On Mother Tongue and Other Tongues

I’m lying on the couch with my eyes closed. My husband sits next to me and watches Dutch news, an item about farmers and the nitrogen crisis. It crosses my mind that despite my passive listening I understand word for word what’s been said. Lazy listening. I don’t need to pay attention to be able to follow an argument between an angry farmer and a politician. 

* 

In the hospital this was different. Apart from the first few days when I slept for most of the time, I was constantly on alert or switched on, carefully listening to what doctors and nurses had to say for instance about my blood values, the use of a breathing exercise device, the drugs that I received or focusing on the instructions of the physiotherapist while we walked through the hallway. I just couldn’t allow myself to get distracted or not pay attention as I instinctively knew I would miss important information about my health. 

 

Three nurses enjoyed speaking English with me. Others, such as the head physician of the ward, the physiotherapist, kitchen staff and other nurses, approached me in Finnish. That was perfectly OK. We managed and I even believe that my Finnish improved during my eight day stay in hospital. For instance, I didn’t know the words  “kasvainmarkkereita” (tumour markers) or etäpesäke (metastasis) before I was hospitalized. The Finnish hospital vocabulary or more precisely, the cancer vocabulary, was anyway completely new to me. When I got ill in January, I decided to keep a wordlist in my notebook and practiced pronunciation. Words like or neo-adjuvantti-sytostaatti-hoidot (neoadjuvant cytostatic treatments) or solun-salpaaja-haitta-vaikutus (adverse cytotoxic effects) made my tongue twist. 

 

Also, whether it was Finnish or English, to avoid communications problems I constantly made a point of summarizing or requesting clarification. If things didn’t become clear, I would ask another nurse or one of my doctors to explain once more.  

 

“I don't follow you. Could you slow down please,” I would also often ask. 

 

It was a two-way direction. To get my message across I was especially attentive to the facial expressions and body language of my counterparts. I sometimes noticed that my Finnish grammar or English pronunciation puzzled others.  

 

Such encounters are normal when you live abroad but my stay in hospital was not exactly a language course about buying forest berries on the market. My fragile health was involved, and of course I felt vulnerable: in hospital, many decisions about your treatment are made without your consultation and often delivered in a non-engaging manner. Frankly, the only decision I’ve made for the sake of my own well-being was to release myself from the hospital. Also, irrespective of language, patients are always running behind the facts anyways. A different language, a medical jargon or a dialect just requires more attention. 

 

I didn’t give the whole language thing a thought when I was in hospital. I’m not a linguist reflecting on syntax or morphology. As far as I’m concerned, languages need to be practical, so I went with the flow and tried my best to be creative with words, facial expression, hand and feet. Since our family moved abroad, first to Germany, then to Canada and finally to Finland, I understand very well it’s up to me to put in the effort.  

* 

But now, a few weeks after my release, listening to a discussion about agricultural pollution in the Netherlands, it strikes me how challenging and tiring it was to be fully immersed in a Finnish hospital environment. To constantly be on your toes to catch up on medical information in a grammatically complex language certainly consumes a lot of energy.  

 

“The Dutch language is not elegant or friendly, it sounds like a throat disease,” international friends often say, and I can understand why they’ve come to that conclusion. Personally, I’d rather hear Flemish or Afrikaans as they sound so much more melodic and friendly than the harsh Dutch consonants.  

 

Yet, fatigued and brain fogged on the couch and passively following Dutch news about a national crisis, I start to appreciate my mother tongue and its rhythm more than ever.  

 

 

 

June: Rehabilitation Month

At home I take a shower to wash off the smell of cleaning products, wound disinfectants, drugs, food, urine and other odours from the poorly ventilated hospital room.  

 

To boost my mood, I ask my husband to pick my brightest pyjamas from the shelves. In the hospital I passively accepted a green-grey pyjama that pushed me immediately into the role of the patient. The shabby fabric made me feel like a dishcloth. It's a well known fact that patients who get dressed in their own gear will walk more and recover faster. Reasons enough to abandon hospital gowns altogether, I think. I hope that my red and white polka dot pyjamas will make me feel real again. 

* 

Nutrition 

While I showered, my husband and our youngest, not prepared for my early homecoming, quickly heated up the chicken soup I’d made weeks earlier. I’m usually fond of homemade soup with lovage, onions and chives from the yard but as soon as I smelled the spices, I felt disgusted. I tried to be brave and swallowed a bit of the broth but instantly put my spoon down. 

 

How weird. I had been looking forward to finally having a good meal and certainly hadn’t expected that my lack of appetite would continue at home. In the hospital, whether porridge, mashed potatoes, buns with cheese, boiled carrots, fish or red beet salad, one bite was enough to make me gag. Yoghurt and tea with honey were the only things that went down well. “You should eat more,” the nurses kept saying. I tried, I really did, but my bowels weren’t functioning properly, I was wearing a tight abdominal binder and found eating from the bedside tiring for my back. Also, I thought it was the hospital food that made me feel nauseous.  

I was mistaken. Later I learned that appetite loss is a common problem after major abdominal surgery and that it can easily take weeks before the desire for food returns. My lack of appetite had nothing to do with the quality of the hospital food. Why did no one correct me on that? 

* 

It is thanks to my youngest and his girlfriend who’d arrived from Edinburgh a few days later that I gradually regained my appetite again. Day by day they did their utmost to cook balanced meals and make sure I got the much-needed calories. My taste had changed so it was a matter of trial and error. By the time the couple set off for Scotland, I ate small portions again.  

* 

Cold Chills 

The first night at home I went to bed around 21:00. As soon as I laid down, the cold chills came over me again. Teeth chattering, shivering under the duvet, I felt cold to the bone, stressed and scared. My husband and our youngest, initially unsure what to do, decided to wrap me up in woolly blankets and put wheat bags (heated up in the microwave) under my armpits. After half an hour or so I slowly got warmer and finally fell asleep.  

I knew that postanesthetic shivering or hypothermia happens when patients regain consciousness shortly after surgery. But my first cold chills took place eight days after my operation. It didn’t make sense and I didn’t know whether this was normal or whether I was dealing with a serious complication. It frightened me.  The cold chills continued for a week or two and then gradually disappeared although I often felt cold during an otherwise summerly and hot June month. 

Much later I read in my notebook that the cold shivers started on the day my epidural was removed. However, I couldn’t find any scientific correlation between the two. But I did read that cold shivers can be related to a heightened period of anxiety. I wish I had known earlier. 

* 

Battered Body 

Back home I also discovered that like in the hospital, my body still felt dilapidated. Whether I sat on the wooden dining chair, on the couch or in the comfortable leather chair, I couldn't sit for longer than 10 minutes in the same position. I kept turning and tossing in bed although my mattress is way more comfortable than the hospital bed. I slept somewhat better, especially after the antibiotics for my bladder infection started to work. Still, it took weeks before my body could quietly sit in the same position for 30 minutes. 

* 

My Scottish “daughter”, who noticed my restlessness, told me about a social health nurse who came to visit her dad at home after a colon surgery. “It was so good, not only for my dad but also for my mum to be able to ask questions and talk about their insecurities and fears,” she said. “Do you have such a support system in Finland?” I told her that I received a phone number. Pensively looking at me, she (a psychology graduate) asked, “Would you do that Ata? Would you call if you had problems?”  

The number of the ward is in my mobile. But are cold shivers, unrest, lack of appetite or physical discomfort sufficient reasons to call? I’d already mentioned my feeling of discomfort to the nurse when I was in hospital. She had given me a protein drink and a pill but no explanation. If I had excruciating pain, I would take a painkiller but it’s not that I was in agonising pain. My body, bones, muscles and nerves were tense and strained and I felt stressed about it. Is that enough reason to call? 

A month later it finally dawned on me that I was underestimating my anxiety, tiredness and the confusion that came with my physical discomfort. Of course I felt insecure and tense about my body and its reactions. I remember telling my family that I’d imagined that my stomach resembled an oval cookie tin. “It feels as if two Dutch “stroopwafels” (bladder and bowels) are firmly glued to the bottom of the tin but I fear the Danish butter cookies (other abdominal organs) will crumble and break into a hundred pieces as soon as I make an unexpected move,” I explained.  Not knowing how to interpret unfamiliar signals of my body made me constantly feel as if I was on the edge, indeed. 

* 

Scholarly Stuff 

By the time I’m writing this blog I decide to go online. I learn that pain is very common after abdominal surgery and that it can have many reasons. For instance, the pain can come from the tissues in the internal organs, from the scars, the abdominal muscles, or the damaged nerve cells. Also, twelve hours on a surgical table can cause pain in the lower spine or back. 

I wish I had known earlier. Why did no one tell me? Clarity and reassurance would have helped enormously.  

While I’m scrolling through medical literature it crosses my mind that the suggestion of my Scottish “daughter” about a visiting social health nurse could have taken away a lot of my discomfort and stress.  

Just someone to acknowledge my fears and educate me on my discomfort would have helped me to feel calmer, I think.  

It also dawns on me that the transition from being under full-time supervision in hospital to not being seen by a doctor or nurse for a month shows quite a hiatus. How on earth do other CRS (cytoreductive surgery) patients keep their spirits up at home, I wonder. Do they constantly call the hospital? What questions do they have? Or should I have asked the surgeon before the operation what recovery at home would entail? But when we met, surgery seemed like an endpoint. At that stage I wasn’t able to look over the fence and comprehend what would happen afterwards. I just don’t know but CRS is associated with postoperative complications and it’s evident that the lingering uncertainties about the effects of a twelve-hour surgery made my rehabilitation month unnecessary wearisome. 

 

I could conclude that I’m just not good at making phone calls (I prefer communication by text message or e-mail). However, before pinning myself down, I decided to ask one of the nurses during my seventh chemo treatment. “What would have been good reasons to call the ward?” I asked. Her answer was clear. “You should call when you have fever or serious pain,” she stated.

Of course it's a problem if nurses don't pay attention to the emotional needs of their patients. But what if the patient finds it challenging or too difficult to ask for emotional support? I mean, who wants to come across as a whiny or demanding patient? I certainly don't. Nevertheless, I realise that I should have made that phone call and talked about my fear and insecurities. 

Still, it would have helped me if someone would have reached out.

Post Surgery

June 1

A male voice on my left side: “How do you feel?”

“I’m thirsty,” I whisper. I feel a straw between my lips, take a sip of water and drowse off again.

Sometime later, another voice, this time coming from my right. I manage to open my eyes for a second and recognize the surgeon I’d met a week earlier. 

“The operation took twelve hours, longer than anticipated, but it was successful,” she says.“ The intestines were clean, so you didn’t need a stoma,” she adds.

I feel foggy and relieved. Bowels, bladder and heart still in the right place, I reason before I doze off again.

*

June 2

The same male voice. He speaks international school English. I talk nonsense. It takes too much effort to open my eyes. I sense he’s monitoring me.

More voices, the smell of coffee, a different kind of light filters through my closed eyes. Maybe the early shift?

I can’t recall being transferred from the recovery to the gynaecological ward.  Neither am I aware of my husband at my bedside. “I was there around noon,” he told me later.

At 17:00 my husband gives me an update of the phone conversation with the surgeon last night. “No tumours were found in your intestines,” he confirms. 

I’m heavy with drowsiness and nod. 

“They removed part of the liver, your spleen, the reproductive organs and all visible tumours. The surgeon said this was the best possible outcome of the surgery,” he concludes. 

“Good,” I reply apathetically and fall asleep.

*

 

June 3

I become aware of the drains, tubes, catheter and the abdominal binder (some sort of corset) around my abdomen. Two other patients in the room. I raise my hand to greet them. I still feel drowsy.

Nurses try to get me up. I feel I might faint but stand straight for a second or so. They praise me for the effort but I’m glad to be back in bed and tucker out immediately.

*

June 4

One of the nurses, bless her, offers to give me a shower. Cables and drains are disconnected, the corset comes off and I’m wheeled to the bathroom. Warm water over my battered body. I feel shaky, rejuvenated and exhausted.

*

June 5

The physiotherapist brings a support walker and together we walk through the hallway. It goes well. Haemoglobin (80g/l) and oxygen are still too low. I’m dog tired.

Ascites drain removed.

*

June 6

I walk independently to the toilet in the hallway and that’s very much needed as my bowels are trying to get back to normal. The doctors prescribed constipation medication with diarrhea as a result.

Nasal oxygen cannula removed.

*

June 7

Urine catheter removed.

I have a bladder infection and keep running to the toilet. I barely sleep anymore. It’s a challenge to roll the infusion pole silently through the cramped hospital room. My nightly expeditions to the bathroom bother fellow roommates.

The doctor visits, I might be released in two days. Yay.

*

June 8 

Epidural and IV cannula removed.

Early afternoon: I’m icy cold. Shivering and shaking I call the nurse who measures my temperature. No fever. I take three blankets, wrap myself in and try to find a comfortable position in bed. In vain, I keep tossing and turning, feeling restless and anxious.

17:00: I’ve had enough. I want to go home, sit in a comfortable chair and quietly sleep in my own bed. I call the nurse and tell her that I have decided to go home. “I keep rolling and moving, there’s no position I haven’t tried,” I say.  “The mattress is uncomfortable, my back hurts, I keep running to the toilet and constantly wake up my roommates. I can’t stand the hospital food, I’m freezing cold, I need woolly blankets, a thick pyjama and my own bed,” I blurt out.

The nurse disagrees, comes up with arguments, valid arguments even – for instance about the need for supervision, about the drain stitches that aren’t removed yet and the immunisation shots I need. Still, looking at her face I can tell she understands I’m serious. I realise I behave like my strong minded Mum now (Dad would never go against the rules), but I feel desperate. Another night on the ward would mean another sleepless night. I’m anxious and worn-out already. I just can’t stand it any longer.

The nurse promises to call the doctor and half an hour later I get the green light. My husband and our youngest who’d just arrived to visit me are taken by surprise when I tell them I’ll be coming home with them. “Are you sure this is a good decision?” my husband asks. But he has seen me sobbing earlier that day and knows I’ve made up my mind. He packs my stuff and our youngest arranges a wheelchair.

The nurse, sporty of her, helps me to get up, and gently administers four (pneumococcal, haemophilus influenzae, meningococcal B and ACWY) intramuscular vaccinations in my thighs. She removes the drain stitches, hands over antibiotics to treat the bladder infection and gives me a sheet of paper with a date to get the sixty-one staples on my surgery incision removed.

“I hope I will never see you here again,” she says with a cheeky smile as she waves me out.

*

During the twenty-minute ride home I notice summer has started. Fresh green leaves on the trees, white blossoms, wildflowers on the roadside and a bright blue sky. I feel as if I’ve just crawled out of a long and dark tunnel and blink my eyes. “The world looks colourful,” I mutter.