Sunday, September 27, 2015

Geeking Out

I am pretty certain my 20 year old self would be mortified that my 33 year old self was out alone on a Friday night. Wearing glasses. At a book event. Mentally fawning over other women. I'm at a Powell's Books writer event, and the place is packed. I happen to be in close proximity, as we speak, to two of my female idols, girl crushes if you will - Sheila Hamilton and Cheryl Strayed. And I just spoke to Sheila. For several minutes. She was as thin, put together, eloquent and kind as I would have imagined.

"May I geek out for a minute?" I say, leaning forward from my stool against the bookshelves in the back of the room where the writers' events are hosted upstairs at Powell's. "I just want to tell you I'm a huge fan, and am looking forward to when your book comes out."

Her long blond hair is curled in a messy, beachy kind of way. She wears skinny jeans and a Rolling Stones shirt with a trim black suit-like jacket. Her eyes are squinty, in a kind way, that I'm sure many men find sexy. 

She tells me her book releases in October, and that she will be speaking in this very room at Powell's on the 20th of next month. She references Mary Karr by just "Mary," and relays that Mary told her how her heart still flutters nervously when she sees her name in print and when people want to hear her speak. Sheila laughed that she couldn't imagine being that well spoken in such a context. 

"That's so funny to hear you say that," I tell her. "Because that sounds like something I might say about someone like you. Must just be the human experience."

I tell her that I just recently sent her book information to a former professor/mentor, whose husband committed suicide when I was under her tutelage at UO. She asks me if I'm a writer, if I was in graduate school for fine arts. I laugh, self deprecating, and tell her I'm a speech language pathologist, that I was in a Masters program in the Communication Disorders and Sciences program.

She inquires further about my interest in writing. I tell her that my husband and I met when we were newspaper reporters in a small town, before needing "real" (higher paying) jobs. I share that I just put my daughter in an extra half-day of care, to allow time for me to start writing rather than just talk about writing. I tell her I've been in touch with, and she looks impressed. I like talking to her, and part of me wants to tell her, tongue in cheek, that I want her to be my mentor, my BFF, my mother figure. Instead, I end our conversation politely by thanking her for letting me be a geeky fan, and confess that I even follow her on Instagram. 

If my 20 year old self wasn't already embarrassed at the entire premise of my evening, she's totally mortified now. 

And then my night got even better. Cheryl and Mary opened their talk with their idea for a talk show they would call Girls Gone Mild. They referenced their potty mouths. Cheryl says she's known for saying the f word. "I think I out fuck you," Mary says in return. 


Sunday, September 20, 2015

(42 Months) - 3 Years + 6 Months

Happy Half-Birthday to my girl! You may now accurately insist that you are "three and a half" rather than just three.

This month you started back at daycare, and are officially in the preschool classroom with Teacher Liz, and some of your old friends, like Asher, Charlie and Iris, Beckley, and Boudica. You insisted on wearing a fancy dress to your first day back to school because "it's preschool!"

You choose your own outfits. Obvi. I try to insist on putting your hair in a pony or a clip, but sometimes you win that one.

You love Daddy's new truck, and you always tell him how big it is. You like that you get to ride in the front seat and see what there is to see.

You've come to request a lot of "silly pictures" from Daddy while he's at work. You're easily impressed and have a beautiful, contagious laugh.

You say A LOT of funny things. I do my damnedest to write them down for posterity.

You still love the Children's Museum, and it's one of my favorite places to spend with you on a rainy Mama Day.

You've already written some inspired poetry.

Although you still remain very ignorant to gender and race differences, you embarrassed your mama at the Children's Museum when playing with the babies you loudly declared, "Only the black babies are sick." In front of a person of color no less. There I was, feeling all proud that you were playing doctor and "helping babies," and then you sideswipe me with that one ;)

You're always anatomically correct.

You are never shy to hold hands, cuddle, or kiss me.

You have a ball playing with friends like Harlow and Monroe.

You are so friendly when meeting and hanging out with my friends, like getting ice cream with Kegan.

You quickly get over being shy with friendly grown-ups, like Kegan.

You are practicing drawing smiley faces that look more like stern faces, and writing letters F, A, P, and M.

You love hanging out with Logan and Max, especially when we go on adventures and eat snacks.

You remind me of your Daddy ...

Daddy also thinks you say funny things, and he tries to be good about texting me what you say.

You are a fun Mama Day date.

Your mama is no good at art.

You insist on taking "selfies" of me. I find it embarrassing, like people think I asked my 3-year-old to take my photo.

You drew this family portrait at school with Teacher Liz. For the record, we've never eaten cake and watched movies, and you've never seen a dinosaur movie. Although we have been watching movies this month, like Toy Story, Winnie the Pooh, and even Frozen!

We took a flakily hike this month.

You were shy and then had a blast eating breakfast at Lovejoy Bakery and running around Jamison Square with Peter.

You are a prolific artist. The teachers at school say you go through the most paper of any of your classmates.

I love to be creepy and watch you sleep. Perfection.

You willingly pose for photos to send to Daddy and anyone else.

I love nothing more in this world than cuddling my nakie Bean.

Like I mentioned, you say a lot of cute and funny things. Sometimes it's not what you say but how you say it. And I want to remember:

"I was thinking we could ..."

"I got a good compromise ..."

"Mom? I like to go for walks with you too."

While reading Olivia Forms a Band, "mama, was this book writed by the same author."

While taking a bath:
F: "Look daddy I'm playing my vagina like a guitar."
A: "Gina-tar."
F: "Hahaha, yeah, a gina-tar!"

While reading a book:
F: "Do you think that's its grandma?"
J: "Hold on, let me check."
F: "It is! Because it has white hair. It's its grandma."

While playing pretend:
F: "My sister got hurt."
A: "Yeah?  What's your sister's name?"
F: "Mike."

Francie to Mama: "I just want to touch your fat."

Randomly: "Is Beebee going to die?"

While cuddling you to sleep:
"But mama, can you point your butt that way? I don't want you to fart in my face."

Mama: I love you. 
Francie: I love you too. 
Mama: Like how much?
Francie: Like, thirty-seven-ninety pounds. 

"Mama I don't have to go potty, I'm just rubbing my crouch."

"Daddy I love your little hairy arms."

You are obsessed with eating breakfast with your daddy in the morning before he goes to work, even if you have to get up at 5:45. You are napping at school, and learning to not wear a pull-up. At home, you do Quiet Time for an hour, using your fancy visual timer. You still like to ride your scoot bike to the park, and could swing for hours. You ask for treats almost anywhere we go, but I can't blame you because I basically have a treat anywhere we go. You still love playing Memory. We get several new books each week from the library. You like taking a stroller ride to Multnomah Village to play at Thinker Toys and read books at the "cat store" (Annie Bloom's bookstore has a cat). We often get coffee together, visit the park most days it's not raining, and you still insist on wearing fewer clothes that is normal. Your tantrums are fewer and further between, and while you are still learning to assert yourself and your opinions, you have been responding easily to redirection or compromise. You have developed some fears, mostly of deer or raccoon coming into your room when you're sleeping. I say a stupid "magic song" before bed that makes you feel better. You sneak into our bed every single night, usually after midnight or early in the morning, right before Daddy wakes up at 5ish. You are mostly cheerful, like to make us laugh, love going to school, and Beebee thinks you are an old soul.

Writing - An Essay Contest

The Bean recently added a half-day on Thursday morning to her daycare week, so that I can start doing and stop talking about this dream of mine to "write." My practical writing goals are all over the map, from children's books to personal essays to a study skills guide. To jump start myself I entered a personal essay contest for the magazine Real Simple. I just submitted it last night. The prompt was to write about a single decision that changed your life. The first things I thought of, mostly trite and cliched, were about deciding to turn right instead of left off Mount Rose Highway, and then parking in that Tahoe World parking lot and meeting Alex for the first time. Or about the decision to move to Block Island the summer my mom died. Or about deciding I was ready to get pregnant with The Bean. But I pushed myself to think a bit outside the box, and wrote about the afternoon in graduate school that I decided to go to a presentation on PTSD, and it propelled me into a career working with veterans with brain injury. I'm under no guise that my essay will rise above any other entries and win me $3K, but it's definitely a good starting point, and I'll count the fact that I entered as a win for now. And I'm posting it here, so that I have it on record that this is where I started.

Serving Those Who Served
By Joanna Close
"I was blown the eff up," he tells me, employing his strategies for clearer speech - a slowed rate, increased volume, and over-articulating each sound.
"That sounded really great," I encouraged. "Now, can you remember to tell me when that was?"
"2010. No, 2012. I graduated high school in 2010 and went straight into the Army. I went to Afghanistan. And I was blown the eff up. In 2012. Hey, I like your shoes. You look pretty, as always."
Devon, a 23 year-old former Army specialist, has been a patient of mine for just a few months. He is seen regularly - very regularly - at our Veteran Affairs (VA) medical center. As a speech-language pathologist, I am helping him with difficulties related to a traumatic brain injury (TBI) he sustained when he stepped on an improvised explosive device (IED) while serving in Afghanistan. He had just two weeks left on his tour. He was the most seriously injured of any of his fellow troops. But he's still here. Alive, and able to tell the story. Or, alive, and working to tell the story that he has pieced together from repeated accounts from others.
It’s been more than three years since his injuries - he sustained a severe brain injury, lost both of his legs, several fingers, and suffered numerous broken bones. Today, he uses a power wheelchair to mobilize, his speech is jilted and imprecise, he needs reminders to keep certain thoughts to himself, and his smile is crooked but nearly always present. He relies almost entirely on his wife, family, and paid caregivers to manage the activities most of us take for granted, from bathing and toileting to scheduling and finances.
He continues to have significant difficulties with attention, memory, reading, speech, and social communication, among other things. Right now he is working hard to develop and practice a personal narrative, one that includes significant events and dates - high school graduation, Army enlistment, Afghanistan tour, injury details, wedding anniversary, family birthdays. He wants to be able to share his life experiences without relying so heavily on his wife, Rebecca. That’s where I come in.
Flashback to 2010, Winter Term. I was a student in the Communication Disorders and Sciences program. Graduate school was demanding, and I loved it. I spent nearly all of my time in class, in clinic, reading, researching, writing, and studying, and I loved it. I was particularly engrossed and inspired that quarter by a course called Cognitive Rehabilitation, taught by the program director and professor who literally wrote the book on the subject. We learned about brain injury and the role of the speech-language pathologist. We learned ways to assess and treat attention and memory problems in children and adults who had been in car accidents, fallen out of windows, had tumors removed, and survived strokes.
When the professor suggested we attend a campus lecture for the Counseling graduate students, hosted by a VA social worker about posttraumatic stress disorder (PTSD), I waffled about whether or not to go. I had hours of schoolwork ahead of me. I also needed to exercise, do laundry, call my dad, and I wanted to eat dinner with my fellow-grad-student husband. The presentation wasn’t exactly within my professional field, but our beloved professor had recommended we attend. And the psychology of trauma had always piqued my interest. I knew I would have to stay up late to study for a midterm later that week. And get up early the next day to prepare for my client. At the urging of my husband, I ditched yoga class and put off laundry one more day in order to go to the lecture.
“Does anyone here know what OIF or OEF stand for?”
I didn’t, and neither did any of the other graduate students attending the presentation.
“Operation Iraqi Freedom and Operation Enduring Freedom, named for the conflicts in Iraq and Afghanistan. And OND, or, Operation New Dawn, which refers to our involvement in Iraq after 2010," he explained.
The social worker showed us video clips of military personnel in the Middle East. Images of men dressed head to toe in camouflage and carrying large weapons. Of far away explosions. Of young men remembering friends lost along the way.
I was disheartened by both the visible and invisible consequences of war. Saddened by brain injury as the “signature injury.” Curious about the long-term consequences of posttraumatic stress. I was also inspired and moved to action. I itched to learn more, and was particularly interested in how best to support the veterans returning to college on the GI Bill. I learned that our campus clinic was forming a professional relationship with the VA. I asked, even begged, to be assigned a veteran client.
My professional aspirations changed when I met Ben. I was already interested in working in a medical setting, but he inspired me to work with veterans in a medical setting, and specifically with veterans who sustained brain injuries. Ben was a 40-something retired Army staff sergeant who ran convoys through Iraq on three different tours. He walked, talked, and acted like anyone you might expect. Because the injuries he incurred in combat were invisible. He and his family of 7 experienced significant hardship upon his final return stateside, including homelessness and substance abuse. He was diagnosed with PTSD. He sustained multiple concussions from IED blasts and mortar attacks. Against the odds, he enrolled at the university with goals of becoming a civil engineer. But he had difficulty listening in class, taking notes, concentrating on homework, retaining what he read, writing papers, and taking tests. Over several months I taught him strategies to support his attention and learning, and he ended the term with a 3.5 GPA.
I truly learned more from him than he ever did from me.
My experience in the campus clinic with Ben propelled me to apply for my student internship at the VA medical center. Then I completed my fellowship training at the same facility. And I now work on a specialized rehabilitation team assisting veterans with brain injuries.
A few of my patients look like Devon - disabilities obvious to even the untrained eye. But most of my patients look more like Ben.
Jon was medically discharged for injuries related to his ankle. He returned home and experienced significant difficulty adjusting to civilian life, including attention and memory lapses, even forgetting to feed his children lunch on the days his wife worked as a nurse. He enrolled in graduate school to work toward his MBA, but experienced tremendous difficulties, despite being very intelligent. I taught him strategies and exercises to improve his concentration and make his academic learning more efficient.
Lucas was an infantryman and sustained multiple concussions related to blasts. He first noticed difficulties with mind-wandering and distractibility when he transitioned home. Leaving his stove on. Missing appointments. Forgetting why he went into a room. Taking incorrect exits while driving. He worked with me to improve cognition, but continues to struggle with his job filing in a university mail room.
Angela is a military sexual trauma survivor, and also had a concussion following a ladder fall while enlisted. She struggles with chronic pain, anxiety, and disordered sleep, as well as difficulties with organization, planning, and follow-through. At just 25 years old, she doesn’t work, is not in school, relies on her family for financial support, and feels hopeless about her future.
Craig is always impeccably dressed, but his affect is flat and it doesn’t come as a surprise that he suffers from severe depression. He recently had his leg amputated above the knee, to address extreme pain caused by a traumatic neuroma after first losing his lower leg following a blast injury. He prefers the company of animals to people, and otherwise isolates himself. No treatment so far - for depression, for PTSD, for attention, whether pharmaceutical or behavioral - has contributed to significant gains in Craig’s functional life.
Sometimes it feels as though I have nothing to offer these former service members - no magic pill, no universally endorsed rehabilitation program. Sometimes I even feel hopeless about my clinical work. And then I think of Ben. He inspired my passion to help this particular population of veterans, often my peers. So I continue to hold out hope for more promising research, and believe that cognitive strategies and supportive counseling offer at least something in the meantime. If it weren’t for that seemingly random presentation for the Counseling graduate students, I wouldn't have requested to work with a veteran. I wouldn’t have met Ben. I wouldn’t have gotten to work with Devon, Jon, Lucas, Angela, or Craig.

I am typically uncomfortable saying this to my patients directly, for fear of sounding trite, but I do, in fact, thank you for your service. And I thank you for allowing me to now serve you.

(All identifying information has been changed to protect privacy.)

Thursday, September 17, 2015

You Know You Work at the VA When ...

You Know You Work at a VA Medical Center When ...

... you see Fox News or CBS on all the TVs.

... the two older men walking slowly in front of you at the canteen are singing the praises of Reno versus Vegas.

... you overhear an obese female tell an overweight female therapist "you're so thin!"

... your productivity hovers around 40%.

... when you are fifteen minutes late to work you receive an email threatening to mark you AWOL.

... your schedule is, honest to god, called your "tour of duty."

... you have to change one of your 10 digit passwords every month or so, and it can never be the same as a previous password, and you are explicitly forbidden from writing down said passwords but must rather somehow, miraculously, commit them to memory.

... you have a demented patient say to your coworker, "I'd fuck your pussy if it didn't smell like a chicken coop!"

... you have as many patients no-show as you do attend scheduled appointments.

... the disheveled guy waiting for the bus is wearing a t-shirt that says, "Sex Educator: First Lesson for Free."

... you see someone in full camouflage at 8 in the morning.

... the "canteen" regularly sells hats, stickers, and t-shirts with phrases such as "he's not heavy, he's my brother" and "mother of an Army veteran."

... there's a car fire in the parking garage because it was parked too close to the smoking shack.

... your patient doesn't consider his 4-inch pocket knife a weapon.

... there are more Bush than Obama stickers.

... your new patient asks you if you if you believe in God. 

... it's easier to get a "therapy llama" in for a vist than a graduate student observer.

... you spend more time completing mandatory online training videos than meeting with patients.

... your patients call you "Dr. Jo." Or "miss." Or "ma'am."

... all the Bluetooth devices are actually hearing aids.

... you see multiple people drinking large sodas. At 8:15 in the morning.

... you regularly ask your patients for their "MOS," even though you can rarely remember what it stands for (Military Occupational Specialty, military speak for job).

... when asked to brainstorm 30 ways to get a cat out of a tree, your Compensatory Cognitive Skills class comes up with mostly violent means such as using a variety of explosives, a tank, chainsaws, etc.

... your patient has a kind of southern sounding rural accent, even though they live just 45 minutes from the hospital. In a town you've never heard of. And they were  born and raised Oregonian.

... you've been in your office nearly 2.5 years before you get a clock hung on the wall.

Sunday, September 13, 2015

(Just Pics) - Sunday Gorge

Apparently it was a gorge-ous kind of weekend. The Bean was a little bit bummed we left her home for our Day Date hike yesterday, and The Hubs had never been to Wahclella Falls before, so despite his hangover of epic proportions (thanks, whiskey club), we hit the trail - all 2 miles of it - for an afternoon flamily hike. It was about 10 degrees cooler than yesterday, but all the other Weekend Warriors were out again in full force. We took care of some business this morning (groceries, laundry, and the like) and headed east on 84 after lunch and with our fingers crossed for a quickie nap. Successes all around. Except swimming. It was too cold to do any swimming. 

Saturday, September 12, 2015

(Just Pics) - Day Date

I asked Alex the other day when the last time we had fun together was. He was quick to name a few recent adventures - camping, Victoria, Ireland - but I pointed out that all of those activities were in the company of others. I'm pretty sure we've been to the movies and to dinner once or twice, but the last purposeful, grown-up, active date we went on was in February to Skamania. That's fucking pathetic. 

I'd been itching to do something more active the last few weeks, and thank goodness for on-call Beebee because with the good weather I was wanting a no-kids-allowed hike, bike or motorcycle ride. So today we spent several hours poking around the Gorge. We hiked Triple Falls and then some - about 6+ miles in total - and then gnarbuckled up the ravine to Oneonta Falls. Surprisingly, despite having both grown up in Portland, neither of us had ever bothered with the Historic Columbia River Highway stop for Oneonta. Today we and about 409 other people were escaping the heat by climbing over logs, wading through waist deep water, and taking iPhone photos of the picturesque falls. Then we got Dutch Bros and returned home to our favorite little Bean. Who was on a Day Date of her own with Beebee, hitting up a Beaverton parade and playing at parks. It was just what the doctor ordered - I blasted the music on the drive, walked as fast as I wanted, and had uninterrupted chit-chat with my husband. 


Triple Falls or maybe Horsetail Falls bridge. 

Triple Falls lunch and foot soaking. 

Alex and A LOT of other gapers.  

Oneonta Gorge. 

There's a lotta aquasocks up in herrr. 

"All of my reproductive parts are now up inside of my body."

Waist deep wading. 

More reach-arounds. 

He swam, I did not. 

Tunnel vision. 

Meanwhile, on the home front, these two went on their own Day Date. 

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