPAP affectionately, but that is like thinking of a wheelchair affectionately. On the one hand, I am glad I have it, but on the other, it is noisy, bulky, ugly, bothersome, expensive, requires daily cleaning, and makes it impossible for me to wander from an electrical outlet. This last part is the worst of all because I don’t trust technology to always be there, and because I have a powerful need to escape it occasionally.

I often lie in bed listening to my CPAP, and trying to understand why it behaves as it does. Last night, just as I was getting to sleep, the pressure started going up and down at regular intervals, as if the machine was a large beast breathing on its own. The trouble was that its breath didn’t match mine. It would force me to inhale for too long, but not allow me enough time to exhale, so I felt like I was suffocating. I tried to breath normally in the hope of forcing it to breath with me, but this required that I work really hard, and I soon lost sense of what a normal breath felt like.

I didn’t know what else to do, so I took the same ineffective steps over and over, things like rerouting the six-foot hose, readjusting the cannula, resetting the switch, and even repositioning the machine. I also wondered if I was imagining the problem. After all, it takes some people weeks to work up to using a CPAP for one whole night, yet I’ve used mine all night every night, so maybe the strain was getting to me. I thought and thought about it—which wasn’t easy while struggling to breathe. After awhile, either the machine or I settled down, and the rest of the night passed peacefully.

The main difference I notice with the CPAP is that I dream A LOT. This was even evident in the sleep lab. Without the machine, I dreamed little (and those dreams were often about suffocating). With the machine, I have one colorful and richly detailed dream after another. Maybe I had built up a dream deficit. My theory is that apneas would end whatever dream I was having, and it would take me awhile to settle back into REM sleep, only to be hit by more apneas as soon as I did.

I’ve also noticed that I don’t wake up headachy and exhausted. Instead, I wake up with my nose raw and achy due to the cannula pushing upward against my nostrils. I also wake up with a devilishly itchy throat if I don’t sleep with a harness that keeps my mouth closed. Since I also use a toothguard to prevent me from grinding my teeth to powder, getting ready for bed is tedious, although it’s not the work I mind, but the thought that I will have to do it for the rest of my life.

My father preferred death to pills because—along with his belief that the pharmaceutical industry was ripping him off—he felt that a life that had to be permanently preserved out of a pill bottle was beneath his dignity. I understand his point, and a CPAP strikes me as worse than a whole boatload of pills, but dignity is subjective and death extreme. I don’t know how Dad felt about the indignity of snot, shit, and the bizarre appearance of human genitals, but he survived all of them. This leads me to suspect that—in his mind—the indignity of pills consisted of the dependency he felt upon the despised industry that provided them.

Food for life, he could, and usually did, grow for himself, but pills for life were from an alien source and made of alien materials. They made him feel powerless in a way that congestive heart failure did not, and by choosing death, he regained his power. It was his choice, and I respect it. Most of us never acknowledge that there comes a right time to die. We say we long for heaven, but we will spend any amount of money and put others to any amount of trouble just so our sorry carcasses can breathe for one more day. Like my father, I believe there comes a time when dignity demands that a person say “no more.” I am closer to being there than I was even five years ago, but I hope to tarry a while longer.

Where was my responsible adult?

When you’ve been anesthetized for surgery, you’re advised to spend the rest of the day with a responsible adult, and warned not to make any important decisions. So why, then, is there a ten-pound bag of Costco chocolate chips draped over my kitchen table like a dead moose? Where was my responsible adult, and what was she thinking to let me buy that?

I woke up this morning—following my first night with a CPAP—rested and refreshed for the first time in memory. By contrast, I usually wake up headachy and exhausted after a succession of nightmares, my mattress wet with sweat. According to my polysomnograms, I awaken seven times an hour, and I stop breathing 43 times per hour—during which my oxygen level drops to 83%. I also grind my teeth and jerk my limbs. People die from such sleep. Nobody wants to pass the night with a noisy air pump and a mask that either feels too tight or leaks, but it sure beats the hell out of hardly sleeping at all.

My hand is greatly swollen, my wrist feels like someone drove a spike halfway through it (which is, actually, pretty much what happened), but I feel terrific. Maybe I will soon have the freedom to think more of things other than my health.

Surgery day

The anesthesiologist had said he would knock me out just long enough to get the primary painkiller started, leaving me awake for the surgery. The next thing I knew, I was waking up in another room. I looked at my wrist, saw that it was bandaged, and tried to wiggle my fingers. To my utter joy, they moved. Two hours and fifteen minutes after Peggy and I arrived at the clinic, we left. The doctor said I could do anything I felt well enough to do, so I shopped at Costco, then came home and helped my neighbor dig dandelions. Then Peggy and I went to pick-up a CPAP machine (continuous positive airway pressure) for my sleep apnea, came home, and took a nap. She vociferously opposed biking with the dogs, so we took them for a walk around the neighborhood. Now, she’s cooking supper.
Typing hurts, so I will stop doing it.

Thoughts before carpel tunnel surgery

Not long ago, the anesthesiologist called about my surgery tomorrow. “You’ll be given two painkillers,” he said, “the first to kill the pain of the second until the second takes effect.” Drugs are funny. One doctor wrote me a prescription for Ambien recently. “This medication has been known, in rare cases, to cause violent behavior,” the packaging warned. A few days later another doctor gave me a prescription for Requip. “This drug has been known, in rare cases, to lead to compulsive gambling,” the packaging advised. “Oh, great,” I thought, “I’m going to be a violent gambler.”

Last night, I was too manic to sleep, so today I took a Vivarin. Since I don’t do caffeine anymore, an occasional Vivarin makes me really manic. I was that way when the anesthesiologist called, and was consequently so bubbly that I wondered whether I sounded drunk. After we hung-up, I went back to my yard work. As I crossed the backyard, I passed Bonnie walking the other way. “Hello, Bonnie,” I said. Then I remembered that Bonnie was in the front yard, and that the gate was latched. I thought that, well, maybe I just thought the gate was latched, so I went to check. It was latched. Things could be worse, I suppose. I could be hallucinating a dog that is dead or never existed.

I’ve spent days doing all the work around the house that I won’t be able to do during my convalescence. Last night, I baked crackers, biscuits, and cornbread. I actually started baking crackers two weeks ago because each batch takes two hours, and that’s if I don’t double it. I was raised on store-bought loaf bread, but my mother kept the larder stocked with homemade biscuits and cornbread. Of course, they were inferior to what I bake. I never use shortening—much less lard—or sugar, and all my breads contain several whole grain meals or flours. There are only two things that I love to cook. One is soup and the other bread; and of the two, I prefer bread. My father believed that whole grains were for hogs (he claimed that bleached flour was purer because it was white), so he was challenged to eat my bread when he came to live with us.

I am more nervous about this surgery than any I’ve had, because the ligament that the surgeon will cut is directly above the nerve that makes my hand function. I’ve thought about what it would be like to go through life with a purely decorative right hand, and whether the odds of that happening are small enough to justify the risk of surgery. I dealt with the issue by opting to stick with the decision I’ve already made, my thought being that I would need new information to back out with any integrity.

My hernia surgery (in January) was hours late, so I had a lot of time to lie on my stretcher and think. I really wanted to walk out of that place while I still could. I remembered my friend, Hulene (a woman after my own heart, her last act before surgery was to write me a letter), who died during hernia surgery five years ago. I also thought about my surgeon, and how I didn’t entirely trust him because he always seemed so harried. I finally reconciled myself to the fact that, having made the best decision I could, and having no new information that would justify a change of heart, I needed to trust the thinking I had done when I was less emotional. Even if it was wrong, it was the best I could do. This is what will make it possible for me to lie down upon yet another stretcher tomorrow. Meanwhile, I do dread the long night ahead.

Thoughts about supporting private and governmental evil

My neighbor, Ellie, also has carpal tunnel problems. Hers is advanced, so a return to normalcy is unlikely even with surgery, but Ellie is obliged to sell plasma just to get by, so surgery is out of the question.

One of my Masonic brethren, Nathan, changed jobs recently, and his new insurance wouldn’t take effect for ninety days. During that time, Nathan came down with an undiagnosed illness that caused his fever to hit 104º. He couldn’t afford a doctor, so he rode his illness out at home.

Linda, the technician who hooked me up to the monitors for my recent polysomnogram, was injured in an accident and unable to work for seven months. Her insurance ran out after six, leaving her $30,000 in debt.
I don’t look for such stories, but now that I have become so dependent upon insurance and so aware of how different my life would be without it, they leap out at me. It’s like never noticing a certain make of car until you buy one.

There is really no way around the fact that, as individuals and as a nation, we spend money on that which we value. I value financial security, so I save money. My sister-in-law values foreign travel, so she spends money on that even though she has to borrow against her house. As a country, we value the War in Iraq. We also value health care for poor people in other countries, although the money has to come partially from the taxes paid by the poor people in our own country, people who cannot afford health care. We say to our own poor that their lives are of less importance than countless other things that we spend money on. If Nathan should die or Ellie should become permanently disabled, well, that’s very sad to be sure, but Africans with AIDS need our help more, even if we are obliged to borrow the money from China.

I am amazed that we Americans put up with as much as we do, but then I am one of those by whom I am amazed. But what to do about it… I met a man last week who was going door-to-door to gather support for Barack Obama, and I wished mightily that there was a candidate who I believed in that much. Hell, I just wish I believed in the goodness of our democratic system that much.

“All voting is a sort of gaming, like checkers or backgammon, with a slight moral tinge…. I cast my vote, perchance, as I think right; but I am not vitally concerned that right should prevail. I am willing to leave it to the majority…. Even voting for the right is doing nothing for it. It is only expressing to men feebly your desire that it should prevail.” Thoreau

I have long admired Thoreau because he writes as if he were beside me, contemplating the same problem that I am contemplating. No matter that the steam engine was cutting edge technology in his day, his issues then are my issues now. Ah, but he knew what to do about them. He avoided marriage partially because marriage would make moral compromise easier, but I embraced marriage because I had yet to meet the issues, and because I naively thought I could have it all. Still, I would not choose to live alone. But what would I do differently if I were alone? I would bury my money in a hole in the ground (figuratively or literally), so the IRS couldn’t find it, and I would stay in Oregon most of the year so I wouldn’t have to pay a sales tax. I feel little compunction to eradicate evil, but a great compunction to abstain from supporting it.

Yesterday, I received a bill for $465 for the carpal tunnel surgery that I haven’t had yet. The letter explained that this should cover my portion—after insurance—of the clinic’s operating room. This means that the clinic is going to charge $2,325 for the half hour that I will spend in that room. If not for the insurance company’s required write-off, the charge would be closer to $3,000. The letter also explained that the surgeon and anesthesiologist will bill me separately.

Last night, I could scarcely sleep for knowing that I am supporting a merciless and avaricious health care system. During one of the short lulls in my wakefulness, I dreamed that I was required, before surgery on Friday, to pay $499.99 in advance for a bath in a stainless steel tub. The tub turned out to be a thin vinyl mattress that was painted to look like stainless steel, and the bath was a damp washcloth with which I was told to wipe myself off.

My father died partially because he was unwilling to support what he considered a greedy healthcare system. People generally thought he was a nutty eccentric, but, for what it’s worth, Thoreau would have made the same choice. Of course, people in Thoreau’s day thought he was a nutty eccentric too. People who won’t support evil no matter what the cost to themselves are ever seen in such a light.

I look at things this way. My wrist hurts and my hand tingles. I sleep in a brace. I avoid certain activities. I am guardedly optimistic that surgery will change all this. On the other hand, if I refuse the surgery, what good will I have accomplished? None, externally. But would I respect myself more? Maybe, but I am still going to put my money into surgery, because I value my health more than I value my own moral approval, especially in regard to a decision that won’t make the world better or worse anyway. How do I live with this choice? I tell myself that the surgery will soon be over, and that I will move on. I usually prize expediency above principal, and I feel bad about this at times, and not so bad at other times. Mostly, I try not to think about it. In fairness to myself, those around me seem to knuckle under more than I do. They just ponder it less.

practically a doctor a day

This has been a doctor week. Yesterday, I saw an orthopedist whose specializes in hands, wrists, and elbows; today, an orthopedist who works on shoulders. Before them, a sleep specialist. I resist being the kind of person who runs to the doctor for every little thing, and I indeed considered canceling at least one of my appointments on that basis alone. But, the thing is, I don’t run to doctors for every little thing. I’ve had sleep problems for ten years, carpel tunnel for twenty, shoulder pains for eighteen months. I’ve put in my time studying—and sometimes trying—self-treatments and alternative treatments, yet I have only gotten worse.

I usually have a tentative diagnosis for a problem, and know everything medicine can do for it before I even see a doctor. I try to keep emotion out of doctor visits, because doctors are at their best when they feel they have something to offer, and few have much to offer in the way of emotional support.

The longer the appointment, the more of a challenge emotional neutrality becomes, and I might not know I’ve lost it until I realize I missed several sentences or failed to understand simple statements. Peggy and I try to go with one another to the doctor to compensate for such deficiencies.

I originally went with her—at her request—to offer moral support, and I usually didn’t ask her go with me because I didn’t think I needed moral support. I’ve discovered, though, that what I do need is another clear head in the room. She takes me with her for an additional reason. She is convinced that doctors—both male and female—treat her better when she’s with a man.

She and I both hold doctors in low esteem until they give us reason to think otherwise. Her nursing experiences have soured her, whereas I react more to the deference they expect and to the exorbitant fees they charge. They’re also typically rushed and, to many of them, medicine is simply a way to earn money. Then there are the limitations of medicine itself.

If a doctor comes into the room and says, “Mr. Thomas, I am Doctor Boneshaker,” he or she loses five points. If he shook hands as he said it, he only loses two points. If he gives his full name (giving me the option of what to call him), he gains five points.

I am often tempted to say, “I don’t do deference. I can call you Bill, or I can call you Mr. Boneshaker, or I can not call you anything. You choose.” I don’t say this because it might arouse hostility, and hostility would inhibit the doctor’s ability to help me. It’s one of those predicaments for which I can find no good solution.

I often run into more interesting problems with doctors. Both my hernia surgeon and the hand surgeon I saw yesterday (for carpel tunnel surgery) proposed the last surgical option that I had expected based upon my research. Every website I visited recommended endoscopic surgery over an open incision for hernia surgery, yet my doctor recommended an open incision based upon my thin build. The hand surgeon had even more treatment options—four in all—yet he chose one-hole endoscopic, the very surgery that has the highest failure rate.

How is a patient to respond? I fall back upon my overall impression of the doctor. Does he seem to care? Did he take the time to explain his reasoning? Is his resume impressive? The hand surgeon explained the discrepancy between my reading and his own approach this way. (1) Less qualified surgeons negatively skew the results. (2) Many websites lean toward conservatism because they are collectively produced across many disciplines, and because a wide range of surgical candidates look to them for advice. His patience in addressing my concern impressed me and that, along with his reasoning and his other qualifications, made me decide to go with his recommendation.

His description of the level of care my wrist I would need after surgery was far more optimistic than what I had read. For example, the Mayo Clinic advised that I not even lift a jug of milk for the first two weeks, whereas he told me to let my comfort level be my guide. When I asked about the discrepancy, he said that Mayo’s advice was based partly upon what he considered outmoded surgical techniques, and that tissue damage from a single puncture would be much less than that from a four-inch incision. That made sense. Whether it’s true, I don’t know. I could consult one or two more surgeons and go with the consensus, but I waited ten weeks to see this one, and this is an extremely common surgery, and it is also his bread and butter.

The amount of caution that is warranted in a surgical undertaking becomes much clearer in retrospect. My knee surgery was a mistake, but I undertook what I considered a prudent amount of research going into it, and I didn’t learn until later that the surgery plus physical therapy is no better than physical therapy alone. But that was two years ago, and I have come far in the amount of trouble I am willing to go to on my own behalf.

I can see how doctors would come to resent all the hours they spend explaining why they disagree with Web MD, but I should think that a patient would have to be pretty naïve to want to remain ignorant. Of course, I might be leaning too far in the other direction. I took complete control of my discussion with the hand surgeon yesterday, and, after I had gotten all of my questions answered and verified the Peggy had gotten all her questions answered, we left without either of us asking the surgeon if he had anything to say. In an ideal world, we wouldn’t need to ask, but I try to look at things from the doctor’s viewpoint.

Yesterday, for example, the doctor tried to take the initiative, but sensing that I knew where I wanted to go—and that I needed to feel in control—he backed off. I later wondered if he didn’t go so far as to stop thinking proactively, allowing himself to become simply a resource for answering questions. I quickly consoled myself with my observation that I have never found surgeons to be a timid species who readily allow themselves to be trodden upon.

My shoulder appointment this morning did not have a happy outcome. I thought I had lingering tendon inflammation from yoga exercises two years ago, but the x-rays showed jagged arthritic damage in both shoulders. The doctor advised that I avoid weight-bearing activities if I want the joints to last. When I asked how she was able to rule out soft tissue injuries, she said she wasn’t, but that there isn’t much she can do about them short of surgery, and I’m hardly ready for that. The best she could offer was an appointment with a physical therapist, and I took her up on it.

Sleeplessness

Last week, I repeatedly mistook the same chair for Bonnie, and I heard voices coming from a radio that was unplugged; both no doubt due to a lack of REM sleep. When the insomnia first hit me, I lay in bed longer to catch-up on my sleep. My back soon hurt so bad that I couldn’t lie on it, yet I couldn’t lie on my sides or my stomach either due to the tendonitis in both shoulders. What sleep I did get was interrupted by dreams of suffocating in airless rooms, suffering cyanide related seizures in a Nazi death chamber, or vomiting due to exhaust fumes. I have never faced a more dismal prospect than that of finding sleep and wakefulness equally impossible. I realized that there was a limit to how long I could hold up either psychologically or physically, yet the prospect of leaving Peggy by my own hand seemed equally cheerless.

I have gone to a lot of trouble and expense (including two surgeries) over the past ten years in an effort to remedy my sleep problems, yet they have grown increasingly worse. The only advantage I have found in such things is that they allow me to make a more accurate appraisal of human frailty. People who have not known sickness cannot know how tenuous health is, yet it is knowledge worth having. I read the thoughts of the benefactors of my species, and I contemplate the extent upon which their thoughts were based upon such things as trace minerals and sleep, things that they so often despised. How ungrateful the man who loathes that upon which his every thought depends.

I bike to get Wittgenstein, his misery contrasted with Hume's happiness

I biked to the library in the rain this morning just to get Wittgenstein’s Philosophical Investigations. I had avoided Wittgenstein because I knew enough about him to know that he dismissed most of the questions that are asked by philosophers as nonsensical, and I didn’t want this to be the case because, nonsensical or not, they are questions I cannot avoid. He wrote:

“People say again and again that philosophy doesn’t really progress, that we are still occupied with the same philosophical questions as were the Greeks. But the people who say that don’t understand why this has to be so. It is because our language has remained the same and keeps seducing us into asking the same questions.”

Okay, great. I can even imagine him to be right, but—and this is another reason I avoided Wittgenstein—the man was suicidal. When he finally learned that he had terminal cancer—at about the same age I am now—he didn’t even care, because as he put it: “I have no desire to live.”

But the skeptic in me might well ask: “But how do you know that his despair was the necessary outcome of his philosophy?” Well, I don’t. David Hume was the most renowned skeptic of all time. He could abolish claims to knowledge as adroitly as a man with a machine gun could abolish chickens, yet he was a happy man, and as he approached death, he remained that way. He even wrote that he had no idea why one with such a dismal philosophy could be so happy, and concluded that it must simply be congenital. Go figure. Surely, nothing is good or bad unless what our thinking makes it so, but what makes our thinking make it so? Optimists say that we are free to choose, but I think they give themselves too much credit. They say “Be like us” in the easy certainty that they too could be jaded, cynical, and pessimistic if they so pleased.

insomnia, thoughts about philosophical skepticism

Sleep? Not much. Maybe four hours a night—five if I’m lucky—and it interrupted every hour or two by nightmares and headaches. I arise several times a night and read—Francis Parkman’s The Oregon Trail of late, but mostly the Britannica’s section on philosophy. I find much that I can’t make sense of, so I reread and rethink. Often, I still make no sense of it, and I wonder if anyone can. Examples are numerous, but I will offer one that is brief, ancient, and famous. In the 11th century St. Anselm made the following argument in favor of the existence of a deity.

“…a being conceived to be perfect must necessarily exist, for otherwise he would lack one of the essentials of perfection.”

Isn’t this the same as saying: “A rabbit that is conceived to be omnipresent exist must necessarily exist, for otherwise he would lack the qualification for omnipresence”? Why has Anselm’s argument survived for 1,000 years rather than being dismissed the day it was made? Much of philosophy strikes me as equally meritless.

The only philosophical stance that has ever appealed to me consistently has been skepticism, because it is the only one that is logically unassailable. To every inductively-based knowledge claim, the skeptic responds: how do you know this to be true?; and the claim is quickly shown to rest upon a train of assumptions that are themselves improvable. The problem with skepticism is that it often defies common sense, which greatly reduces the number of thoroughgoing skeptics. If I say that a given bachelor is single, I might be redundant, yet I will be right 100% of the time, based upon the definition of the terms. On the other hand, I might truthfully argue that there is no absolute proof that pressing my face to a red-hot griddle for ten minutes will damage it (a knowledge of past events justifies, at most, predictions of probability), yet I have no intention of holding pressing my face to a red hot griddle for even ten seconds.

Skepticism is a cure for illogical proofs rather than a source of logical ones, and hence it is of small comfort when one is wide awake at 4:00 a.m., almost panicked by his inability to sleep, and twitching and trembling while struggling to coordinate his movements—all while wondering what in the hell life is about. (I personally delivered a friend to the asylum when he became stuck on the question and would say nothing else all day long.)

Of course, I err logically in assuming that life is about anything. I even err in assuming that insomnia is a problem. After all, I can’t prove either, and I can’t even define my terms since words like meaning, purpose, and problem are among those words that we think we have a clear grasp of until we are called upon to define them. As do most words. Table, for example, or even red; words that are either umbrella words or that define a quality of perception as opposed to a quality of measurability (as in the water is hot, versus the water is 110. 246841º). Only is there, really and truly, such a thing as objective measurability? After all, words and numbers are a human creation, a way of describing reality in terms that we can understand and communicate. We impose an artificial construct over that which our senses can detect and our minds can comprehend, so we can never know that we have experienced reality as it is as opposed to how it seems to us. There is my perception of my dog, and there is my dog, and I cannot know how closely the two coincide.

Peggy in Paris

I just talked with Peggy. It was ten p.m. Paris time, and she was on a busy street. Spotlights highlighted Notre Dame; the Eiffel Tower twinkled; and searchlights crossed the sky. A continual din of sirens made me nostalgic for Inspector Clouseau. The César Awards were commencing across the street, and the press of the crowd was threatening to push her off the sidewalk. Peggy didn’t know what the César Awards were, so I did a web search, and told her they are France’s version of the Academy Awards.

I haven’t heard Peggy more excited in years than she has been every time I’ve spoken to her on this trip. It is the excitement of youth, and I miss that in her. When a boy marries a girl, he expects her to remain a girl (all evidence to the contrary notwithstanding) and, as the years past, and she moves ever further from girlhood, he grieves for the loss of his young love. I have often wished during these thirty-six years that I could protect Peggy, not so much from the ravages of physical aging as from the ravages of disillusionment (some of it, alas, caused by me). Disillusionment makes discernment possible, but we pay for discernment with reduced joy. It is the difference between puppyhood and dogdom, and is as sad as it is necessary.

I would have my young bride back if I could, but, to keep her love, I would have to go back too. Only, I was never so young as she, at least in my capacity for joy, because joy requires absorption in the moment, and I could never escape the thought that the moment must end. The frailty of life loomed ever before me, and its poignancy was always by my side.

When I heard her today, I wished so much that I could be there on that noisy, crowded sidewalk, not so I could see France, but so I could see Peggy. Beside her face, a million twinkling Eiffel Towers would be as dim as the cold darkness of space.

the joys of solitude are diminished by the needs of the dogs

What a pleasant morning. I remained in bed a sinfully long time; the sun is shining yet again; I’m listening to happy harpsichord music; and I have absolutely nothing that I must do.

Yesterday was a day of phone calls as a surprising number of people checked-in on me. I was delighted to hear from them, but was perfectly happy to be alone. Sometimes, when Peggy is away, I worry that I will come to enjoy solitude so much that I will dread her return, but, by the time she does return, I am always glad to see her. Meanwhile, it is grand, not having to adjust in the least to anyone else’s needs, schedules, preferences, moods, or requests. Furthermore, I have no meetings this week except for my nerve conduction study, and I am dreading even that. Oh, but if only I could be fully alone—what a joy.

Ah, but my joy was just interrupted in mid sentence. I was on a cancellation list for my sleep study, and someone cancelled, so I will spend the night at Sacred Heart Hospital with wires glued to my head.

Yet again, the dogs are a burden. They will be miserable tonight. They are already miserable. They are miserable because Peggy is gone. They are miserable because it’s pretty weather, and I can’t take them on an outing. They spend their days unhappily dozing except when they’re staring at me accusingly. Three weeks ago, they stared pleadingly, but quickly realized that something was seriously wrong with me. They still know that something is seriously wrong, but they don’t like it. They wonder why I don’t go to the vet and get it fixed, and I can’t convince them that the vet is of no use. A cat in heat could help as much as a vet, and a cat in heat couldn’t help me at all, although it would greatly entertain them. If only a cat would step through their doggie door and be unable to find its way out, they would be happy dogs indeed. Baxter enjoys looking out the window for a few hours each day, but Bonnie has no life apart from her walks and her tennis balls, and she needs me for those.

Yesterday the temperature reached into the fifties, so I put one of my three remaining houseplants out by the curb, and it quickly disappeared. It was a snake plant that I had had for years, so putting it out felt treacherous, the more so because I realized that whoever took it might not want the plant but just the pot. But I had grown tired of caring for it. Now that I can do so little for myself, the more desperate I am to reduce the number of things that require my nurturance. I don’t want to be depended upon by dog, wife, plant, friend, or lodge brother. I don’t even want a book on a shelf to be awaiting dusting unless it is a book with which I truly cannot part.

my recovery continues

Peggy made it to France on only three tranquilizers. I knew she had taken one in Eugene, so when waited to take the other two in Atlanta, I asked her if she was more afraid of crash-landing in the Atlantic Ocean than in the Rocky Mountains. She said NO in a tone that implied it was a silly question.

My Friday doctor’s appointment was actually with his physician’s assistant, and he gave me to the go-ahead to bike and to do pretty much anything that caused me no pain. I therefore took the dogs for an hour’s ride Saturday, and was so swollen and sore afterwards that I’m back on narcotics. Several people called today to ask if I needed anything, but the one thing that I am unable to do for myself is to exercise the dogs; and it is a task for which there are few volunteers. I certainly can’t take them biking again, and even short walks are an ordeal for a man who feels like he has been kicked in the groin.

My moods range from despair to guarded cheerfulness. I spend my time reading, watching old Westerns, and editing old journals. I just started on 2006, the year I had the arthroscopic knee surgery that left me worse off than I had been. I can but wonder if this surgery won’t turn out the same. I know it is unlikely, but then I felt the same way about my knee.

Despite my surgical fears, I made an appointment for a nerve conduction study in preparation for carpal tunnel surgery. The last thing I want right now is even more forced inactivity, yet the higher my medical expenses during a given year, the greater the portion that insurance will pay, and I had planned to have the surgery this year anyway. I am also scheduled for another sleep study (the last one was five years ago). This is something else that was on my list of things-to-do, but now that I having to sleep entirely on my back, I literally wake up more tired than I went to bed.

I still entertain the hope that there is a silvery lining to all these gray health clouds. After all, I am but 58 (at least for a few more days), and am greatly motivated to regain as much vigor as possible. The worst challenge is that I feel forced to turn my surgical care over to people without any certainty that they know what the hell they are doing. If I were rich, I would get four second opinions for every one procedure, and I would fly to the foremost surgeons at the foremost medical centers, but I’m not rich so I must make do.

I managed to limp behind the dogs to the end of the block today, and we passed a string of maybe ten teenagers, each with multiple piercings and all black clothing. Two of them asked me for money for cigarettes, and I wished I could somehow convey to them how few years they can take their good health for granted. In truth, no one can ever take good health for granted, but most of us have thought we could, and decades passed during which it seemed that we were right.

how I pass my days, the joys of Percocet, thoughts on disability and euthanasia

The ultrasound showed the source of my abdominal pain and swelling to be a hematoma. It is large enough to be visible through my clothes, and will have to be excised if it doesn’t dissolve on its own. I was sent home with Percocet and told to alternate between ice and heat. I can neither take walks nor bike rides, and the Percocet makes me unsafe to drive; so I am as housebound as I have ever been. I nap, read, eat, watch squirrels, listen to Baroque music, and, once these many labors have been completed, I beging them again. I’ve read Silas Marner, two books on logic, the 1882 novel John Eax, and parts of other books.

This is not such a terrible way to live when one gets used to it. Friends are solicitous, painkillers make the days run together dreamily, and even a recent sunny day scarcely tempted my thoughts outward. The sun emits a pleasant glow through the window, but the air is chilly, and I am too lethargic to venture out even if I could.

Josh took Bonnie out on Sunday, over did it with her ball-throwing stick, and had to carry her home. He is unable to understand the limitations of a ten-year-old dog, and she is unable to understand that she can no longer run, jump, and make u-turns at full speed. Bonnie and Baxter have both gained two pounds now that I am unable to take them for their daily bike rides.

I ponder the lot of those whom we used to call “shut-ins,” and of what it must be like to lead a life devoid of all ambition aside from passing one’s days in warmth and comfort with plenty to eat. Imagine, no one looking to you to do anything, of no longer having the ability to do anything—at least not anything much. Maybe a hobble down the hallway for stretching exercises, or else a wheelchair ride to the common room to hear a community volunteer play the piano. Then, every other Thursday, another volunteer would arrive with her golden retriever for the residents to pat with the paper-thin skin of their perpetually bruised hands. With the illumination of Percocet, I can see how such an existence might not be so bad—assuming the ability to afford a “nice home” rather than a warehouse where manacled residents with open bedsores slump in odiferous corridors atop squished feces.

But does anyone ever really come to want nothing more than that? With enough drugs, maybe. The power of a pill to alter one’s life is remarkable. Percocet is like a comforting hand, like a voice that says, “Doesn’t it feel beyond heavenly just to lie here, just to read ten pages, nap for two hours, read ten more pages, and then nap for another two hours? How could anyone ask for more? Yes, the world is out there, somewhere, but it’s a crazy and frenetic world—as you yourself have often observed—so why not just let it chase its tail while you lie here in warmth, and peace, and a joy that is as real as it is mysterious?”

Such feelings are one reason I hold back on the Percocet. My prescription calls for a maximum of twelve a day. When I found that I was becoming unable to remember how many I had taken or when I had taken them, I began keeping a record. Most days, I take no more than five, and only then if I really need them to keep the pain from reaching a fever-pitch.

Peggy leaves in two days, and I will miss her dreadfully. I miss her badly enough when I am well and have projects to occupy my thoughts, so how much more will I miss her if the zenith of my capacity is to sit at a desk doing paperwork. She departs on Valentines, and returns two days after my birthday. It is a bitter pill to swallow, but it would be even more bitter if she stayed home to nurse me—as she is even now tempted to do. As much as we love our dogs, we have come to think of them as more a burden than a joy; and I want to do everything I can to prevent Peggy from seeing me in the same light.

I question the wisdom of a person devoting their own life to the deteriorating life of another. Peggy’s father has cared for her mother in such a way for years with no end in sight. I can but wonder at my society’s many contradictions regarding our so-called reverence for life. On the one hand, we are determined to keep every frail, damaged, deformed, demented, and aging human being alive as long as possible no matter what the financial or emotional burden. On the other, we have shown the consistent willingness to send our youngest and healthiest adults to die in foreign lands for reasons that seem nonsensical a decade later. And is it not the epitome of irony that we “put our pets to sleep” because “it would be cruel to make them suffer” even while we denounce human euthanasia and imprison those who help make it possible? So many of the values that are commonly esteemed by my society appear so damnable in my eyes that I don’t feel that I am a part of society, but am instead like one who was caught in a current too powerful to resist.

I storm my surgeon's office, thoughts on being aggressive but not too aggressive

The surgeon said on Wednesday that he would order an ultrasound if the swelling didn’t go down by Monday. Today—Monday—I was at his office at 8:30, because I didn’t want to wait until the phones were turned on at 9:00, be switched to someone’s voicemail, receive a callback at noon, and an ultrasound appointment later in the week.

The staff made much ado about my presence, and insisted that I be examined, first by a nurse, then by a physician’s assistant. I told everyone that I didn’t want to be examined, I just wanted an order for an ultrasound, yet I submitted in the hope that being seen today meant that I could cancel my appointment on Wednesday.

I finally did get an ultrasound appointment for this afternoon. I’m supposed to drink 40 ounces of water one hour in advance and hold it for the half hour exam. Now, does that seem feasible to you? I have every anticipation of (a) running from the exam room or (b) pissing on the table. There was a time when I wasn’t embarrassed by my bodily functions because I thought I was so good-looking. Now I’m not embarrassed because I’m too homely to give a rip. I’m just glad someone else will have to clean up the mess.

Life would be easier if getting medical care didn’t require that I assert myself so much. If I’m too aggressive, the staff balks at my every request, but if I wait passively for my request to be honored, odds are that it won’t be. I suspect there are people who stay home and die simply because they get tired of jumping through the hoops.

Medicine is like the legal system in that it habitually deals with people who are in a horrible predicament, yet it expects those people to behave as if everything was business as usual. This is why I said it won’t do to advocate for oneself too assertively: you are not helped on the basis of need but of influence and likeability—if that. The “if that” arises from the fact that patients are tiny, anonymous, plentiful, and highly expendable cogs in an immense profit machine.

Thirty years ago, I had but one doctor, and his wife was his only assistant. My current surgeon works in an office with ten other surgeons, and I would not be the least surprised but what there are more than thirty clerks, receptionists, schedulers, nurses, nurse assistants, physician assistants, and who knows who else. Most of my doctors have so many examining rooms and so many twisting corridors, that I get lost on my way out. And these doctors don’t even own their practices; they are on the payroll at Peace Health, the same outfit that employs Peggy along with thousands upon thousands of other people, and which expects its doctors to see a LOT of patients. The more patients, the more insurance claims; the more insurance claims, the more money. Tell me, does this sound like an organization that encourages caring, no matter how many crucifixes it glues to the walls?

The surgeon came by my room beforehand on the day of my surgery. I was in the bathroom at the time, and Walt was sitting fully dressed in a chair by the bed. Although Walt weighs twice what I do, and although the surgeon had seen me five days earlier, and had made a big deal about how my thinness would affect the procedure; he still called mistook Walt for me. Our healthcare system is like a conveyer belt, and conveyer belts only work when everyone moves in a straight line.

hell-week

I had hell-week until Wednesday night. I had been in significant pain since Saturday when a lump the size of several inches of garden hose appeared from the top of my incision to my groin. Starting Sunday, I spent most of my time flat on my back—that being the only position in which I could find even a little relief. Monday, I called the doctor’s office only to learn that he would be in surgery all day. His nurse assured me that my symptoms were to be expected since I had lymph nodes removed during the hernia surgery.

I wanted to believe her, but I couldn’t understand why the pain and swelling was getting worse instead of better, and why the swollen area resembled an intestine. No, I thought, it can’t be intestine because the internal repair mesh is holding that in place. Tuesday night, it hit me that the mesh must have broken free, and allowed the intestine to float upwards. I was positively distraught, not so much because I would have to go through another surgery with a less rosy outlook, but because Peggy would miss her trip to France. By the time she got home from work, I was in tears, insisting that she go no matter what, and promising that I would have friends care for me.

Peggy was puzzled. “You never wanted me to go to France in the first place, and now you’re insisting that I go at such a bad time!?” I said that for me to miss her and worry about her while she away was entirely different from me wishing to be the reason she stayed home. She said she would decide after we saw the doctor.

Along with my anxiety over her trip, I was also mad at myself for not insisting that I be seen on Monday. I stand up for myself well except when I’m sick, and then even mundane tasks sometimes overwhelm me. For example, changing my e-mail address this week was a major coup given my condition, and actually facing real people in any situation required so much heroism that I wondered how I ever pulled it off.

Nonetheless, I was unable to think of anything Tuesday night and Wednesday except my appointment with the surgeon on Wednesday afternoon. That I had to do, and I had to do it well, meaning that I had to be prepared to battle for getting the second surgery done immediately, because I knew that Peggy would not leave if it wasn’t behind me. I therefore took a written copy of everything I wanted to tell the doctor. I made the list partly because he is a terrible listener, but also because of my problem with remembering things when I am in pain. Although Peggy would serve as my backup, I knew that I could stand up for myself if only I could marshal my resources.

The surgeon read my list, examined my belly, said he thought the swelling was fluid and that my pain was caused by going off the Vicodin two days after surgery: “Pain left untreated feeds on itself.” He also said that the possibility of a mess failure was “too insignificant to consider.” As for my list, he admitted that it had grabbed his attention, but he said he was sorry that I felt the need to grab his attention. I was sorry too.

The Percocet helped so much that I couldn’t believe how much it helped; and the surgeon’s assurance that my problem wasn’t dire was an even bigger help.

Now, I’m happy, and Peggy’s happy. Peggy is also excited about her trip actually coming off, having passed through, first, the cancer scare, and then the failed mesh scare. I am also resigned to the necessity of letting Peggy do things for me until her departure. Oh, but how much easier it is to be the helper than the helpee, because the latter feels humiliating despite my knowing that we all have to endure it at times. The greater my need for help, the greater my resistance to accepting it. This, I’m sure, is my real weakness, for I would never make the same judgment against others that I so readily make against myself.

the surgical holding area, the strength of old ladies, I make my incision swell, my father's stubbornness

Rain all day, as usual. Last Sunday—the day before my surgery—we had five inches of snow—a phenomenal amount for the valley floor—and I spent the day clearing it from the patio roof.

After I checked into the hospital, I was taken to a room that held six patients. Curtains offered visual privacy, but there was no verbal privacy. My surgeon was running two and a half hours late, so I saw other patients come and go. One was 88, and had suffered for nine years from infection following a knee replacement. He was there to have the joint removed and the space packed with antibiotics for three months. Then would come another replacement and, if that didn’t work, a fusion. He was sharp of mind and did his own talking. We were taken to the surgical holding area together, and, as he was wheeled into the O.R., I kept thinking, “You are screwed, dude; you are not going to survive this at your age.” Then I realized that he was probably screwed anyway.

Every day, I watch Mrs. Fredericks walk by. She is 90, lives three houses down, and lost her husband to diabetes last year. A few months later, her daughter and a couple of her grandkids were killed in a plane crash. She stays in her house until she “can’t stand the loneliness anymore,” and then she walks. I ponder the pain she suffers with every faltering step, and I wonder how much longer she can holdout. We denigrate men by comparing them to old ladies (“an old lady could run faster…lift more, etc…than you”), but old ladies usually live to see their once strong men dropped into holes.

I feel sicker now than I did the day after surgery, and I finally figured out why. It’s because I am forced to sleep on my back, and my sleep apnea is worse that way. Last night, I had dream after dream in which I was trapped in dark, dank, putrid rooms without enough oxygen. The constipation came back with a vengeance too. I lay awake most of the night reading Silas Marner.

This morning, I decided I was babying myself too much, and that I might feel better if I did some light housework. I unthinkingly lifted two empty backpacks from the top of a closet, and the area around my incision swelled alarmingly, forcing me back to bed. Peggy was in tears for worry.

Walt stayed with us at the hospital all day Monday, Shirley brings us food every morning, and others have reached out too, but I feel too vulnerable to open my heart. Instead, I am more annoyed by their faults than usual, and can hardly be civil. I am surely a difficult person to befriend, much less to be married to. But then aren’t we all, more or less? Maybe the human race is perpetually at war because we are too obnoxious to tolerate ourselves.

Peggy, I can tolerate better than usual, partly because I see how hard she is trying to help me, partly because I am in no shape to be argumentative, and partly because I see how hard things are for her. I don’t know how people who live alone are able to survive life’s travails, but, come to think of it, if Peggy were alone, she would be free to go to France.

I want Peggy to go to France no matter what, but Peggy wouldn’t be able to enjoy France no matter what. This makes me even more regretful of my foolishness this morning. I wanted so very much to not feel helpless that I made myself more helpless. Every year finds me longing for my comparatively strong body of the previous year. I apprehend further deterioration, and will have to grow stronger of mind if I am to survive.

The surgeon’s nurse said he might want to do further testing for cancer despite the biopsy coming back normal. Why didn’t he think to do “further testing” when he had me cut open on Monday? I seldom go to a doctor but what I leave less enchanted. As a group, they know so little, and most of them know even less than that. Besides, their services are so half-assedly rendered that I can but conclude that money is the main motivator. A five-minute visit costs $200.

Peggy and I tried to hide the cost of my father’s pills from him, but when the day came that he found out, he argued that if enough people chose death over “highway robbery” that medical costs would come down. This is probably true, but how few are willing to volunteer.

Everyone dismissed my father as a stubborn fool. I knew his faults better than most, but I have also observed that normal people don’t achieve sainthood. You’ve got to be a hardcore hard-ass to be a saint and, for better or worse, my father was that.

fun times with Vicodin

The lymph node biopsy came back negative, but now the surgeon wants to biopsy the other side.

I had an iodine-contrast CAT scan yesterday to look for a reason for my partially collapsed lung. Preliminary blood tests were ordered for the day before, and I was in a lot of pain when Peggy drove me to the internist’s office. I had called twice to verify that these tests hadn’t been run as a part of my pre-surgical blood-work, but Peggy asked a third time when we got there, and was told that they had. The nurse had an “Oh, well, shit happens” attitude, about it, so Peggy complained to the practice manager.

Another nurse promised me that we wouldn’t be charged for coming, but I stopped at the front desk to verify it. She appeared while I was there and, looking hurt, reminded me of her promise. I couldn’t very well tell her that I no longer trust anyone in the medical community to get anything right.

I took full advantage of Vicodin for the first two days. Even with it, I hurt too much to sit up for long, but time passed pleasantly enough in bed with an ice pack on my groin. I was determined to read a book on informal fallacies, but I dozed off so often that I re-read most of it twice.

I was just starting to understand how people get addicted to painkillers when the side effects hit. I hadn’t pooped in three days and was eating heartily, so my weight shot up an incredible ten pounds, and my abdomen became as rigid as it was bloated. (When you’ve had hernia surgery, the last thing you want to do is to strain to poop.) Then came the itching. No sooner would I scratch in one place than it would start in another, and I was soon itching in way more places than I had hands to scratch. Last—but not least—I was forgetting to breathe. I would be feeling all happy and mellow, when all of a sudden I would gasp for air, and realize I had missed a few breaths. It was like sleep apnea, but I was doing it while awake. I can’t say enough bad about how this feels.

The surgeon’s nurse advised that I cut the Vicodin in half, but I decided to simply endure the pain. I thought that, being two days post-op, it just couldn’t be that bad. It was. Now, four days post-op, the pain is so intense that I have trouble walking. It is worst in my privates, which are purple and swollen.

19 hours hernia post-op

Surgery went well, as far as I know. The doctor was running 2 1/2 hours late, and I spent the last hour, as usual, in a line of ten gurneys in the pre-op holding area. These gurneys face a bank of windows opposite which stands a two-story cross (the sole evidence of Sacred Heart’s Christian ideals is that cross and a crucifix in every room).

Just before I was rolled to pre-op, Peggy read on my chart that I am 6’10”, so I passed the wait pondering the implications. As a young man, I would have thought it great to be a foot taller, but now I can see the downsides, things like beds being too short, chairs being too low, airline seats being too close, and so forth.

The surgeon wanted me to stay awake during surgery so he could have me cough when he was done. He apparently decided against this, because while I was still on the table trying to ask questions, he was calling a friend to make dinner arrangements. It was by now 5:30 p.m., and he had put in a full day, so I naturally accepted the priority of his dinner plans over my health issues (in all fairness, the tranquilizing agent might have caused me to forget being told to cough).

He did say that the lymph note he removed didn’t look ominous. I went home shit-faced on Percocet, but optimistic that I had dodged the cancer bullet. Bright and early this morning—7:30 in fact—a nurse from my internist’s office called to say that I needed to come in for blood work and a full-chest CAT scan. This was more than a bit of a surprise since the surgeon had said nothing to me about my x-rays being abnormal. The nurse had no explanation, so I asked if she might please find out and call back (or, better yet, have the doctor call). She called (no surprise there) with a confirmed diagnosis of chronic atelectasis (a word she couldn’t pronounce, but that Peggy could upon hearing the first four letters). Chronic atelectasis is a lung blockage that can be caused by any number of ominous diseases, one of which is asbestosis (I used to work around asbestos, and have long worried about it).

Other than the kind of shabby treatment that I have learned to expect from doctors, and the fact that my anesthesiologist was pitifully sick with a cold, everyone else who was involved in my care were terrific. From the young man who shaved my groin to my many nurses, I have only praise. As for the doctors, I can but reflect on the irony of the fact that they make far and away the most money, yet act as if they are doing me a favor by treating me at all.

The surgeon said I would hurt and swell more than most people (I don’t remember why), and I suspect he was right, but the pain meds are keeping the hurt down to a dull roar, and ice applied thirty minutes every hour is keeping the swelling manageable. My bandage is bloody, so even as I write Peggy is out getting a new dressing.

With this, as with my last surgery, the post-surgical pain is minor compared to the aggravation of trying to get information from nurses who don’t know and doctors who won’t talk to me.

That’s where things stand at 11:00 a.m., nineteen hours post-op.

credo

We’re like the people in the Twin Towers just before the planes hit. We can do nice things for others; we can enjoy good food and good books; we can even create meaning in our lives, but the moment will come all of this is gone from us—or rather us from it. We will then exist in the same way we existed before we were born, which is to say as matter and energy. I ate sardines tonight. They used to be little fishes; now they are me. Soon they will be something else. Such is our existence. The personal is transitory. The eternal is indifferent.

The universe is incredibly dark, incredibly cold, and infinitely uncaring. This I worship because it is nobler than an anthropomorphic deity such as the petulant and vindictive god of the Bible. Yet, I could happily partake of mass or communion because they are like the word god in that they have so many different meanings that they lack meaning. It’s not the object of worship that matters but the impulse to worship. I refer to worship that comes from the inability to not worship. In this, I find purity.

France when you might be dying!

Peggy asked if I thought she would still go to France if I have cancer. I said she should consider the prognosis. Her response was that there was no way she would go. I was so surprised that I didn’t think to ask if she would stay home to support me, or because she would be too bummed to enjoy France. I wouldn’t want her here unless the prognosis was grim. I would miss her, but no more than I would miss her anyway; and I would be awfully sorry about all those nonrefundable reservations.

Peggy and I differ in that I am much more likely to make decisions based upon money. I love watermelon, yet I didn’t buy a single melon last year because the prices were too high. Peggy was horrified. “You’re worth the money,” she argued with generous intent, but with logic that reminded me of a television commercial. “What does my worth have to do with overspending on a watermelon?” I countered. “You could just as easily argue that I am worth saving the money.”

When I spend big, it’s on non-consumables like tools or that $1,750 bike I bought last year. I’m not cheap; I’m frugal. I’ve been this way as long as I can remember, and I have no desire to change. Peggy is also frugal, but not as much. If she weren’t frugal, we wouldn’t be together. She would be out spending like the average American, and I would be home packing my bags and separating our finances. She does have her indulgences, but we’ve worked it out so that I can live with them. Her skiing—like her trip to France—comes out of common funds. Her buttons are another matter because the expense is ongoing. When she began spending what I considered a lot of money, we agreed that, for every dollar she spent, I got one dollar for myself. Her “dollars” are displayed in cases; my dollars are in mutual funds.

She argues that the stock market could crash tomorrow and I could lose everything, whereas she has already gotten enormous enjoyment from her buttons, and is unlikely to lose them. She might be right, but then again, a fire or a flood could take her buttons while my funds would go on doing their compound interest thing. Maybe I don’t enjoy greenbacks as much as enjoys buttons, but they still give me a warm feeling. Money alone can’t buy security, but I never heard anyone say he felt more secure without it.

Peggy is away (reluctantly, due to my health) on her annual “Girls’ Weekend Out,” and I’m cleaning house in preparation for surgery. Hernia surgery is low risk, yet I had a friend who died on the table, so I’m doing a more thorough job than usual. Things like cleaning out closets, rearranging cabinets, putting contact paper in drawers, backing up computer files, updating lists, and getting rid of unneeded items. Peggy literally doesn’t know how to operate the washer and dryer, and she is all but computer illiterate, so I know I would be missed.

Yet, she would survive, I suppose, which is more than I might do if she died. I can’t say for sure because I haven’t crossed that bridge. I just know that I always hold suicide as an option, and that she does not. This is another of our differences.