Tuesday, January 10, 2012

Episode 16: FAIL!!! Part Deux

See Part One for the prequel.

The first time I noticed something wrong, I was working part-time at a community college and commuted over an hour to the closest university with graduate programs in English.  There, I took two courses and taught two sections of Freshman English.  Of course, I was also a single mom with two boys, the older one just entering his teens.  My schedule was tough.  I described it in a Christmas letter, to which one person responded, "It sounded like a cry for help."

But I was thrilled.  I was doing what I was meant to do.  Yes, teaching caused me extreme anxiety, but over time I got more comfortable in the classroom and even had some amazing classes.  But I was feeling awfully tired.  "My stamina is so bad," I thought, but I had no idea why.  I was only thirty-seven.  I wasn't overweight and, as far as I knew, I was perfectly healthy.  Why did I feel as if I were walking under water most of the time?


The women I worked with became concerned with how haggard I looked.  Later, one told me she feared walking by my office, afraid she'd see me dead at my desk.  I worked in health continuing education, and one day a nurse asked if she could take my blood pressure.  I had leaned against the wall and told her I felt as if I were going to faint.  She sat me down and had me rest for a moment, then put on the cuff and pumped it up.  After she finished, she looked at me with a strange look.  "I think you need to go to the emergency room."

When I got to the ER, my blood pressure read 183/113.  Not stroke level, necessarily, but unusually high.  Brief lesson for those who don't know much about blood pressure:  "Normal" is below 120/80.  The higher number, the systolic, is not as concerning to physicians as the lower number, the diastolic, which measures the pressure while the heart is at rest.  Thus, the 63 extra points on the systolic was not as dangerous as the 33 extra points on the bottom--but neither was particularly a good thing.  My physician admitted me for several days and ran tests such as an echocardiogram and a stress test.  The echo showed that the left ventricle of my heart was enlarged, and my ejection fraction (the amount of blood pushed out of the heart with each beat) was quite low.  Something was certainly not right.

I spent the next thirteen years in and out of hospitals.  No medications would keep my blood pressure in the normal range for long.  The numbers spiked dangerously high.  I'd get migraines.  My energy was sapped.  Yet I kept working.  I could not slow down.  I still wanted to teach college English, but I put off any plans for a PhD after receiving my Master's Degree.  I couldn't really afford to go on; my kids were older and needed more stuff.  And I needed health insurance.

So I took a job in a non-profit health education organization.  I really didn't care much about health issues then.  The only contact I'd really had with the health care system was when my parents and kids were sick and, now, for the ever-more-frequent ED visits and hospital admissions for my hypertension.  I wasn't happy about this; I'd just as soon stay out of hospitals and doctors' offices forever, but that would not be my fate.  Years before, when I brought my five-year-old son in for his third neurosurgery, I'd felt physically ill as the smell from his previous two operations that had occurred before he was one year old wafted to my nostrils--the sickly sweet smell of the goop they used to seal surgical wounds that had covered my baby's skull over the criss-crosses of stitches with black thread from his crown to the back of his skull.  Shiny and sweet with that gook.

But the job paid the bills, and I actually came to love it.  This was where I eventually got my second master's degree, this one in library "science."  I'd loved doing research as a graduate student in English--but I learned far more about the process by becoming a librarian.  The agency did not pay for my degree, but they paid for my books, which they added to their library, and they gave me work time to do my homework with the idea that it would relate to my job there.  In fact, I wrote a grant proposal for a class that was later funded by the federal Institute of Museum and Library Services as a National Leadership Grant.  I wrote other funded federal, state, and local grant applications that brought in close to $2 million for that little agency in a two-year period.  My writing was paying off.

I promised the agency I'd work at least a year after I graduated with my library degree.  I was courted by a mental hospital in town that needed a librarian and offered a big salary for Appalachia.  But I turned the job down, obligated to fulfill my year at the agency that had supported me.  At the end of that year, though, I took a job as a reference librarian in the university from which I'd earned my bachelor's degree.  I could look out my front door and see the university library; I couldn't ask for a better commute.

While there, I taught adjunct courses in English, and I found that they were what kept the job interesting for me.  The atmosphere at the university library was the very opposite of vibrant.  The supervisors had worked there for time immemorial and had no desire to retire.  Within a year, I was jumping out of my skin.  I'd driven by a two-year college in West Virginia and a funny feeling twinged in my chest.  Something akin to Fate.  Within a couple of days, an ad for an English professor at the West Virginia college appeared in our local paper.  Though I lived in Maryland, the college was only about 35 minutes from my home.

I applied; I got the job.  The starting salary was $8,000 less than I made at the university library, but I did have summers off.  I figured I could make up most of that money by taking a summer job.  What I never looked into were the health benefits.  This was a part of the state system; surely, the state benefits would be comparable to Maryland's, and I knew they were good.  It never occurred to me to check policies such as sick leave or short-term disability for faculty.  Who would have guessed that the West Virginia higher education system gave NO sick leave or paid short-term disability to faculty members, even those considered full-time.  Secretaries got those benefits.  Administrative personnel got those benefits.  Even those administration employees who worked a ten-month contract got full benefits.  But faculty did not.

I was actually told by the provost of the school, when I learned of this, that the college system was overseen by the legislators, and the legislators came from blue collar backgrounds and were suspicious of college professors.  They believed we only worked the few hours a week we were scheduled to teach.  In fact, I never worked harder or longer hours than when I taught English at that college.  I'd regularly bring home stacks of essays to grade, giving up my evenings and weekends.  And I always had to be prepared for the next day's classes as well.

My first semester there, my anxiety came back full force.  I had been given an evening class with students who'd enrolled at the last minute.  This was a developmental English course--a remedial course--that should have had a student-teacher ratio of no more than 16:1.  Experts would say 6:1.  But 31 unprepared students filed into that room--about half of them from the inner cities of New Jersey and Baltimore; the other half from the "hollers" of West Virginia.  The room was configured with 25 computers facing the walls in a U-shape, with several large round tables in the middle.  Each space was filled with a body that did not want to be in that class.  In addition, I had three other classes with 25 students in each on campus, AND I went to a high school near-by every day of the week for 1.5 hours, where I taught both college English and their high school English content, though I'd never been certified to teach secondary ed.  Talk about strung out--I couldn't sleep; I couldn't eat; I barely made it through the semester.

It was a student who turned it around for me.  He'd been a rough customer, challenging me in his Freshman Comp class.  But one day he came to my office, shut the door behind him, and burst into tears.  His girlfriend and his baby had been killed in a car accident the night before, and he begged me not to fail him out of class.  Eventually, I had to because he never showed up again--but the encounter made me realize that this job was not about me; it was about these kids, and these kids had difficult lives of their own and just wanted to make a better life for themselves.

In time, I found my confidence in the classroom.  I could make the students laugh, and I could help them write better.  I saw their work improve over the semester.  I connected with them; they often stopped by my office to chat.  Twice I was nominated "Outstanding Professor," and an informal poll for the student newspaper named me runner-up for "Most Unforgettable"--second only to the cafeteria lady!

In the meantime, though, I was getting sicker.  I missed one or two days a semester for doctor's visits or because I was simply too ill to leave the house.  My blood pressure numbers kept creeping up.  By my last semester of teaching, I could barely walk up the flight of stairs to my office; I became exhausted and winded after a few steps.  My BP was reading 200+ over 120+.  Twice in the ER, my diastolic--the bottom number--was 135.  This was serious.

I had to take naps, which I did in the recliner in my office.  I missed meetings.  I became confused, unable to think well--but still trying to teach my classes as well as I could.  Okay, so I couldn't get to my committee work, but I wasn't going to cheat those kids.  That semester, my student evaluations were as high as ever.  But I got into trouble with the Administration for missing those meetings and for sending out an email asking for help the day I learned I had an adrenal tumor.  I didn't know much about these things then, despite having been a medical librarian--I thought that meant I had cancer.  And I certainly felt sick enough for it.  So I used a campus-wide email someone had sent to send out a plea:  "Can someone take my classes tomorrow?  I just found out I have a tumor in my adrenal gland.  I have a movie to watch, and you just need to pop it in for me."

Okay, that was bad judgment, I suppose.  I erroneously believed our campus was a small, close-knit family.  I didn't realize the big email list included some folks at the "big" campus or others who took offense at what I'd said.  It didn't matter that professors used movies and multimedia all the time for class.  And I was asked by my chair, "What if a janitor had responded?  Why did you send it to everyone?"  Well, I told him, I would've told the janitor I needed a teacher to fill in, for Christ's sake.

Quickly I understood that my personal "tragedy" meant very little to the larger campus community.  As I've said before, I tend to be a bit naive--and if I made a mistake sending that email I can say that I was not thinking very well that day.

Apparently the email miffed the Dean of Curriculum and Instruction.  He was a curmudgeonly old guy who needed to retire, but he liked running the place with an iron fist.  If he took a disliking to someone for any reason, he would relentlessly make their lives miserable.  He had hired me, and we'd had a good relationship for the six years I'd been there, though he did tell me my missing a day or two a semester was a problem.  He was the one who informed me that the system had no sick leave or short-term disability for faculty.  I took his telling me that as a treat, but in all fairness he was telling me the truth and wanted to warn me.

As a medical librarian, I knew about a site called clinicaltrials.gov.  I did not trust the doctors in my rural area; I wanted to get the best possible care.  I applied for a clinical trial on adrenal neoplasms, and I was accepted.  The study would mean two weeks as an in-patient.  I could not miss two weeks of a semester, so I applied for and was granted a one-semester leave of absence WITHOUT pay.  This was the policy for faculty--leaves of absence for any reason, including medical ones, were unpaid.

At that point, I took out a loan to get me through the semester, which I used to pay bills.  The clinical trial confirmed that I had a condition known as primary aldosteronism.  This condition, in which the hormone aldosterone is hyper-produced, causing abnormal electrolytes, used to be considered rare, but now doctors believe upwards of 10 percent of persons with "essential" (meaning no cause has been figured out) hypertension actually have hyperaldosteronism.  I'd had the classic symptoms for years--intractable hypertension and hypokalemia--low potassium--which my doctor had ascribed to the diuretics I took to lower my BP.

My tumor may have been producing the extra aldosterone, or it could have been due to hyperplasia (enlargement) of both adrenals.  The test to figure that out cost $24,000.  By then, I'd figured out that the West Virginia state medical insurance paid only 80 percent of medical bills, unlike the nearly 100 percent paid in Maryland.  That year alone, I would rack up $7,000 in out-of-pocket medical costs even with "full" medical coverage.  Fortunately, the clinical study at NIH paid for the two weeks of testing, including the adrenal vein sampling that determined my hyperaldosteronism was due to hyperplasia of both adrenals.  The tumor, apparently, was "non-functioning," meaning it just sat there, doing nothing.  No need to have it removed.

By then, I was so weak from the effects of the aldosterone that even with treatment I was not feeling well.  I was put on a high does of an aldosterone-blocking pill, Spironolactone, but it didn't bring my hypertension down immediately, so I was also on my other blood pressure pills--Toprol, lisinopril, and HCTZ.  I did not feel well enough to teach full-time, so I requested a partial leave of absence for the next semester.  I worked 60 percent of full-time in the tutoring center, helping students with their English papers.  I liked it, but I missed teaching.

My older son, the one with the three neurosurgeries as a baby, had suffered a psychotic break just before my health became so desperate.  I'm sure dealing with that heartbreak, and trying to get my son well, added to the stress and exacerbated my condition.  While I was tutoring, my son relapsed.  He was not truly psychotic, but he was manic and agitated.  I spent much of my time that semester trying to get him well again.  But I also did not feel better as time went on.

Over the summer, I worried about my job.  I was on tenure track, and this was my critical year.  I requested and received a delay of one year for that.  I met with the provost over the summer to discuss my concerns.  He had pulled all my evaluations from my supervisors and the college-wide review committee, which were top notch.  I always got merit raises when they were available.  "I have found that a tiger does not change its stripes.  These evaluations tell me who you are, and you are a shoo-in for tenure.  I know you're ill, but you will get past that."  Within two months of that meeting, I would be fired.

Why?  Ostensibly, it was because I hadn't asked for another leave of absence in advance.  Now, true, the college could not have kept me on leaves of absence forever.  But another faculty member had become seriously ill the same semester I took off for my clinical study; he suffered a devastating stroke and would never teach again.  But he was still on the roster at the college when I was fired.  He was not even capable of requesting a leave of absence, so I firmly believe this was a trumped up excuse to get rid of me.

Why?  Because I had annoyed the Dean.  The Friday before the fall semester had begun, I went to the emergency room.  I hadn't slept in close to five days; my physician had referred to me a cardiologist when I described my symptoms, with whom I had an appointment the Thursday after classes began.  But that night, I wasn't sure I'd make it to Thursday, so to the ER I went.

I was admitted that night.  I was so sick I could barely walk; I needed the support of  a nurse to get me to the bathroom in the room, where I puked up what little was in my stomach.  A cardiologist came to talk to me.  "You're in heart failure," he told me gently and paternally.  "You have probably had one or two mild heart attacks already."

MORE TO COME

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