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.




So which do you vote for? Medevac’d, medevaced, or medevacked?

On Tuesday evening I’m getting on a plane and starting an almost entirely unexpected journey. After the surprise of my superficial but quite extensive blood clot back in October there was always the possibility that some kind of complication would cause the doctor here to decide I’d be better off getting medical attention somewhere with a more extensive healthcare network than what’s available to us here. It’s not necessarily that there aren’t excellent doctors in Ghana. I’m sure there are. But the medical infrastructure isn’t what it is in Europe or the U.S. and the medical unit at the embassy doesn’t have the level of knowledge of the local medical resources that would make it possible to identify the best places to seek treatment and the best doctors to see. Ultimately, there aren’t supposed to be complicated medical situations here. I’m here in the first place because I have a Class 1 clearance – which should mean I’m not going to have grave health issues that need addressing. I’m supposed to make it through my two years with nothing worse than an occasional sniffle or case of the flu. But of course life happens, and it seems to happen more and more with age, at least where health is concerned.

Not long after the clot I started waking at night – not every night, but frequently – with the disconcerting sensation that I was about to pass out. These spells would come and go for some time, and I’d usually get up and read or otherwise distract myself until I felt they had passed or I was so tired I thought I could get back to sleep anyway. I thought perhaps it was a side effect of the blood thinner. Eventually I talked to the doctor at the embassy about it and she wasn’t so sure. She did a quick neurological check, an EKG, and some blood pressure measurements (all of which looked OK) and then asked me to keep track of the spells and see if there were any patterns, how frequently it was actually happening, etc. She also asked me to check my blood pressure when the spells occurred.

Turns out that – by my personal standards, at least – my blood pressure was relatively low during these spells and so was my pulse. My pulse tends to be low-ish anyway, but it was markedly lower than usual, and all of this in combination with the fact that the spells just don’t seem to be resolving or demonstrating any easily-parsed pattern, led the doctor to request a medical evacuation for me. The goal: to figure out what’s going on with the spells, which she thinks may be linked to my long history of cardiac imperfections (I started young in this department with a congenital cardiac birth defect). Also, while I’m getting the spells checked out, I can see a hematologist and receive guidance on treatment for my stubbornly clotty blood.

While it’s not anything I would ever have wished for, and it comes with a lot of angst over being away from Andres and the kids, I’m trying to see this as a positive. Throughout my life various cardiologists have told me various things. That I have a mitral valve prolapse. That I don’t have a prolapse. That I have a troublingly low ejection fraction. That the ejection fraction is not a danger. That I have abnormal EKGs, which is a problem. That I have abnormal EKGs, but that it’s completely fine and expected due to the surgery I had as an infant. I’m being sent to the Cleveland Clinic, which has an excellent reputation for cardiology, so I’ll be happy to perhaps get a more definitive reading on my cardiac health. And maybe that will lead to a solution for these night-waking near-fainting spells.

My worry is for the length of time I’ll be away if they can’t figure out quickly what’s going on with me. By virtue of being evacuated I lose my medical clearance and I can’t go back to Ghana until I get a new clearance, which I’m guessing they won’t give me until they figure this out. The doctor here is hoping I’ll just be gone a week, possibly two. I am hoping the same, of course. It’s the trickiest time of all to be away, with the kids on break, but thankfully they’re old enough to fend for themselves if need be while Andres is at work, and we live among a very strong and tight-knit community. They will be looked after. But I like to be the one looking after them.

I’ll keep everyone posted on my situation and my wild adventures in exotic Cleveland. It’s the start to 2018 I could never have predicted.

5000 miles

According to Google Maps, the bare outline of our home leave trip was in excess of 4600 miles. So I’m going to go ahead and claim we drove in excess of 5000 miles during home leave, given that in addition to what I’ve mapped here

Map 1 home leave

and here

Map 2 home leave

Andres and I made a trip or two to Oklahoma City from the farm (Togo on the map) and we also visited some state parks in the vicinity of the farm and took various side trips in the Canandaigua area. It was a pretty phenomenal road trip. Any trip that involves Roswell’s annual UFO festival, a small-town New Mexico Fourth of July parade, the Grand Canyon and Niagara Falls is quite an adventure.

As fate would have it, we left Ciudad Juárez the same weekend my hometown of Roswell was holding its UFO festival. During our two years on the border Isaiah had repeatedly requested a visit to Roswell (not to see his dear mother’s birthplace but to revel in alien lore) and we’d never made it. This seemed like the perfect opportunity. So after a stop at Ruidoso’s Inn of the Mountain Gods for a casino buffet lunch and admiration of gorgeous mountain scenery, we made Roswell our first home leave stop.


An unexpected highlight of the UFO festival for Andres and me: delicious Thai food. Who knew? There was a food truck at the festival selling some very tasty noodle dishes. Roswell has come a long way since my childhood. We enjoyed the kitsch of the festival, and were even able to attend some talks and roundtable discussions. Isaiah went in to the experience a skeptic but found some of the presentations pretty convincing.

We also visited my childhood home while we were there. The kids were good sports about it, but it definitely was not as interesting as the aliens. My dad planted the tree there in the background, which was tiny at the time. He never did drive a lowrider. So I’m guessing it looks considerably different now than it did in my day.


From Roswell it was on to Silver City, via the essential stop at the Owl Bar in San Antonio, NM for green chile cheeseburgers. We stayed downtown and spent Fourth of July watching the local parade and participating in low-key festivities like ice cream socials and music in the park. Small-town New Mexico really knows how to do a chill holiday celebration. It was quite relaxing and pleasant for all.


From Silver City we moved on to Arizona, stopping for the night in Holbrook before visiting Petrified Forest/Painted Desert National Park and then continuing up to the Grand Canyon. After the Grand Canyon we stayed at a total tourist trap hotel in Williams where our accommodation was inside a caboose. I found it rewarding that Isaiah named it his favorite hotel of the trip because from an adult point of view it was less than ideal – hot inside and rather a lot of money for a kind of uncomfortable night. But they loved it, so it’s a win in my book.

Flagstaff was the next stop. There we visited Riordan Mansion State Historic Park, an amazing arts & crafts mansion-turned-museum, and the Lowell Observatory, where Pluto was discovered. Both stops were fascinating, but I have have a special place in my heart for Pluto, having known Clyde Tombaugh, the man who discovered it, during my Las Cruces years. Hearing his story, and the story of Pluto’s discovery, was fascinating. He was a self-educated farm boy who came to Lowell Observatory basically as an assistant/errand boy without any formal astronomy education and ended up discovering Pluto. It was delightful to hear the story, told by probably the best museum guide I’ve ever had. The kids were so fascinated by the observatory’s interactive astronomy museum that we had to drag them away. Another highlight of that visit was seeing the most beautifully constructed observatory I could imagine – built of gorgeous local wood with the dome ingeniously designed to rotate on tires from Ford trucks.

From Flagstaff it was on to Phoenix, where we stayed downtown and took in a baseball game (the Diamondbacks lost, sadly) before the following day putting Isaiah on a plane for his first-ever solo trip. He flew to Dallas, where he was picked up by my friend Dana for several days of fun with his lifelong friend Vivian and the rest of the LaMure crew. Marisela, Andres and I continued on to the Dyche family farm in northwestern Oklahoma via Albuquerque – the town where we met and married. Although we did stop at the Big Texan in Amarillo, Marisela disappointed us by failing to even attempt the 72-ounce steak. Don’t be deceived by the picture!

For the next month, more or less, the farm was our home base. We stayed there and enjoyed visits from family, kind of a rolling version of the annual farm reunion. We cooked and baked and played in the pool and fished and had a wonderful, relaxing time. Isaiah caught a ride up from the Dallas area with some of our Dallas-area-based family and we all spent some lovely quiet time together – much needed after the frantic pace of our last days in Juarez (and the frantic pace of Andres’ entire two years of work in Juarez). We were able to take everything out of the car and stay in one place for a while, which was lovely, and it was just a half-hour drive to visit “GG,” the kids’ 96-year-old Great Grandma Dyche.

There were a few side trips from the farm: the kids and I made a jaunt down to Dallas, which – as always – was packed from morning to evening every single day with wonderful times with the best of friends. And Andres, Isaiah, and I left Marisela at the farm with cousins and aunts and uncles and grandparents while we camped out in a cave at Alabaster Caverns State Park. Between the complete dark and the sound of a running stream it was a very peaceful place to sleep. We had to wake Andres up around 10 the next morning so we could “check out” on time.

Unfortunately our time at the farm eventually had to come to an end. The clock was ticking again and we had to make it to Arlington in time for vaccines at the travel clinic and West Africa area studies class. So we loaded up the car again and headed north. We gave ourselves time to make the trip to the DC area interesting. The kids and I had never visited the areas of New York Andres called home as a teenager and young man – the Canandaigua area and the area around Olean, where he attended St. Bonaventure University. So, making stops in St. Louis and Cincinnati along the way (and enjoying meals at midwestern institutions Culver’s and Skyline, as recommended to us by midwestern friends), we aimed for western New York, starting out with a visit to Niagara Falls, something I (as a desert-born-and raised girl) had always hoped to see one day. It did not disappoint. As much as I will always love the desert southwest and its arid mountains there is something about this quantity of water that just seems almost miraculous to me. While we were in the vicinity we crossed the border into Canada and the kids and I visited a wax museum (at Marisela’s pleading) while Andres enjoyed a quiet hour or so sipping beers at a nearby brewpub. Marisela enjoyed seeing the wax replica of her comedy idol, Lucille Ball, Isaiah loved the homage to Alien, and they both were fans of the Harry Potter display.

From Niagara Falls we embarked on a tour of Andres’ New York landmarks. We visited House of Guitars, the George Eastman home, and Nick Tahou’s (restaurant famous/infamous for the “garbage plate”) in Rochester. We stayed several days in Canandaigua and visited Bully Hill Winery, Sonnenberg Gardens, St. John’s Episcopal Church, Andres’ Grandpa Brennan’s former general store in Geneva (now painted purple and in business as a hair salon), Grandpa Brennan’s grave, Grandma Brennan’s house in Canandaigua, and the home of Hal Clark, Andres’ high school buddy, and his wife Kim. We also went on from Canandaigua to spend some time in Olean, visiting St. Bonaventure University and walking the halls of the philosophy department, the stacks of the library, and the woodland trails behind campus – all paths frequented by Andres in his undergrad years. After spending two years practically in my childhood backyard it was lovely being able to see and share with the kids places that are special to their dad, as well.

This all seems like something of a distant dream now. From Olean we charted a course for Arlington and the morning after we arrived we were in the Foreign Service Institute health clinic getting vaccinated and receiving our antimalarial meds for our move to Ghana. A few weeks after that we were on our way across the Atlantic. At that point I was convinced I wouldn’t set foot in the USA again for two years. Turns out I was wrong. Next week I embark on an unexpected journey to, of all places, Cleveland, Ohio. About which I will write more very shortly. But right now I have to go brave the Christmas heat and humidity to do some stocking-stuffer shopping and to buy some outrageously overpriced canned tart cherries for a Christmas pie.

How buying a car made me cry. Twice

So I’ll start with the positive. Because I like the positive. I try, always, not to dwell on difficulties or challenges. So I’ll start with the good stuff of recent days and weeks.

First, our awesome boy turned 14 and I was delighted to have several of the nicest, mellowest, most polite teenagers I’ve ever met hang out over here and eat lots of chips and pizza and cake to help us celebrate. They played video games and board games and swam and it was just a delight to have them here. I’m really thankful for the friends our kids have made so far in Accra.

Also, we got our stuff. Actually, we got it right before Isaiah’s birthday party, but young teen boys are the perfect crowd to have over amidst boxes and piles of junk. They barely seemed to notice. With the notable exception of Marisela’s room, pretty much everything else in our house is now reasonably well-ordered. And though for the most part I was quite content with what we had with us from home leave, it is nice to have a few more clothing choices, and drinking good coffee again (thanks to our grinder and espresso machine) is lovely, and of course the best thing of all . . .

I HAVE MY BIKE NOW!!!! I am so delighted to have my bike. Yes, a helmet is very much necessary. Yes I am, at every second, thankful for the rear-view mirror and bell I installed on the handlebars. Yes, I do have to time outings so I miss morning, lunch, and evening traffic surges. Yes, I have to be strategic about my routes. But having my bike has been a game-changer as far as shopping and errand-running is concerned. I don’t want to take a cab to the closest grocery store here when I need a few cake ingredients on the day of Isaiah’s party – it’s less than a mile away. But it’s huge to be able to get there in 3-5 minutes on the bike as opposed to 15 minutes on foot. Also less sweat involved, which works for me and for everyone around me.

Thanksgiving was wonderful. We had a turkey from the commissary, learned that stuffing is still edible (if not quite the same) without celery, and found that the old Vacation Bible School staple of ziplock bag ice cream works just fine with UHT cream and milk. I wasn’t willing to pay for canned pumpkin here but apple pie a la mode turned out to be quite a tasty way to finish off our meal.

OK. Now on to the complaining.

We’ve been trying to buy a car since we got here. We sold both of our Fords, having been told that Ford parts and service are nigh impossible to come by here (though we have since seen lots of Fords and are thinking now we should have brought the Ranger, as a “bridge” vehicle if nothing else). Since we arrived at the end of transfer season, there haven’t been many options in the diplomat-to-diplomat market, at least not at the prices we were willing to pay for a vehicle that’s likely to be bumped in to and driven in less than ideal conditions. We wanted a reliable, but not new or perfect, vehicle. We checked out the local market but found that for what we were willing to spend there was just not much of quality available. I test-drove an old, beat-up CRV and and old, beat-up Ford Explorer (irony of ironies), both of which were going for around $10,000. In the U.S. I wouldn’t have paid half that much for either vehicle. I also contacted lots and lots of potential sellers with whom I never ultimately connected.

Then we found the Highlander. A shiny, almost-new-looking one-owner 2010 Toyota Highlander at a dealership in Lubbock, where my parents and my sister and her family live. And according to it was not a good, but a great deal. My dad went over and checked it out. He gave it a thumbs-up. My uncle, who is a seasoned car guy, also gave it a thumbs up. We decided to go ahead.

I realized that it was unlikely anyone in Lubbock, TX had any clue about selling a car to someone in the foreign service, so I did lots of homework in an effort to make it easier for the dealership. I contacted the State Department’s transportation department and got a list of all the information they’d need to start organizing the shipping process. I contacted our insurer about shipping insurance. I contacted the Texas DMV and taxation departments to find out what we would or wouldn’t pay in taxes and title fees and how to document that accurately. I proactively had Andrés fill out a tax exempt certificate showing that we would not be operating the vehicle in Texas (except to get it out of Texas). I sent the salesman the certificate and copies of both of our driver’s licenses, along with the (pretty simple) list of documents they would need to provide to us for State.

The first hiccup came when it turned out that (contrary to what I had read online – which was that online document-signing/verification services could be used) I needed to assign power of attorney to someone to physically go in and sign the papers. Easy. Thanks to my sister’s flexibility and generosity (my parents had left Lubbock for Santa Fe the day after the test drive) and thanks to American Citizen Services at the embassy, I was able to draw up and have notarized a limited power of attorney for Lisa to sign on Andrés’ behalf.

Now we’re almost to my first tears. I had asked, as repeatedly as I could without being too impolite, for the total amount we would owe for the car so I could go ahead and get the funds wired from our checking account, where we’d been holding on to a lump of cash for this very purpose. I was repeatedly told that it would be sent to me at any moment. My sister was doing me a huge favor in stopping by after work on a Friday to sign the papers, at their insistence that it happen that day, and yet they were not getting me the total amount I had been requesting since the day before. As it worked out, they didn’t get me the “deal sheet” with the total amount until Lisa was already sitting there waiting to sign. So it wasn’t until she was already there that I discovered our bank uses a form of 2-step verification for wire transfers that I was not able to complete from Ghana. I called the bank either four or five separate times and received four or five different (ultimately unhelpful) suggestions from bank employees before I finally had to say I was stumped. Lisa was going to have to go back again the next day. Cue the first tears. I hadn’t wanted people to have to scramble on my behalf to make this deal happen.

I proposed to the dealership all the different means the bank had suggested that I get the money to them – via the online bill pay function, using PayPal, sending them a limited power of attorney document allowing my sister to get a cashier’s check from our account, putting it on our credit card, having a family member get them a check from the family member’s account, then reimbursing the family member. I didn’t get answers on any of these – just insistence that I figure out how to do the wire transfer. I could hardly believe that I had sufficient cash just sitting in the bank and wanted to buy this car and could not figure out how to move it, and in the meantime, my sister was stuck in the middle.

In the end the credit card payment worked out. By the time the dealership had approval from corporate for taking a $10,000+ credit card payment my parents could have paid by cashier’s check and I could have reimbursed them, but never mind.

As it turned out, the headache was only beginning. After we had agreed that credit card would be the way to go I sent (now for the second time) the relatively simple list of information I’d need to initiate the shipping process. All along they had seemed hesitant to believe that the State Department would handle the shipping. They kept asking me (and apparently my sister) which port to send the title to and how the car would be registered in Ghana. None of which they needed to do or worry about. All they needed to do was to get me two PDF documents and answers to a handful of simple questions that I think would take an industrious person no more than half an hour to assemble.

Throughout the week I checked in with our sales guy. I received repeated assurances that things were underway and that I’d have my documents and information soon. I asked if there was anything else he needed from me. No, I’d been great. Thanks so much. He’d get this stuff to me soon. Finally on Friday – a week after my sister had first gone in to (try to) sign – he asked me to re-send the list of information I needed (I think this was the third, and possibly the fourth, time I had sent this). I did send the list again, along with a plea that he get things assembled that day and get it to me. I was promised that “within the hour” I’d have it. Within the hour I did not have it. When I went to bed Friday night I did not have it. No answer to my text on Saturday asking if he was in that day and if I could expect to get the information.

Then yesterday both my dad and I contacted our friendly salesman to see what was going on and we were both told that he had already sent me what I needed. My sister had told me, over the weekend, that she had received the physical paperwork from the sale, so I though maybe this was for real – and it had landed in my spam folder, or I had somehow missed it in my inbox. So I checked both places thoroughly. Nothing. I found it unlikely that, after all the messages and documents that had transferred back and forth with no problem, this one had somehow vanished in cyberspace. But I tried to give our buddy the benefit of the doubt, and asked him to please go into his sent folder and re-send the documents and information. Nothing. Nothing. And more nothing.

And then this startling information, quite a bit later in the day: the engine number, a must-have bit of information for Ghana customs, was stamped on the engine in such a way that it couldn’t be read without removal of the engine, so they wouldn’t be able to get that to me. From back before the sale was even finalized I had told them this was a key and essential piece of information. Only a week later after LOTS of pressure was this revealed. I did a little research. Apparently the Highlander engine number is tricky or maybe impossible to see (I did see some posts online saying with a mirror, a stick, a flashlight, some tape and some determination it’s possible to see it). But apparently you can also call Toyota with the VIN and they can provide the engine number.

So I called Toyota. The person I spoke to seemed friendly and seemed – in a general sense – willing to help, but cautioned me that she might not be able to give me what I needed. After I gave her the VIN I was on hold for a while before she came back and said that she had located record of the vehicle, and confirmed that it’s a 2010 Highlander, blah blah blah, but that she couldn’t give me the engine number. At first it seemed she was saying they simply didn’t have the engine number among their data. But as she kept talking I got the distinct impression that she did have it, but wouldn’t give it to me because engines could be changed out and there was no guarantee it was accurate. I told her that I had a pretty thorough looking Carfax report and that while I knew there was some possibility the engine had been replaced at some point there was nothing to indicate that it had been. She still refused to give me the number. Here came the second set of tears.

I am not the kind of person to try to manipulate people with tears. In fact, I try really, really hard to keep emotions out of what should be rational discussions. But I lost it, and in my teary voice from all those thousands of miles away I asked her if I really now had paid more than $10,000 for a vehicle I would have no way of getting across half the country and the Atlantic Ocean to where I actually live. She still would not/could not give me the number.

My poor dad happened to call me just seconds after I had hung up from that call. I tried to not be falling apart but I was falling apart. There I was an almost-46-year-old woman crying on the phone with daddy. Not my proudest moment. But poppa came through. He called Toyota himself and whether he got a more sympathetic person or communicated the issue better or goodness knows what, he got the engine number for me and communicated it to Mr. “Gee-Why-Didn’t-I-Think-of-That” Salesman, who proceeded to then get me most of the answers to my simple questions (is there a jack? a spare tire? how many keys?), but then also to tell me that the “PDFs had been sent to accounting” and he’d have to retrieve them before he could send them to me. I think 20-somethings know how to find their “sent” box, so if ever he did send PDFs to accounting, he should be able to find them and send them to me. More likely explanation: there are no PDFs. Now it remains to be seen if there are copies in their files that they can scan and send, or if they’ve sent everything to my sister and I’m going to have to – once again – call upon her to help me out with something they should have done.

This morning I sent a detailed email to the general manager at this dealership. Enough is enough. I like to give people a chance to do things right. I like to give people the benefit of the doubt. But my patience is gone now. In retrospect I halfway wish we’d walked away when they were so slow to get me the deal sheet and made Lisa waste a trip rather than letting her know they weren’t ready for her. But at each step I thought, “If we can just get past this hurdle . . .” and also, it’s kind of the perfect vehicle, so given that we’d already lost 2.5 months or so in the car hunt, it didn’t seem like a good idea to let go. I really hope we can get our Highlander before, oh, March of next year. And next time we will definitely be purchasing a car in person!




It’s been about two and a half weeks now since Isaiah, Marisela, and I went on our first out-of-Accra trip with several families from the Embassy. Andrés, unfortunately, was not able to join us because we left on a weekday and work was too pressing. We all pooled funds and rented a bus from the commissary. The commissary bus rental includes the cost of a driver, which felt like a tremendous luxury. He had made this trip many times before and we were never lost or in any doubt about how to handle police checks, etc. It was nice, for our first trip, to not have those concerns.

We had four destinations: two of the so-called slave castles, Cape Coast Castle and Elmina Castle, a beach-side hotel/resort in Elmina, and (the following day) Kakum National Park, the closest national park to Accra and home of the locally famous rainforest canopy walk – 700 meters of suspended rope-and-board walkway through the upper layers of Kakum’s rainforest growth.

Going in to the trip I had misgivings. I was excited to get out of Accra. I’ve enjoyed getting to know our immediate surroundings but I was ready to see more. I had hardly glimpsed the ocean yet, and was eager to hear the waves – notoriously strong here – crashing on shore. Kakum was one of the first tourist sites I’d read about when we first learned of our Ghana assignment and I’d been looking forward to a visit ever since.

But the slave castles. I both did and did not want to visit the slave castles. Of course I had to. Ghana/Gold Coast was not the only African nation to suffer the brutality of the slave trade but it was an epicenter of commerce in general and as the transatlantic slave trade burgeoned human beings became yet another profitable export. The slave castles were fortresses where captured people – those who had survived the trip to the coast – were held for months at a time waiting for ships to take them on the Middle Passage, stories of which are certainly among the most harrowing and shameful in human history.

I know that it was essential to visit these places. But then, and still now, it was hard to reconcile, impossible to reconcile, the enormity of suffering and inhumanity encountered there with a trip to a beach resort and an exhilarating, dizzying nature walk. I had thought about writing this blog entry in two parts – one for the slave castles and one for the rest. But I’m leaving it as I experienced it. You may also feel discomfort at the contrast, but then I suppose I will have more accurately conveyed the reality of my experience.

We visited two castles, Cape Coast Castle and Elmina Castle. At both, we visited dungeons where – in room after room – men, women, and children had been held in the dark, crowded together with nothing but crude canals in the ground to divert their wastes. They had been stolen or sold from their homes and forced to walk to the coast. At the coast they could be held for months waiting for a ship, which of course was just a new kind of hell. There were separate dungeons for men and for women and children. There were also punishment rooms for women who resisted the castle officers’ assaults and claustrophobia-inducing chambers where anyone who dared attempt escape would be sealed away until death came.

I challenge anyone who feels race has too long continued to be a charged issue in the United States to visit these castles and continue to hold that belief. The degree of inhumanity, the vastness of the moral violation that occurred there is palpable still today. Atop the men’s dungeon at Cape Coast Castle is a chamber that used to be an Anglican church. The English officers would worship there while their brothers in Christ stood, sat, or lay, many of them deathly ill, in their own waste in the dungeons below. I just can’t think of Matthew 25 (“I was hungry and you gave me no food, I was thirsty and you gave me nothing to drink, I was a stranger and you did not welcome me, naked and you did not give me clothing, sick and in prison and you did not visit me.” Then they also will answer, “Lord, when was it that we saw you hungry or thirsty or a stranger or naked or sick or in prison, and did not take care of you?” Then he will answer them, “Truly I tell you, just as you did not do it to one of the least of these, you did not do it to me”) and imagine how these officers could purport to worship a loving God who created us all while simultaneously brutalizing these stolen human beings. How many generations does it take to be truly free of a mentality that allowed this to happen? I don’t believe we’re there yet.

We were fortunate to be visiting the castles during an ongoing art installation by artist Kwame Akoto-Bamfo. It is called In Memoriam: Portraits of the Middle Passage, In Situ and consists of 1300 sculptures of heads, a contemporized version of a traditional funerary sculptures, that were displayed throughout the dungeons. These sculptures were haunting and terrifying and beautiful all at once. As we left one room in the men’s dungeons I was stopped in my tracks by one that looked like a teenaged boy. Certainly my teenaged boy, tall and broad-shouldered as he’s become, is as much a man, physically, as that boy was. As many boys were who passed through those rooms.

The Middle Passage – the journey from Africa across the Atlantic – claimed at least two million lives. For every one hundred people who made it across alive (to yet another hell) forty had died at some point along the way – whether during capture, on the way to the castles, in the castles, or during the journey.

The final room we visited at Cape Coast Castle included information on the Akoto-Bamfo installation, some of the sculptures themselves, and several poems. Among them:



I feel left at shore

right at the cursed spot

where our black bodies

dissolved into the blue

nothingness of the


Where waves

conduct the

symphonies of

stories that

drowned untold.

They slave me to carry

them home

in my palms

bury them

in the gaps

on their family trees.

-Hakeem Adam


To move on from this to our beach resort was . . . I’m sitting here watching the cursor flash and waiting for the right word, which simply isn’t coming. Irreconcilable is the best I’ve got. The resort was lovely. Far, far nicer than anything our personal family unit would likely have chosen (for which Marisela was quite thankful – she has never been on board with our rustic preferences). We sipped coconut water from actual coconuts as we watched the waves crash. The kids waded and splashed, then later swam in the beautiful pool. We ate in the open air with the ocean breeze sweeping through. And bit by bit this luxury washed away enough of the memory of all we’d seen earlier in the day that we could talk again, and laugh again, and open a bottle of wine and take cheer in each other’s company. I’m not sure it should have been that way, but then I’m also not sure how else to respond to that kind of horror than to be in, and be thankful for, the presence of human warmth and friendship and kindness. Not to let those lovely moments erase our experience with the injustice and terror but to be reminded that there is also good and there is also beauty, both in the world and in people.

We spent the afternoon like this, and then the evening. Enjoying the company and enjoying the place and feeling grateful to have the chance to be there together. And the next morning, after breakfast, we headed for Kakum and the rainforest. We left Cape Coast behind, not forgotten – I hope never forgotten – but removed, for the moment, from immediate thought, because otherwise there could be nothing else.

I should mention the kids at this point. They were along for all of this – for the unflinching descriptions of what happened to the prisoners of the slave castles, including the stomach-turning fates of the women who were assaulted by the officers or of the others – men, it seems, mostly – who tried to run and were locked up and left to die. We had visited the Smithsonian Museum of African-American History and Culture in Washington, D.C. right before coming here and that really provided a perfect context for them to understand far better than they would have otherwise just how closely those castles and their terror is tied to the history of our nation. As for me, though, and for the rest of us on the trip, the hours spent in beautiful surroundings with good company had eased the intensity of emotions for Isaiah and Marisela.

But then we went to Kakum. Before this visit, I’m fairly certain that our flight from the U.S. to Ghana was Isaiah’s most terrifying experience. He is not a fan of airplanes even in the best circumstances (best for him meaning a short and entirely non-turbulent flight that takes off and lands on time). Our flights here were long, quite turbulent at times, and the flight from Brussels to Ghana ran about an hour late. But given the choice between reliving that experience and reliving Kakum, I’m guessing he might be ready to put his tray table up and his seat in the upright position. Those rainforest walkways were definitely not something he’ll be eager to experience again.

There were seven of them, each about 100 meters, and they were suspended by a network of ropes between treehouse-type platforms. Although we got there relatively early most of the wildlife there is nocturnal, and there were already crowds and crowds of tourists (which is the case every day, I’m sure), so we didn’t see as much as a single bird. But the rainforest itself was spectacular, especially to this desert-dweller’s eyes. Shades of green I’d never seen before, as far as the eye could see. We could see the ground in places, or imagine we could see the ground, if we were brave enough to look down, filtered through layer after layer of leaves and branches.

Isaiah says he doesn’t feel proud of having made it through the walkways because he didn’t have any choice, but I’m proud of him nonetheless. He did it and he did it without complaining, protesting, or even grumbling. He even looked down. It may not have been an experience he would have wished to have, but he recognized it for something worthwhile and he made the most of it, and I’m very proud of him.

Marisela was not particularly bothered by the heights, or the swaying walkways. She was several walkways ahead of me, with a group of other Embassy kids. Isaiah and I were bringing up the rear. I would love to visit Kakum again and stay the night. There’s a “treehouse” where visitors can camp and hope to see some of the park’s wildlife. Maybe that would be a more palatable way for Isaiah to enjoy the scenery there. He and I could hang out in the treehouse while Marisela shows Andrés the walkway.

The trip back to Accra was uneventful – unless traffic is an event. We stopped at a very chill beachfront restaurant for lunch (which took a while – there were 25 of us, after all, which is a lot to accommodate) and ended up getting a later start than we’d intended. At first we were making great time and it seemed we’d be home on schedule. Then suddenly we weren’t. We were at a series of dead standstills for several miles, and what had been a three-hour trip on the way out to Cape Coast turned into about a five-hour trip on the way home.

Our short excursion made me all the more aware of the fact that there is much to see and do here in Ghana, and our two years will fly by, I’m sure. I came home with a new determination to find a car and start having our own adventures. I even scheduled a time to view a car we were interested in – it was for 10am last Friday. So if you read my blog you know that, rather than test-driving a Hyundai Santa Fe last Friday morning, I was having blood drawn and an ultrasound done on my right leg. Tomorrow I’m looking at a Honda CRV. I was waylaid for a bit, but I haven’t lost my determination altogether. Just crossing fingers that I can keep the appointment this time.

I went back and forth about how to share my pictures. In the end I decided that, rather than putting them with the appropriate part of the written description, I’d put them all together at the end, in chronological order. That way you can read about the whole experience, and then see the whole experience.

Next time I will finally tackle our epic home leave road trip, complete with maps to demonstrate just how crazy we are (the trip was undertaken in a Ford Focus hatchback with all four of us AND all of our belongings that we didn’t have shipped straight from Mexico to Ghana).





Well, that was unexpected

So you may have noticed it’s been a while. And also that I never did (yet) write about our trip to Cape Coast. Still haven’t reached back into the summer memories and written about home leave, either. Both of those posts are in the works, but it may be longer than I’d anticipated before I get to them.

A week ago Friday an unpleasant bit of the past came calling. I had awakened Thursday with my right calf feeling tired and achy. At the time I wasn’t terribly concerned. The day before had been parent-teacher conference day at the kids’ school, and I had visited all of Isaiah’s teachers and Marisela’s home-room, French, music, and art teachers, often standing around outside classrooms waiting for my appointments. The veins on the back of my right calf haven’t been in the best shape since I had a DVT (deep vein thrombosis/blood clot) more than 15 years ago. So I did what I generally do when those veins complain – I put a compression sleeve on that calf and went about my day.

At bedtime I took the sleeve off and was irritated to find that my calf still hurt, and that it was maybe even more painful than it had been in the morning. The full day of compression made it hard to see if there was swelling, but it seemed to me that perhaps there was. And Friday morning there was no doubt – it was painful, red, swollen, and hot, the exact combination of symptoms someone with a history of DVT does not want to encounter. I was off to the health unit at the Embassy as soon as the kids left for school.

To the credit of the medical staff at the Embassy, I was treated quickly and efficiently. The doctor and I agreed that it didn’t seem quite like DVT – we could see and feel hardened veins right under the skin, and the inflammation seemed much more immediate than it had when I had the DVT – but given my history it was still quite concerning. I was taken in an Embassy motor pool vehicle to have lab work and an ultrasound done. By noon the diagnosis had been made: the long saphenous vein, a superficial vein, was pretty much entirely clotted up from behind the knee down. It was a clot, which is never good. But it wasn’t DVT, which is good. But it was really big. And I’d had DVT before. And I most likely have a clotting disorder (more on that later). So the wise course was to treat it as if it was DVT, because in something like 40% of cases like this (superficial clotting with DVT history) the clotting ends up turning into DVT.

I want to emphasize that now, more than a week later, I am in a good place, health-wise. As good as can be, given the circumstances. I’ve been on two different blood thinners since this was discovered and had my blood tested every other day to make sure the dosage is properly adjusted. I’m in the right therapeutic range and between the medications and the constant wearing of compression stockings the symptoms are resolving nicely (at night I just wear the calf sleeve but during the day I wear the full pantyhose version . . . a lovely garment to wear when it’s 88 degrees and 80% humidity, let me tell you).

More than any physical discomfort this incident has caused, it’s been a psychological blow, one from which I feel I’m now slowly recovering. If you’ve been reading the posts I’ve made since our arrival you know that I’ve been loving life here. I’ve been doing what I can to get engaged with our surroundings, to meet people, to experience what life here has to offer both within and beyond the Embassy community. For a time, at least, my clot brought all of that to a screeching halt – to a certain degree out of necessity (until the most acute phase resolved the doctor wasn’t keen on me walking my usual 3-5 miles a day, and frequent visits to the medical unit for blood draws kept me occupied), but also because it was so discouraging that it felt like it robbed all the momentum I had built up in our first several weeks.

I need to backtrack a bit. When I had my first clot, the DVT, back in 2002, it seemed to come out of nowhere. I was young and healthy. I wasn’t a smoker or overweight or sedentary. I had recently taken a road trip in the backseat of my parents’ VW Beetle, but that alone still seemed like a stretch as a reason for the clot. In the end my hematologist postulated that I had a particular variety of a particular clotting disorder, called protein S deficiency. Protein S is something that inhibits clotting – or perhaps it’s better to say that it’s one of the proteins that regulates clotting. Because clotting is a good thing when you’re bleeding and need it to stop, but it’s a bad thing if it happens spontaneously in your veins. And my protein S levels were fine overall, but apparently were somewhat lacking in activity. My protein S was present and accounted for, but not as busy as it should have been.

Given that situation, there were certain things I needed to keep in mind, I was told, for the rest of my life. First, if ever I were to have children, I would need to be take a daily injection of a pregnancy-safe anticoagulant throughout pregnancy and six weeks  postpartum. Second, for the rest of my life, any time I flew overseas (or any flight over four hours) I would need to use that same anticoagulant (at least one shot beats daily shots for 9 months). Third, I would need to be aware any time I took road trips or was on a bus or train for a long time that I should get out/up and walk frequently, and probably also wear compression hose to aid circulation in my legs.

And so it went for 15+ years without incident. Two awesome kiddos born – no trouble. I was terrified at first when I was pregnant with Isaiah. Then that went fine and I was less scared when I was pregnant with Marisela. Then years and years passed and not a single incident. I had really stopped thinking about blood clots, although I did still follow the precautionary rules. I wore my stockings. I made my frequent walking stops during road trips. I told doctors about the protein S deficiency and was periodically monitored by a hematologist.

Then came my medical clearance for the State Department. It was 2014 and after we submitted our initial clearance papers, it was no surprise that the medical unit in D.C. wanted a hematologist’s report before deciding what kind of clearance I should receive. We were in a hurry to get our clearances done and the hematologist I’d been seeing in Dallas was not available for an appointment on short notice. I’d never really developed a great relationship with her anyway, and didn’t feel particularly loyal, so I made an appointment with someone new. He ordered the blood work, looked at my history, and told me something I was very excited to hear: not only did he feel my DVT history wasn’t a particular concern, he wasn’t at all sure that I even had protein S deficiency. Of course, he said, I should use the anticoagulant when I take a long flight. And wear the stockings. And stretch my legs. But that was just because I had a DVT history. He was quite dubious of the protein S deficiency diagnosis (my levels of active protein S were always almost in range).

I’ve heard a lot recently about confirmation bias. This was confirmation bias in action. I’d gone years without any clotting incidents. The shock of the original DVT and the fear I’d felt during that first pregnancy had receded into the deep past. How many long road trips had I taken without incident? How long had it been since there was even the shadow of a fear of another clot? This guy seemed to have it right. I was on board with his un-diagnosis. And I ended up with the coveted Class 1 medical clearance – worldwide available.

Two years in Juárez. No overseas flight, but a five-day road trip from D.C. to the borderland without incident. So many road trips to Lubbock and Dallas and Santa Fe during those two years I’ve lost count, plus trips to Big Bend, the Davis Mountains, and Tucson. Nary a twinge in that calf. The home leave road trip extravaganza from Juárez to Arizona to New Mexico to Oklahoma, down to Dallas, back to Oklahoma, and to D.C. via western New York. The flight from D.C. to Brussels to Accra. Nothing. I was fine.

And then I wasn’t. And it felt like a knockout punch when I didn’t even know I was in the ring.

I’m getting back on track now. I have a determination, at least, that I didn’t have last week, to not be stopped by this unexpected development. There’s no reason, physically, to let it stop me. In the years since my last clot the idea that people need to be immobilized in the wake of a clot diagnosis has gone away. For superficial clots, in particular, mobilization is supposed to be part of the treatment. So I’m walking again (dang it’s hot with those stockings, though!) And today I went back to church. Next weekend is the Marine Ball and we’re going to that, and this weekend has been packed, between neighborhood happy hour, a dinner at the Ambassador’s residence for new officers and spouses, and a few birthday parties. I’ve been working again, and I’m loving that.

But it’s been a real blow. And it’s the first time since we started our foreign service adventure that I’ve found myself feeling homesick and melancholy for the comfort of having old friends surrounding me. I’ve had moments, of course, those blues that come and go as I think about the things I’m missing in the lives of those I love and the things they’re missing in mine. This felt different, though. Because I had been feeling pretty immortal. Pretty in-control and in charge of my destiny. Which of course is always an illusion. It’s not an altogether bad thing to be reminded of one’s own limitations and reliance on others. And there are people here for me to rely on – Andrés, of course, and the kids, and neighbors and friends I’ve met here, and my amazing house helper, Rose, whom I had providentially met and hired about a week and a half before this happened.

This is part of foreign service life. It’s the kind of thing we know we’re signing up for but can’t really grasp until it happens. It’s part of why making friends amongst the foreign service community tends to be so fast and so easy – we all know what it’s like to feel so far from home and we all know that we need to create home here in order to make it through.

So friends, family – I miss you! But I am fine. I’m surrounded by my fantastic husband and awesome kiddos and new friends and by the love I know you all send. I’m getting back out on my well-worn paths. I’m getting healthy again and have a new appreciation and awareness of the continued reality of my clotting risks. My own health is definitely something I had come to take for granted. I’m very thankful that my wakeup call wasn’t as dangerous as it could have been. And also that I didn’t get med-evac’d. London is a lovely city, but I’d rather see it under different circumstances.

Coming soon: the Cape Coast trip. Within a week, I promise!