Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

Mind

Apocalypse Not

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So, the Mayans were wrong. We’re still here. No escaping all those unpaid bills, looming deadlines, promises you made that you wish you hadn’t, closets to excavate, thank-you notes to write (does anyone still do this?), books you were going to read by the end of 2012, dirty laundry, December re-runs, Washington gridlock.

For those survivalists who paid $20-million for an armageddon-proof ark, I hope they rethink their investment strategy. Doomsday is big business, and they’ll probably find another apocalypse to pin their hopes on. But think of all the good that could have been done with that money to make life on Earth more livable.

Ridiculous as the 12-21-12 deadline for life-as-we-know-it seemed, however, I have to admit that a little part of me wondered . . . what if? I didn’t do anything differently. I didn’t stop making appointments for January or not bother to plan menus for the week or call my daughters to say how much I love them in case we never saw each other again.

But I did imagine, if only for a few minutes, how I would fare if there were some kind of earth-shattering disaster. One of the ways I drive myself crazy in morbid moments.

As always, when my mind travels down this rabbit hole, I concluded that I would not fare well. Chances are I’d get an infection in my fingers that would do me in without antibiotics. Or I’d fall behind and collapse in any escape or mass exodus that required strenuous physical exertion. No way to stock up on enough bandages and medications to last me five years in an underground, waterproof bunker. Which I guess is okay, because we couldn’t afford one to begin with.

Really, who would want to survive an apocalypse, anyway? The only people left would be the crazy ones with enough money and guns to hole up in a multi-million-dollar ark or a renovated missile silo out in the middle of nowhere. I’ve read Cormac McCarthy’s The Road. I don’t want to go there.

No, I’d rather be right here, with all the messiness of daily life. The Mayan Apocalypse was just another distraction, a way to avoid the mess. But that’s what we’re stuck with.

Healthy or not, wealthy or not, we’re all vulnerable as soon as we leave the womb. Facing each day, sticking with it despite all the struggles and risks and disappointments and losses takes courage and fortitude and faith. You can sequester yourself in an ark of your own making. But the only way really to survive—and thrive—is to dive in and swim.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.

Grieving

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I had a blog post in mind for today, one that has been incubating since the middle of last week, as is usually my practice. But it can wait. After the Friday massacre of so many innocents at Sandy Hook Elementary in Newtown, Conn., it seems self-serving to write about what’s going on in my own little corner of the world.

Since last Friday, as more details have emerged about the shooter and his victims, about the heroism of those who sacrificed their lives trying to save more children, about how many rounds of ammo the shooter had in his cache, about how many more might have been killed if the police hadn’t arrived when they did, I have been struggling, like so many, to grasp fully what happened.

One morning you send your first grader off to school, and then. Gone. Murdered. No, slaughtered with a semiautomatic. Along with dozens of classmates, teachers. The images don’t go together. The pain is too great, too hard, even from a distance. My heart hurts. My prayers of comfort go to all of those who lost loved ones. But that seems inadequate, even still.

As President Obama spoke to the Newtown community Sunday night, you could hear a baby cooing somewhere in the audience. No one shushed it. Perhaps that was the most profound response to the nightmare.

Even in the midst of such tragedy, we are resilient. The will to live and heal and flourish, despite overwhelming loss and pain, is powerful, thank God. More powerful than the will to destroy.

And yet. As the days go on, as we return to our routines, will we maintain the focus and fortitude to ensure that our schools and malls and movie theatres are safe places for our children? Safe for all of us, regardless of social class, race, ethnicity, religion, sexual preference, physical disability, health challenges, whatever sets us apart?

President Obama issued a challenge. We need to change. The time is now. Yes.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.

Gift of a Lifetime

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Twenty-eight years ago this past weekend, on another mild December Sunday, about an hour before Al and I were to exchange our marriage vows, I arrived at our synagogue carrying the white satin-and-lace wedding gown I’d sewn myself. The sun was streaming through the lobby windows at the opposite end of the hallway. And there stood Al, so handsome in his white cutaway tuxedo. We startled as we glimpsed each other, then laughed. I ducked into the Bride’s Room to get ready and hide until the ceremony.

We still joke about that moment, all the excitement and anticipation and hopes for a good life together packed into an instant of recognition. It was my second marriage, his first. All I wanted was for everything to work out right, this time.

We’d dated for just nine months. But our introduction was through our rabbi, who had known Al since childhood. Sterling credentials. Still, there was no way to know, as we stole those glances on our wedding day, whom I was really marrying.

I began to understand within a few weeks after we returned from our Cape Cod honeymoon. Before our wedding, when we’d had blood tests for our marriage license, I’d told our internist that I’d been experiencing fleeting joint pain, and my hands had been swelling recently. The wedding band we’d ordered was too tight when it arrived, and the jeweler had to stretch the gold to fit my ring finger. Our doctor ordered an ANA blood test to rule out any complications and referred me to a rheumatologist for an evaluation in January.

Back from the Cape, I was happily setting up our apartment and not thinking much about all of this, even considered canceling the appointment as a waste of time. But, being ever-diligent, I went, anyway.

The appointment turned my world upside down. My rheumatologist explained that my ANA had come back positive, a sign of some form of autoimmune disease. He thought it was one of three possibilities: rheumatoid arthritis, lupus or scleroderma. We discussed my long history of cold hands, sun-sensitive skin since my early twenties, migrating arthralgia for the past year or so, struggles with fatigue. We examined my cuticles under a magnifying loop, and he pointed out the wriggled, abnormal capillaries. We scheduled more tests and follow-up appointments.

I came home and sat on the love seat in our small living room, barely able to speak. Al sat with me. We looked at each other. I felt like damaged goods. I was terrified. Of the possible diseases, I only knew that lupus had killed my literary heroine, Flannery O’Connor, at 39. I was 30. I’d never heard of scleroderma. Neither had Al.

Much later, he told me his mother had warned him when we got engaged that I looked thin and frail. Even though she liked me, she was concerned about what kind of a wife and mother I would make.

Whether or not he had second thoughts when I came home from the rheumatologist, however, he never expressed them. Instead, he put his arm around me, and we sat there as I cried about what might happen and why this had to happen now, just as everything in my life seemed to be finally working out.

In the months that followed, we struggled to learn how to cope and talk about my health. My body kept doing strange things without warning, like suddenly flaring with a bout of pleurisy when I was serving Friday night supper to Al and his mother, or creating so much pain in my wrists that I couldn’t lift a pan off the stove. I was often tired and had to pause from my freelance writing to nap in the afternoon. I couldn’t play tennis anymore. I got exhausted from hiking or camping. I couldn’t finger my violin, which Al had had refurbished as an engagement present. There were times when he seemed distant, and I didn’t know how to reach him.

But this turned out to be just a prelude. That fall, Al’s mother was hospitalized with the first of two strokes. Running back and forth from work to see her in the hospital several times each day, working a second job as synagogue youth leader, Al contracted mono. On an icy night, Thanksgiving weekend, he began rasping in his sleep.

I found him, eyes open, pupils dilated, drenched in sweat. On instinct, I slapped his face to make him come to. He started breathing normally again, and we were able to talk. Pumping adrenaline, on auto-pilot, I called our medical service and was told to bring him to the ER. For some stupid reason, I thought I could do this myself, but when I tried to get him out of bed, he collapsed on top of me. So I finally called the ambulance.

Over the next few days, we learned that Al’s spleen had ruptured and he was being held together by a blood clot. He came home from the hospital, sans spleen, with a long scar down his chest that was still healing, the day before our first anniversary.

For seven more years, we watched over Al’s mother, helping her through a second stroke, at-home care and the transition to a nursing home. We lived through many more family medical emergencies—for Al’s mom, my parents, our two daughters, Al himself. I became an expert at managing the details of everyone’s medical history and medications. My scleroderma progressed, slowly but relentlessly.

With time, some counseling, and a lot of practice, we learned how to talk about all of this, how to cope, and how to thrive in our marriage. Even as my disease has made itself at home as the unwelcome third partner in our relationship, Al has never failed to know the right thing to do or say about my own health challenges. He has patiently supported me when I needed him, but never babied me or made me feel like an invalid. He has always expected me to be just myself, my whole self, not this supposedly frail woman with scleroderma. We both understand, all these years later, I’m a lot tougher than that. And a lot more.

No way to know, as I glimpsed my husband-to-be in the sunlight on our wedding day. No way to know. But what a blessing. And what a gift.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.

Fantastic Voyage

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In 1966, when movies still cost 50 cents and popcorn a quarter, I went with a friend to the Peekskill Paramount movie theatre on a Saturday afternoon to huddle in the crowded balcony with a bunch of other giggly, wise-cracking kids and watch Fantastic Voyage.

In what has become a sci-fi classic, a team of miniaturized surgeons enter the body of a scientist to zap a life-threatening, inoperable blot clot in his brain; the scientist is the only person in the world who knows how to make the miniaturization state last more than an hour, a secret essential to U.S. Cold War military strategy.

The team travels in a mini submarine through blood vessels and organs, battling antibodies along the way and a fiendish saboteur in their midst. If that isn’t enough to pique your curiosity, the movie stars a very young Rachel Welch and won two Academy Awards for some pretty neat special effects before the days of computer animation.

I’ve been thinking of this movie lately and just added it to my Netflix queue. One of the curious aspects of living with a complicated disease for so long is that I’ve seen more and more of my own internal landscape in recent years. With each new complication of my scleroderma, there are tests and more tests. And with digital imagery and optic probes the norm in medicine, and X-ray results easily viewed on an exam room computer screen, I’ve seen some pretty fantastic, albeit sometimes disturbing, sights.

There are the basics—all the many, many X-rays of my deteriorating hands, with each iteration revealing less bone at the fingertips and more starbursts of calcium floating under the skin. There are some foot X-rays, too, more recent, to confirm calcinosis in my toes.

There was the MRI of my chest a few years ago, when a CT scan to check rasping in my right lung (a possible sign of interstitial lung disease) revealed a questionable spot. It turned out, my pulmonologist explained while we toured the results on his computer screen, that the spot was nothing to worry about, just evidence that I’d contracted histoplasmosis years before, probably while spelunking one weekend near Pittsburgh when I was in grad school. As he scrolled through the MRI, the inside of my lungs revolved like the ceiling of a planetarium speckled with tiny white stars. Some scarring, yes, but so far, nothing too debilitating.

There have been regular echocardiograms to monitor signs of pulmonary hypertension, a late-stage scleroderma risk. Sometimes I close my eyes and try to doze through this non-invasive but often uncomfortable procedure, which requires the tech to press a rolling probe all over my chest and ribcage. Other times I’ll distract myself by watching the dark computer screen, with its blue and red images of blood surging through my heart, like an animated deKooning.

More tests. A CT scan of my brain and skull X-ray one Fourth of July weekend when I started to go numb on the left side of my face. Cross-sections of my very own convoluted gray matter. Yes, that’s where all those thoughts and images and feelings ping around. No stroke, thank God; rather, an inflamed trigeminal nerve was the culprit. But there was something eerie about seeing an image of my own facial skeleton, not some Halloween mask—the exact position of my eye sockets, nasal cavity, cheekbones, jaw—shades of what will remain when the rest of me turns to dust.

Of course, there have been all the routine images, too—ultrasounds of my womb when I was pregnant with Emily, the squashed elliptical pancakes of my breasts as seen on a mammogram, a slew of dental X-rays revealing how some of the roots of my teeth are resorbing—a rare scleroderma complication. Fortunately, I slept through my colonoscopy a few years ago.

I’ve seen the pink marbled walls of my bladder and the black-and-white image of a PICC line snaking into one underarm vein and then the other, when the first side was blocked by too much scarring. Not fun.

Most intriguing, once we got past the unpleasantness of inserting an optical probe through my nose, was a view of my pharynx. This took place when I saw a speech therapy specialist a few years ago to evaluate problems with swallowing. There are times that I feel like food gets stuck in the back of my throat, and I worry about choking. She handed me items to swallow—crackers, apple sauce, Jello—tinged with Kelly Green food dye, so we could see if the pathway to my windpipe closed properly as I ate. It did, a great relief, and also fascinating. I thought of a camera lens opening and closing when you squeeze the shutter.

I’m sure, as time goes on and my scleroderma does its own thing and medical technology becomes ever more sophisticated, I’ll see even more of my innards. Not the kinds of images you put in your photo album, like pregnancy ultrasounds. But miraculous, nonetheless. Even if the reason we’re digging around with probes and such is due to damage caused by an insidious disease, I’m still amazed by the view.

We take our bodies for granted, all the inner workings so hidden beneath our skin. If we could see what was really going on inside, all the intricacies of our interior universe, how the balance here affects the balance there, would we take better care?

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.

Star Gazing

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Since Thanksgiving, lying in bed before sleep, I’ve been exploring the constellations beyond our ceiling. I do this with the help of the StarTracker iPhone app. Day or night, inside or out, cloudy or clear, you can raise your iPhone to the sky and see what stars and planets are overhead. Very cool.

I’ve been fascinated by the night sky since childhood. So last Wednesday, with help from Emily, home for the holidays, I downloaded the app and we bundled up to go outside and give it a test drive. The night sky was overcast, charcoal gray, and we could only see the moon and one star. But with StarTracker, we could still locate the position of our favorite constellation, Cygnus the Swan, flying westward toward the horizon, as well as Cassiopeia’s glistening W and where to seek Jupiter when skies cleared.

This was at the end of a difficult day that had begun at 6:50 a.m. with a call from Mindi in Tel Aviv, reassuring me that she was fine and far from the bus bombing minutes earlier, and had ended with our relieved evening texts about the cease fire between Israel and Hamas. In the middle, I’d received an email from a friend whose sister had been dying from scleroderma, with the sad news that she had passed the prior week.

Later that night, struggling to sleep after the day’s emotional roller-coaster ride, I thought about my friend’s sister, how her family’s sorrow must be mixed with relief that her soul was finally free of the rigid prison her body had become. I went to the bathroom window to see if the moon’s gleaming face was still visible. I matched it to my iPod’s screen and looked again for Cygnus.

The next evening, after a great, grateful Thanksgiving meal at our cousins’, we came home to clear, cold night skies. Em and I bundled up again and took my iPhone outside. This time, we saw Cassiopeia sparkling high overhead, found Jupiter’s bright pinpoint nearby and Polaris at the tip of a barely visible Ursa Minor. From the app, I learned to identify Cepheus’ box with a peaked roof. Em got cold and went inside, but I stayed a few minutes longer to figure out more constellations—Pisces, Perseus.

Back in our warm kitchen, I sat down with my stars and planets field guide and began reading, trying to figure out the relationships among the constellations. How did sailors and shepherds understand the night skies they knew so well? No apps back then. Of course, the answer was stories.

In Greek mythology, Cassiopeia was married to King Cepheus of Ethiopia. No wonder they were assigned neighboring constellations. Nearby are also the constellations of Andromeda, Perseus and Pegasus, the winged horse; Andromeda was Cassiopeia’s daughter, whom Perseus rescued from Cetus, the sea monster (another close-by star cluster), after he escaped on Pegasus, after slaying Medusa.

Here in the West, we understand the night sky through a Greek lens. But, I wondered, what about other cultures? The Chinese have their own constellations that look more like zig-zags than enclosed shapes, with names like Celestial Kitchen and Mausoleum, and legends about individual stars, including several in our constellation Orion that the Chinese describe as fighting brothers who had to be separated.

And what of the Arab world? Here, intermingling of Greek and Arab cultures produced Arabic names for Greek constellations. Cassiopeia is known as That Al-Korsi, roughly translated as Who (Lady) Has Chair, describing the Greek’s illustration of a sitting woman represented by the W of stars. Cygnus is Ad-Dajajah, The Hen. Ursa Major, which includes the Big Dipper, is Ad-Dubb Al A’kbar, The Greater Bear.

Every culture has its names for the brightest stars. Ancient astronomers of the northern hemisphere, wherever they lived, recognized the centrality of Polaris, the North Star—Tien Hwang Ta Ti in Chinese, for the Great Imperial Ruler of Heaven; Al Kiblah in Arabic, for the star least distant from the pole—all observing how other constellations wheel round it as the Earth revolves on its axis.

We all share the night sky. We all share the Moon’s silver face, the cycle of life and death. Our beautiful blue planet, so massive in our minds, is but a gleam of sapphire in the endless universe. Seen from afar, do rockets fired at enemies appear as sparks? Does a freed soul emit energy into the void?

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.