Spaz

Spaz

A heavy thud sounds in the living room, followed by the shrieks of my nephews, two-month-old Jamie and three-year-old Mikey. I’ve just gotten home from high school, and as I enter the room, I see my mother convulsing on the floor beside the couch with Mikey tugging on her arm and Jamie beside her on the floor crying. Mom’s eyes are squeezed shut tight like a child’s during the scary part of a movie and the tip of her tongue protrudes from her pursed lips. Her petite frame is jerking uncontrollably and her hands are flexed into tight fists. She wildly flails her arms and legs, nearly knocking Mikey down. He begins to shake her arm and cries, “Grandma, wake up! Grandma!”

At first, all I can think is “Make sure the kids are safe.” I put Jamie in his swing with a pacifier, but he spits it out and continues to howl. Mikey refuses to leave his grandmother’s side, and I don’t have time to fight with him. Mom has writhed her way off of the carpet of the living room so she is partway onto the hard tile floor of the kitchen. I take her clenched fists and drag her to the center of the plush carpet so that she can’t crack her head and elbows on the tile. Grabbing her glucose meter off the kitchen table, I attempt to test her blood sugar. I have to kneel on the palm of her hand to make her manicured fingers uncurl. Her whole body is tense and jerking.  I barely manage to squeeze a drop of blood from her calloused fingertips; the skin is thick from a lifetime of needle pricks. The meter’s screen shows an hourglass as it calculates her glucose level. A healthy blood sugar for her is between 90 and 120, but the machine just shows “LOW”. That means she must be below twenty--too low to even register on the machine.

I unhook the long tube connected to her insulin pump so that she can’t get any more insulin and unclip the pump from the waistband of her classic “mom jeans.” I leave the short tube that is connected to a needle in her stomach so that she doesn’t have to re-inject herself later. When she recovers, she will try to reconnect the pump before she is ready for more insulin, so I have to hide it from her. I run to the desk drawer for the glucagon injection kit my father has stashed for us to use, but it’s gone. I ransack the refrigerator, where sometimes a spare is hidden behind the butter, but that too is gone. Both probably used last week. Growing frantic, I race to my parents’ bathroom. The sound of my nephews’ cries is slightly dimmer here on the other side of the house, but the vaulted ceilings make them echo enough to make my heart thump in my throat. The pounding of my pulse against my larynx feels like a boxer pummeling a punching bag. I untangle a mess of surgical masks and glass vials in Dad’s bathroom drawer, but find only a large bottle of 50% dextrose solution. Dad can inject it straight into her veins, but he has been a doctor for more than twenty years, and I have to try several times just to make myself jab that long needle into my mother’s forearm to inject the medicine intramuscularly like he taught me and my four older siblings. The phone is lying on the bathroom counter, and I quickly dial my dad’s cell phone. It goes straight to voicemail. He must be in surgery; his phone never gets reception in the operating room. I’m on my own this time.

As panic and frustration swell in my chest, I hurry to check on the chaotic scene in the living room. Mom is getting worse. She is moaning and her eyes are open now, but they are still and glassy. Her jaw is still tense and she bites her thin lips so hard I worry that they might be bleeding. Her dark, usually perfect, hair is matted to her head from her convulsions and sweat glues her clothes to her body. A combination of sweat and tears has sent streaks of mascara running down her softly wrinkled cheeks. “When did she last eat?” I wonder. “Why is it so hard for her to eat on time?” I put a pillow beneath her head in case she starts convulsing more fiercely. Mikey’s face is red and wet from crying, and I hold him on my lap while I watch my mother writhe on the floor, unable to save her.

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Mom zipped the suitcase shut so hard that she snapped her fingernail, but she didn’t care. She stormed out of the bedroom and headed for the front door. Dad walked in just as she reached for the handle.

“Look, just stay here,” he begged.

“I don’t want to be around you anymore,” she spat back.

“Fine, I’ll leave and you can stay here. You can’t be alone.” I cringed at these words, having just been yelled at for half an hour about how she could take care of herself.

“How would you know? Get out of my way!” she shouted and pushed her 5’6” frame past his 6’4” and slamming the door in her wake. I think I was trembling.

Dad sighed deeply and asked in a tight voice. “Do you know where she’s going?”

“No, but she said…” my voice trailed off as my throat tightened with tears. My voice sounded thin and tinny. “She said she didn’t need us. She said she is sick of us always checking on her and she can take care of herself. She said she isn’t coming back.”

My dad didn’t respond. My heart felt like it suddenly weighed too much for my rib cage to hold up. Mom had gone out to do errands that morning without her cell phone, as usual. She was gone much longer than we expected, and we started to get worried that she had spazed while driving or in a store somewhere. My dad had called in a favor with another doctor so he could leave a surgery to drive all over town looking for accidents. Meanwhile, hours after she had left, Mom walked into the house and found me frantically calling every place I thought she might be. She exploded. She was a grown woman and she could take care of herself, she didn’t need us checking up on her all the time, we were so inconsiderate, we treated her like a child. She shouted and raged, pursing her thin lips until they were indistinguishable from her skin. Suddenly, she ran to her bedroom and started throwing clothes in a bag. I tried to convince her to stay, but she was in a panicked frenzy. She left so she could prove that she could take care of herself, and proving it could kill her.

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When Jennifer was diagnosed with diabetes at the age of 15, her doctors told her that she would never have children and she wouldn’t live past 45. When she was 21, she gave birth to her first daughter and proved that though it was difficult and risky, her doctors were wrong. She could have children, and she went on to prove them wrong three more times, adding another daughter and two sons to her posterity. After each of her four children, Jennifer was given a complicated medical spiel about the dangers of high risk pregnancies like hers and warned against having any more children. As a Type 1 diabetic, pregnancy was very hard and hazardous to her health, and with each successive child, her doctors became more adamant about the urgency of her sterilization.

“Mrs. Thomas, having children is very dangerous for you. You should be grateful to have had one healthy child and have the procedure now to prevent any further risk,” a know-it-all intern told her after her first child.

After the second baby, a kindly doctor explained, “Your blood sugars were fairly stable during this pregnancy, but who’s to say they would be again? You know the dangers both for you and your child. Please seriously consider having the surgery.” But Jennifer held out. Her husband, Mark, was a doctor as well, and he decoded the embellished lectures so that Jennifer understood the risks and benefits. He was nervous for her health, but knew that it was her decision.

“Mrs. Thomas, this is incredibly irresponsible of you. You are placing yourself and your unborn baby at risk. Your diabetes is twice as hard to control when you are pregnant and all of the regular risks you face are doubled. Your body simply cannot take the stress of carrying another child to term,” was the persuasive attempt after the first son was born.

“All right. You have two healthy daughters and two healthy sons. That’s more than many people without diabetes can have and you should count yourself incredibly lucky to have safely delivered them and have so little lasting damage to your body. Your kidneys are in good shape and your circulation is good. Count your blessings, Mrs. Thomas, and let us do the surgery.” Finally, Jennifer gave in. Believing four to be enough and following the doctor’s instructions to “count her blessings”, she allowed the doctors to perform a tubal ligation, permanently sterilizing her. Within months, she regretted the decision.

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We must have used the other shots on the previous week’s spazes, and Dad just hasn’t had time to refill the prescription yet. Medically speaking, what my diabetic mother is going through is hypoglycemia, an insulin reaction. It’s a kind of insulin overdose. Basically, there is too much insulin in her blood and not enough sugar. It could be caused by her not eating enough, by her giving herself too much insulin, or both. Physically, there just isn’t a high enough level of sugar for her brain to function normally. The brain is the only organ that requires that high of a level to function, so the rest of her body is fine, but her brain, the control-center for everything else, is temporarily broken.

For as long as I can remember, my family has called this being “spazed.” Usually when her blood sugar is just a little low, Mom just acts goofy, like a spaz. Her reflexes slow, her speech slurs, she twitches, and something in her voice changes. It is just a slight audible twinge of looseness. It’s so subtle that hundreds of grocery store checkers and even close friends have never noticed it, but it’s so distinct that her children and husband can detect it over the phone. In those cases, we simply ask her to test and eat something. A soda, or some candy. Once, my dad even fed her hummingbird food. It’s just straight sugar dyed red after all, and as they were on vacation at the time, that was all he had immediate access to. But this spaz is not the kind that can be fixed with a handful of Skittles. I could try to force feed her candy, but she has lost the muscle control needed to swallow, so it would only choke her. I need a glucagon shot to save her. Unhooking her insulin pump will prevent her from getting any lower, but it won’t make her any higher, and every second that she remains this low causes irreparable damage to her brain. 

I continue to call my dad, and he continues to not answer. If he can’t come help me, there is only one other choice. Mom has had 911 called for her before, but it’s incredibly embarrassing for her. She hates for anyone to see her so indisposed and incapable of controlling herself. Once, when she was pregnant with my older sister, she spazed after taking a shower. Hours later, after a nervous neighbor called the police, the paramedics kicked in her door and found her naked and unconscious. They gave her an injection, and when she came to she was surrounded by uniformed men and very aware that her pregnant body was exposed. Mom has had some bad memories with 911, but I can’t think of anything else to do. It’s a choice between saving her life and saving her pride.

My hands are shaking as I take up the phone again. I dial the three fateful numbers and hold the phone to my ear, when suddenly my cell phone begins to ring across the room. I hastily hang up the phone before it even rings and reach for my cell phone. Miraculously, it is my dad.

“Hey Hannah, I saw your missed calls. What’s up?”

“Mom is spazed really bad and I can’t find a shot.” I rush the words, not wanting to waste any time talking.

“Damnit, I just put a patient on the table. Are you sure there isn’t one in the back of the desk drawer?”

“I dumped the drawer out.”

“Have you checked the car?”

The car! How could I have forgotten the car? We always keep one stashed in the glove compartment of Mom’s car since she’s totaled two cars by spazing while driving. I dash out to her white SUV and grab the orange case that holds the glucagon shot, tripping over one of Mikey’s toys as I run. Racing to mix it as quickly as I can, I shoot the sterile water into the vial of powdered glucagon and shake the mixture together. I carefully draw the liquid back into the syringe and flick it with my fingernail to pop the bubbles. Mom isn’t moaning anymore; she is completely still on the floor, which scares me even more. I keep thinking of her last visit to her doctor. He told her that someday soon she is going to spaz and just not come out of it no matter what we do. I’m praying that this is not that time.

I have to psych myself up to stick the needle in Mom’s arm even though I know I have to do it fast. After a few deep breaths, I quickly plunge the needle in and press the plunger. She barely even winces. Done. I get some blankets from the closet and cover her up since she always gets cold as her blood sugar rises. While I wait for her to recover, I check on the kids. Mikey has stopped crying and is sitting beside Jamie, who has fallen asleep in his swing. Suddenly, I notice a large red mark on Jamie’s forehead. As I examine it, I remember Mom’s position when I entered the room and realize that he must have rolled off of Mom’s lap and hit his head on the foot of the couch when her convulsions made her fall off. I pick him up and cradle him in my arms, terrified that his fall might have caused some lasting damage. What will my sister Michelle say? Our mom watches the boys every day while Michelle works, but Mom’s inability to control her diabetes is putting them in danger. She has spazed while watching them before, but they were always safely locked into high chairs or napping, and those experiences were scary enough. I wish that Michelle would find someone else to watch her kids, both for the boys’ sake and for Mom’s, but she doesn’t think it is a big enough danger. This time Mom’s spaz has actually caused physical harm, and Michelle won’t be able to ignore that. Jamie squeaks a tiny cry and I realize I’m holding him too tightly. I loosen my grip but still clutch him to my chest, trying to protect him from a danger that has already harmed him. Dad will have to check Jamie out later and make sure there is no damage. If there is, Mom will never forgive herself, and neither will I.

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         Mom stayed away the whole weekend, but so did Dad. He was on call and just slept at the hospital, hoping that she would go home if he wasn’t there. Not wanting to stay at the house by myself, I went to my sister Michelle’s.

         “I hate her,” I said as we stress ate Oreos.

         “No, you don’t,” Michelle answered calmly. “You just think you do right now. If you hated her you wouldn’t be so worried about her.” Michelle hadn’t been there for the dramatic escape and preceding tirade, so she was much calmer about the situation than I was.

         “Fine. I hate how she treats Dad and I hate how completely insane she is.”

         “Me too. But when she does crap like this you just have to remember that you are going to be a better wife and mother than her. We don’t have to be like her just because we are her daughters.”

         “I will never treat my family the way she does. I would kill myself before I got to point where I was as miserable as she is. That’s no way to live. She is determined to be miserable no matter what. If Dad is with her, she thinks he is annoying. If he is at work, she thinks she doesn’t matter to him. If he calls her while he is at the hospital, he is interrupting, well, nothing, because that’s all she ever does, unless she is babysitting. I couldn’t handle having that kind of useless life.”

         “So decide now that you never will. Whatever Mom does, you will do the opposite.”

         “Don’t let me be like her, Michelle. If I talk to Dad in that snotty voice she always has, slap me. If I’m upset and unreasonable like her, call me out on it.”

         “Okay, but you have to do the same for me. And we can’t ever get mad at each other for doing it either. We’ll correct each other because we love each other.”

         “Deal.”

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Dave rolled onto his side and faced his wife on the right side of the bed. She was breathing deeply but he knew she wasn’t asleep.  He watched her stomach rise and fall with each breath and saw how her belly was swollen just enough to make the buttons of her pajama top pull slightly. The couple had recently discovered that Jennifer was four months pregnant despite the fact that she had had a tubal ligation four years ago. They were understandably shocked, but thrilled because they had prayed for a way to have another baby. They had investigated adoption and surrogacy, but both were expensive and they barely made ends meet with the four kids they already had. Dave worked as an anesthesia resident at a hospital in Portland, Oregon, and his pittance of a salary left less than no room for saving. Dave and Jennifer were delighted that medical science had failed them in this instance, and since only 0.4% of all tubal ligations fail they felt very lucky. They knew the pregnancy would be dangerous, but they felt that the baby was blessing and the Lord would help both mother and child to be healthy.

Dave’s excitement about Jennifer’s pregnancy was dampened by his intense worry about their finances. His salary as a resident was next to nothing, and they had already used half their savings in the year they had been in Oregon. He still had two years of residency left before he would be able to make any real money. Jennifer had just been hired as a checker at a local supermarket when she found out she was pregnant and had to quit. She couldn’t work when she was pregnant—it was too stressful and made the pregnancy harder for her and the baby. Finances were strained enough with the two girls and two boys they had, but now another daughter was coming. How would they be able to pay for this baby? How could they possibly afford it?

Cautiously, Dave reached out and touched Jennifer’s arm. “Honey, we need to talk.” Jennifer looked at him but didn’t turn her head. The dark room was still and uncomfortably silent.

“I’ve been thinking about how we are going to afford this baby. You know we don’t have much left in savings…” Dave trailed off, but Jennifer didn’t respond. He ran his thumb along a crease in the sheets.

“The only thing I can think of is reenlisting.” Dave had joined the Air Force to pay for his schooling, and though he freely admitted he would do it again, he had hated his experience. It was the only way he could pay for school without racking up tens of thousands of dollars debt, so it had to be done, but every day in the military was a struggle. Dave was a product of his generation; he had been raised in the “Question Authority” age, and the sentiment still rang true in his heart. He was never outwardly rebellious, but he was rabidly independent and hated needing help. He wanted to be able to do his own thing and be his own boss, but the Air Force wouldn’t allow that. The day he was released from active duty was one of the best days of his life.

“I could reenlist for the rest of our time here, and then we would owe them another two years of service. We wouldn’t be free to go where we want for another four years—“ Dave’s voice cracked as his vision grew watery. The stress of their financial situation suddenly became more than one person could bear and a few tears ran over his cheeks and into his sandy brown hair. “Honey, please tell me what to do. Help me figure this out. What do you want? What do you want me to do?”

Jennifer stared at the ceiling for a moment while Dave wiped his eyes, trying to be strong. She took a slightly deeper breath and rolled over on her side, away from her husband. She was silent. Dave stared at her back, not surprised but bitterly disappointed and hurt. This was just another stab into scabbing wounds she had already inflicted. A knot of anxiety in his chest throbbed as he searched, alone, for some way to keep his family afloat.

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Mikey now leaves his post by his baby brother and kneels by Mom’s side. He leans down and kisses her cheek several times.

“Mikey, leave Grandma alone; she’s sick. Come over here with me and Jamie.”

He kisses her one more time and furrows his little brow. “It’s not working.”

I realize that he is attempting to revive her. From the time he was just a baby, we’ve taught him to play a game where we pretend to die and he kisses us to bring us back to life, and now he is applying that logic to my mother. I gently pull him aside and explain, “Mikey, Grandma is sick. Kisses won’t help this time, but I gave her some medicine and she will get better in just a little while.” He doesn’t understand, but he nods and lies down beside my comatose mother, hugging her arm to his chest.

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         When Mom came home, Dad didn’t. He told Michelle and me that he was going to start looking for an apartment because if she couldn’t be happy with him around, maybe she could be without him. He would still call and check on her and run to rescue whenever she fell apart, but he wouldn’t be at the house so she couldn’t say that he wanted anything but her safety. She wouldn’t be his cook or maid (not that she really was to begin with; she hadn’t done real housekeeping since I was in elementary school), so even in her twisted mind she couldn’t say he was using her. When Dad said he was moving out, I hated her even more. Dad was the best person I knew and the only thing that made living at home for the summer bearable. If she pushed him out, I would go and stay at Michelle’s until it was time to move back to college.

         The day after she came back was my 20th birthday. We had planned on going to dinner as a family, but I didn’t want anything to do with her. I didn’t want to talk to her or even see her. This was not the first birthday she had ruined by being completely crazy. I just wanted to spend the day with my dad and siblings. They were the only people who understood what it was like to be related to her. We were bonded together by blood and the sheer fact that we everyday survived being her family.

         “Hannah, you have to have Mom come,” my brother chided. “Maybe making them be in the same room will make her be nice.”

         I looked at him sarcastically.

         “Okay, not nice, but maybe it will make her realize that we won’t be a family if she lets him leave.”

         “Fine,” I groaned. The birthday was ruined whether she was there or not.

         At dinner, Mom and Dad sat on opposite ends of the table and didn’t speak. Mom’s gaze was icy and the smiles she gave me because of my birthday were fake and insincere. Dad was loving and tender, but his face was pained whenever he looked at her. I remembered asking him when I was younger how he could still be married to her. He answered, “I’ve tried not to love her, but I can’t.” For better or worse, he loved her and would never abandon her. Even if she deserved it.

         After the birthday festivities wrapped up, Mom and Dad disappeared into their bedroom. Not long after, Dad came out and said he was staying. He told her he wouldn’t stay unless she wanted him to, and after several long, uncomfortable silences, she barked, “Fine.” Hardly a loving invitation to come home, but it was enough for my affection-hungry father. He would stay and endure her irrational treatment so that he could take care of her because he couldn’t not love her. “You and me both,” I thought.

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The doctors were wrong about Jennifer being unable to have children, but she paid a high price for her fifth child. After her healthy daughter was born, Jennifer developed hypoglycemia unawareness. This new side effect of her disease made it so she could no longer tell when her blood sugar was dropping. She didn’t feel shaky or weak as she had before when her blood sugar dropped. Without these warning signs, Jennifer had to rely entirely on her glucose meter to determine whether her blood sugar was at a safe level. She now needed to test two or three times as often to manage her diabetes, and even then it sometimes wasn’t enough. Hypoglycemia unawareness made the disease much more difficult to control and to live with and put her at even greater risks for complications. Through some incongruous twist of Providence and Science, she was forced to trade most of her ability to lead a normal life for the newborn daughter she was never supposed to have.

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Cradling my nephews in my lap, I sit beside my mom and blot the sweat off her forehead with a towel. My hands are shaking slightly from the adrenaline rush of the crisis and I feel slightly nauseated. I’m terrified that this will be the spaz that does her in, I’m worried about little Jamie’s head, and I’m growing increasingly angry. Furious. It doesn’t seem right to be so angry at someone who is currently incapacitated, but I am. This is her fault. These episodes are preventable. All she has to do is be careful how much insulin she gives herself and make sure she eats on time. Millions of diabetics do it every day, and many of them have had it far fewer years than her. She has had diabetes for more than 35 years, and yet she still acts like an inexperienced teenager, like she doesn’t know what will happen if she isn’t careful. She is careless and doesn’t think about the consequences of her actions, not only for herself but for us, her family. She seems like she is just tired of being diabetic, like after 35 years it’s just too much work. I know testing every half an hour is a hassle, but it’s not hard either, especially when this is the alternative. I’m thinking horrible thoughts about her and I hate that, but I’m so annoyed at her for her negligence. She not only put herself in danger this time, but the boys too. That may be unforgivable, depending on Jamie’s condition. I want to reach out and slap her unconscious face. I want to shake her limp shoulders and yell in her ears that she is doing this to herself and I hate it. I want to tell her that she better take care of herself because next time I won’t be there to stab a needle in her arm and save her—but I can’t. I know it isn’t true. I can’t not save her. She’s my mom.

She is starting to come around. She can’t talk yet, but her eyes are focusing on me now. A few minutes more and I may be able to get her to her bed. Mom slowly reaches out and squeezes Mikey’s hand; he is thrilled. He jumps up and down and kisses her cheeks, rejoicing that she is okay. Now assured of his grandmother’s survival, he turns to me and asks, “Can I watch a movie now?” I smile and turn on a cartoon for him. Mom is trying to sit up now, and I help her to her feet. She still can’t walk very steadily or smoothly, so I put her arm around my neck and together we hobble to her bedroom. She sinks into her bed gratefully and falls asleep immediately. Bad spazes like that always wipe her out. She will feel sick for the rest of the day and maybe even tomorrow, but she is better. She is better, and now I can turn my attention to my possibly traumatized nephews and our family’s greatest problem of all: how to save my mother’s life.

If this keeps happening, she’ll be dead within five years. Brain-dead at the least. She’ll rot in a nursing home garden because she has always said she couldn’t bear to burden one of her children in her old age. She’ll be a slowly decomposing vegetable. My dad and my siblings have thought up a million different plans to prolong her life, but nothing works. We got her a cell phone so we can find her and check on her when she goes out alone, but she always forgets it. My dad calls five or six times a day to ask her to test, but she just yells at him for annoying and interrupting her. I’m graduating in a month and I’m considering postponing college just so I can stay and take care of her until we figure something out. She acts like this disease is hers alone, but it is infecting all of our lives. She won’t take care of herself, so we have to. We can’t, won’t, just let her die. My anger has given way to desperation now, to a hollow pleading with the universe to make her change. I collapse on the floor beside Mikey and cry. He has already forgotten about the fear he felt before and is completely wrapped up in his cartoon. He doesn’t notice me beside him heaving wet sobs. He is totally unaware of the gravity of our situation, of his grandmother’s impending death. I weep and find myself incredibly jealous of his ignorance.