The Snowman PDF

# The Snowman ## By Sonia B. SyGaco I was quietly building my snowman as everyone else climbed up the hill to snowboard between and through with canopies trees draped in white umbrella spreads. I was now working on his eyes, two round rocks I found nearby and paused to contemplate his outcome whe...

# The Snowman ## By Sonia B. SyGaco I was quietly building my snowman as everyone else climbed up the hill to snowboard between and through with canopies trees draped in white umbrella spreads. I was now working on his eyes, two round rocks I found nearby and paused to contemplate his outcome when snow flakes would begin to fall once more. How fast would he become a heap unrecognizable snowman? I wondered. This was my first time to experience winter and soon I'd be going home to a place where there are only two seasons: the wet and the dry. To observe the passing of American summer and the falling of the leaves were phenomenal experiences. Someone told me to come back middle of spring to see the revival of life from the frosty season. I declined as I had many other things to attend to. Months earlier, I had been switching places and time zones. Most often woke in the middle of my dream, asking where I was. Was I at home... in the pension house nearby the nursing school... into the Palm Plaza in Manila... or somewhere in America? I had been used to this sudden pace of life, my traveling bags on queue, waiting to be pulled for my next destination. I quickly glanced at my unfamiliar surroundings and pretended to know everything... caught whether to appreciate the beautiful Central Park or raise my weariness among the conjoined structures that kissed the Manhattan skies. I could join a marathon walk from this 30 minutes city exploration. Yet found my way --- 5 east, 98th Street and button 14 of the elevator showcased a medical office. "Is Dr. Salky around?" "Yes, he is and do you have an appointment?" the receptionist questioned. I nodded, showing my email message from the doctor. She handed something to keep me busy, same old paperwork--- detailing all health records of my companion, who was silently mousing behind me. The questions on the form forced me to review our circumstances on my mind. When had previous medications ceased not to work at all? When had I realized that my husband's stomach bloating was no ordinary case? I remembered losing so much of my time in Manila, searching for a physician who could answer the ailment that plagued his life. I came to know what Gastro Esophageal Reflux Disease (GERD) was all about. It was something bad; acid flowed back from his weakened valve located on top of his stomach to the esophagus. Constricting the esophageal passage, acid reflux even traveled as far as his throat. It gave a burning sensation on the tongue leaving an acidic aftertaste. When all the local doctors in our place could do nothing about it, I placed my stakes on something seemingly unattainable. My gamble meant speeding things up and hurrying before time would tell me that I had been too late. Our livelihood had to be maintained as we searched for a cure. I did not know how to tell it but should my flyer program which accumulated a wealth of points be something to be proud of? I even forgot to wash my son's hair for the time being and looking at Keanu digging his fingers into his dirty hair was heart piercing. The nanny could only give a body wash because all his confidence was placed on me. To bring my two year-old son into this pressing schedule was not easy. We could only be with each other on a Friday. A mother should be ashamed of, such brief catching up. Faced with multiple responsibilities, there was so much to do which included a coaching program for my workers in my cellular store. This aged little store which had been quite attached to me. By daybreak, I would warm my seat for a six hour drive to an out of town nursing school. I was becoming a sponge, ready to endure an extensive 14 hour lecture on nursing care. Physical and mental exhaustion would occur by Sunday afternoon. I would stare dryly at the mountain ridges of the road leading home. Without regard for the consequences, I was even elected president and juggled those chameleon roles when essential. Then came the time when my husband's body weight dropped tremendously, Dr. Solano, remarked, "Pare... I am sorry there is nothing I can do about your situation." Was I hearing it right? Could he do nothing about it? The words came like a hammer blow, this medical prognosis coming from a top-notch doctor. We were facing a dead-end for any hope of recovery. "You must travel with Uncle Winnie to San Francisco right after Christmas." "Must I?" "You must.... "I insisted. "I can't accompany you. Been there barely two months ago and going back to the consular office for another visa might just give me a rejection slip." "I will just accept anything." "But think of the little boy. What will I say to him when he grows up?" He did not answer and I knew exactly the words that should have been said. For at this time like any other newly married couple, the kind of words we would exchange would have been different. Perhaps it should focus towards household affairs, adjustments, and more adjustments with each other, not this kind of negotiation. I had to deal with him, only stopping when he finally agreed to travel. We sent him and Uncle Winnie to the airport after Christmas Eve. A melancholic season that reflected his well-being and caused him to feel deprived of what others were doing: no family gathering on Christmas evening and our house without the yuletide glitters. My expectations for a favorable medical outcome moved closer to the truth. Little had I known that a sick man would also lose his ability to make decisions. Now I guessed so. San Francisco General Hospital would accommodate him in the next five months. He couldn't even visit Seton Hospital or take a pick at Kaiser Permanente. I was prophesying all the things he should do when I realized the ability of working it out would lead to the impossible. When his short stay in America became insignificant, I advised him to return home. The preference of choosing an open surgery meant long months of recovery and so I became interested laparoscope operation. I found a specialist in Manila capable of performing a surgical wrap. This Laparoscope Nissin Funduplication would entail attaching a camera that passed through an incision on the stomach. The camera would send images to a video screen as the surgeon would make tiny skin cuts to continue placing other small instruments for surgery. The fundus (part of the stomach) would be tied around the lower esophageal sphincter to provide support. This was the only way to correct the acid reflux that affected his body weight. Months earlier, he had battled for his weight. Each attempt to increase a pound only led him away from the scale. Solid food couldn't move down from the inflamed esophagus. Mixing food in the blender was an easier way to eat. Yet what was there to taste when anything to be taken was bland? I couldn't blame him if he lost his appetite with all these food restrictions and the length of time each meal would take. The discomforts of acid reflux forced him to take an incline position with two or three cushions behind the bed to avoid the heartburn attacks. He even skipped his usual Sunday church service and became hesitant receiving visitors at home. He tinted the car darker so he could just drop me off the store without stepping out. When our friends asked me where he was I would simply say he was sick. "Sick" in the sense that they thought he had fever and they would reply that they wished he would get well soon. It was a private matter that couldn't be discussed with anyone, except for those very close around us even his trip to San Francisco. A call from America came through the day my husband was expected to arrive here. My aunt informed me that Uncle Winnie had something to say. My uncle had problems with phone connections and so I reasoned that this time the plane would still be flying across Manila. Upon reaching home, my husband declined to make a call back. One could see a face that could only smile when forced to. Only to know the following day, "I should be the one taken" he said softly. "Uncle Winnie accompanied me all the way to San Francisco and all the while, he pretended he was alright. Worst of all he worked at a cardio hospital. How could he be dead from heart failure?" Death had claimed him. The San Francisco trip was perhaps meant to account for Uncle Winnie's remaining days. That phone call intrigues me to this day. Was my uncle worried because my husband was unable to find a doctor while everyone was so preoccupied with their respective jobs? Unknowingly, months later, fate would bring us to the best gastro specialist, Dr. Salky. **Yahoo! Mail** **From:** [email protected] **Date:** Sun, 4 April 2004 17:33:34 EDT **Subject:** Redo I need to know what you mean by the Nissen fundoplication not working. I need to know the tests that have been done to show it was a failure, and I would like to have the pre-operative evaluation you had before the surgery. At least, I need a recent endoscopy report, motility study, barium swallow ray with fluoroscopy if possible, and maybe a pH study. The pH study could be the new "Bravo" system. The hospitalization for redo surgery is overnight, so it is a one day hospital stay. I will have my office manager check on the hospital charges for you. I assume you do not have American Health Insurance coverage. Please email Marietta (office manager) at [email protected]. She will get the costs of everything together. Depending on the actual cause of the failure and the preoperative physiological assessment, the results of redo surgery vary. However, it is generally quite good, assuming GERD was the problem to begin with. Approximately 90% of the redos get excellent long lasting relief, but certainly not 100%. It is usually easier to communicate with me via the [email protected] email address. Love your country. The last time I was there in November as an invited professor for the surgical society there. How did you get my name? Dr. Salky Through a series of email exchanges, Dr. Salky had been very accommodating. Today, he told us what we were going to do in the succeeding days. We took a train to the Bronx and felt a sense of belongingness with the Catacutan family. At sundown, the house along Wallace Street was often visited by neighboring Filipino friends. Discussions brought them back to the homeland; tales never to have any endings. The arguments and stories started what was left from yesterday's topic, until they asked, "So what are you here for?" My husband stared at me, "For a stomach operation. He had an operation in Manila three months ago and did not work well so he will have a redo." I answered. "Operation... ouch! And do you have a medical insurance for him?" I shook my head. "Well that is expensive and the hospital---? " "Mount Sinai" Their silence at that signified the end to further queries. We too became silent... perhaps too frightened to tell them what was going on. Unlike in Manila that took over a month of medical examination, this time, a wireless capsule was embedded inside his stomach. This single-use pill accurately captured thousands of pictures of the small intestinal lining then sent back through a small receiver placed on his belt. Days after, this electronic pill passed naturally out from his body. When the results were in, Dr. Cohen, of the New York Gastroenterology Associates opted for a no-surgery declaring that acid reflux was controlled. He further expressed an opinion hat the surgical wrap around the gastric sphincter was just too tight for food to pass through. He said that it would expand in due time and that another surgery was too premature at the moment. Dr. Salky on the other hand voted that surgery was necessary and that deletion wouldn't work. He reminded us to: "Keep track of your weights. If you lose weight, I need to know that. Regarding the difficulty swallowing, this is secondary to the inflammation around the "wrap". I would still want to wait until 6 months have elapsed between the original surgery and potentially doing anything. The only thing that could be done is to take the wrap down completely. That can be accomplished laparoscopically, but there is always a risk that it would have to be done open. Big difference in recovery. I would estimate that the chance of that happening would be around 1%." Embraced by the difficulty of deciding which table to turn to, we decided to go home and postpone any procedure. Life in the house was no different from my earlier tasks except that my flyer program came to a standstill. My husband continued to live as a recluse since nothing was getting any better. Food continued to stick in the esophagus. Two weeks later, danger must have followed. I discovered a purple bruise in one of my son's legs and begged him to watch his steps. I didn't have the energy of monitoring him closely nor had the power of taming him. A toddler would always remain within his world of play. That night, he asked for a cookie and this unwittingly led to a horrifying scenario. By dawn, blood... Blood was all over my son's pillow. We rushed him to the hospital and were relieved that bleeding from his gums just stopped. But in the succeeding hours he was becoming a speckled trout with spots all over his body. Grief ran through me as this bizarre illness gripped our family. One must learn to live with all the odds --- odds which force us to accept the uncertainty of our lives, lives colored in monochrome gray. Hundred days back - I was struggling to find the courage to keep a dying man's spirits high. But surely not this one. This my very own son to be taken into the ordeal that adults were undergoing, was something so hard to accept. The pediatrician reported an Idiopathic Thrombocytopenic Purpura (ITP), a rare and serious blood disorder of unknown origin. The antibodies destroyed the red blood cells that caused the inability to clot the blood and manifested through multiple bruises on the body. My thoughts played on me once more, thinking of the other diagnosis --- the possibility of acquiring leukemia. We had a history of children dying from blood cancer. And with two patients at hand, all I needed was more than divine intervention. Using steroids to increase the body's platelets created a moon face on my son. I pondered upon the complications: keeping him away from any physical contact. Otherwise, an internal hemorrhage might occur. To rule out that it would be ITP and not leukemia, a bone marrow test was essential. Lying face down, I saw the longest needle as it pushed down through his bone marrow. Taking tissue samples as the hematologist moved the handle of the instrument in circular motions. Despite the local anesthesia, my son could only utter, "Mama! Mama!" from pain. The bone marrow test confirmed enough production of the red blood cells. This gave me an immediate relief that leukemia had not taken its toll on him. The next minute, someone phoned me that my mother who worked in a judiciary court was not feeling well and needed to be fetched from her office. I responded immediately as I recognized mom's twitching mouth, knew she was suffering a mild stroke. I felt partly to blame for allowing her to stay with me every night in the hospital since my son was too young to be left alone. To make crucial decisions on three medical cases brought me to the scriptures - the threshold of Job's pain. I was leaping between mom's room which was in the third floor and the fourth floor where my son was confined. Now, that the bruises had appeared and reappeared after leaving the hospital twice, I was compelled to get a U.S. visa for Keanu. With an arranged schedule for surgery in New York, we might as well bring our son with us for treatment if things here wouldn't work out for him. My passport was annotated: accompanying husband for surgery in New York. Two asterisks were marked below my picture and a faded backdrop of President Abraham Lincoln. This had been my third time to get a US visa and each entry had a time line, each with a given purpose. It was not easy to get a Lincoln label. It was some sort of a wonderland the first time I joined the long anthill queue of other Filipinos. It was indeed a sort of a roller coaster ride or a bet for what next would come. Yet, each new day brought forth hope. The little boy became unmindful when blood drained from his index finger from the platelet routine. He was undertaking another kind of therapy from Cebu Doctors, another medical house across the island. When Dr. J. Queteves declared that my son was free from the bleeding and bruising disorder: it was time to travel to the United States. What annoyed me was the $10,000 increase in the medical quotation I had requested four months previously from Mount Sinai Hospital. I knew that every dollar added to the bill would be multiplied 56 times against the Philippine currency. I was no person with a big name in my place but merely one ordinary citizen. So more than anything else, I haggled and finally got the original price. My attempt to pull-out from surgery with the soaring medical bill was crazy, my husband told me. But nothing to be more stressful and crazy than to wait for the unfolding of a surgical procedure. Hopeful and altogether uncertain, I sat there for hours reminding of the medical journeys that brought me to the different places. It was a non-stop travel to hospitals... to live in and out. To quickly learn the language of medicine: esophageal manometry and motility, barium swallow, endoscopy, and ph study. Further than this, I could even be someone desperate enough to even rely on faith healing and other forms of oriental therapy. It was more than a measurement of one's faith and one's ability to think fast. Unable to reject thinking of the inevitable, I channeled my spiritual petition through my thoughts in this quiet time of waiting. I watched my restless son circling the medical lounge of Mount Sinai over and again. It was as if something had changed in him. He was so different from previous days. Now he had developed the fear of walking down the streets. I had to carry him each time I bought food down the alley of the Filipino Apostolate where we stayed and my back bent with the additional burden. However, I was the only one who needed to buy food since my boy was lactose intolerant. We brought along with us 24 big cans of powdered milk while my husband relied on the nutritional drinks available at American counters. By the time my son had fallen asleep on my lap I was completely glued to the spot and prevented from going elsewhere. I remembered, meticulously checking a catalogue of important things necessary for surgery. I'd been so engrossed on this aspect that I was having trouble confirming where we would spend the night upon our arrival at La Guardia. Every person we knew in this metropolis declined and provided the complex excuses for not offering us a night's stay. I silently argued that if only I knew which way to go, there would not have been a problem. But I was bringing along a sick man. Our cousins and some very close friends failed to see what we were going through. So the day my husband and I were scheduled to fly, I met a distant relative and her companion in a fashion store. In the course of our discussion, she told me that her sister who was with us lived in the Bronx. The kind-hearted couple M. and D. Catacutan offered their home to us until the time we flew back to San Francisco. Another example of kind heartedness occurred when my husband's surgery was set for early October, my mom's friend, Tita Perla picked up the three of us at the airport terminal. We stayed at the Apostolate because she lived at the Queens and thought that staying within Manhattan would be easier for me to go around the city after the operation. How then could I be assured that my life - or rather our lives- would be better after the operation? Any minute now the final verdict would be handed in. Things would happen too quickly for any of us to think of how to achieve "self-healing". For no stranger would believe these tell-tale stories of mine. My face showed no signs of anxiety and maybe I was good at hiding my feelings. Past lunchtime, Dr. Salky told me that he had taken the wrap down perfectly. He said that there was nothing to worry about. Although during the operation he had detected a scarring on the liver that may have happened during the previous surgery. My husband felt that every breath would be his last after his surgery in Manila. For him it was better to die with the knowledge that there was no cure rather than knowing death would come to him this way. When he sat on the bed with a bluish face, I instantly saw my future. I was losing him now and all I could do was to hold his hands and pray. And surely to receive a comment of "was nothing" from the doctor responsible was not an excuse. Should I be angry with our physician for keeping such secrecy? I should. But after what we went through things didn't matter to me now. What was more important was being able to hold on throughout those long months of my winter year. And being able to experience the first few days of snow fall was symbolical for me. I marveled at my snow sculpture and 'the way I created his body, arms, and face. The yellow scarf wrapped around his neck swayed from the falling frost. I embraced the three of them and wrestled what it would take. For it would take a complete detour when billion snowflakes would declare winter's end so all the trees draped in ice would give their colors once again (Philippine Free Press, 2008).