"Sirens in the Distance"

 

            Before this morning’s freezing daybreak, emergency sirens sounded in the distance. Sympathy seeped into my waking thoughts. With all of the construction surrounding our home, that wail signals an accident on the highway. Someone’s day sucks before sunrise. The single scream lasts only seconds as a second and third join in with discordant harmony.

            My imagination transports me to the scene where crumpled cars with unpaid balances block the road. The incessant red and white of flashing ambulance lights dance in the soft morning light. Police honoring their code to protect and serve hover nearby. Fire trucks stand alert. The injured drivers and passengers, attached to monitors, get loaded and zip away.

           

            What tragedy awaits these people? Vehicles demolished beyond repair. One trip to an emergency room, even with insurance, costs too much. An accident caused by one second of inattention in a high construction area, and every person impacted faces financial disaster. I don’t allow myself to envision death within the destruction.

 

            I don’t attend to the returning siren songs as my morning routine pushed away their lament. Only now, with my mug of hot tea and keyboard before me, do I wonder and worry about the sorrows of these strangers.

Daylight and still dangerous!

 

Copyright 2025 Elizabeth Abrams Chapman

"Cat Scratch Fever"

 

Six year old me (scars and all!)

            “Lizzy, let Penn in,” my mother directed as she shifted an overloaded bag of groceries onto her right hip and struggled to fit the house key into the back door.

            Penn, our Welsh Terrier, sat obediently at the gate, his little stub tail wagging eagerly in anticipation of entering the house. Penn, a typical Welshie, perked his head to the side in curiosity as his gaze shifted from me to Mom as she opened the back door. Carrying groceries, I elbowed the gate latch up, shifted to butt the gate out of the way, and followed Mom into the house, taking it for granted that our spunky terrier would follow on my heels. After all, we carried food!

            Feeling a whoosh of air around my legs, I spun around to witness a black and tan streak blur out of our yard and head for open spaces.

            “Peeeeeeennnnn! You come back here!” I yelled, dropping the groceries as I leapt down the back steps in pursuit of our dog.

            Now, Penn had a reputation in our neighborhood. A high energy dog, his devotion to my sister, brother and me made him extremely protective of us. My parents returned twice from evenings out to find our babysitter sitting on the back porch, us three kids playing in the kitchen within her sight, and the dog guarding the back door in ferocious dedication. Like most Welsh Terriers, Penn formed his own decisions and would never back down from perceived “danger.” For him, that meant he had to defend his kids at all costs.

            Freedom made him crazy with doggy glee, and he cut across the play area, running in circles around me as I tried to get him to jump into my arms. He’d dash full speed at me, make as if he would come into my embrace, and then veer off wickedly at the last second. Each time he made his circle, he widened the circumference of his loop until his orbit started zipping him into the back yards of our neighbors who didn’t have fences.

Suddenly, he broke from his circular rotation and made a dash to the opposite side of our field, and I pelted after him, my legs pumping like pistons. I’m not certain what happened next. Penn shot across one yard where neighbors had their cat staked out on a super long lead. I remember watching the cat spring straight up in the air, almost like a cartoon, with her fur bristling out and her snarling meow and menacing hiss bringing Penn to a full halt. At that point, I lunged for Penn, but he escaped my tackle attempt and continued on his mad dash. As I got to my feet, the hysterical cat started climbing onto me, digging her claws into my skin as she tried to get onto my shoulders. She dragged her lead with her, tangling my feet and legs. Before I knew it, I hit the ground again. Startled even more, the cat caught my right arm in a death grip and wouldn’t let go.

By this time, Penn sensed my pursuit of him had stopped and circled around in time to see me go down in a free fall with the cat attached to me. Terrier instinct took over, and he swooped in to defend me from the cat by grabbing the cat’s leg and pulling with all his strength. He’d pull and shake, pull and shake, trying to rip the cat free. And the cat’s claws dug deeper and deeper into my arm.

By this time, the entire neighborhood’s on alert! One woman, nine months pregnant, grabbed a broom and started beating Penn over the head, but he ignored each blow. Our next door neighbor, who played often with us and Penn, managed to pull the dog off the cat and haul him away while other kids and adults examined the pulp of my arm.

When my mother ran up, she found me sobbing uncontrollably as blood seeped through my sweater. Always calm in emergencies, she grabbed an offered towel from one neighbor, instructed my sister to get her purse and car keys, told the boy holding Penn to take him back to our yard, and carried me over to the car.

The emergency room staff, of course, knew me. I had enough visits to the ER that my parents worried the nurses would report them for abuse. My injuries, though, always had a bizarre tale attached to them that dovetailed with the physical evidence. Coming in with a clawed up arm and a story of my dog trying to rescue me probably topped the list. With efficiency, the nurses cleaned my ripped fingers and doused gallons of antibiotic scrub on the deep punctures the cat’s claws gouged into my arm. The doctor took a look at their handiwork, gave me another shot of penicillin for good measure, and sent us on our way.

Within a few days, the fever started. My arm throbbed constantly and overnight the wounds began oozing white puss. Another trip to the ER had the young doctor pouring over his medical books to diagnose Cat Scratch Disease. He changed my antibiotics, gave explicit instructions on how to care for my wounds, and sent us on our way. Every day, I’d head to the school nurse’s office to have my injury cleaned and new bandages placed on my arm. At first, the nurse would cringe and grimace at the seeping mess. Eventually, the antibiotics kicked in and the fever and infection went away.

I still carry the scars on my arm from my encounter with Cat Scratch Fever. Fortunately, I never attached any type of trauma or phobia to the participants in this event. I still love dogs and cats, and I don’t panic when I see pregnant women waving around brooms! I’ve never met another person who also contracted the disease, so as a child I enjoyed my notoriety that the disease afforded me. Finally, I survived the years of teasing from my family that I endured once Ted Nugent’s song hit the airwaves.   

Copyright 2011 Elizabeth Abrams Chapman

           

"The Last Dance"

  On November 4th, I found myself sitting outside the door of my mother's hospital door, weeping. The nurse huddled next to me, looping her arm around me in sympathy as I cried. I couldn't get my mother to eat, or drink, or take medication. Whenever anyone placed something in her mouth, she pushed it out with her tongue, or let it sit with a slack jaw until it spilled from her lips in a nasty pool of drool. My mother's sudden inability to swallow anything caught me unprepared. The week before, she ate her pancakes swimming in syrup, drank her hot chocolate Boost laced with Carnation Instant Breakfast. She devoured a bowl of homemade split pea soup loaded with onion and bacon, and asked for her favorite, spaghetti. Within a period of a few days, Mom's tongue insisted on doing the opposite of what she needed in order to survive. Anything placed in her mouth got uncontrollably shoved right back out.  

When I called to have the home health care nurse check Mom because her fluid intake dropped so much within a twelve hour period, the nurse suggested that Mom may have had a urinary track infection. She'd had other patients exhibit confusion and passivity along with the swallowing problem. We began enticing Mom with cranberry juice, made certain she drank more water, and watched her carefully. By the next day, Mom only drank twelve ounces instead of her usual thirty-two. She barely ate any food and asked often to go "home." When she needed to use the restroom around 11 o'clock that evening, I noticed her hands felt cold, her legs looked shrunken. We immediately tried to get her to sip some water, but she pushed her tongue against the straw instead of drawing the tube into her mouth. Finally, we tried using a syringe to place fluid into her mouth. She let it pool loosely until it trickled from the corner of her lips. Alarms rang. We decided not to wait for nurse's visit scheduled for first thing the next morning. Instead, we warmed Mom in her favorite blue robe and rushed her to the ER once again.

  Hospital time matches nothing in the outside world. Every minute passes with excruciating slowness. In the four hours that it took for the nurses and doctor to run tests and process everything for Mom, she'd shrunk into a withered prune. The skin on her hands creased into ridges. The pads of her fingertips changed from smooth to wrinkled surfaces. Her hands lost all heat, and when I held one I thought, "She's turning to ice." Mom's legs kicked about in anxiety as her chorea surfaced with the stress of the situation. I watched the skin on her shins pull tight over her bones while her calves puckered. Whatever fluid her body contained pooled toward her center, leaving her extremities cold as death. Eventually, an IV relieved Mom's dehydration. By 2 PM, her hands and feet thawed to room temperature. Her sunken cheeks still looked skeletal, but some color splashed across her face. By the second IV and round of antibiotics, Mom could eat a few spoons of the pureed pork chops and mashed potatoes the dietitian provided for Mom's lunch. Medication still resulted in a battle, though. The nurses left it up to me to administer the pills because Mom wouldn't or couldn't cooperate with them. This troubled all of us, and so the nurses contacted the on duty doctor and requested Mom have a swallowing evaluation performed as soon as possible. Within the hour, the specialist wheeled Mom down to XRAY for the test. The specialist explained to me that one of two possibilities appeared to be happening with Mom. In the first scenario, Mom's slightly elevated white blood cell count could indicate a urinary track infection in it's early stages. She proposed that Mom's HD made her susceptible to more confusion and physical symptoms like the swallowing problem. If that was the case, once Mom rehydrated and responded to the antibiotic treatment, she should return to her baseline swallowing--pills with foods like pudding, pureed meats and veggies, pasta cut in small pieces. I clung to her hopeful suggestion because I knew all too well the second option the specialist would offer to me. Mom's HD had shifted into a new level. Her frequent tendency to do the opposite from what she wanted (like pulling back when she wanted to move foreword, or not being able to move at all when she's trying to shift out of her wheelchair) could now be affecting her ability to take something into her mouth, maneuver her tongue to pushing the food back into the throat and then swallowing. She said Mom either couldn't or wouldn't move her food in any direction but forward and out of her mouth. The woman asked if we'd discussed tube feeding as an option with Mom. I assured her that we had, and that Mom had made it clear to everyone that intubation was not an option for her.

  We have lived with the dance of Huntington's Disease for ten years, the slow and inevitable death that carved away aspects of my mother's physical abilities along with her personality. Most days, her spirit stayed strong, but clouds of vacant thoughts sometimes blurred her eyes, and for short periods of time, Mom vanished. During the end of October, she disappeared for longer and longer periods. In her place were empty green eyes that disengaged by looking into the corners of the family room. When the hospital suggested we set up hospice, I knew that our lives would change once again. 

  In the weeks that followed, Mom rallied several times. A couple of mornings, early on, she ate an entire pancake or scrambled eggs. When she couldn't manage to suck through a straw, we spirited water, colas and Boost into her mouth using a syringe. A week after Mom's hospitalization, she began spending her entire day in her bed. We moved a television into the room and a comfortable rocking chair for me to use. Days strung together with hours viewing Mom's favorite television shows. I'd search Netflix every evening to line up possible movies for the following day. The little amounts of food Mom ate during those first days dropped off rapidly. Each day she ate half of what she'd eaten the previous meal. She never regained her ability to draw from a straw, and so one of us tempted her with fluids a syringe-full at a time. The hospice nurses explained that we fed Mom more for our own emotional needs, and that eventually her body would let us know that she wouldn't take any more food. The last thing I fed my mother was a bowl of ice cream--the food of her nightly ritual for most of her adult life. One afternoon she ate about half a bowl, but by that evening she refused to swallow any. Nothing enticed her to eat after that point, and I feared she would aspirate something if I pushed too hard. Eventually, Mom followed the same pattern with fluids. Weakness swathed her, and I became uncertain that she'd make it to my brother's promised Thanksgiving visit, but Mom rallied the moment he walked into her room. She smiled and held his hand, pushing her energy forward as he sat and talked to her. When he left the next day, she slept for hours, waking up only for minute amounts of water.

          The nurses assured us repeatedly that Mom felt no pain. They explained that the brain shuts down pain receptors as the body starves. I know, without a doubt, that this was true as Mom slowly melted away. I reached out to close friends and family members during those last days, I relied heavily upon the hospice nurses, social worker, and aid who energized me with their genuine compassion for our family. I found myself longing to sit down to write and somehow find control over everything.

  Yesterday, I put Sleepless in Seattle on the television, pulled my red fleece blanket up to my chin, and stroked Mom's brow as she slept for a second day in the row. Her breathing, slow and steady in slumber all day long, changed into a rapid pant. I called David into the room when it didn't stop and had him sit with Mom while I called the nurse. She suggested I start the morphine and said she'd be right over. An hour later, Mom's rapid breathing took on a little gurgle. When the nurse arrived, she administered a second drug and another dose of morphine. She examined Mom, told me to call family to get them here, and went over instructions for the rest of the evening. By the time she left, Mom's breathing rate had nearly returned to normal, but that only lasted a matter of minutes.

  And so we began the last dance with my mother.

  In Mom's dreams, she always walked. I like to think she's walking now, hiking up one of the crooked paths behind the cabin. I imagine her twirling in circles, a graceful dance unmarred by Huntington's.

Edna Abrams, November 2011

Copyright 2012 Elizabeth Abrams Chapman

"ER"

         About two weeks ago, my mother’s internist decided to add Zoloft to her daily cocktail of medications in an attempt to alleviate her frequent bouts of crying and thoughts of dying. I quickly reminded him that he’d tried prescribing Cymbalta for her a couple of summers ago with disastrous results. He assured me that Mom would be fine with this new drug, wrote the prescription, and sent us on our way.

         That Monday, Mom took her first 25 mg. dose, and she did seem less tense in the afternoon. On Tuesday, she didn’t cry even once during the day. However, that night she had the worse episode of insomnia I’ve ever witnessed! She not only kicked her feet back and forth, but also continually threw her pillow and blankets to the floor. She would pull herself into a sitting position by grabbing ahold of her wheelchair, and then fling herself back onto the bed. This went on hour after hour. Finally, after receiving her morning doses of her medications, she fell asleep.

         When Mom woke up around noon on Wednesday, she couldn’t speak at all. She could only manage to grunt in response to my questions. I tried to feed her by spooning scrambled eggs into her mouth. She clumsily shoved the food around, her tongue lacked coordination. She couldn’t swallow the soft food. Once I noticed she couldn’t even suck on a straw, alarms sounded. I began making calls to Mom’s internist—leaving messages on the voice mail because it was their lunch hour. Each time I called, I added another symptom to Mom’s growing list. Finally, I reached someone and was told to take Mom to the ER right away.

         By this time, her body had grown completely rigid. My son and I muscled Mom into the car and drove to our neighborhood hospital. She’s already in their system, so it didn’t take long to get the preliminary paperwork done.

         “As soon as we have a bed ready in the ER, we’ll get your mother back. It should only take a few minutes.” I felt a little calmer with the assurance that Mom would be bumped ahead of the other patients in the waiting room.

         Then a teenaged girl rushed in, followed slowly by a young man on crutches. The bandages on his foot couldn’t begin to sop up the flow of blood that gushed from him. A river of blood trailed from the sliding glass doors, across the floor, and to the nurses’ station. Someone rushed up with a wheelchair, and the blood pool continued to grow under the chair. Two nurses dashed to his aide, and the security guard fetched a custodian, who calmly began cleaning the area.

         “I’m sorry,” a nurse came over to us, “we’ll see your mother as soon as the area is cleaned.”

         So the promise of seeing my mother immediately ended up taking about forty-five minutes.

         Eventually, we wheeled Mom back into a room where the usual ER triage began. Blood pressure, heart rate, oxygen level, EKG, blood work all started quickly at that point. The doctor ordered a CT scan, x-rays for her lungs, and a urine test looking for any reason for Mom’s condition.

         I think I asked everyone I saw, “Could this be a reaction to Zoloft? She just started taking it. Could she be having some kind of reaction to it?”

         No one wanted to make a committal to anything until every test returned—all with normal results.

        Finally, the doctor came to talk to us. To my question about the Zoloft, he answered, “I’ve never seen anyone react to Zoloft in this way. I think you need to talk to your mother’s doctor tomorrow.” However, by this time it had been twelve hours since Mom’s dose, and she had regained her ability to answer simple questions.

         “Do I continue to give her the drug?” I asked.

         “That will be up to her doctor.”

       I made one of my executive decisions that I wouldn’t give Mom another dose without having a long conversation with both Mom’s internist and her neurologist.

        On Thursday morning, I called the internist as soon as his office opened. He returned my message quickly and said that he didn’t think the Zoloft had anything to do with Mom’s condition the previous day. Because I expressed so much concern, he agreed to have the dosage cut in half “for a few days.” My gut screamed that it was too much of a coincidence that Mom had this horrible HD incident within three doses of a new medication, but I couldn’t seem to get anyone else to make the connection! That is, not until Mom’s neurologist called.

         “Don’t put her back on the Zoloft. She’s having an overdose reaction,” he warned.

        “Both Mom’s internist and the ER doctor seemed to think it was okay, but I kept feeling that something wasn’t right,” I told him.

      “For most people, adding Zoloft wouldn’t have this affect,” her neurologist explained. “But for your mother, and the way HD’s hit her brain—along with the other medications I already have her taking, well—it’s good that you stopped the dose. Bring her in on Monday so I can check her over.”

         Exhaustion forced Mom into a deep sleep almost all of Thursday, and I fretted because she didn’t eat any food or drink any fluids for another day. On Friday, she could drink and eat again, but I had to feed her and hold her mug for her. During the weekend, Mom slowly regained more of her ability to move and to speak. By the time her neurologist saw her on the following Monday, she was speaking in short phrases again and could raise her arms up to shoulder level briefly.  

         Recovery comes slowly, though. Before the incident with Zoloft, Mom occasionally couldn’t remember me or David, especially after she had a round of insomnia. Now it’s almost daily that she’ll ask one of us who we are. She’s fixated on wanting me to take her home, forgetting that she’s lived here for eighteen months. The optimist in me clings to the hope that she’ll get more recovery as each day passes. My sister just left after helping us for the past four days, and Mom seemed to improve a little. Maybe she’ll be closer to normal once my brother arrives on this coming Friday.

HD brain on left. Normal brain on right

Copyright 2012 Elizabeth Abrams Chapman