My First Derailment

I'm seeing a bike chain come off the derailleur, not a train off the track. But it was definitely a bit of a train wreck. 

Monday March the 20th I was having a very good morning at the Wild Iris Cafe here in Prescott. Reading the latest Tara Brach book, Trusting the Gold, and vicariously joining Tara as she recounted finding her way through an episode of self-recrimination for not living up to her goal of always coming to the world with loving attention. I resonated completely with her finding and nourishing with kindness her own deepest, earliest levels of feeling rejection and inadequacy in her Garden Days. Like her in the book, I was now at my quietly radiant best in peace and contentment. Radical acceptance Tara calls it, as I radically accept the fact of my aneurysm.

And then Mary Jo walked in. Not her real name, but her real presence. A powerful and attractive woman I'd met on a walk in my neighborhood last summer. Trained in law enforcement, she made a career in related employment, finishing out in a service business with a marvelous second husband who after a year or so turned out to be about as dark a creep as I have encountered in my recent career as a good listener. There was bankruptcy and his incarceration and a divorce. There had also been earlier such stuff in Mary Jo's 60 years of life on earth. 

I knew this and more from the habit Mary Jo got into of stopping by my place in the months of summer and fall. We had long talks on my porch. It was a good thing, but in the winter and early spring Mary Jo, as I thought, had disappeared to go places and do things I knew she intended. 

Now I haven't mentioned that I suffer from a mild but real form of prosopagnosia. So I also haven't mentioned that when Mary Jo came up to me, I mistook her for somebody else. After finally asking her who I was talking with, I was enjoying discovering how her situation had developed and one thing and another. But my old, old feelings of being a hopeless misfit in this world where people can actually remember names and faces and all were swarming around behind my talk and my listening. 

At one point, a previous obstacle to good talk between us came up, and I found myself forcefully interrupting her to say, "Wait, wait Mary Jo -- just give me ten seconds here! And listen to me." 

That was the derailment. I realized with quite a bit of a jerk not only what a jerk I was being, but also how way over-excited both I and my aneurysm were. I extricated myself pretty well and quickly from this mess and we parted on good terms, but my inner tension, both physical and emotional did not go away so easily.

I spent the summer of 2020 in southern Oregon just a quarter-mile away from a railroad track that got some use. I'm not sure I can think of anything so mysteriously right and calming while at the same time ominous as the sound of the locomotive's whistle coming around a bend in the  Rogue River near Ti'lomikh Falls early in the morning. I am sure that place of happy consciousness requires the train and the tracks be steadily maintained.

My AAA choice

I have chosen to do nothing.  When I made that choice, the state of my mind, my consciousness, was hugely altered for the better, happier, quieter.

Not for long, but for an evening. And now I find I can call it up again when I think to do so.

This is not a small thing. It is very large. When I go again to that frame of mind, I am notably more at peace with the world than before when I was somehow always warring with it. I was constantly judging others and recriminating with myself over past actions that could fill me with sudden chagrin. Now, much more, I tend simply to listen to, look at, and learn from both the now and the then.

I call that discerning. 

This new state of mind was not my intention; it just popped in one evening when I decided to do nothing about the aneurysm. I had reasons for the choice -- I didn't want the constant alertness to and testing for the common endo leaks and other issues with the stent. And I liked very much the idea of knowing with good probability that I would die quickly and suddenly when the aneurysm tears at last. If the stent procedure removes that likelihood, what manner of death am I going to discover down the line? And, of course, at 87 I knew I did not have a long ride ahead.

I develop this thinking a little more in my next post, Why it feels so good to be as good as dead.

AAA options

Do nothing. Open surgical repair. Endovascular repair.
Dr. Phong Le (Lay) is the only vascular surgeon in our town. I have met with him twice and submitted myself to the appropriate exams. I like and trust him a lot.
He recommends immediate endovascular repair, a relatively simple procedure that uses the two big arteries at the groin to implant a long stent inside the descending artery. The reasons for this are pretty obvious, the size of my aneurysm, 6.2 cm, my good health otherwise, and the 15 to 20% probability that the aneurysm will rupture on its own within a year. The EVAR as it is called only requires a night in the ICU and you walk out with a little assistance the next day. Within 2 weeks you are able to return to normal activity.
Open surgery is not a good idea for a person of my advanced age, 87, nor did the doctor recommend it.
Doing nothing requires that a person be ready for the consequences of course. The doctor's nurse said the first symptom of a rupture of the Triple A aneurysm was going unconscious. The second is death. The doctor, when I mentioned this to him, pointed out that he did many open surgeries in the ER on people whose AAA's ruptured and were in great pain. The medical literature I read says that up to 80% of the people who are rushed to the ER with a ruptured AAA don't survive the operation.
The EVAR is highly rated for safety and side-effects. However, the attachment of a stent popped open from inside the artery is not as secure as one sutured from the outside in open surgery, so you do a series of follow-up CAT scans to monitor the leakage that can and often does develop over time, and even during the EVAR procedure itself. These ENDO leaks are not generally dangerous, but can become more serious.

 

My AAA choice