Chapter Three: Run-away Toddler

Chapter 3 Sub-sections

Why did my active curiosity lead me into trouble as well as other directions? As I repeatedly discovered throughout my life, stimulation has been my ongoing motivation. Growing up in Chicago, at age 16 months, I began to run away from home. We lived in the 83d block on South Morgan St., a busy boulevard, and my family, including my two aunts (who lived with us during the depression in 1935) and my 5-year-old sister, kept a close watch on my wanderings. But I'd slip away, and someone would say, "He's gone again," and they'd start searching. They'd meet people on the street who'd say, "He went that way." I even crossed Morgan by myself -- unaware of traffic.

This behavior evolved as follows: my brother Don, 20 months older, developed a mild case of polio when he was three years old. His legs were weakened and he fell easily. I learned that I could give him a shove, he'd fall, and I'd take from him whatever I wanted. My father had had a tough, insecure life. He'd lost his mother at age 13, and quit school to support his work-injured father and younger brother. His present job as a printer was tenuous, saved in part by a depression craze for jigsaw puzzles. He was a strong Missouri Synod Lutheran and had been taught, as my siblings and I were later, that children's original sin needed to be punished, at times, harshly. So he began spanking me to correct my terrible behavior toward Don, to rid me of the ‘evil.' Lutherans created rigid, strict responses. Later, I learned that Catholic kids had it easier, as the seven McCarthy's on our block put it:

"Do what you want, tell in confession, the priest takes care of it, and it's gone, no worries."

I began to leave whenever I could. I was subject to tough spankings for years, with resentment toward my father for decades. He used a bamboo stick when I was 5 to 10-years-old, terrifying me. My sister told me decades later that she and my two brothers told my father that this was overdone, but it didn't change things.

Migraine Headaches, Prostatectomy

At age ten, I developed migraine headaches. They begin as a scintillating scotoma next to the fovea, on either side. It's as though the sun is reflected off a rippling lake surface. If you close your eyes, it looks like a brilliant lightning flash that holds and holds. Most of mine affect the left visual field. A migraine's beginning is fascinating, except for the anticipation of pain. The beginning blind spot is small and next to the fovea. It can involve just one letter of a word, e.g., take the word ‘date' --- you focus on the ‘a' and the ‘d' is obscured. You move your focus to the ‘t' and the ‘d' reappears and the ‘a' is obscured. As the blind spot enlarges, entire words disappear. The scotoma gradually enlarges into a curvilinear shape, moves out to the farther reaches of that half of the visual field, and gradually fades. It's exactly the same in the visual field of each eye. The scotoma fades in about 45 minutes,. About 30 minutes later, the headache begins.

From my youth into my 30s, these headaches could be pounding and severe, on the side opposite that of the affected visual field, but sometimes central. I assume that this might be due to localized cerebral edema related to temporarily diminished blood flow. It lasted three to five hours or so, a crescendo-type of unbearable pain that broke dramatically with harsh retching and vomiting. It faded over the next two or three days.

As I aged, the emesis disappeared, and the headaches were generally less severe. These headaches occurred about five to seven times per year. I have had a few years in which I had no migraines at all, and they almost completely disappeared in my late 60s. I've thought over the years that emotions in part control these, as the abrupt release of suppressed feelings seemed to prevent a possible headache from occurring.

This was confirmed in fall, 2007: I developed localized prostate cancer and was scheduled for radical prostatectomy and pelvic lymph node dissection. I was fatalistic about it, and wasn't particularly disturbed, or so I thought. I hadn't had a migraine in a long time, but then had nine migraines in five weeks, six in the left visual field, more than I've ever had in a brief period. I've had none post surgery.

My migraines disturbed some of my youth and later life, but didn't prevent my achieving whatever I wished. But recently I had a most rare migraine pattern: On March 31,2011, late afternoon, I slipped and fell on my right buttock, with severe pain in groin muscles and buttock. While my wife Pat was driving me home, I suddenly saw quite rapid development of right visual field migraine eye signs, beginning as usual, next to the fovea, and spreading much more quickly than usual out to the periphery. As these moved out, the exact same rapid changes began in my left visual field. I have never had a bilateral migraine. The eye changes subsided within 2-4 minutes with no headache. I suspect multiple venous emboli from my broken hip (it was replaced a day later), and that these changes reflected emboli throughout my entire body.

A Common Anesthesia Mystery

A common anesthesia mystery is simply how to control expected pain during emergence from anesthesia. When surgery is finished, respirations are depressed, to the point of apnea, and unconsciousness needs to be reversed, so that there is spontaneous adequate respiration, yet with minimal to no pain. The mystery is to judge when and how much pain-reliever to use: too little and the patient suffers, too much and the patient either doesn't breathe or cannot manage her/his airway. Furthermore, pain relievers are soon re-distributed from the blood to various tissues in the body, and their analgesic effect diminishes, requiring additional drug. This can be frustrating to those caring for the patient emerging from anesthesia.

As to my prostate surgery, my surgeon's analgesic approach eliminated immediate postoperative pain. I had opted for open prostatectomy for two reasons. First, the laparoscopic approach requires more time, and the elderly deteriorate during long anesthetics. Second, I wanted my surgeon to have a wide open view in case there was tumor spread. As to pain control, he introduced a new approach. He asked me to use Celebrex® the morning of surgery, and for four mornings thereafter, to diminish pain stimuli to the spinal cord. He also injected bupivicaine and epinephrine into the incision site prior to cutting, and again at wound closure. Now my anesthesiologist didn't need to consider the mystery of immediate pain control at emergence. Whenever I gave an anesthetic, I was personally always quite concerned at that point, because I prided myself on an awake comfortable patient at emergence. I awakened and my tracheal tube was removed in the operating room, although I don't remember it. I became aware immediately thereafter in the recovery room, and felt as though I was emerging from normal sleep. A wonderful emergence. I had no pain, was slightly hoarse, and didn't have a sore throat. Postoperative pain wasn't expected to be too severe, since my abdomen had not been opened nor my intestines explored. The incision was vertical, from below the umbilicus to just above the pubic area.

I did experience the vagaries of night-time hospital care. There is always concern about postoperative bleeding, so every four hours they checked my pulse and blood pressure, and every four hours they drew blood samples to check my hemoglobin. Unfortunately the sampling and pressure measurements were not coordinated, and occurred every two hours. In addition, the infusion pump for my intravenous fluids beeped a signal for air bubbles every 30 minutes or so, and, in between, my room-mates beeped. The charmer for fixing air bubbles was the nurse technician. This 20-year-old college student would answer our signal immediately, bubbling with good humor. With such irregular sleep, we talked. She was from a nearby small town. Her father was one of 18 children, and had married a woman with seven siblings. This charmer adored her family and said that family gatherings were just wonderful.

Sleep deprivation added up pretty quickly. On the day following surgery, I was really tired, and every time I closed my eyes, I saw a pattern on my eyelids that I'd never seen before. It looked like museum tapestry, gently fluctuating in and out. I went home the next afternoon, with just one night in the hospital. I hadn't needed any pain medicine. The museum tapestry pattern persisted for two days, as I caught up on sleep at home. How severe are the effects of sleep deprivation for long term patients?

I needed a mild opiate (Vicodin®) for pain relief the first morning at home (too much pain to get out of bed), and none thereafter. I hadn't been hospitalized since age 16, when I spent 122 days in bed for rheumatic fever, but that didn't involve pain or sleep deprivation.