Friday, October 31, 2014

Back in the Light...

Two adorable Ninjas just left my house:

Now I'm being inundated by little Elsa's. 

It's good to be home.

Babygirl is still headache free, and she an I spent much of the day outdoors, without sunglasses, raking leaves and tearing down the garden.  We harvested 30 pounds of green tomatoes. We found some lettuce hiding beneath them, one lonely cucumber clinging to the dead vines, and a dozen peppers.  There are still herbs, kale, and broccoli out there but they are all frost tolerant ones. 

I'm exhausted.  Nearly 800 miles of driving, four nights in beds that aren't my own (two on a pull out chair smaller in width than the average coffin and likely less comfortable).  Three nights with a kid who was so overhydrated that she needed to get up at least once an hour, unplugging the IV pole (conveniently plugged in directly above my head for one night).  One night with the IV beeping every half hour.  Loudly.  I think it might be kinder to just keep someone up all night than to let them think they just might get some sleep.

It was worth it.  It was worth it to see the nurses and doctors suddenly see my Babygirl emerge from under the blankets, out of the dark, into the land of the conversant and confident. 

And I have to tell you, being in a place that 'gets' what it's like to have a headache is amazing.  NO one comes in loudly.  NO one comes in and flips on a light, ever.  The dimmer switches were an awesome, amazing thing, making it possible to go gently from dark to light as tolerated.  And having window blinds that allow you to let in only as much light as you can bear is a gift beyond price.  Babygirl has been living in the dark with her headache for the better part of 6 weeks. 

Praise be to God for the Light.


Wednesday, October 29, 2014

The DHE Miracle....

They've run a ton of crap through that little IV.  Saline.  Methylprednisilone. Reglan. Benadryl. Depakote. And finally, this afternoon, DHE.

They had considerable trepidation about using this drug.

Dihydroergotamine is an derived from an old, old drug.  Ergot alkaloids have been in use since the cavemen discovered them in fungi growing on rye seeds (  Historically they were used to induce labor, and to treat severe headaches.   Because the sumatriptan caused her to have chest pain, and ergot can cause similar side effects for similar (frightening) reasons, there were concerns that there might be some underlying cardiac issues (oh for the love of all that's holy look at the kid's chart! she's had TWO full negative cardiac workups in less than 3 years, the last less than 6 months ago), so they had to call cardiology.  Nephrology had already cleared the drug, so once we got the final go ahead, they put it up.

Within an hour she was headache free.  The sunglasses are off, the lights are on, and she's getting restless and actually having conversations.  They are hanging another dose at midnight, and reassessing the situation in the morning.

Headache free is a blessing.  It isn't out of the woods, exactly, but it's a good start.


PS Oh, and the medical student did manage to make a fool of himself on rounds.  I did my best not to point it out but the attending neurologist was not so kind, poor kid.  Ah, I do not miss those days at all.

Tuesday, October 28, 2014

Coctail Via IV.....

After making the 384 mile round trip to and from CHOP Sunday and Monday, I got up and checked on Babygirl this morning, hoping against hope that she'd be all ready for school. 

Not so much.

The headache recurred at about one AM, meaning that she got less than 12 hours of relief from a procedure that I'm willing to bet we'll pay over $500 for. 

Did I mention that her Medicare is up this month?  Yeah, pretty sure.

Rather than wake me so we could start rolling back to Philly on 2 hours of sleep (sensible child) she waited until I got up.  I cleared some work while I had a quick breakfast and hit the road.  At 8:30 I called (hands free!) to let Philly know we were on our way, ETA about noon.

We got a bed on the neuro floor, a new place for us.  The nurses were not at all put off by the sunglasses, the room lights are all on dimmers, and the window shades are adjustable up to three layers thick. 

The neuro fellow is a Dr Christian, who, if the scar on his neck is any indication, has been in the fellowship of suffering himself a time or two.  His third-year (translation: freshly-hatched) medical student was about 3 steps above average and managed not to make a fool of himself even once.

That being said, she is a significant anomaly on this floor. They simply do not know what to do about the transplant and are, thankfully, tripping over themselves being hypervigilant about it.  It took until 5:30 to start the first of what I think will be a graduated run of 6 different medications aimed at breaking the headache. 

I'm sure they'll succeed.

What I'm not sure about is how they plan on keeping it gone.  And to judge by the looks on their faces when I pose this question, I'm guessing that this is not the first time they've been up against this.  And they don't likely have any really easy answers.


Monday, October 27, 2014

Nerve Blocks.....

After two years of headaches that range from annoying to unrelenting neurology finally called us down to try nerve blocks to break the most recent run. 

Nerve blocks are basically the application of a local anaesthetic to a nerve, like when your dentist numbs a tooth.  You can do small area, or a really big one depending on the nerve you are aiming for.  Epidural anaesthesia is one form of nerve block, and in that case you can hit up to 10 nerves at a time, numbing everything from the waist down, or just one nerve, numbing part of one leg.  I wasn't entirely sure what they were going to be aiming for here.

They offered a sedative ahead of time (and finally got it phoned into the CVS nearest my sister-in-law's house).  I was quite surprised by the dose: Ativan at 2 milligrams is pretty hefty. I order 0.5 mg to sedate a grownup, but hey, maybe they know something about how badly these shots upset a kid, so I give her the pill as we are leaving for downtown.  By the time we arrived at CHOP she was drowsy and more than a little cranky.  The nurse went through the risk/benefit talk, and explained that we don't know how or why it works.  I responded that at this point it doesn't much matter if they come in with grass skirts burning incense and waving maracas.  I need Babygirl better.

The doc explained the process and asked her where the pain was.  Since it was all in the back of her head, that was where the shots were to go:  Four of them, each with one injection to be fanned out under the skin.  Then the doc started looking for anatomical landmarks.

Take a moment and feel the back of your head, where the neck meets your skull.  The bones behind your ears rise up and meet above the center of the neck, and there's a bump on the back of your skull like the keystone of an arch.  Locating the nerves is done by touch, based on these landmarks.

Babygirl doesn't have them. 

When she was born in Guatemala, her mom knew that she wasn't going to be able to raise her.  She had already had one baby, and he was being raised by his father's parents.  She didn't want her Babygirl to go the US adoption agencies and leave the country, so she gave her to a local family.  She came back a few months later to see her, and found Babygirl lying on her back, starving and nearly dead.  With no remaining choices, she took her back and went to the agencies.  Most of them turned her away because they thought Babygirl was too far gone to save, but one agency took a chance, put her in the hospital, fed her up, and she ended up becoming MY Babygirl.  But one result of this history is that the back of her skull is completely flat.

It made the neurologist's day more challenging.  He figured it out.

Her scalp completely numb, she lay down and fell asleep for two hours.  When she woke up she was hungry, thirsty, high as a kite and some teen-girl place far beyond cranky.  The first time she stood up she would have fallen down if there hadn't been a chair behind her.

The doc discharged us.  We are to come back for admission if she gets a headache again this week.  Aside from that, what happens next is anyone's guess.  Nerve blocks work not at all, immediately, for a few hours, for a few days, for months, no one knows in any one patient.

Watching Babygirl try to select coffee was entertaining. We had to go through the line twice for her to make up her mind and she was purely evil.  It was a relief to have her pass out in the car, so I drove all the way home without stopping. 

It took a leap of faith  to even consider leaving Philly without being sure she wouldn't have another headache.  But...what it she wakes up tomorrow without one finally and can go to school?  I have to have her here.  Hope is thin, but it's hope nonetheless.


Sunday, October 26, 2014

Philly Rerun....

Babygirl had blood work done on Tuesday to see if the kidney has recovered from the most recent headache medication.  It has, mostly.  So when I finally got the results, I contacted the headache docs to let them know that, once again (or still, depending on one's perspective I suppose) we are in headache hell).  Babygirl's most recent trend has been headaches that begin about 3 PM, keep her up all night, and end at 10 AM.  I am beginning to get calls from the school, since she is neither attending nor able to meet with her tutors.

The headache folks began the debate on Thursday morning with the usual:  What's she tried?  What does nephrology say is okay to do?  What do you mean, she isn't going to school?? I'll call you back routine.  Among the discussed choices is the option to bring her in for outpatient nerve blocks and admit her if they don't work.  I tell the nurse that I think that this is a grand plan, but this isn't my first hayride, so please don't admit us on a Friday so we can sit in a hospital all weekend and do nothing, 'kay?   Good point, she admits.

By Friday at noon it is agreed that she is having nerve blocks at 1 PM on Monday.  My office manager clears my schedule for Monday, and, just in case, Tuesday.  The nurse tells me that they will call in a sedative for her to take before the procedure.  I suggest that they consider trying another rescue medication over the weekend as well, since the one they gave her to try a few weeks ago worked but had intolerable side effects.  I also point out that our pharmacy closes at 6 PM so she needs to make sure that this stuff gets done before then. 

At 5:30, I'm still at work, so I call Hubby to do the pharmacy run, and , Oh Happy Day, there is a prescription there for her!  The fact that it I later discover that it is the asthma medication I called for earlier this week was less happy news.  I'm still trying to figure out how I want to work around that one.

We'll be leaving this afternoon. I'm re-packing that toiletries bag. Say a prayer, will you?


Friday, October 24, 2014

Ebola Training....

I get asked every day about Ebola.  Am I afraid? Should people worry?  Is it going to kill a lot of people?

My standard advice? 

Last year, no one in this country died of Ebola, but about 30,000 died of influenza.  Quit smoking and get a flu shot.

People seem genuinely surprised and unimpressed by this advice.  The fact that more people die of bee stings than rattlesnake bites somehow does not make people less afraid of rattlesnakes does not escape me.  I get it.  Ebola is like a bucket of rattlers.  On steroids.  On Fox News.


Over the years I've seen a lot of my doctor colleagues die young.  Cancer seems terribly common.  Heart attacks, once in a while.  Suicide, far to often.  A tragic accident, not too long ago.  And a couple of years ago, the Swine Flu got one of us.  Just. Like. That. 

We see diseases, we catch diseases.  I've been hospitalized for meningitis. I've had my share of influenza in the past and get my flu shot every year now.  I've caught strep throat and colds and scabies.  You can't avoid everything, and if a baby sneezes, they sneeze, right? 

I can't speak for my colleagues.  I wash my hands.  Wear protective gear when I need to.  Use gallons of hand sanitizer.  Clean my stethoscope between patients.  But honestly, my lifestyle of sleepless stress, laziness and donuts is more likely to get me than anything I catch from a patient.  Wasting an hour of my week on Ebola training seemed pointless.

There is, perhaps, and odd level of denial mixed with commitment that allows doctors and nurses to do what they do.  Carried to its highest level, the Doctors Without Borders travel to places where they are almost guaranteed to be exposed to either deadly disease or gunfire in the name of providing healthcare.  We aren't afraid, like tightrope walkers aren't afraid, like stuntmen aren't afraid - it's just a job.

Quit smoking.  Get a flu shot.  And remember: HAVING a gym membership is not nearly as good for your health as USING your gym membership.....

Rare viruses are not on the list of things you should be worried about at this point.


Wednesday, October 22, 2014


Scut is term, leftover from medical residency, referring to any list of unwanted tasks, as in:  "What kinda scut's on your list?  I have 6 IV starts, 2 EKGs, a STAT blood draw and that infection in room 202 needs another new bandage...."  It's a list of the stuff they make students do all night long, or at least they used to, as a form of convoluted payback for the privilege of paying money to stay up all night trying to learn how to keep people from dying by being sent to do useless scut while people who already know something keep people from dying.  I remember being told it was an acronym for 'Some Common Useless Task." 

This should, of course, be differentiated from a 'Learning Experience'.  A 'Learning Experience' was doing something that NO ONE would ever want to do, as in, "Hey, let's have the student figure out how to get the maggots out of that drunk guy's leg wound.  That's a REAL "Learning Experience!"  In this case, scut might be translated, "Some Common Unpleasant Task." (And the kicker at the end of THAT particular 'Learning Experience' might be when the chief surgical resident explains, with some degree of asperity, that he would like you to leave his maggots where they ARE thank-you-very-much because they were doing a great job of debriding the wound and YOU just made his job that much harder, you moron.  And then you realize that the guy who gave you this 'L.E.' knew that, the effin' bastard.  Yes, this is how they train doctors.)

What, you ask, brought on the reminiscent ranting?

When I left work at 6:30 last evening there were 13 'tasks' left on my computer.  When I arrived at work today at 7:45 AM there were 57.  This does not include the 40 charts I need to review for my NP and my PA.  These do not include the stack of disability, school physical and handicap sticker request forms on my desk, nor the inch-thick stack of lab and x-ray reports that need to be looked over.  It doesn't include all the billing forms that patients walked out of the door with last month that I need to look up a note for, rebill and sign.

I saw about 20 people today.  I took about 10 minutes for lunch, and I'm pretty sure I made it to the  bathroom a couple of times.  There were two empty cans of seltzer on my desk, and an open jar of peanuts, so I clearly took fluids and nourishment.

But I kept tabs - I always do, to some extent.  I cleared over 150 separate tasks - chart notes, prescription refills, recommendations to the worried well (no, really, you won't get Ebola at Walmart), deciding if that fall from a crib warrants an ER visit, adjusting medications for Hospice patients - finally getting to the bottom of my in box for the first time in weeks.  There are still 15 tasks on the computer list, the 40 charts still need review, and about 5 more forms.  I left at 7:30.  And I get to do it all again tomorrow.

I guess there are differences between then and now.  Now, it's 'tasks' and not 'scut'.  And I'm paid to do it instead of paying to do it.  And I get a little more sleep. 

But I can't say it's an awful lot more fun.


Thursday, October 16, 2014


"I hereby declare, on oath,

I want to tell you a story.  It is an entirely true story.

 that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince,

Once, many years ago, I awoke from a very vivid dream of a little girl with curly hair.  Somehow, I knew that she was my little girl.

potentate, state, or sovereignty,

I already had a lovely little girl, but I knew that there was another one out there.  So I started looking for her.

of whom or which I have heretofore been a subject or citizen;

I looked in India.  She wasn't there.

that I will support and defend the Constitution and laws of the United States of America

I looked here at home.  She wasn't here.

 against all enemies, foreign and domestic;

I looked for a LONG time. 

that I will bear true faith and allegiance to the same;

An adoption agency sent me a picture of a little Colombian girl with a lollipop, and a long, sad medical history.  If the story was true, she was going to die whether she came home to me or not.  So, heavy hearted, I said, "No."

that I will bear arms on behalf of the United States when required by the law;

But that little girl DID have a curl on top her head...and she didn't look like she matched the long, sad history.  So I suggested some extra medical tests.  And I went back to looking.

 that I will perform noncombatant service in the Armed Forces of the United States when required by the law;

And a few months later, the agency called me back.  Those tests are all do you think?

that I will perform work of national importance under civilian direction when required by the law;

I think she needs to come home. 

and that I take this obligation freely,

And yesterday, with her little boy on my lap, I watched her take her Naturalization Oath of Allegiance to the United States of America and prove she is a US Citizen.

without any mental reservation or purpose of evasion;

And all the way home my heart was squeezed tight full of gratitude to God for the gift of my beloved Curlygirl.

so help me God."


Saturday, October 11, 2014

Itty Bitty Blessings....

A few weeks ago I notice that the heat in the car wasn't working.  The AC was fine, but there was no way to take the chill off in the morning.  But, hey, it was summer, so most of the time I just forgot it was a problem. 

Getting up at 5 AM to go to the gym in October, however, would be more pleasant with heat in the car.  Seat heaters are awesome, but they don't defog the windshields, right? 

Friday morning I scraped frost off my windshield and discovered that my 'defroster' was adding layers of frost to the inside of the window, making it difficult to forget that I had a problem, so I took it straight to the car doc.  At the end of the day, they called me.

"Good news!  Your car has heat!" 

Good news indeed.  "What's that going to cost me?"

"Hope you're sitting down." 




Apparently some wire was bent.  He bent it back. 

Give the man credit.  He could just as well have told me that he had to replace the hunkafundkle and the solenoidal sinus and charged me $322.50 and I've been none the wiser.  So praise be to God for an honest mechanic and an affordable car repair.


PS Babygirl and I both had a rare day of excellent brain function.  She commented on it almost as if it seemed impossible.

Wednesday, October 8, 2014

Miserable Migraine....

I've had a couple of days this week where I feel  like somebody beat the crap out of me.  Muscles I didn't know I have have been cold and crampy and achy and tired.  I worked Monday and called in sick yesterday with a combination of headache and muscle pain.  I went to bed at eight last night and got up and went to the gym this morning.

(Aside story:  If you swim regularly, you kill bathing suits, especially since the people who make a plus-size suit apparently assume you will wear it for 10 minutes at a time once a year rather than actually exercise in it.  At this time of year, the only place to get a suit is online.  I ordered two, and one of the new ones seemed rather generously sized on the bottom and snug on top, opposite to the usual fat girl sizing.  It wasn't bad, but I discovered that breathing and swimming at the same time were not compatible activities in this suit.  The good news is that the ocean will NEVER be able to remove this suit, so it will go to the beach next time.)

I went to work, and toward the end of my first patient's visit, I got that telltale ache at the base of my skull on the right side (I nearly typed 'left'.  When I get these things it's almost always the right side and I almost always say left.  I don't know why).  It was followed by the sensation that the back of my scalp was wrinkling, with a crawling sensation (one of my least favorite auras).  I immediately took my migraine medications and moved on to my next patient.  I had barely finished when the side effects of the meds and the migraine hit together along with a massive wave of nausea, and I was done.  Nurses move fast when you say, "I'm going to throw up."

They had to walk me to a dark room where I watched the light show behind my eyelids and kept my ears covered against all the noise.  They shot me up with anti-emetics and called Hubby from work to come and get me.  He bought me a cup of full-strength coffee, and I went to bed and slept until three PM. 

My tongue is still tingling.  My head is still sensitive and noises are still a little much.  Time keeps jumping around.  Last time I looked it was four, and now it's six.  Babygirl has her own headache and s laying low.  Hubby is ordering pizza because it's the least noisy thing to make. 

I see the doc in the morning.


Tuesday, October 7, 2014

Coming Back...

Yesterday's lab reports represented an improvement:  Creatinine is down from 1.3 to 1.1 with her baseline being 0.8 (and normal for age 0.6 or less).  Potassium back to normal at 4.3 (but we had a better phlebotomist - our man Frank was there and he doesn't fool around.  The girl the other day did a lot of the vein-patting delay-tactic stuff that can cause an artificial rise in potassium due to trauma).  She still has too much acid, but that's better also.

The good news is that they aren't immediately calling us to Philly. There was a grumble about the fact that our next appointment isn't until the end of November, so after the team chats this morning, that might get shifted.

Babygirl wasn't up to school but she was very productive with the math tutor (the poor young lady whose first experience was to watch her cry the other day).  She says Babygirl covered four days of math.  Yippee, I say. Now she's only TWO weeks behind in one class, and three weeks behind in eight others, but who's counting?  TutorGirl was a bit startled by this take on reality, and she's not in charge of the big picture, but he sent a text to Babygirl's advisor outlining my ongoing concerns about ALL of her classes. 

Meanwhile, I'm on day three of some kind of crud that makes me feel like someone ran me over with a truck, and I just cannot get warm.  Who gets goosebumps on just one half of the body? I swear they are rolling up and down from my right ankle to my shoulder.


Sunday, October 5, 2014

Day Of Rest.....

Babygirl has spent today recovering.  Headaches and tummy aches off and on with the sniffles that mark the end of the cold that's been riding in the background of the past two weeks.  She ate dinner and we're watching some TV, waiting for bedtime. 

I spent my day curled up with a book.  I couldn't get warm, so I finally got out the heating pad and plugged it in underneath myself while I read.  I've been too tired to read, which is very unusual, so I've been stuck on the same page for weeks.  It was a relief to finally finish something - an almost overwhelming sense of accomplishment.

I reset my brain with a handful of Sudoku puzzles. 

I stopped crying.

It's not much.  But it's the best I can do. 

I think I'm ready to face the week.


Saturday, October 4, 2014

Grateful Relief....

On the way into work on Thursday morning I was in a dark place - exhausted, discouraged, sad and hopeless.  An optimist by nature, this is a hard place to get to, and I'm so rarely there that I don't have a lot of plans for getting back OUT.  I climbed out of my car into a pile of bright yellow leaves and even THAT didn't make me smile.  On the way into the building I struggled to find something, ANYthing, I could sincerely and without a trace of snark tell God I was thankful for. 

As I contemplated the number of patients I knew were loaded into my schedule against the amount of paperwork backed up on my desk, I rewound the weeks' workload and realized....very few of my scheduled patients had actually kept their appointments. 

"No Shows" are a chronic problem in our office.  Our patients are poor, mentally ill, careless, overstressed, and overbooked.  They run out of minutes, pay their rent ahead of their phones, don't get reminder calls and take extra work hours when they are offered.  And sometimes the 'no shows' come in clusters.  The only reason I'd been able to manage all Babygirl's phone calls to the school and all her docs was because my patients weren't there.

So I stopped, and said a 'thank you' for the no shows. It wasn't much, but it was, honestly, the best I could do. 

Babygirl's neurologist called, concerned about the medications and the kidney.  The bottom line is that he doesn't want to be responsible for wiping out her kidney function.  He's not.  But he's freaked, a little.  Nephrology didn't call.  The school called.  I told them not to send a tutor.  Babygirl's still just too sick.

Friday morning, after 24 hours without the lisinopril, Babygirl awakens with a small tummyache and a small headache, overall, an improvement.  I asked her if she could handle a tutor and she said yes, so the school sent one over for a couple of hours after school.  Nephrology called and said they want the kidney retested Monday, so we won't know if the kidney damage is permanent or temporary until then.

Last night we went out for dinner.  Babygirl ate a salad and part of a bowl of soup, the most I've seen her get down at one sitting in over a week.  We went to Barnes and Nobles and she bought a Manga, getting into an animated conversation with the sales clerk about his 6-month stay in Japan.  It was beautiful, heartbreakingly beautiful, to see.

Crawling up out of any hole takes time.  Each battering we take lays open scars laid down by the last one and revives fears barely buried.  We keep walking.  Falling.  Crawling. 

Lord, give us the strength to get back up. Again.  And again.  As many times as it takes.



Thursday, October 2, 2014


Babygirl is on the fourth (fifth? it's been such a crappy month that it's beginning to run together) day of this ongoing episode of inexplicable abdominal pain.  No fever, no urinary symptoms, one day of vomiting for a couple of hours, some nausea, some weight loss.  Just total, ongoing misery. 

Recapping her school attendance:  Three weeks ago she missed Wednesday through Friday with a severe headache. The week before last she missed Tuesday and Thursday with headache. Last Monday she called Hubby for  ride home from school with a headache and stayed home Tuesday through Thursday with more of them, and Friday with a cold. She began having the belly pain Sunday and hasn't been to school all week.  We haven't seen a home teacher through all of this.

Yesterday I called the school and spoke to the head of the health office and explained where we were.  It was reassuring to hear her utter exasperation when I told her that there was some confusion about how to meet her 504 plan.  I think that she will be clearing that up. 

I heard from Babygirl's advisor that a tutor was available for the evening, so would I bring her to school for tutoring?  Um, no.  The kid is sick.  Get the tutor to our house, okay?  Okay.

I called Nephrology. They reviewed things, heard the story, looked at the dose of the new headache prevention medication (which, at 15 mg twice daily is under the 40 mg/day adult maximum but is more than they usually use in children.  Keep in mind, however, that Babygirl is 15 and adult-sized).  They ordered STAT blood work (at 4:30 PM, with a tutor scheduled to arrive at the house at 5:30 and me still at work and Bible study scheduled at 6). It turns out that among the rare side effects of this medication (rare indeed since I prescribe this drug all the time for over 25 years and have NEVER seen it)  is abdominal pain.  Seriously?

Keep in mind that I haven't seen Babygirl for more than the 30 seconds that it took to wake her up and see that she was too sick to go to school at 7 AM, so I really don't know how she is feeling right this minute, right?

I hover over the fax machine, call AGAIN when the fax doesn't come, grab the papers and run.  I hustle poor Babygirl to the lab and get her home in time for the tutor to arrive.  This lovely young lady has never met Babygirl.  She is expecting that Babygirl has some books, or texts, or papers, or SOMETHING for her to start working on.  I was told that she was going to be given a packet of work for a couple of Babygirl's elective classes to work on.  She had no idea what I was talking about. 

She started to see if Babygirl had any grasp of in this year's math - her most difficult subject.  She was patient and kind, and in less than ten minutes Babygirl had put her head down and was sobbing.  Sometimes you are just too sick to deal with anything, you know?  In all of the time we've had tutors, I think this may have been the third time we've had to send one home because she just couldn't manage.

On a happier note, Citygirl wanted me to come and listen to a band that she was thinking of hiring for a party she's planning.  I collected myself, got in the car, settled into some very relaxing music with a fruity drink and......

The on-call Nephrologist called.  Babygirl's kidney is most unhappy.  Her creatinine is up to 1.34 from 0.8 only two weeks ago.  Her potassium is high and her bicarbonate is low (lots of acid that the kidney is not getting rid of).  Her advice:  Stop the new medication, and stop it NOW.  I check the time - it's 5 minutes to medication time.  I call hubby's phone.  No answer.  Home phone - same.  Babygirl's phone - same.  Repeat all four or five times.  Finally Babygirl answers, and I tell her, "Dad has to change your medicine. Go tell him to call me."  He calls, I tell him, and he says, "But she just took it!"

There is not enough rum and pineapple juice in this world to cope with this, just not enough. 

Screw it.  There's nothing more I can do about it tonight.  I had an appetizer, called it dinner, and enjoyed Citygirl's company and the music, and came home and resorted all the pills.

This morning they will call with a plan. 

All of this is overwhelming enough, right?  But this is the script that runs in the background of my life.  In front of this, I go to work, to the gym, clean my house, spend time with the grandkids, do the grocery shopping, take care of my mom, go to church.  Most of the time I don't feel sorry for myself, but last night I just wanted to turn the clock back somehow - but to where?  There is no point on that timeline that doesn't bring us back to here, since there is no choice I wouldn't make that would exclude any one of my kids from my life.  There really is no 'might have been.'  There is only THIS.  It's just that watching her suffer is So. Damned. Hard.

Citygirl prayed for us all last night.  Something to the effect of, "We know You're taking care of us, but we'd kinda like to see some proof of that...."  I'm sure she was more respectful than that.  And I'm sure He got the point.  And I'm sure I agree.