Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

resilience

What My Mother Wrote

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My mother would have been 101 this Thursday. She died 24 years ago of a rare and virulent form of thyroid cancer that took her life in four months. I have often thought, in recent years, that I’m grateful she was spared our current domestic and global turmoil. She and her parents escaped Nazi Germany in 1936 and made a good life here in the U.S., and she died, albeit too soon, in peace.

I’ve been thinking of her as I prepare to meet our younger daughter in Asheville, N.C., on my mother’s birthday. We’re getting together for a weekend conference about Black Mountain College, which was a small, experimental college centered on the study and practice of the arts, run as an earnest democracy by students and faculty. Mom loved her years there, a place of deep self-discovery. She focused on psychology rather than the arts, though she was a dedicated member of the theater stage crew, and she also helped to build part of the campus. I know this, because I have all of her correspondence with my grandparents from her college years.

Rereading this huge treasure trove, I came across her letter from December 7, 1941, the day that Japan attacked Pearl Harbor. I share part of this with you because it resonated for me so deeply after the horrific events in Israel this past weekend. For some context, in the months leading up to Pearl Harbor, she had been commenting on everyone’s concerns that war was inevitable, as her male classmates, one by one, were already enlisting.

Here is what my mother wrote. She was 19 years old:

Dearest folks,

It seems so funny to be writing a letter today, after all that has happened. The day started out like any other Sunday around here. I had most of my studying done, and was feeling very good. Around 10:30 I went up to Paul’s to give back a book I had borrowed. Roman came up later on, and the three of us had a swell time just talking about Paul’s work. The manuscript of his new book had just come from the publisher’s for correction, and we helped him with that. By 3:00 o’clock Roman and I went to the study building, because he wanted to work on his new room. As we were going through the hall Bob B came up to us and asked us whether we had heard any news. Upon our question as to what kind of news, he told us that Japan had declared war on the U.S. Both of us felt at once relieve that it finally had happened, and yet puzzled that it was Japan who did the attacking. Paul, to whom we brought the news, said it was the beginning of the end of Hitler, when the latter had to resort to Japan’s attacking the U.S. in order to stop whatever little help we have been able to give Russia.

We went back to the lodge after that little illumination, feeling very depressed and gloomy about the whole affair. Everybody was in that depressed mood, because we realized that this war was finally destroying whatever there was left of the world as we knew it, and the effect it would have on the future of the college and ourselves. It was after dinner that Lies K. and I got together in the lobby to discuss what was really happening to us, and most of all what the positive values were that might still be in the world. After a rather lengthy searching we came to the following conclusions: After all it does do us not much good to ask why we exist or what we live for, or what the purpose of life may be. We realize that there is no God, but that there is a lot of beauty in the world. We do not believe in the nobility of man, but we do know that men have written great literature, thought many thoughts, thoughts about the question of life and death, that they have composed great and beautiful music and art. We do not believe in any utopia which will make everybody happy because of some political system, but we do realize that all people are in the long run depended upon one another for the bare fact of living. What then are the values that remain for us to hand on to our children, values that will be true even in the changed world after the war and the struggle that is still coming to us and to them? Every human being has a right to food, shelter and clothing. Every human being has a right to affection and happiness (even though that is relative), and to the security arising from self-confidence and the relations with other people. The right to breathe fresh air, to enjoy a sunrise or a sunset, or a moonlight night, the self-realization that comes out of a love relation between two people; the right to enjoy music, literature, and art; the right to think and worship, the right to learn—all are the birthright of every human being. Those are the positive items which we are going to teach our children, and those are the things to see ourselves through the struggle ahead of us.

I am not sure whether we or the next or even the immediately following generations will achieve a state of existence in which those rights will be put into practice, as a matter of fact I seriously doubt it. However, as long as they remain present in the minds of people there is a hope left for their eventual realization.

With those ideals in mind we are willing to make the sacrifice of our life, of fighting a war, of eventually marrying and having children, if we are not killed in the process of the war. I think that I am able to face whatever is coming now with a comparative peace of mind, even though I am aware that my friends may be killed, that I may be killed, and that it will be “tough going” for the rest of my life. Another thing, no matter how hard the going may be, I shall always try to see the brighter side of happenings and get all the genuine happiness out of life that there is to gather. . . .

While Mom’s worldview evolved from that grim manifesto, rejecting atheism for an agnostic spirituality, she remained an optimist, despite all the disruptions that she endured. Even in her last days, she confronted death with great calm and courage. May her memory be for a blessing—and for an inspiration in these dark days.

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. Please view Privacy Policy here.

In Stitches

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It’s been five years since I last had calcium deposits removed from the bridge of my nose, the fifth time I’ve endured this procedure. Usually, I take care of this annoying issue about every three years, but the pandemic put that on hold this time around—which ultimately meant that the calcinosis got worse.

Originally, I thought the problem was caused by the weight of my glasses. I get calcinosis in my fingers at pressure points, so it made sense. But I switched from wire frames to very lightweight Silhouettes years ago, and it has not solved the problem.

No one really knows why scleroderma can cause this build-up of calcium in unwanted places. My theory is that, regardless of how thoroughly my ENT plastic surgeons have tried to remove the calcium growths from my nasal bone, a seed remains that grows more calcium crystals over several years. They always biopsy what they remove, and it always (thank goodness) is benign. In any case, once it gets big enough, it becomes unsightly and increasing uncomfortable, stretching skin that is no longer very elastic.

This spring I met my new surgeon, Dr. E., who is chief of Otolaryngology at Boston Medical (his predecessor had done the last three extractions). I liked him and his team immediately. He is thoughtful and conservative about performing a procedure that is either unnecessary or has low potential for success. In fact, he was at first reluctant to take me on, given how fragile the skin on my nose has become, but we came to a meeting of the minds, with a plan to do a skin graft if necessary to close the wound.

And that is what he and his resident did last Wednesday. I’d had to postpone the procedure twice over the summer, given unexpected schedule conflicts. During that delay the calcium had pushed through the skin, so I was managing an open wound and doing my best to avoid infection until we could finally take care of it.

Nonetheless, I was not looking forward to the procedure. Getting Lidocaine shots in your face is no picnic, and neither is having the bridge of your nose cut open and calcium deposits scraped out of bone. Then there was the added complication of the skin graft, which they took from below my left ear. And sewing me back together.

I’ve learned from past experience that I do not do well with Lidocaine mixed with epinephrine, which is a preferred concoction because it limits bleeding. So, instead, with plain Lidocaine they had to use a cauterizer, which, even with local anesthesia, feels like pins and needles, and sometimes like tiny darts. And it smells like burnt roast, which is, of course, essentially what’s happening.

This all took over an hour. I did my best to keep breathing evenly through the process. Some music from the High Holidays was a welcome ear worm. In addition to suturing the graft, they stitched a rectangular piece of gauze, called a “bumper,” on top of the graft to hold it in place for a week. That comes off, I sincerely hope, tomorrow. Between the stitches under my left ear and the bumper, I looked a bit like Frankenstein’s monster when they let me see my face in a mirror.

“Can I have something to cover it?” I asked.

“What did you have in mind?” asked the resident.

“A bandage?” It seemed rather obvious. His concern was that it not pull at the bumper to dislodge it in any way, but there was no way I was going to walk around with a piece of bloody gauze stitched to my nose for a week. So he found a light blue bandage, which I later replaced with one of my good cloth bandages, and I have been carefully tending it since. I also started antibiotics the day of the procedure to avoid infection. Pain has been easily managed with OTC meds.

So, this has been the every-few-years routine. Except, Dr. E told me when he finished, there’s not a lot of bone left where the calcinosis has repeatedly invaded. He was clear that this is the last time he would do such an extraction. If it grows back, which it most likely will, then we’re talking rhinoplasty. “Well,” I quipped, “at least I have a lot of nose to work with.”

And that is where I find myself after Extraction #5. It’s a lot to process. If the calcinosis re-emerges in a year or so, I may not wait until it begins to form a noticeable bump to undertake the inevitable. I’ll be 70 next April, and if I need major nose surgery, it’s better to do it sooner than later. In the meantime, I’m glad this round is done. And the immediate benefit: I can breathe better.

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. Please view Privacy Policy here.

Image: Anne Nygård

First in Line

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I got my new Covid shot a week ago, as soon as it was available. Glad to have that out of the way. It seems that the wily virus is popping up everywhere, once again disrupting lives, albeit with less serious risks for most, thanks to progress with vaccines and a build-up of natural immunity.

Just one way Covid has caused disruptions, of late: I sing in a quintet at my synagogue for the Jewish High Holy Days. Just before Rosh Hashanah the weekend before last, the wife of one of our tenors tested positive, so he could not sing with us out of an abundance of caution and consideration for others. Then this past week another member, who also sings tenor and was covering for the first tenor, was exposed to Covid while traveling, so we were scrambling to figure out who could sing which solos and harmony.

Fortunately, our game of musical chairs resolved over the weekend. The first tenor’s wife is better and he never tested positive, and the other tenor remains negative and symptom free. So both could join us in song for Yom Kippur, although the second tenor wore a mask to be extra safe.

So it goes in this post-pandemic time, when we all wish Covid was behind us, but it still lurks. I got the Pfizer vaccine, since I’ve had rashes and aches from Moderna. While my arm was a little sore for a couple of days and I felt very tired by day’s end, that was it for side effects. A small price to pay for protection.

Next up, getting a flu shot in early October, and then I’ll get the RSV vaccine. I take them one at a time, to avoid a pile-on of side effects. Not so for Al, who got his Covid, flu, and second shingles vax all on one day last week and never felt the worse for wear. I admit, I’m jealous.

However you go about it, Dear Reader, I hope you take heed and get your Covid vax as soon as possible, if your medical condition allows—for your own well-being, and for that of those around you. While the worst Covid outcomes are limited by antiviral medications like Paxlovid, the risks of long Covid remain real and serious, and increase with repeated infections and lack of vaccination. Be well.

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. Please view Privacy Policy here.

Image: Tim Mossholder

Enter Fall

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It is rainy and chilly and dreary as I write on Monday afternoon. Here in Central Massachusetts, we were fortunate to avoid the worst of Hurricane Lee over the weekend, and the rest of the week looks sunny. But I’m feeling the chill in my hands today, knowing that fall officially begins this Saturday.

Already, the days are notably shorter, the transition even more striking since we came back from the Baltics, where the sun sets later because it’s farther north.

And so, it’s time to make my annual adjustment, mentally and physically, to inevitable colder weather. I should be used to it by now, but I always hate to bid summer adieu. Time for lined leggings and sweaters and wrist-warmers, heavier coats and gloves and hats, more effort to get dressed and out the door.

Sigh.

At least there is fall foliage to look forward to. That, and crisp air, and fewer mosquitoes, and the way that autumn light etches shadows. Even as leaves begin to drop and trees harden off for winter, new buds are forming. My hands will adjust as I remind myself: Only three more months until the pendulum swings and the days grow longer, once again.

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. Please view Privacy Policy here.

Baltic Souvenir

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Last Wednesday, at midnight, Al and I returned from a two-and-a-half week trip to the Baltic states of Lithuania, Latvia and Estonia. I’m still processing all that we saw and heard and learned. It was a powerful journey that exceeded all our expectations. I planned a complex itinerary: fly to Helsinki, Finland, stay a couple of nights to recover from jet lag, then fly to Vilnius, explore for five days, go on to Riga for four days, then to Tallinn for another four days, catch the ferry back to Helsinki, and fly home the next day. And that is what we did.

We promised ourselves, in making this trip, to honor the memories of family who had perished in the Holocaust. Al was especially committed to commemorating his maternal grandmother’s brother, Avram Itzek, whom he believes was his namesake, and who chose not to leave his home town about an hour from Vilnius, in what is now Belarus, because it was where he felt he belonged. He was killed in the Holocaust. I hoped to uncover traces of my maternal grandfather’s Berlin cousins, who were deported to Riga in 1941 and perished there, though details of their fates are not known. We also hoped to learn more about the vibrant Jewish communities that once flourished in these countries and about what it meant to break free of the Soviet Union three decades ago—a historic moment made all the more poignant and relevant in light of the war in Ukraine.

Geopolitics made it impossible to visit Avram Itzek’s home town of Ashmyany—the day we landed in Helsinki, our embassy in Minsk told all Americans to leave Belarus because activity there by the Wagner Group, which has supported Russia’s invasion of Ukraine, made it too dangerous. The day we landed in Vilnius, Wagner leader Yevgeny Prigozhin’s plane fell out of the sky, undoubtedly retribution by Putin for his short-lived revolt against the Russian military back in June.

So, even a trip to the border for a glimpse in Ashmyany’s direction was out of the question. But as Al read more of the family history he’d brought along, he realized that before his grandmother’s family moved to Ashmyany, they had lived in the small village of Dieveniškes, located in the far southeast corner of Lithuania. With help from a friend, we traveled there on our last day in the country and found the Jewish cemetery where Al’s ancestors were laid to rest.

In Riga, we took a Jewish heritage tour with a private guide, and at the Museum of the Riga Ghetto and Holocaust in Latvia stood a long Wall of Remembrance with thousands of names. On the wall for Jews deported from Berlin in 1941, I found the name of my maternal grandfather’s first cousin, though not her husband, young son, or mother, who had all come with her. The Museum’s executive director, who sat with me to take all the family information that I had about these lost relatives, gave me a much needed hug and promised to research archives to find out what became of them all.

Not everything on our travels was heavy. A few fun facts: People in this part of the world are TALL. I thought it was my imagination, or a stereotype, but it’s true. In fact, in our Air BnB flat in Riga, I at first wondered why the closet hooks and hanger rod were up so high—then I realized, for tall people it was just right, especially because their longer clothes need more room to hang. Also, although ice hockey is the national sport of Latvia, both Latvians and Lithuanians are crazy about basketball. That, and chess. Everywhere we went, we saw chessboards, in libraries, in courtyards, in parks. And, everywhere we went, the food was outstanding.

The Old Town in Tallinn was the most beautiful of the three we stayed in, one of the best preserved medieval towns in Europe, still with its walls in tact. Much work is ongoing to preserve and restore buildings, many of which, here as in Riga and Vilnius, were destroyed in wars. One of the buildings in Old Town is painted a sugary pink. It is surrounded by metal crowd-control fencing, which is covered with posters protesting the war in Ukraine, as well as occupied lands in Georgia. This is the Russian Embassy in Estonia.

Throughout our travels, we saw Ukrainian flags flying in solidarity, Ukrainian blue and gold everywhere—from the Town Hall in Vilnius on our first night, illuminated as a rippling blue and gold flag on the eve of Ukraine’s Day of Independence anniversary, to an exhibit of new Ukrainian medals for bravery in battle at a museum of knighthood in Tallinn. These Baltic states, all about thirty years old as independent democracies, understand what it means to be conquered by Russia. Stories, of exile to Siberia under Stalin, of authoritarian rule, of always being under surveillance by the KGB, have not faded. And history is tragically repeating in neighboring Ukraine.

Whenever I travel abroad, to countries with much longer histories than these United States, I am reminded that world dominance ebbs and flows like the oceans that separate our continents. Authoritarian forces threaten democracies around the world and here at home. If history is any guide, we cannot take our own democracy’s survival for granted. I came home convinced, more than ever, that we must do all we can, especially this year, to preserve and protect free and independent, inclusive elections, so that the fate of our nation rests in the hands of the many, not of the few who would remake it in their own image.

So, that is what I’ve been thinking about as we traveled through the Baltics, and what I continue to wrestle with now that we’re back home. It was a journey that will stay with us for the rest of our lives. Here are just a few images from our trip . . .

 

Helsinki, Finland

In and Around Vilnius, Lithuania

In and Around Riga, Latvia

Tallinn, Estonia

Ferry to Helsinki

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. Please view Privacy Policy here.