[not making this canon, per se. But I wanted to share a writing exercise that I went through to help me work through a difficult situation, in the hopes that it might help someone else.]
The twins sat in what was once their old bedroom, upstairs at their parents’ house. It had been a long day for both of them, albeit for different reasons.
The visit had not been planned. But when their mother called, saying that their father had been taken via ambulance to the hospital in excruciating pain, the twins did what they could to rearrange things to make the trip back home. It wasn’t urgent, Chichi had insisted. He hadn’t fallen or broken any bones (a concern now that they were getting older). He was not life threateningly ill. They had given him pain medication and released him the same night. Still, it warranted more than a long-distance phone call. The boys were in agreement about that.
Perhaps it was good that they did.
“Is he at least comfortable?“ isamu asked, nervously fiddling with a book he’d finished three hours ago.
“As comfortable as he can be.” Minoru replied with an exhausted shrug. “I got him situated in the recliner in the living room because it’d be easier for Mama than trying to help him get up and down from the futon. He fought me, though.”
“He has his pride.” Isamu agreed.
“That, and he was acting like he didn’t want to hurt me.” Minoru shrugged. Which Minoru didn’t really understand. “I was like, I can lift you. I know how to do it safely.”
Isamu let a small laugh escape his lips. “Perhaps if or when we become parents we will understand the need to protect our children at all costs. Even when it is highly illogical to do so.”
“Yeah, maybe…” Minoru laughed a little too, but it quickly trailed off.
“When he and Mama asked you to take him to the emergency room this morning, I did not expect you to be gone the entirety of the day. Dare I say Mama did not either.” Isamu admitted. “She was beside herself with worry.”
“I know. She called me six times.” Minoru sighed. “I felt bad saying the same thing. But I didn’t know anything yet. You know how hospitals are.”
“Not as well as you do.”
Minoru nodded. It was one of the reasons why he was the one asked. Still, he sighed. “It’s a lot different when you’re on the other side, though…”
Isamu tilted his head.
“I mean, sure, I transfer patients, get them dressed, clean them up, run errands for the nurses, but I this wasn’t the hospital I work at, Bro. I was just another family member in the waiting room on the verge of climbing up the walls.” He confessed. “And I know this is going to sound strange, because my entire job centers around handling patients, but when I was back with him… holding your own father up? Helping him put on his pants? It’s weird, Bro. It’s just weird.”
“I do not understand.”
“I don’t know if I do either. I mean, how many times every night am I helping somebody use the bathroom. But when Papa needed assistance to sit up and relieve himself, I had to step out of the room.” He admitted, shaking his head. “Like, that was too private, even for me. I like to think I’m an empathetic person. I treat the patients with kindness and dignity. I smile and try to help them feel better. But yeah, this… this was harder than I thought it’d be.”
Isamu stood up, crossing the distance between the two twin beds, and sat down next to Minoru.
“You are a very empathetic person.” Isamu reassured his brother. “Which may be why you needed to step out of the room. It was not because you felt nothing. But because you felt too much. And there was no safe outlet for it, at least, not at the moment.”
Minoru looked down at his hands. At that moment, the desire to run laps around the hospital parking garage was pretty damn high.
“It is difficult to be clinical, or even to think rationally, when someone you care about is suddenly in your care. Percival's Medical Ethics argued for the separation of professional and personal identities in the care of family members back in 1803, a sentiment echoed by the American Medical Association guidelines from the Council on Ethical and Judicial Affairs.” Isamu noted. “And while you may not be a doctor, you are a worker in a medical setting, and dare I say, subject to the same competing expectations. Given by the fact that Mama specifically asked you to assist Papa with the emergency room visit in the first place. She believed, for better or worse, that your expertise would be best suited for the task.”
“I do want to make it better.”
“Of course, you do,” Isamu put a hand on his brother’s shoulder. “You love Papa. We both do. And no one desires to see their loved ones in pain.”
“They did x-rays and a cat-scan to look for hairline fractures, a sonogram on his leg to check for blood clots, all the normal blood workups doctors always order.” Minoru was uncomfortable enough that he changed the subject. “They did a full body checkup, which is how they found the rash on his hip. Papa claimed he’d probably just been rubbing it, but it didn’t look like something you could cause by rubbing. There were blisters. A couple of them had already crusted over. One looked pretty raw still.”
“Blisters and excruciating pain?” Isamu asked. Minoru could see him putting the pieces of this puzzle together almost instantly. “Do they suspect he has singles?”
Minoru nodded. “Yup.”
“Well, it is fortuitous that they conducted a more thorough exam than the first ER doctors did. Or perhaps, the rash had not yet presented itself in such a way…” Isamu nodded resolutely. “With appropriate antiviral medication, he should begin to feel much better in two to six weeks.”
“Unless there’s complications. Which you probably already know about because you know everything about everything.”
“The most common complication would be postherpetic neuralgia.” Isamu commented. “Damage to the nerve fibers due to the singles outbreak. There is no cure, but treatments can still ease symptoms…”
“He can’t walk, Bro. His feet are swollen. It’s like the nerves in his right leg are completely messed up. I’m not worried about him getting complications. I’m worried that he already did.”
“Well, it is true that if pain is the initial presenting symptom, the likelihood of postherpetic neuralgia increases.”
“They wrote him a scrip for gabapentin.”
“Oh.” Isamu blinked, understanding immediately. That was an anticonvulsant, but it was typically prescribed for postherpetic neuralgia.
“And for hydrocodone with acetaminophen.” He added. “You know, vicodin. For pain.”
“Your concern is well-founded. That treatment regimen does suggest a high degree of nerve involvement…” Isamu shuddered. “Which could take a considerable amount of time to resolve. Months perhaps. In some individuals, up to a year, if the studies I read are accurate…”
What he didn’t add was that sometimes that pain was not only chronic, but also permanent.
“It may be beneficial for Mama to seek out a pain specialist if this does not resolve in a timely manner.”
“Regardless of how long it lasts, I think he’s going to need physical therapy.” Minoru added. He’d studied conditions like this in his Fundamentals of Disease class. And while he didn’t have nearly the kind of eidetic memory that Isamu had, he remembered enough to know what could be done for chronic pain.
“Have you broached the topic with either him or Mama?”
“Yeah.” He nodded, knowing that she was more preoccupied at the moment with writing out a schedule for the prescription drugs and making sure dinner was prepared than she was with discussing future treatments. “She said that we’ll all just have to take it day by day.”
“Wise words.”
“He can’t walk!” That, in particular frustrated Minoru, and Isamu put an arm around him.
“That bothers you as much as seeing him in pain does...”
“Until a couple of weeks ago, he was a happy, active old guy. I mean, he wasn’t running marathons, but he was working out, doing laps around the block as part of his neighborhood campaign to clean up litter. And now, he can barely stand long enough to transfer from a bed to a wheelchair!”
It was sudden, like many diseases tend to be. And that made it all the more frightening. Even more so for Minoru, who was extremely active himself.
“It is okay to be scared.” Isamu encouraged.
“What if Mama can’t take care of him? What if the pain doesn’t go away? What if he doesn’t regain his mobility?”
Isamu pulled Minoru closer, letting his brother lean against him.
“We do as Mama so wisely suggested, and take this one day at a time.” He whispered. “When it is time for physical or occupational therapy, their doctor will write a prescription for it. And then a licensed physical therapist will create a treatment plan built around regaining what mobility was lost, or retraining the nerves how to work properly again. You know better than most that is a long-term plan. It is nothing that can be fixed now, or even while we are here this week. It is something Papa must unfortunately endure until it has run its course.”
“I want to help him…”
“All right, then… Ignoring for just a moment the guidelines we have already established for medical professionals not being responsible for treating immediate family members, what would you do if Papa were another patient assigned to your clinic while you were doing your rotation? What would your role be?”
Minoru thought for a moment before replying. “As a physical therapy assistant, I’d be helping him complete the treatment plan the physical therapist laid out. Whatever it was.”
“For how long?”
“It depends on how often they’d prescribe therapy. I might see him every day, or maybe only once or twice a week.”
“But for an hour or so each time?”
Minoru nodded. “Yeah, something like that. However long it takes him to do the exercises, and if we need to apply ice or heat, or use massage…”
“Then instead of one day at a time, I would suggest taking this one therapy session at a time. If you spend more than a couple of hours once or twice a week worried about one patient, you will not be able to adequately help the ones you see during all those other hours.” Isamu clarified, rubbing Minoru’s back soothingly. “Just because you have the medical knowledge does not mean you have the responsibility for carrying the weight of the problem. Not as a physical therapist assistant. Not as an orderly. Not even as a son.”
“Why does that sound so cold?”
“Probably because you are such an empathic person.” Isamu smiled a little as he pulled back from the hug. “But it is true.”
“But…”
“Minoru, no matter how many times Grandma Mikoto might cry Obasuteyama, remember, there are many ways to honor one’s family beyond traditional filial piety that do not carry undue burdens of guilt, pressure, unhappiness and loneliness.” He insisted. And there was precedence for that in their own family - after Grandfather Fuusuke passed away, neither Itaru nor his wife chose to return to Japan. Instead, they began their careers an ocean apart from the rest of the family, and started a family of their own. “Papa raised us to honor where we came from without being tied to it. With you, dare I say, he had a hard enough time trying to tie your feet to the ground.”
Minoru laughed at that.
“The best way we can honor what our parents have done for us is to live our lives with meaning and purpose. And allow them to do the same.”
Minoru was not entirely convinced, but he nodded. “Okay.”
“They are not alone. They have an entire community of friends and neighbors that will check in on them. Papa has a team of doctors that can coordinate his treatment plan. Things will return to normal at their own pace.” Isamu stood, and motioned his brother toward the door. “But speaking of normalcy, I am sure it will settle Mama’s nerves - and ours - to indulge in a traditional meal at the table, even if Papa is sleeping off the painkillers they undoubtedly gave him at the hospital.”
“Oh, they did. He was so high, he was giving me the most hilarious directions all the way home.”
“Hopefully, you were not attempting to follow them.”
“Heck no. I had the GPS on.” Minoru laughed. He nudged Isamu on the shoulder on the way out of the room. “Thanks for the pep talk, Bro.”
And in true Minoru style, he hopped up over the banister, and climbed his way down without even bothering with the stairs. Chichi admonished him in the quietest way possible, not wanting to wake her sleeping husband. In the distance, Isamu could hear Minoru laughing.
“Well, that is certainly normal for this household…” Isamu quipped under his breath, shaking his head. He may not have been accustomed to providing the motivational sentences - but his brother’s body language and the exchange coming from downstairs proved that he’d done all right.
Hopefully, their father would be all right soon too.
2 - Making Things Better
The twins sat in what was once their old bedroom, upstairs at their parents’ house. It had been a long day for both of them, albeit for different reasons.
The visit had not been planned. But when their mother called, saying that their father had been taken via ambulance to the hospital in excruciating pain, the twins did what they could to rearrange things to make the trip back home. It wasn’t urgent, Chichi had insisted. He hadn’t fallen or broken any bones (a concern now that they were getting older). He was not life threateningly ill. They had given him pain medication and released him the same night. Still, it warranted more than a long-distance phone call. The boys were in agreement about that.
Perhaps it was good that they did.
“Is he at least comfortable?“ isamu asked, nervously fiddling with a book he’d finished three hours ago.
“As comfortable as he can be.” Minoru replied with an exhausted shrug. “I got him situated in the recliner in the living room because it’d be easier for Mama than trying to help him get up and down from the futon. He fought me, though.”
“He has his pride.” Isamu agreed.
“That, and he was acting like he didn’t want to hurt me.” Minoru shrugged. Which Minoru didn’t really understand. “I was like, I can lift you. I know how to do it safely.”
Isamu let a small laugh escape his lips. “Perhaps if or when we become parents we will understand the need to protect our children at all costs. Even when it is highly illogical to do so.”
“Yeah, maybe…” Minoru laughed a little too, but it quickly trailed off.
“When he and Mama asked you to take him to the emergency room this morning, I did not expect you to be gone the entirety of the day. Dare I say Mama did not either.” Isamu admitted. “She was beside herself with worry.”
“I know. She called me six times.” Minoru sighed. “I felt bad saying the same thing. But I didn’t know anything yet. You know how hospitals are.”
“Not as well as you do.”
Minoru nodded. It was one of the reasons why he was the one asked. Still, he sighed. “It’s a lot different when you’re on the other side, though…”
Isamu tilted his head.
“I mean, sure, I transfer patients, get them dressed, clean them up, run errands for the nurses, but I this wasn’t the hospital I work at, Bro. I was just another family member in the waiting room on the verge of climbing up the walls.” He confessed. “And I know this is going to sound strange, because my entire job centers around handling patients, but when I was back with him… holding your own father up? Helping him put on his pants? It’s weird, Bro. It’s just weird.”
“I do not understand.”
“I don’t know if I do either. I mean, how many times every night am I helping somebody use the bathroom. But when Papa needed assistance to sit up and relieve himself, I had to step out of the room.” He admitted, shaking his head. “Like, that was too private, even for me. I like to think I’m an empathetic person. I treat the patients with kindness and dignity. I smile and try to help them feel better. But yeah, this… this was harder than I thought it’d be.”
Isamu stood up, crossing the distance between the two twin beds, and sat down next to Minoru.
“You are a very empathetic person.” Isamu reassured his brother. “Which may be why you needed to step out of the room. It was not because you felt nothing. But because you felt too much. And there was no safe outlet for it, at least, not at the moment.”
Minoru looked down at his hands. At that moment, the desire to run laps around the hospital parking garage was pretty damn high.
“It is difficult to be clinical, or even to think rationally, when someone you care about is suddenly in your care. Percival's Medical Ethics argued for the separation of professional and personal identities in the care of family members back in 1803, a sentiment echoed by the American Medical Association guidelines from the Council on Ethical and Judicial Affairs.” Isamu noted. “And while you may not be a doctor, you are a worker in a medical setting, and dare I say, subject to the same competing expectations. Given by the fact that Mama specifically asked you to assist Papa with the emergency room visit in the first place. She believed, for better or worse, that your expertise would be best suited for the task.”
“I do want to make it better.”
“Of course, you do,” Isamu put a hand on his brother’s shoulder. “You love Papa. We both do. And no one desires to see their loved ones in pain.”
“They did x-rays and a cat-scan to look for hairline fractures, a sonogram on his leg to check for blood clots, all the normal blood workups doctors always order.” Minoru was uncomfortable enough that he changed the subject. “They did a full body checkup, which is how they found the rash on his hip. Papa claimed he’d probably just been rubbing it, but it didn’t look like something you could cause by rubbing. There were blisters. A couple of them had already crusted over. One looked pretty raw still.”
“Blisters and excruciating pain?” Isamu asked. Minoru could see him putting the pieces of this puzzle together almost instantly. “Do they suspect he has singles?”
Minoru nodded. “Yup.”
“Well, it is fortuitous that they conducted a more thorough exam than the first ER doctors did. Or perhaps, the rash had not yet presented itself in such a way…” Isamu nodded resolutely. “With appropriate antiviral medication, he should begin to feel much better in two to six weeks.”
“Unless there’s complications. Which you probably already know about because you know everything about everything.”
“The most common complication would be postherpetic neuralgia.” Isamu commented. “Damage to the nerve fibers due to the singles outbreak. There is no cure, but treatments can still ease symptoms…”
“He can’t walk, Bro. His feet are swollen. It’s like the nerves in his right leg are completely messed up. I’m not worried about him getting complications. I’m worried that he already did.”
“Well, it is true that if pain is the initial presenting symptom, the likelihood of postherpetic neuralgia increases.”
“They wrote him a scrip for gabapentin.”
“Oh.” Isamu blinked, understanding immediately. That was an anticonvulsant, but it was typically prescribed for postherpetic neuralgia.
“And for hydrocodone with acetaminophen.” He added. “You know, vicodin. For pain.”
“Your concern is well-founded. That treatment regimen does suggest a high degree of nerve involvement…” Isamu shuddered. “Which could take a considerable amount of time to resolve. Months perhaps. In some individuals, up to a year, if the studies I read are accurate…”
What he didn’t add was that sometimes that pain was not only chronic, but also permanent.
“It may be beneficial for Mama to seek out a pain specialist if this does not resolve in a timely manner.”
“Regardless of how long it lasts, I think he’s going to need physical therapy.” Minoru added. He’d studied conditions like this in his Fundamentals of Disease class. And while he didn’t have nearly the kind of eidetic memory that Isamu had, he remembered enough to know what could be done for chronic pain.
“Have you broached the topic with either him or Mama?”
“Yeah.” He nodded, knowing that she was more preoccupied at the moment with writing out a schedule for the prescription drugs and making sure dinner was prepared than she was with discussing future treatments. “She said that we’ll all just have to take it day by day.”
“Wise words.”
“He can’t walk!” That, in particular frustrated Minoru, and Isamu put an arm around him.
“That bothers you as much as seeing him in pain does...”
“Until a couple of weeks ago, he was a happy, active old guy. I mean, he wasn’t running marathons, but he was working out, doing laps around the block as part of his neighborhood campaign to clean up litter. And now, he can barely stand long enough to transfer from a bed to a wheelchair!”
It was sudden, like many diseases tend to be. And that made it all the more frightening. Even more so for Minoru, who was extremely active himself.
“It is okay to be scared.” Isamu encouraged.
“What if Mama can’t take care of him? What if the pain doesn’t go away? What if he doesn’t regain his mobility?”
Isamu pulled Minoru closer, letting his brother lean against him.
“We do as Mama so wisely suggested, and take this one day at a time.” He whispered. “When it is time for physical or occupational therapy, their doctor will write a prescription for it. And then a licensed physical therapist will create a treatment plan built around regaining what mobility was lost, or retraining the nerves how to work properly again. You know better than most that is a long-term plan. It is nothing that can be fixed now, or even while we are here this week. It is something Papa must unfortunately endure until it has run its course.”
“I want to help him…”
“All right, then… Ignoring for just a moment the guidelines we have already established for medical professionals not being responsible for treating immediate family members, what would you do if Papa were another patient assigned to your clinic while you were doing your rotation? What would your role be?”
Minoru thought for a moment before replying. “As a physical therapy assistant, I’d be helping him complete the treatment plan the physical therapist laid out. Whatever it was.”
“For how long?”
“It depends on how often they’d prescribe therapy. I might see him every day, or maybe only once or twice a week.”
“But for an hour or so each time?”
Minoru nodded. “Yeah, something like that. However long it takes him to do the exercises, and if we need to apply ice or heat, or use massage…”
“Then instead of one day at a time, I would suggest taking this one therapy session at a time. If you spend more than a couple of hours once or twice a week worried about one patient, you will not be able to adequately help the ones you see during all those other hours.” Isamu clarified, rubbing Minoru’s back soothingly. “Just because you have the medical knowledge does not mean you have the responsibility for carrying the weight of the problem. Not as a physical therapist assistant. Not as an orderly. Not even as a son.”
“Why does that sound so cold?”
“Probably because you are such an empathic person.” Isamu smiled a little as he pulled back from the hug. “But it is true.”
“But…”
“Minoru, no matter how many times Grandma Mikoto might cry Obasuteyama, remember, there are many ways to honor one’s family beyond traditional filial piety that do not carry undue burdens of guilt, pressure, unhappiness and loneliness.” He insisted. And there was precedence for that in their own family - after Grandfather Fuusuke passed away, neither Itaru nor his wife chose to return to Japan. Instead, they began their careers an ocean apart from the rest of the family, and started a family of their own. “Papa raised us to honor where we came from without being tied to it. With you, dare I say, he had a hard enough time trying to tie your feet to the ground.”
Minoru laughed at that.
“The best way we can honor what our parents have done for us is to live our lives with meaning and purpose. And allow them to do the same.”
Minoru was not entirely convinced, but he nodded. “Okay.”
“They are not alone. They have an entire community of friends and neighbors that will check in on them. Papa has a team of doctors that can coordinate his treatment plan. Things will return to normal at their own pace.” Isamu stood, and motioned his brother toward the door. “But speaking of normalcy, I am sure it will settle Mama’s nerves - and ours - to indulge in a traditional meal at the table, even if Papa is sleeping off the painkillers they undoubtedly gave him at the hospital.”
“Oh, they did. He was so high, he was giving me the most hilarious directions all the way home.”
“Hopefully, you were not attempting to follow them.”
“Heck no. I had the GPS on.” Minoru laughed. He nudged Isamu on the shoulder on the way out of the room. “Thanks for the pep talk, Bro.”
And in true Minoru style, he hopped up over the banister, and climbed his way down without even bothering with the stairs. Chichi admonished him in the quietest way possible, not wanting to wake her sleeping husband. In the distance, Isamu could hear Minoru laughing.
“Well, that is certainly normal for this household…” Isamu quipped under his breath, shaking his head. He may not have been accustomed to providing the motivational sentences - but his brother’s body language and the exchange coming from downstairs proved that he’d done all right.
Hopefully, their father would be all right soon too.