Mother’s Day in Ada Foah

We have yet to make a trip in Ghana that we regret or can’t find positive things to say about. Some of the places we’ve visited we may not choose to visit again, but we’re happy to have been there.

And then there is our experience this last weekend at Dreamland Beach Resort in Ada Foah. Life is uncertain, plans can change quickly, and we still have a lot of Ghana to see, but we definitely hope to return to Ada and the peace and warmth of this guest house.

For those unfamiliar with Ghana, I should say a few words about the use here of the phrase beach resort. Before coming here my main point of reference for a beach resort was the very polished and very decadent resort we visited in Cancún during our Juárez tour. There were two pools, a beautiful beach with abundant, comfortable, and well-maintained lounge chars, beach- and poolside food and drink service, and a family suite as spacious and comfortable as the corporate apartments we’ve lived in during our D.C. training stays – but with an ocean view from the balcony and a fridge stocked with water, soft drinks, beer, and wine.

Beach resort in Ghana means something different. Or I should say it can mean something different. There are resorts here so expensive that I can only hope for their customers’ sake that their amenities rival those of the Mexican resorts.  Then there are some that are more attainable for mere mortals but still quite expensive by the standards we’d come to expect in Mexico – and that tend to have rooms ranging from Super 8 to maybe Holiday Inn standard. And kind of a run-down Super 8.

And then there are “resorts” like Dreamland. Which, I want to emphasize right away I absolutely loved. But just so you have the right picture in your head, a U.S. traveler might consider a place like Dreamland something between a hostel and a guest house. There is no air conditioning. If you don’t turn the water off in the bathroom overnight you’ll hear the shower dripping – almost flowing – constantly. Sometimes a bucket of water helps the toilet flush all the way. It’s a good idea to just acknowledge that the spiders in your room are more interested in eating the mosquitos (which is good!) than biting you. And anyway, maybe the lizards in your room will eat the spiders. There is a fan (which works if you plug it in just right) and the windows are screened. There’s a mosquito net if you want to bother with it, but the cross-ventilation from the windows and the blowing of the fan seem adequate to keep mosquitos away.

So it’s that kind of place. And we loved it. Loved it so much. Will be dreaming of it all week. Because this was the view from outside our upstairs room:

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And this is what it looked like around the table where we ate breakfast:

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And when we said we’d like fish for dinner the night we arrived, the proprietors went and bought a freshly-caught fish and cooked it on the grill for us, served with sides of rice and plantain. Every meal was cooked to order, from scratch (give them about 2 hours lead time for meals if you go there – or order your food before you even get there and they’ll have it ready when you ask).

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The beach itself has some of the same issues we’ve encountered at every beach here – there are spots where trash has washed ashore, and that’s not particularly appealing. And there are waves so strong they knocked Andrés over a time or two, so we stayed within arm’s reach of Marisela at all times. But we were the only ones out playing in the water, and only saw a few other people walking the beach. The waves were beautiful to watch and hear, and the sun filtered through the clouds in postcard-worthy style.

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On Sunday – Mother’s Day! – David, one of the proprietors, took us on a boat tour on the Volta River. Ada Foah is the point at which the Volta spills into the Atlantic, and in addition to fishing, the people of the area also harvest clams both for food and for their shells, which are used in paving and brick-making, and there is a fairly small but significant tourist trade. David and his friend John, who owns the boat, took us to an island in the Volta where a family maintains a fish farm, harvests and sells mangos, and keeps up a small crocodile pond to show tourists and visitors. He tells us that at one point the crocodiles dug a hole and escaped their confinement, but that they later returned. He figured they preferred the regular meals they received in the pond.

Our boat tour gave us the chance to see touristy entertainments like the crocodile pond, but also to see regular life along the Volta – the families digging for clams on the banks, the men rowing out with traps to catch crabs, the elaborate, luxurious shoreline homes owned by the wealthiest of the wealthy (one of them looked like an amusement park – complete with huge walrus and whale statues, an enormous faux riverboat that must be a house right at the shoreline, and a huge arched entryway topped with a sign reading “TREASURE ISLAND” – unfortunately I missed getting a picture of that, as I had assumed it was a hotel, and while it didn’t seem photo-worthy as a hotel it was definitely photo-worthy as a private home).

David was incredibly knowledgeable, telling us about the economy of the region, the difficulties posed by climate change and habitat loss, some of the traditional foods and cultural celebrations of the region. It was a trip that I think will be one of the highlights of our time in Ghana.

 

Something I can’t capture in photos or even describe adequately is the sense of welcome and hospitality we experienced during this trip. David and his colleagues at Dreamland were all gracious and genuinely kind and understanding. They welcomed Marisela in to the kitchen and let her help cook and serve the food. They recognized Isaiah’s clear desire to just read quietly and be left alone and they never once (I don’t believe) mentioned how tall he is (this earns big points with him these days).

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I know it’s unfair to generalize a group or a culture. Not all New Mexicans, for example, are laid back and green chile-obsessed, I know (though I would say I tend to be both). But there is a pervasive spirit of easy friendship and warm openness here that I find very touching. Foreigners, as a whole, over the centuries, have not always done right by Ghana. And yet we have met with such openness, such warmth, and such welcome.

We stopped at a gas station to use the facilities before starting the two-hour trip back to Accra yesterday, and while other family members took their turns in the bathroom Marisela busied herself collecting bottle caps in the dirt surrounding the station (which also had a little outdoor bar/cafe, so there were plenty to find). She took the last turn in the bathroom, and as we were walking back to the car, the mother or an auntie of the family that ran the cafe called to us. Her daughter, who looked perhaps Isaiah’s age, or somewhere between Isaiah and Marisela, had seen Marisela collecting the caps and had assembled a pile of her own to give us before we left. She ran inside to get a plastic bag to hold them all. Her name was Rejoice – a common Ghanaian girl’s name, and one of my favorites – and she seemed pleased just to see Marisela’s delighted smile. Marisela ran to the car and got a rainbow loom charm she had made during the drive and gave it to Rejoice. It was such a nice moment – a tiny moment, but one I’ll certainly remember.

And it’s not just away from the big city that we’ve experienced random kindness. Today as I was walking along the road from our house to the embassy a woman in the passenger seat of a car driving by smiled a huge smile and said, “Hello, madam! I hope you are well today!” No reason. No need. No ulterior motive. Just a kind hello as I walked by. Our road is currently chopped up by some significant potholes (potholes that could have swallowed our Ford Focus whole) and the extreme slow-down that causes meant the car was just creeping by. Slow traffic and potholes are not generally as much a cause of irritation here as they are to people in the U.S. Why waste that energy? Why not use it instead say a warm hello to the obvious foreigner walking by? That is Ghana.

 

 

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Accra again

I should have written this about a month ago, or even just a few weeks after getting back to Ghana, because now my whole nearly-three-month medevac experience feels so distant and being here feels so normal and comfortable that I have to dig to find the thoughts and feelings I had when I first returned.

I think often about the concept of chronotopes that I heard about on a podcast and then wrote about back during our Juárez time. It really does feel sometimes like there are different realities, different worlds that I live in. When I was in Cleveland and Lubbock, despite the fact that rarely a day passed without a conversation or at least multiple texts exchanged with the kids and Andres back in Ghana, it was hard to reconcile the parallel realities of the two worlds. And now that I’m back it’s equally hard to imagine the day-to-day life I had there. My thoughts still go there, every day, as my thoughts came here during the medevac. But daily life there just feels more and more distant.

One big event that occurred during my absence was the long-anticipated and hard-won delivery of the Toyota Highlander we’d purchased from a dealership in Lubbock.

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Andres and the kids had enough time before I arrived home to really get used to driving/riding here, but it was certainly a new experience for me. Driving here isn’t a lot different from driving in Juárez, but it is different – same song at a higher volume, I suppose. And there are more and different obstacles here. My terror is still driving into one of the open gutters that line most of the roads. In the picture above there are blocks covering the gutters (see the sidewalk-looking strip on the right), but on most roads the gutters are open, with no curb to stop a foolish and inexperienced person like me from driving her overly large vehicle into the ditch. I don’t think I’ll ever stop fearing that.

What I have become fairly used to is the traffic, and its quantity and (by U.S. standards) general unruliness. It’s not really an Accra car trip if you don’t at least once fear an imminent collision. People don’t always look before turning or changing lanes or pulling out into traffic – that’s the job of the people already out on the road, I guess. Motorcyclists tend to conduct their vehicles as if no traffic rules apply to them – not red lights, not traffic direction, not lane markings. The “make your own lane” philosophy very popular in Juárez is very much in use here, especially at roundabouts. The major roundabouts often have three or even more “lanes” circling around with no particular order to who goes where. And pedestrians, bicyclists, scooter-drivers and motorcyclists are peppered in liberally (and fairly randomly) to make the game even more fun. Oh! And often police or other emergency vehicles drive on the wrong side of the road when there’s a lot of traffic and they need to get somewhere. It’s never dull driving somewhere in Accra.

My most entertaining (in retrospect) traffic experience so far: one weeknight Andres and I went out to dinner here in our neighborhood, only to find that the restaurant wouldn’t open for another hour. We decided to try a restaurant one neighborhood over instead (about 2 miles away). It was a foolish decision to make right at rush hour, we soon learned. We found ourselves in nearly standstill traffic very quickly. It was a straight shot to get where we were going, but the whole road there was like a parking lot. When we had only moved about a quarter mile in 15 minutes we decided we’d turn off on a side road and go back to find a restaurant in our neighborhood.

Only problem was that after we had pulled in to the lane that turned on to this littler road – and thus would be hard-pressed to get back in to the congested road – we discovered that the road we’d planned to take back had been commandeered by traffic as a two-lane one-way road for people trying to turn on to that busy road. This was not an official change. People just got tired of waiting in single file in one lane.

I am thankful for two things here: 1. Andrés was driving; 2. there was a Ghanaian guy in a tiny little car ahead of us who was also trying to get through going the right way. So I watched out the window, sometimes opening the door, to make sure we didn’t veer in to the ditch while Andres caught this guy’s wave and pushed along. Sometimes our lead car driver would get out and yell and gesture and get people to squash back in to the proper lane. Sometimes he’d essentially forge a third lane (this was tricky because it was not a very wide street, and while it was easy enough for him in his Kia Morning to squeeze through tiny spaces, it was a bit more fraught for us in our giant soccer-mom-mobile).

Then we reached a point at which – according to Google maps on my phone – there was a road we could turn on to and take back roads to get where we were going. It was a dirt road, but that did not deter us. Lots of the roads even just a block or two away from major thoroughfares in busy neighborhoods are dirt roads. So we turned. We should maybe not have left the protection of our Ghanaian trailblazer. After about 200 meters the road was blocked by a massive pile of debris (of which apparently Google maps was not aware). And now the prospect of getting back on the road we’d turned off of – going either direction – seemed doomed to certain failure. We asked a few people on the side of the road if they knew a different way back to the street we needed to reach. We got a lot of confused and puzzled looks and no suggested routes. In the end we turned on another dirt side street that went in the general direction we needed to go, and (woohoo! what luck!) this road opened on to an apartment building’s parking lot and the parking lot opened on to the road we’d been struggling along with the Kia Morning’s help. But by this point we were far enough from the congested road that there wasn’t an improvised double turning lane any longer and we were able to get back to the original restaurant just as they opened. We had spent a full hour going about a half-mile.

So the traffic has been something to readjust to. And so has the heat. Now, two months home, I’m feeling completely fine again. But when I first returned the heat actually bothered me, for the first time since we arrived. When we first arrived it was still fairly cool and rainy – the end of summer, which here is the coolest season (even though we are north of the equator, so the seasons aren’t officially different). So I was kind of like the proverbial frog being boiled in a pot – as the temperatures went up I didn’t really notice or mind. But after the bitter cold of Cleveland winter and the beginnings of spring in Lubbock I was not prepared for the daily highs around 90 with 70-80% humidity. It was a struggle for this desert girl. But I’m back to feeling comfortable here now, and with any luck the rains we’ve started to have will increase and soon I’ll be even more comfortable. I am back to working in my “office” up on our screened-in balcony. It took a while to feel comfortable out here again, temperature-wise. It’s a great view, though, with all the activity going on in the street below.

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The best thing about being back and having the car is that we can finally get out of town on the weekends and explore. The kids and I went to Cape Coast early on in our Ghana stay, and we were fortunate enough to visit a botanical garden just north of the city with a family friend as our guide, but we had yet to make any forays on our own as a family. Not long after my return we finally did. Our plans for Christmas had included a beach trip – but we’d had to cancel our plans when we learned that I’d be medevac’d. Once I was settled back in we decided to give that trip another try. We went to stay at a guest house nearby called Kokrobite Gardens – Kokrobite is a seaside village easy to reach from Accra (only about 25 km away but it takes an hour or so to drive there between the traffic and the not-exactly-U.S.-interstate roads). The beach has something of a reputation as a backpacker destination and Rasta hangout, with all that entails, but Kokrobite Gardens is a little family-run and family-oriented guesthouse about 200 meters from the beach, so we could go enjoy the beach during the day, when it seemed mostly frequented by families, and have a bit of distance from the party atmosphere at night.

In the early mornings we enjoyed walks in the village. One thing that never fails to entertain here is the directness of communication. Short and to the point:

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We’ve made three little weekend forays so far, and the most recent needs its own post (coming soon), but it’s wonderful to be back and even more wonderful to be back and really able to enjoy seeing this beautiful country and meeting its unfailingly warm, cheerful, and welcoming people.

How all that medical nonsense resolved

I am home! Have been for close to six weeks now, I think, and those six weeks have zipped by in a glorious blur. They will be the subject of my next post, which won’t be today (three in a day just ain’t happening) but I hope will be soon.

Here is the last chapter of my unexpectedly lengthy medevac saga:

I had been told I would need to demonstrate “medical stability” before I could return to Accra. Of course that was an improvement over the first murmurings I had heard, which indicated I might either be completely banned from going back or that the stability period they’d require could be as long as six months. A six-month ban on returning would have been, in essence, a complete ban. We would not have wanted to be separated that long and Andres would have requested a curtailment.

But that didn’t happen! We remained diplomatic and positive and I did all the things the MED people asked me to do and I marshaled my recommendations from medical professionals at the Cleveland Clinic saying that I was fine to return, and I started working on getting a machine that would allow me to monitor my blood thinner levels at home (I thought it would be as easy as it is to get, say, a home glucose monitor – which can be bought even at a CVS or Walgreens. It isn’t. It’s a process. But if Andres’ many years working for the federal government has taught me anything, it’s how to ride out processes.) And our diplomacy, positivity, and patience were all rewarded, to as great an extent as we could have hoped for. I got a call one fine evening from the doctor in DC proposing this deal:

If I could go six weeks with no new clots, no bleeding problems, decent blood measurements, and no trouble from the near-fainting spells I’d been having, I could go home. And they were willing to make a deal as far as my locale was concerned: if I was willing to fly to Lubbock, TX (my home of record – and yes, it does make my New Mexican heart weep just a little to admit that) on our own dime and stay with my family instead of in a hotel, they would continue the “meal and incidental expenses” portion of my per diem for the duration of my time in the U.S.

It was a win-win, really, because we had enough travel points to cover my airline ticket and I could get out of lonely Cleveland and spend an unexpected “vacation” with my parents, sister, brother-in-law, niece, and nephew. Technically I suppose I could have said I wanted to stay in Cleveland and they would have had to pay for the hotel and my meals (much more expensive in Cleveland than in Lubbock), but I had no interest in staying there. They could also have called my bluff there and done some bureaucratic hocus-pocus that would take me off medevac status and put me on a “separate maintenance allowance,” which would have meant no per diem at all and a smaller stipend instead. Really it seemed like a great deal for all involved.

And so I said goodbye to icy Cleveland and soon found myself integrated in the everyday life of my Lubbock-based family. I got to see my niece’s drama presentation and tennis tournaments and band concerts. Dinner one evening was at a massive Lion’s Club pancake supper where my Eagle Scout nephew and my brother-in-law were flipping flapjacks by the hundreds. My sister and I got to hang out and go to the gym and shop and eat lunch together. We’d all have dinner together at her house and then watch the Winter Olympics. It was surreal, especially since I’d – not too long ago – said goodbye for what I thought would be a few years, and especially after all that time on my own in Cleveland. I still missed Andres and the kids desperately but we knew the end was in sight, and somehow I think knowing I was at “Nonnie and Poppa’s” house and hearing me talk about their cousins and auntie and uncle made it easier for the kids.

While in Lubbock I got my home blood monitor. I had yet another hematologist confirm that I was fine to go back to Ghana. I had yet another scan of my leg to prove no new clots. And I kept feeling well, and not bleeding excessively, and not having any night-time spells at all. And before I knew it my time in Lubbock was ending. It was a bit of a nail-biter at the very end. I needed a new clearance in order to leave the U.S. and it didn’t seem to be forthcoming. There was some hesitation, I think, due to the fact that my blood hadn’t always been right in the range they were wanting (though it was for the last two weeks before my planned departure). And there were reports that had to be made and processed and approved and all of that seemed to take too long.

In the end I just got on the plane back to Cleveland and banked on the fact that they would probably not want me just hanging out there on the government dime when really there was no reason to keep me there. As it turned out I received and responded to my last communique from MED while I was waiting to board my Accra-bound flight in New York (avowing that I understood I was responsible for taking my blood thinners and monitoring my blood levels and that State Department would not pay for those medications or tests, even if I had to leave Ghana to get them). Really, it’s a pretty fair deal. I’m even still eligible for medevac (good Lord forbid!) if I were to have another clot, as long as I’m abiding by the treatment plan I’ve agreed to. And of course I’d be a fool not to.

So here I am, back home and healthy (though my right leg will never feel the same again, I suppose – it’s perennially achy and somewhat swollen after three clots to date). I feel better than I’ve ever felt here, given that I was still adjusting and getting settled when the first clot hit, and the spells started around the same time. I absolutely love it here and am glad I still have almost a year and a half to enjoy. Most of all, of course, I am overjoyed to be back with Andres and Isaiah and Marisela. It was a serendipitous thing to be able to spend extra time with my parents and my sister and her family. I wasn’t going to be able to be home, so it was a wonderful treat to be able to be there. My sister and I hadn’t been able to spend time together like that since before we had kids. I’m sure that time was healing for me, and I am thankful to have had it.

 

While I still remember Cleveland . . .

Well, somehow despite the challenges of being separated from my family and continuing to slog through medevac drama, the time since I last posted (can it really be almost three months?!!) seems to have just evaporated.

I write this from my upstairs family room in Accra, cool and comfortable thanks to the air conditioner, but finding it hard to believe that places like this exist and that it was my reality not so long ago:

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It’s probably warmed up a bit in Cleveland by now, but when I left not much over a month ago there were still sub-freezing temperatures and piles of snow dotting the sidewalks.

I said nothing medical in this post so there will be nothing medical in this post. I’ll save that for the next one – which I hope will the the all-time wrap-up of all things medevac.

I’ll get straight to Cleveland and its beautiful churches. I reached a point at which there was really not much to do but wait for decisions to be made in Washington. I had a few appointments here and there (whenever MED wanted me to visit a doctor or have a test done I *jumped*). Mostly, though, I had time on my hands. More of it than I’d had probably in decades. Isaiah had been kind enough to send his retired laptop with me, but it was retired for a reason and it didn’t prove to be up to the task of even the simplest work, so I couldn’t do my usual stuff for the publishing company I freelance for. I’d visited the art museum (over and over) and the museum dedicated to the city’s history. The natural history museum looked pretty kid-oriented, and while I probably would have enjoyed it, I thought it would also just make me miss my kids more. Then my good pal Dana (who had left Cleveland right before I was “going home” – so a day or two before my new blood clot) suggested I start visiting all the beautiful churches we had seen lining the streets of Cleveland.

Dana and I had gone to the Episcopal cathedral the Sunday she was visiting. I had visited a few other churches myself. After she left and once I realized I’d be stuck in Cleveland for a while I bought a bus pass and started going to mass pretty much every day. The services themselves were certainly a comfort, and it was good to be around people, even if they were strangers. In fact, the presence of smiling and welcoming strangers felt curative. I became a regular at a healing service at the Episcopal cathedral and I found services here and there along the bus routes I was getting to know, and used getting to them as a way to explore the city a bit more. Here are some of the photos I took during my period of ecclesiastical tourism:

The beauty and peace I found in these places was not something I had expected to encounter, and it was all the more lovely because it was so surprising. I am so thankful for Dana’s suggestion. It gave structure and beauty and meaning to a time that was very trying and potentially very lonely.

I continued to bus- and light-rail myself around to other Cleveland destinations, as well. I can’t recall now if I’ve already mentioned that I visited Cleveland’s famous West Side Market, an enormous indoor/outdoor food and produce market. Lovely place, but melancholy trip for me personally under the circumstances. Though I had bought myself a few cheap ceramic bowls and some actual metal utensils at a dollar store, I wasn’t in any way equipped to do much of anything with the amazing array of produce and other ingredients on offer at the market. There were ready-made foods, but I was not lacking for delicious food to eat, so the appeal there was limited. Seeing all those fabulous ingredients just made me wish I had a kitchen to cook in and a family to feed.

Delicious food, as I mentioned, was not lacking in Cleveland. With time I found some favorite culinary haunts – the young woman at the counter of a tasty Indian takeout joint next to the Episcopal cathedral certainly knew me by sight by the time I left. And there was a fantastic ramen place a little further downtown. I ate my fair share of sushi. A long-overdue reunion with a dear high school friend who was in Cleveland for work introduced me to The Greenhouse Tavern, a downtown gem serving maybe the tastiest brussels sprouts ever made (among other deliciousness, but those brussels sprouts are what I remember best).

So despite the less-than-ideal circumstances, I managed to enjoy my time in Cleveland. When I was able to leave (more on that in the next post) I was more than ready to be out of there, but that had to do pretty much entirely with the situation and the isolation, not the city itself. I saw the Cleveland Orchestra perform at Severance Hall, one of the most beautiful concert halls I’ve ever seen (and I did live in Prague at one point, so that’s saying something).

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I went back every “bargain Monday” to Cedar Lee cinema, seeing back-to-back movies on a few occasions (those snowy bus stop pics at the top of this post are from one of my movie-going journeys). I think I saw the vast majority of Oscar-nominated movies this year, something I don’t think I’ve had the luxury of doing for eons.

I watched a lot of Netflix. Also something I don’t generally get to do. I wish I had read more, but I found myself too preoccupied for reading, for the most part. I have to feel settled to really read, I find, and I never did feel quite settled there, not without my people around me and with so much uncertainty in the air.

Yes, Cleveland was good to me. Now and then I think about riding the “Health Line” bus up and down Euclid Avenue or breathing in the cold but delicious wood-and-stone aroma of the old churches and I smile. And then I think about how lovely it is to be home and my smile grows.

 

Neither here nor there

I realize that I have yet to actually put anything on my blog about the latest installment of my medical soap opera. So although I actually logged on to write with the specific intention of not writing about my health, when I saw that I’d not yet addressed this, I decided I’d better do it.

I’ve been banned from Accra. The medical powers that be don’t want me returning for an as-yet-to-be-determined period, during which I have to demonstrate to them that I am “medically stable.” Meaning: no more new clots. Also meaning: “presyncope” episodes eliminated? Or possibly just reduced and explained? I’m not sure if they’ll have any tolerance for any of those near-fainting episodes. It’s one more thing I need to get clarified. Because they have all but disappeared since I started taking a beta blocker, but not entirely. They are far less frequent and far less dramatic, though. And the cardiologist and neurologist have both deemed me acceptably healthy (in their views) to return to Accra. As has the hematologist, for that matter, but “Big MED” does what it does.

The clearance decision has yet to be officially made. We were just warned of what’s pending. So there is nothing to appeal or directly fight against so far, but I have sent my Washington contact (with whom I have now developed a much better rapport – it was hard to lose the last guy, but the new doctor is actually quite good, too) an email enumerating the reasons Andres and I feel that a four- to six-week period should be adequate to demonstrate stability. We’re guessing they won’t go for a period that short, but we’d rather start low and meet in the middle somewhere.

Nobody is happy with this. We don’t want to be separated. But we knew, when we chose the foreign service, that this kind of thing is always a possibility. Medevacs are very common. Loss of medical clearance for a post does happen. And of course we knew from Andres having spent the bulk of his working life with the federal government that complicated situations are not always handled with speed and efficiency. It’s all something that we accepted as a risk from the beginning – like the possibility of a post being evacuated or Andres being assigned an unaccompanied tour. That doesn’t stop it from being a miserable situation to find ourselves in, though.

The kids are handling things really well. They’re sad. They’re disappointed. We all are. But they’re hanging out with friends and going to school and doing all the stuff they normally do. Andres is somehow juggling work and kid care and home management (at least he has help with that a few days a week thanks to Rose). And here I sit at the hotel in Cleveland, doing what I can to support them from afar as they do the same for me.

This coming week I should be going through whatever nightmare process State Department has dreamed up for transitioning from “medevac” status to “medical curtailment.” I’m guessing Andres will have to fill out some forms between visa adjudications. He’ll probably also have to start a travel authorization for me in order to get me out of Cleveland to Lubbock. In many, many regards I cannot complain about being an “EFM” (eligible family member), but it does chap my hide that there is very little I am allowed to do in the realm of Official Stuff, even when it pertains entirely to me.

I continue to be overwhelmed with gratitude for everyone’s outpouring of support and love. I will keep folks posted on the latest news, but next time – next time! – I am not going to write about anything health related. The next post will be entirely about bus stops and buses and the ridiculous number of beautiful churches in Cleveland. And addictive Indian takeout food. Stay tuned.

The pleasures of industry

Well, here I still sit in Cleveland. It’s still cold (having warmed up at this point to 11 degrees F from a starting point of 6). And my blood is still not adequately thinned. In fact, it’s taking its sweet time thinning out at all, unfortunately. My INR (a measurement of how quickly blood clots) is being checked every other day. “Normal” INR is 0.9 – 1.3. “Therapeutic” INR for people with an active clot situation who are taking blood thinners is usually considered to be between 2.0 and 3.0. The doctors here want me to be at or above 2.0 for five days before I can discontinue the injectable “bridge” anticoagulant I’m taking in addition to the warfarin. On Monday my INR was 1.0. Today it was 1.1. This isn’t what I was hoping for.

I’m also dealing with a new person in DC. The doctor I had really become fond of, and who had really been in my corner, trying to help me get home as quickly (but safely) as I could is no longer in DC. He had only been filling in there, passing time while he himself was on medevac from his post in Beijing. And though he had once been in charge of the entire State Department medevac program, he took the Beijing assignment as a last hurrah: he has hit State’s mandatory retirement age for FS folks of 65, and he’s only in Beijing to retrieve his belongings and tie up loose ends before leaving for good. So now I have a new point of contact. And so far (I continue to hope it will change) she is neither the strong advocate nor the proactive and informed professional Dr. Miron had been.  So far, she is much more the medical bureaucrat I had expected to be dealing with in the first place. Dr. Miron spoiled me.

I do have positive things to report today, but they might have to wait while I complain just a little bit more. And I realize how ridiculous this complaint is going to sound, and perhaps how ungrateful, but I’m being honest here about how I feel: I’ve had enough of no agenda (other than waiting for blood tests and dosage adjustments). I’m thoroughly tired of my life of relative leisure. Never in my adult life – never! – have I had this kind of unstructured time. And I feel like a spoiled brat complaining about it. I wish I could share this time with Andres, who never gets this, especially not right now as he is not only shouldering the burden of his never-relenting job but also care of the kids and their practical and emotional needs. I wish I could share it with my many friends who juggle kids and work and housework and volunteer work and immense obligations with such grace and good cheer.

But what I am longing for right now is the sense of purpose and satisfaction that my usual responsibilities bring. My regular life can sometimes be exhausting, without a doubt. Before I was medevac’d I was definitely on the verge of feeling utterly overwhelmed. I love our foreign service life, and I am very glad we chose it, but it’s hard sometimes. It’s a real grind starting from scratch with everything from spices in the cupboard to daily routines to friendships. It’s a grind in the best of circumstances, but just as I was settling in and feeling at home in Accra the blood clot happened. And then the disorienting and frightening near-fainting spells during the night, which not only added stress and worry but left me sleep-deprived and foggy. Through it all, Andres and the kids and my friends and family were all so clearly and vocally on my side that I kept going, but it was a real struggle.

So at first the rest was so healing and restorative. Once the arrhythmia was diagnosed and the nighttime spells stopped, I started to feel so much better. Night by restful night I felt like my body and mind were rebuilding themselves, and I would be ready to return home stronger than ever. I’d had opportunities to be with loved ones I hadn’t thought I’d see for two years. I’d had unprecedentedly leisurely time with my friend Dana – in all our years of raising our kids side by side we never had the kind of opportunities we had in Cleveland to just be together without any particular agenda. It was delightful and I realize how very fortunate I am to have had the time I had with her and with my parents and with my mother-in-law. It all left me ready to return home with a renewed spirit and the confidence of good health. I felt so very ready for a fresh start.

Now the confidence I’d had in my good health has taken a beating. I don’t feel defeated, by any stretch, but definitely taken down a notch. There are vastly worse medical fates than a lifetime on blood thinners, but the idea still takes some adjustment. When I was at UWC (the boarding high school I attended) I went through a bad jag of one nasty virus after another and just couldn’t seem to get healthy. My advisor (the inestimable Hannah Tyson), in no uncertain terms, gave me the kick in the butt I needed, encouraging me to take my health seriously, get active, and feel more in control and less a victim of circumstances.

I took up tennis and stair-running and started making far better use of the school’s sublime mountain setting for hikes and jogs. I started eating a bit more carefully (though I was still a teenager and had my share of pizza parties with my music buddies). And bit by bit my self-image changed. I had been an athlete as a tween/early teen and had left most of that behind in favor of violin and writing in later years. I reclaimed it, and it’s been a huge part of my self-identity since. In Dallas I rediscovered bicycle riding for fun and transportation and would walk and ride all over Oak Cliff. Juarez city design left me not as able to bike but I still walked daily, whether to the supermarket or friends’ homes or the Consulate, or just around my neighborhood.

We haven’t had a car in Ghana so far, so I was gleefully walking and biking, enjoying that so much was accessible on two wheels or two feet. Again, I feel like I’m whining, given that I should be grateful I’m alive and getting excellent treatment, but the knowledge that I will have to seriously reassess my daily life in Ghana in light of permanent blood thinner use is a blow. The bicycle is probably out. There are far more hazards on the roads in Ghana than in Oak Cliff. There are open concrete gutters with no barrier on the roadsides. Roads are often narrow and traffic unpredictable. Motorcycles zoom between cars and pedestrians and cyclists. A young girl in the Embassy community was hit by a motorcyclist as she walked on an Accra street (there are not always sidewalks). She was ultimately OK, but she was hurt. These are risks I was able to live with when bleeding wasn’t a risk. But they’re not anymore. So I guess part of my task when I return home is to find a warfarin-friendly way to still feel active and athletic and strong. I’m not typically one for the gym, but maybe it’s time to explore new options.

But I’ve become distracted from my original theme. I guess not really, though – because this is part of my dilemma now. I’m feeling so well. I have no pain in my leg, just a sort of sense of heaviness sometimes. Only the mildest swelling. I’ve caught back up on my rest post-hospital. But I don’t have my husband and kids’ company or the joy of doing things to support them. I love being a homemaker. I love cooking and baking and being responsible for our home. It brings me immense satisfaction. I love my proofing and editing work, as well, and I find it fulfilling, but it’s not in the same category. Even when it’s hard I absolutely love my “real” job as a part of my family, and I miss that so, so much. So in so many ways right now I feel separated from who I am, who I have chosen to be.

Well, this is a downer. Sorry for that. And again, I want to say that I am well aware of the potential anger my complaints could provoke. I realize that most wouldn’t volunteer for a potentially life-threatening health situation, but who wouldn’t like some time to spend with family and friends and no agenda and no obligations beyond making it to appointments and receiving/acting on periodic instructions from doctors? I am unspeakably fortunate to be here, receiving the care I’m receiving. I realize that as a family we make sacrifices most employers don’t expect of their employees and their families, but most employers also don’t send family members to world-class medical facilities when there’s a serious health issue, either. Had all of this happened while Andres was still with EPA-OIG I would not be receiving this level of care. There is so very much to be thankful for, and that’s where I am trying to stay focused. But I miss being useful. I miss being the crazy lady on the bike or the crazy lady walking to Accra Mall from Cantonments (it’s actually only maybe 3.5 miles but people seem to think it’s not doable – it is, and there’s even sidewalk the whole way). I miss my husband and my kids and being there for them.  Come on, INR. Come on!

 

People can just stop making me cry any day now (actually, keep it going, please)

I’ve been out of the hospital for about 24 hours now. Last night felt like one of the quietest and most restful of my life. I feel very well. There’s very little swelling and virtually no pain in my clot leg, and I don’t have any restrictions on my activity (which those of you who know me well know I truly appreciate). What happens now is I take my medications and wait for my blood reach a point at which I have a stable therapeutic INR level – which is jargon for when my blood is adequately thinned to relieve fears of further clotting. I’m guessing/hoping it will take about a week, but I also don’t know for sure if hitting that point will mean I can go home or if the State Department doctors will want me to stay steady at that point for a bit before getting on the plane. I might learn more about their thoughts on the matter Tuesday.

In the meantime, today I’m going to write about my tendency to weepiness. My friend Dana and my kids kind of enjoy teasing me about how sentimental I can be. I enjoy a good cry – catharsis, you know – and although I have some pretty diverse taste in books, one of the unifying factors of my very favorite books is that they all leave me a puddly mess. But it’s not just books that do this to me. Movies make me cry. Sometimes hearing a favorite song or hymn makes me cry. Sometimes sermons in church make me cry (like today – it was not a sad sermon, but it was a moving sermon and that’s all it takes). I’m a mess with the crying.

Another thing that makes me cry is gratitude and thinking about how kind and generous people have been to me. So I’m here to tell you there have been plenty of tears shed recently. Yes, some of those tears have been of sadness or disappointment or frustration. I certainly shed some of those as I talked to Andres and told him that I would not, as I had hoped, be heading home last Thursday or even this Monday. But by far what has brought tears to my eyes most often during this complicated time is gratitude – gratitude for the love and support of people here with me and far away, people I love and cherish and people I’ve only just met.

Time and again on this trip I have had occasion to marvel at the kindness and helpfulness of people I don’t know at all. Lynn, the patient ambassador who has helped me so much at Cleveland Clinic. Dr. Miron, the doctor in Washington who has been my State Department point of contact. The various doctors and other medical professionals here at Cleveland Clinic. People I’ve met at the churches I’ve visited. Just today, after attending church and adult forum at St. Paul’s Episcopal in Cleveland Heights, I found myself without a phone (no Uber) and without the proper change for a bus, which was how I had made it to church in the first place. I could overpay on the bus and get a day pass, when all I needed was a trip home, but instead I decided to do something that’s quite uncomfortable for me: ask for help.

One of the people who had spoken at the adult forum had identified herself as the pastoral care coordinator for the church, so she seemed like a good person to ask. I asked if she could help me either get change for the bus or find a ride back to the hotel. She told me that she and her husband could take me back, and that they were quite familiar with the Cleveland Clinic campus because he happens to be the pastoral care director at the clinic itself. What are the chances? We chatted during the brief ride and both made it clear that I was welcome to contact them any time during my stay.

Then there are people like Cray, manager of the organization that runs the commissary and school bus services at the embassy, whom I have met only a few times in passing, but who emphasized that if there is anything our family needs, to let him know. Or Gideon, one of the guards at our compound, who asked Andres where I was and sent his get-well wishes. Or Rose, my wonderful house helper, who texts me periodically with her prayers for my recovery.

Of course all of this is on top of the outpouring of support I’ve received from friends and family, which is also overwhelming. Please know that whether it’s a visit or a call or an email or a Facebook “like” or comment, or just you sending your good thoughts, I appreciate it all. It sustains me. And, of course, it makes me cry. 😉

Well, that was unexpected (redux)

Ah, the hubris of my previous post!

I’m still in Cleveland. In fact, I am not only still in Cleveland, but I have moved from my hotel to the luxurious accommodations of the Cleveland Clinic hospital.

Here’s the thrilling tale:

Thursday was a limbo day. I was maybe going home and maybe not. It was a game of chicken between my sleep study results and the deadline for moving my airline reservation to a later date. Or at least that’s what it was supposed to be. I had a seat on the plane home and was scheduled to leave Cleveland around 2:30, then catch a nonstop flight from JFK to Accra around 5:30 that afternoon. I’d be in my house by mid-morning Friday and – if I could stay awake – back at the Chicago Compound happy hour Friday afternoon. But the doctor in DC needed to see the results of my sleep study (and they needed to be normal) before he could clear me for departure. Added to the excitement was the fact that my ticket was booked by the State Department’s contract travel agent in South Africa, and the time difference meant I really needed to contact them by 11:00 am if I needed the reservation changed.

For me, that’s enough drama. But the universe likes drama, apparently, or at least it seems that my corner of the universe has a high-drama preference. Because Wednesday evening, after my usual little workout and a walk, I felt a bit of discomfort in my right leg, right up at the top of the inner thigh. I chalked it up to the humiliations of middle age – that even though a 3-mile walk is well within my usual range, I had strained a muscle or somehow tweaked something.

I woke up obscenely early Thursday morning and noticed the same feeling, only now a bit more pronounced and accompanied by a touch of swelling. Also the veins in that area were prominent – not hard, not red, not sensitive, but just more prominent than usual. I was still mostly certain this was due to some kind of musculoskeletal insult, with the veins prominent due to the swelling beneath. But given that this was my problem child leg, the double-clot leg, I thought it would be sensible to ask some expert advice. I emailed both the hematologist I’ve seen here (Dr. Silver) and the doctor in DC who’s been managing my medevac (Dr. Miron). Both called me and told me I had to get my leg checked.

As fate would have it (I’m telling you, it was my day for drama and it was only going to get better) Dr. Silver was not going to be at the clinic Thursday, so he wasn’t able to put in orders for a scan or check in with vascular medicine to see if they could get me in. He told me, and Dr. Miron concurred, that the ER was my best option. Of course I understood the importance of checking this out, given my history and the fact that I was, if not that day, then on Monday, scheduled to take a transatlantic flight. But I was so convinced it was going to be nothing that I didn’t even consider that I might want to pack up my belongings before leaving, just in case. I couldn’t imagine an outcome that would necessitate it. I could, thankfully, imagine an outcome in which I waited a really, really long time for a leg scan and a really, really long time for results, so I packed phone, laptop, Kindle, and chargers. Yay for me on that count, at least.

As I’m sure you have already guessed, the leg scan ended up showing that I have an extensive clot, a DVT in the femoral vein, extending from groin to knee. This is a new variation. I guess my calf was getting boring for the clot monsters and they wanted to check out new terrain.

I was admitted to the hospital, but there was quite a wait for a bed. During my wait, more drama. I had to get checked out of the hotel. Medevac rules (sensibly enough) do not allow hotel/per diem on days when the medevac’d person is in the hospital. But all my awesome support team had already gone home (as I was looking so obviously in the clear) and allowing me to leave to pack my things and check out would mean I lost my place in line for a bed, which the ER doc was not willing to let me do (though I have to give him credit for trying to think up some very creative ways for me to not be discharged but still get my stuff – he really was trying).

First I called Lynn, my “patient ambassador,” who has set everything up for me since before I even left Accra. She ensured me that she could contact the hotel and make sure I could be checked out, even though it was a few hours after checkout time. She wasn’t quite as sure about getting my things, but said she’d see what she could figure out. Then I got a call from a hospital social worker. Once she realized I was needing to collect my things from a hotel on the Cleveland Clinic campus and not from Ghana (which was somehow her initial take on the situation) she seemed to think it was a manageable task. She suggested that Cleveland Clinic police officers could go get my things for me. Hence my visit from a few pretty confused Cleveland Clinic cops about 15 minutes later. Nope, they could not go get my stuff for me. Though they were very sorry.

Oh! And I neglected to mention that in the middle of all this my phone had started periodically and seemingly randomly restarting. So I was placing calls as I was able between restarts and supplementing my calls with emails (thanks for the laptop loan, Isaiah!)

This is about the time the ER doc came in to brainstorm about what actually could be legally defined as staying “in the hospital” and how maybe I could go get my stuff without being discharged since the hotel is on campus. Unfortunately I was not staying in the hotel that’s actually built in to the clinic buildings, but there is a shuttle, which is maybe also the Cleveland Clinic? Like I said, he was really trying.

Then Lynn, patient ambassador extraordinaire, saved the day. It was the end of her work day, but she came by to see me in the ER and offered to go get my things herself. She took my key, I gave her the code to the safe and she took off like the superhero she is. Just minutes later I had a message from her that she had my safe contents in her personal possession and the rest of my things were being stored for me at the hotel.

It was almost 9:00 pm before I got in to my room. So I can see why they didn’t want me to get knocked out of line for a bed. I was pretty tired and ready for sleep, but it was not to be a very peaceful night. My roommate, whom I’ve still only met very glancingly, really enjoys the TV. It’s on 24 hours a day. Her tastes are diverse: old movies, talk shows, infomercials, My Little Pony (!), Murder, She Wrote!, a dog show, a sprinkling of CNN and local news. So that was one headwind I was battling.

Then, of course, there’s the medical stuff. I realize the hospital isn’t a spa. I’m here to be kept alive, not to be pampered. But it still stinks to be awakened for vitals every few hours, and additionally to have a nurse twice (or three times?) during the night turn on the light to draw blood, and another one come in with a Lovenox injection. Obviously – need that Lovenox (blood thinner! The whole reason I’m here!) – but still just not a pleasant night. Also, I had a cardiac monitor, an IV for hydration, a sequential compression device on one leg, and a bed mattress that also inflates sequentially to prevent pressure injuries. It’s kind of wonderful and miraculous that I slept at all.

Yesterday the main event was a CT scan to determine whether the clotting extended up past the leg at all. Because of that order I was put on “NPO” status (nil per os – nothing by mouth) after midnight until after the scan. I’m not exactly running marathons here, so the lack of food didn’t bother me at first, but as the day stretched on (infomercials!) and on (Steve Harvey!) and on (lots of alarming weather-related news!) I was getting a little cranky. And unable to concentrate. My phone had gone ahead and died completely, so I didn’t have any brain-numbing apps to play with. I wasn’t reading anything challenging to start with, but I couldn’t focus even on the fluff I had going after a certain point. And I’m pretty sure I sent some fairly incoherent emails. I was finally taken for the scan around 3:00 in the afternoon. I had never been so happy to undergo an unpleasant medical procedure. Maybe that’s the whole strategy.

And it was unpleasant, although mercifully brief. The contrast dye they injected stung like nobody’s business going in and then made me feel like I was wetting myself. And weirdly warm all over. Good times.

But then back to my room and I was allowed applesauce and graham crackers. Pure joy! And later on, my dinner – again, I think this a strategic move. If a patient is hungry enough even an unseasoned chicken breast, white rice, corn, and brown gravy (“brown” accurately describes both the color and the taste) is a marvelous feast. As I ate I thought about the decadent eating Dana and I had done just days before: oysters on the half shell and linguine with clams and a lovely charcuterie plate and dim sum . . . in retrospect I feel like I didn’t appreciate it enough.

The results of the scan were encouraging: the clotting does not spread beyond the leg. That’s fantastic news, because it means no “procedure” to remove clots. Today they’ll start me on warfarin (my old friend!) and, with any luck, send me back to the hotel and monitor my blood outpatient until it’s at the right level and I can stop Lovenox. I have had confirmation from not one, but two medical professionals that this is the goal: discharge me today. Alleluia. But of course we’ll see if the wheels can turn in time to get me out of here before bedtime. It is a weekend, and things are a bit sluggish here today.

I don’t know for sure yet what this means for my trip home. For absolutely sure I’m here until my warfarin levels are in the right range. With my calf clot it took a bit less than a week, I think, to get my blood to the magic number and feel like it was going to stay there. The other part of the equation is when the DC medical folks will deem me ready to return. Dr. Miron did emphasize that there’s no reason I can’t return (in other words, I won’t lose my clearance), but he didn’t want to say when. Of course that was before the CT results, which were good. Oh! and speaking of results, my sleep study results came in late Thursday afternoon. So I couldn’t have flown home Thursday anyway. The results were normal in terms of neurology but did confirm that I was having cardiac issues at night – which had already been diagnosed and treated by the time these results came in.

So now I’m waiting. Murder, She Wrote! is on. My Bluetooth earbuds ran out of charge long ago (I was streaming podcasts on Isaiah’s computer to combat TV noise) but they make handy earplugs even in their inert state. Dietary department just delivered lunch (I ordered baked cod – maybe a mistake, but we’ll see). I hope next time I post I will have definitive, final news of a departure for Accra that will actually hold. I’m guessing the S. African travel agents will be almost as grateful for that event as I’ll be.

Quickest medevac in the (mid)west

I hope I don’t later have to retract this, but it’s looking like I’m going to be Accra-bound early next week. Given that I came here with little clue what might be happening and little consistency to my symptoms, I think it’s been a pretty quick turnaround. The doctor at the medical unit in Washington has suggested I go ahead and start making plans to return to Accra on Tuesday of next week.

The likely culprit for my night-waking near-fainting spells: premature atrial contraction, or PAC, a potentially noisome but not dangerous type of arrhythmia. My two days hooked up to a Holter monitor (during which I would press a button and write on a log when I felt either an incidence of arrhythmia or a near-fainting spell) showed that I am having PACs quite frequently, including during the times I signaled that I was experiencing the near-fainting sensations. PAC can sometimes go unnoticed altogether, sometimes can feel like a thump or lurch or “skipped” beat, or sometimes can cause dizziness or a fainting sensation like what I’ve been experiencing. It doesn’t need to be treated, but a beta blocker can generally control it and could probably help me sleep again without these interruptions.

I also checked in with a neurologist today, before seeing the cardiologist and receiving this news, and he said that from what he could tell from examining me and taking my history, neurology is unlikely to have the answer. He didn’t think atypical migraine was likely, given that I do have a history of migraine and that the migraines I’ve had are nothing like this. He did order a sleep study* and an MRI to rule out anything he might be missing, but really doesn’t think it likely we’ll see anything out of the ordinary.

What he did suggest, and this turned out to be quite prescient, was that there may be some benign cardiac cause that would show up on the Holter monitor, and that the reason it’s been waking me up now (and wasn’t before) is that my sleep has been disrupted by the move, by stress over the blood clot, or some other change to my sleep/wake patterns. He suggested that melatonin might help get my sleep back in order and then, as long as it seemed that the underlying cause of the spells is harmless, I could sleep through them again.

So when, about an hour later, the cardiologist told me about the PACs, I felt like things were clicking into place. It was exactly the type of scenario the neurologist had described. In addition to going over the Holter monitor results with me, the cardiologist gave me the excellent news that my echocardiogram looked perfectly fine. The low ejection fraction noted on the echo I had when I was pregnant with Marisela – not low this time. All is well!

The doctor in DC wants me to stick around Monday so we can be sure the MRI and sleep study results are available for review before I get the final go-ahead to leave, but he told me I could go ahead and book my return for Tuesday. If need be, that can be changed, but chances are good there won’t be a need. Two weeks gone feels like forever, but when I consider the amount of investigation that’s gone in to my stay here, it feels lightning fast. The DC doctor commented that he can’t imagine all of this happening anywhere near this fast had I been sent to DC or to any other medevac location he can think of.

But you’ll remember there was an * up there. The * is the part of my day that probably guarantees I’ll have some spells for the sleep study to investigate tonight. When I made the MRI appointment the scheduler told me they don’t usually schedule MRI’s with less than five days lead time, because it can take that long to get insurance approval. He told me that, given my situation, he’d schedule me for tomorrow but that it could help if I would call Blue Cross Blue Shield, too, to create a bit greater sense of urgency.

So this afternoon, after updating DC with the latest medical news (and, to pat myself on the back, being commended by the doctor for communicating it so clearly), I did a load of laundry. I called home and talked to my husband on our FIFTEENTH ANNIVERSARY (this is not how I had planned to spend it, by the way). Then I got around to calling Blue Cross Blue Shield. And what an adventure ensued.

The MRI, apparently, had already been approved. The sleep study scheduler had never mentioned getting pre-approved, but while I was on the line I asked, so innocently, “So am I all set for the sleep study this evening, too?”

The answer: No. No, I was not. Turns out BCBS likes to have a fifteen-day window to approve sleep studies. And a few hours is well short of fifteen days, as it happens. I calmly explained my situation. Still the fifteen days. I not so calmly reiterated my situation. No budging on the fifteen days. I cried. It was shameless. And yet it did no good. Fifteen days.

So I called and emailed my very helpful, very friendly doctor in DC and left messages about the situation. And waited a bit. But only a bit, because time was ticking. I didn’t hear anything back, so I didn’t feel I had much choice: I called the patient representative I’ve been working with at Cleveland Clinic and explained the situation. She agreed that there wasn’t much to do but cancel the appointment, and said she would do that for me.

So my elation – absolute skipping-around-my-hotel-room giddiness – at the notion of not only going home, but going home under probably the best possible circumstances: an explanation found, and it’s benign and easily treated, with all potentially dangerous causes checked and ruled out, that elation just evaporated. Because one of two things would happen: I’d go home without the sleep study, which actually I could easily have done, because I’m pretty convinced it’s not going to turn up anything worrisome. But I’m not sure it would have been approved. And although I was sure I could get something scheduled in less than two weeks, my perfect schedule of everything wrapped up with a bow on it in time for me to go home early next week would certainly have been shot. And I would have been here longer, maybe considerably longer, waiting for a test that’s about ruling stuff out – stuff that nobody really expects is actually a problem.

Around this time I heard from the DC doctor, who did NOT want me to cancel this appointment. He, of course, is getting squeezed in the middle of this situation: it’s up to him to approve me to go back, and I’m quite sure he neither wants to approve my return without all the ordered tests nor have me lounge around on per diem for 15 days waiting for a test that’s unlikely to reveal anything. And also he just seems like a nice guy who doesn’t want me to have to endure that. He urged me to contact BCBS again and see if there was any loophole to be found. I called the Cleveland Clinic back first and, miracle of miracles, they were able to reinstate my appointment. I told them I may still have to cancel again, but they were incredibly helpful and understanding.

So then I called my friend at Blue Cross Blue Shield once more (Dolores . . . if ever “pains” was an appropriate name . . . ). If ever she leaves BCBS she could be typecast in a movie as a strict schoolteacher who smiles and speaks sweetly to the kids but totally revels in abusing her power. I was calm and composed this time, and asked if the approval could be sped up if I could email or fax the neurologist’s report from this morning (this was a suggestion of the DC doctor, who supplied me with the report). She very sweetly said that while she really, truly did sympathize with me and could understand what a horrible predicament I was in, there was no way around their rules. A doctor would have to call their nurse reviewers and make a case that there is a life-threatening need for this to happen now. I took the number, thanked her kindly, and got back in touch with the doctor in DC.

I don’t know what the good doctor said to the certifying nurse. I don’t know if I was on my deathbed in his telling or if she was just a little more sensible and flexible than her gatekeeping colleague, Dolores. Whatever the case, I report in about an hour and a half for my sleep study. And I am so, so thankful. I’m thankful to the doctor in DC, to the doctors and all the amazing support staff at Cleveland Clinic, and to everyone who has been with me through every step of this experience.

I hope to see all my Accra neighbors next week. Thank you to everyone for being with me on this crazy ride.

Home of the Browns

I guess, as a Cowboys fan, Cleveland isn’t a bad place to be. It reminds me that some folks had even worse seasons than we did. But much to my pleasant surprise I’m learning that Cleveland has far more to offer than just assuaging my football angst. Within striking distance of the hotel and clinic – dual centers of my medevac universe – are world-class cultural institutions including an expansive art museum and a stunning symphony hall, a major university, and a neighborhood that resonates strongly with my Oak Cliff-loving heart (Cleveland Heights). And that neighborhood even has a really cool movie theater that seems to show a wide variety of both indie and big studio films (my parents and I saw “The Darkest Hour” there yesterday).  So add to the list of medevac positives (it can use all the additions it can get) that Cleveland is a cool place to be.

It’s also literally cool, although that’s a bit euphemistic. It’s &%#*# freezing here. Yesterday I think the difference in temperature between Cleveland and Accra was 70+ degrees F. Lows have been in the single digits here and highs in the teens (if it gets that toasty – I think 12 was the high at least one day I’ve been here). Meanwhile Andres and the kids ate breakfast at a beachside hotel and went for a swim at the compound pool yesterday.  As long as I layer on every article of clothing I brought and wrap my head in a scarf I’m fine. Good thing I knew where my wool coat was stowed.

So I guess I may as well keep rolling with the positives. Another positive: I know a whole lot of supportive, loyal, loving people who are doing everything they can to make this unexpected disruption of our lives as manageable as it can be. I know I’m failing on a daily basis to thank everyone who has, on that given day, done things to make my life and my family’s life easier. Or everyone who has prayed for me. Or written to me. Or sent warm thoughts my way. I am humbled and moved beyond words by the generosity of our family, friends, and neighbors. Neighbors I’ve only spoken to for a total of maybe two hours, maximum, at compound happy hours gave Marisela a ride to a play date for us. Our social sponsors continue to set the bar high for social sponsors the world over by whisking the kids off to movies and keeping Marisela entertained with crafts and baking projects. Our next-door neighbors practically have Marisela living with them (not to mention they took her surfing on her lowest day, right after she’d found out I was going on this medevac, which lifted her spirits enormously). Our entire compound has made it clear the kids have open invitations to hang out. And as Isaiah’s friends trickle home from holiday trips his invitations are piling up.

Andres is my rock, as always, managing his beyond-stressful job and the kids and the home and still providing me with tremendous encouragement and support. My parents are here with me, sharing meals and movie outings and just being present through all of this. My sister is here in spirit and sent me thoughtful gifts of faith and encouragement that remind me of her and of all the love her family sends. My mother-in-law will soon be visiting, and my dear, dear friend-sister Dana. My cousins and aunts (that includes you, Marlene!) and uncles and church families in Dallas and El Paso and my FS family from Juarez . . . all have flooded me with their warmest wishes and kindest concern. So all of these in the positive column. And as I write all of this the negative column, which had been building in my head this morning as I sat down to log my thoughts, is seeming smaller and smaller. It’s practically fading away.

But now, noting its insignificance in the face of the sheer power of all the love, I still should record here the contents of the negative column. Everyone who has done so much, I’m sure, would like to know all that’s going on. And the main negative is just that I still don’t have any answers about the nighttime near-fainting spells, and I’m not sure how long it’s going to take to get answers. The cardiologist I saw did not think it likely that my heart is to blame. That’s a huge one in the positive column, given that the potential cardiac causes were not particularly desirable (heart block, pacing problems that may require a pacemaker). We’re still investigating any possible connection, using a heart monitor, echocardiogram, etc., but he said he feels these are mostly means of ruling out a cardiac cause – he just didn’t think it likely. He actually thought my initial notion that it was a side effect of the warfarin (blood thinner) might have merit.

Speaking of the blood thinner, that’s another positive. The hematologist I saw told me I could stop taking it. I had been taking it more than 45 days, and he said 45 days is really what was indicated in my situation, given that this latest clot was superficial. Despite my history of DVT and possible borderline protein S deficiency, he said he just didn’t see continued warfarin therapy as justified. He (like the doctor I saw for my clearance actually – maybe he wasn’t so wrong after all) said he considers my first DVT to have been “provoked” (by medication I was taking at the time and by a road trip I’d been on) and said that the superficial clot, extensive as it was, was also explicable given that I have varicose veins in that leg and it’s not at all uncommon for varicose veins to develop superficial clots.

So we will get to test the theory of whether the warfarin was causing these spells. I stopped taking it Thursday. Apparently it takes about 10 days to be out of the system. If I’m still here 10 days out (which is looking increasingly possible) he’ll run some blood tests to check protein S levels, so I might also get a more definitive answer on that (protein S being a protein involved in clotting – something I’ve been told in the past is borderline low, which could cause a tendency to clot). Yesterday I was riding high. I hadn’t had a spell Friday night. I had one Thursday night, which was a good thing because I was wearing a heart monitor and they wanted to have that on while I had a spell to see what my heart was doing at the time. But then I didn’t have one Friday night, so I was feeling quite certain the warfarin was to blame and that maybe I was done with that.

But last night was not so great. Last night was a negative column night. Could still be the warfarin, I’m telling myself, as it’s still certainly in my system. But it’s feeling less definitive now. I can’t lie – it was hugely discouraging to have that happen again when I’d managed to convince myself it was resolved, or at least resolving.

Back to the positive column, though: on Thursday I have two appointments, one with a neurologist in the “headache clinic” and a follow-up with the cardiologist. We’re starting with the headache clinic because this type of spell can be caused by atypical migraine (thank you, Ashley, for making me aware of that) and I have both a personal and family history of migraine. From there I can be referred for whatever tests they think would help illuminate the situation, or sent to other areas of the neurology department (like their sleep clinic).

Another huge positive is the Cleveland Clinic itself. I’m blown away by the efficiency and professionalism I’m encountering here. Although the week-long wait between appointments frustrated me, given my situation, the fact that I can step off a plane, spend an entire day with appointments and diagnostic tests, get follow-up appointments a week later, all with some of the best doctors in the U.S., is something for the positive column, to be sure. I had to wait more than a month for a routine well woman check with a doctor in El Paso last spring, so I need to adjust expectations here a bit. I’m just eager to get home.

Which is the biggest weight in the negative column. I miss my husband and my kids. I miss my home, which I had just finally finished making into my home. I miss the friends I had started building bonds with. I miss Accra in many ways (especially the warm weather!) I know we need to sort this out. Again, to be totally honest – these spells freak me out. They jolt me awake and they’re scary when they happen. I want them to stop. But I want to go home. So I appreciate your continued love and prayers and support. I appreciate all you do to keep that negative column in perspective for me. Thank you all.