Better III: The Opposite of Everything

(This is the third section of a three part essay) Part I Part II / Part III

In April I swallowed a camera.  This was a first for me.  I’ve eaten strands of pollen, jellyfish, and sliced tongue, but never a camera. Once, I tried to eat a drinking glass, but I was four then.  I know better now.  Certain things are not food.  So I was naturally suspicious when the doctor asked me to swallow a plastic capsule about the size of a .38 round.  The clear bubble-shaped window in the front reminded me of the submarine from the Fantastic Voyage.  The doctor assured me that the miniaturization process that shrunk the camera would not wear off in transit.

The doctor wasn’t sure the capsule endoscopy would reveal anything, but this was the only test left.  That’s a bad sign, right?  The last test. If they didn’t find anything, I’d be a medical mystery, a helpless case, or someone who was just ‘making it up’.  But I’m a diagnostic junkie, so I couldn’t pass up the opportunity to have 10,000+ photos taken of my insides.  I couldn’t pass it up. I couldn’t leave just one option unexplored.

“It might get stuck,” the doctor said.  “One percent of patients need to have the camera removed surgically.”  This risk was greater for me, because I was diabetic and presumed to have gastroparesis, a slow stomach. There was talk about taking Reglan to speed up my stomach, but he decided against it because of the potential side-effects, which include irreversible neurological damage.

This turned out to be wise.  He called me the next day, his usual nonplussed self.  “Not much to report,” he said.  Deep sigh.  He focused on the positives. The ulcers had cleared up.  Everything else looked clear and healthy.  “Oh,” he added as if it were an afterthought. “There was one surprise.  The camera went through your stomach in about three minutes.”

“Is that normal?”

Food is supposed to stay in your stomach for two to four hours. That is if you have a normal stomach. As the doctor switched from talking about  gastroparesis to tachygastria, a slow stomach to a fast one, I had to do a double take. How is this not new information?  How is this not the opposite of everything?  The doctor explained, somewhat sheepishly, that people can have both conditions. Basically, the stomach is controlled by pacemaker tissue, much like the heart.  If the contractions in my stomach are too fast, the stomach can’t keep up, so it may skip a beat, slow, or stop temporarily.  But he’s less concerned with whether my stomach is going fast or slow.  He’s more concerned about the symptoms,  and the fact that he still can’t explain the underlying cause.

I thought on this for a while.    No.  It still seemed significant. Through all my diets and diagnoses, gastroparesis was a constant, and the treatment was eat less fat, smaller servings, and more fiber.  For the last eight months, I spent forty-five minutes every morning stirring a pot of steel-cut oats.  I’m not a morning person.  I don’t deal well with the world until I eat or drink coffee, but there I was abstaining from both, stirring my oats and thinking good healthy thoughts.  I not only endured this ascetic ritual, I came to embrace it as a righteous cause.  I was doing what’s good for me, and steel-cut oats are so rustic, so earthy, so utterly devoid of earthly pleasures, that I can easily imagine monks in sackcloth eating it during prayer.  Please God, I would whisper to the pot.  Please Jesus or Allah or Buddha or that bearded guy from Hogwarts. Please accept this offering of my time and trouble and make my stomach better.

But God didn’t want me to eat oatmeal.

He wanted me to eat French toast.

Preferably made from brioche or challah.

To be fair, the doctor didn’t tell me to eat French toast.  He told me to separate eating and drinking, because even a sip of water could trigger the contractions.  But the additional fat from egg-based breads, milk and butter in French toast does seem to help slow things down further.  A little Cointreau or Grand Marnier probably doesn’t hurt either.  Alcohol is notorious for slowing digestion.  I also stopped taking Protonix.  All of these seem to have had a salutary effect.

Don’t get me wrong.  I stand by my last post.  The extended pleasures of food are more important than immediate gratification.  Growing your own food, gathering it, cooking it, sharing it with others gives you reason to eat in spite of suffering.  But you know what else is good?  Less suffering. Less suffering and more French toast.

I still don’t like the word better.  When people ask, “You’re better now, right?” I say yes, but it catches in my throat.  I have to explain.  The heart of my stomach still runs too fast.  It still flutters like a wounded bird.  It’s not better.  I’m just not provoking it anymore.  I’m feeding it what it wants.  I eat more and hurt less.   Maybe that is better . . . I roll the word over my tongue and try to get used to it.  It feels right in my mouth.  Just not in yours.

After several weeks of the French Toast Diet, I decided to really test out my new stomach.  It was May fifth, which Ann insists on calling “Cinco de Ted,” because it was the day I woke up in hospital.  It’s also my parents anniversary, so we’ve often spent that day eating out; now we just have a new reason to continue that trend.  For our first Cinco de Ted, we decided to go to the newest addition in Jose Garces’s empire, JG Domestic.  It’s probably not his best restaurant, but I find its awkwardness endearing.  It tries to combine the idea of local, American food with small-plate, tapas style eating.  Since when have American’s been into small plates?  Or for that matter, since when has a clientele of mostly suits and ties wanted to unwind by throwing back drinks and sharing miniature fondue pots with their almost exclusively male co-workers?   But I like to think Garces, with his regularly rotating menu, might eventually find a way to make it work.  The restaurant has many charms, not the least of which is a tasting menu chock-full of foods that I have been avoiding for the last two years.  I started with an “Adirondack,” a bourbon drink flavored with rosemary agave and mezcal and let it settle in before tackling the meal.  You have to pace yourself with Garces meals.  They start quietly with a few snacks and a salad that should only be picked at tentatively.  They’re good, but unexceptional.  From the Peekytoe crab croquettes onward, the meal seems to get increasingly rich and decadent.

Hickory smoked pecans with maple and bacon; house charcuterie and cheeses; seasonal salad with local mixed greens, seasonal baby vegetables, and citrus vinaigrette; peekytoe crab croquettes with avocado and pumpkin seed; wood oven flatbread with black trumpet mushroom, truffles, shaved cheddar and farm egg yolk; baby artichokes with potato dumpling, black truffle, smoked ricotta; Creekstone natural adobo rubbed rib eye with refried rancho Gordo cranberry beans and Vidalia onion rings; Barnegat light day boat scallops with cauliflower, black truffle, and kumquat; Bourbon beignets with bourbon vanilla mousseline, and Marker’s Mark butterscotch; Richter Farms rhubarb-swirl ice cream & jam with crème fraiche parfait and pickled rhubarb.

Sure, I felt full about a quarter of the way through, and I had to forgo the final bit of gelee served at the end, a dark reminder of Mr. Creosote and his wafer-thin mint. My stomach sounded like a garbage disposal, and I wanted to throw up for at least two hours.  But you know what?  So did everyone else.  That’s what’s important, isn’t it?  Feeling better and eating better is good for the everyday, but it’s nice to know that once in a while, if the occasion demands it, I can still compete in a no-holds-barred bacchanal dedicated to the pleasures of excess.

Speaking of Garces, Marisa McClellan won the Latin Evolution giveaway. She’s been giving away stuff on Food in Jars for years, so it’s nice that she gets to win something too.  Check her site out if you’re interested in all things preserved.

Coming soon:  Seasonal Cookbooks



(This is the first section of a three part essay) Part I / Part II / Part III

This time last year, I was making my first forays out of the house.  Even under “home care,” I took a daily constitutional, a walk to the curb or to the corner.  Ann or a PT supervised while I hobbled on my cane.  Spring turned into summer while I was in hospital, so everything looked sharp and bright.  This was the best part of recovery. Each day, I walked a little farther than the day before.  Progress could be measured in feet and yards.

Better is a bit of word magic that summons up positive thinking.  When I was still in the hospital, no one talked about normal. They talked about better. From the moment I woke up, they had me pushing my legs against the end of the bed to avoid blood clots and breathing into an “incentive spirometer” to help increase lung capacity. They had me doing exercises in bed, against a wall, with a walker, with a cane; they gave me a home therapist, individual sessions with an out-patient therapist, and a Pilates class where little old ladies with hip replacements outperformed me on every sidekick and stomach crunch.  They estimated that it would be a year before I really would be able to assess the damages, and it’s hard to spend all that time thinking that you’re doing all this work just to get back to may-or-may-not-be-normal. So you focus on better.

Better is whistling past the graveyard. I was actually excited by surgery.  Doctors said the gallbladder was probably just a casualty of septic shock, but they acknowledged that the “pre-gangrenous” nub of an organ, might have contributed to my current problems, and the stomach issues before it.   Long before the big bad, there was the little bad—stomach pain that lead to a string of hospitalizations.  After the third incident, they ran a string of tests but they were inclusive.  The best diagnosis that I could get was ulcers combined with diabetic gastroparesis.   That never sat well with me. I’ve been a type I diabetic for most of my life, so I would understand if I developed some form of neuropathy.  But this is supposed to start at the periphery.  Why would it skip the hands and feet and go straight for my stomach? A swollen gallbladder on the other hand, made sense.  It was a simple, concrete, diagnosis.  It was a ring of bright pebbles around it on the X-ray. So cut it out.  Take it away.  I’ll be better.  Better than I was before.

“You’re not supposed to be happy that they found something,” the doctor insisted.  I knew it was a long shot, but I figured I wouldn’t have to cope with the disappointment for a month or even a year, and I’d be in a much better position to cope with it then.

The day I left hospital, I threw up breakfast along with my Percocet.  I had a tummy pillow which I was supposed to clutch whenever I felt like I was going to sneeze;  it helped support my stomach and the incisions. I clutched it in the car all the way home.  We were terrified but it was really the best choice.  I’d have more control over what I ate. The only real dietary restriction I had been given was to avoid fats, but the gallbladder was really only one issue.  I was eating for recovery.  All those changes in your endocrine system and metabolism are a lot like grief.  You want to eat little or not at all.   So I turned mostly to congee.   The last time I had been a lively and energetic eater was in China.

Ann was teaching a course abroad through Saint Joseph’s University, and I tagged along.  Even then I was nervous about my stomach, and worried about how it would hold up.

When traveling, I have an almost uncontrollable desire to eat my way through every town and city, and our hosts eagerly fed that desire. We dined around large tables as our hosts gorged us on plant pollen, 1000-year old eggs, chickens with their heads and feet still on them, and enough baijiu to fell a water buffalo. We were told it was impolite not to drink when anyone made a toast, and that it was impolite not to make toasts. If you’re seated at a table for twenty-four that takes its toll.  After we had already drunk to our hosts, to international relations, to education, I once found myself toasting the free-range chickens, pecking the ground outside the window. But for all that, I never felt sick.

So I returned to life with Chinese food in general and congee in particular.  Congee, also known as Jook or Zhou is basically just boiled rice.  It sounds like the blandest most impoverished food in the world, but like Risotto—every grandmother seems to have their own recipe.  The simplest, used for medicinal purposes is just a few grains of rice boiled in water, but the actual quantity of rice used, how soupy it is, or how well cooked the rice is varies tremendously.  Congee actually served for meals is often garnished with peanuts, scallions, and ginger, along with any form of meat or vegetable.  The first congee I ever had was at the Congee Noodle House  in Vancouver, and it was served with Ostrich, so it goes without saying: congee is more flexible than most American comfort foods like chicken-noodle soup. It’s varied enough to merit its own cookbook, The Book of Jook: Chinese Medicinal Porridges.  It’s fed to children with sick stomachs, and equally important, it’s eaten during times of grief.  In Joan Didion’s The Year of Magical Thinking, congee is all she can eat after the death of her husband. In Nicole Moyes The Last Chinese Chef, the protagonist eats congee with a family grieving for the loss of an esteemed elder cook.

She mixed her congee with her spoon and tasted it.   Oh, so good.  She shivered.  The salty and piquant flavors against the delicate fragrance of rice, the crispy fish against the tofu and the soft gruel. Sheer goodness.  She caught Sam’s eye and said one word, “Wonderful.”

The uncles agreed. “I would come back from the dead for this,” said Jiang. “What is that poem? The one that calls back the soul to the table?”

“Oh! From the Zhou Dynasty,” said Tan.

To their surprise, it was Liang Yeh who started to intone, in English.

“O Soul, come back!! Why should you go far away?

All kinds of good foods are ready:

Rice, broom-corn, early wheat, mixed with yellow millet –

Ribs of the fatted ox, tender and succulent;

Sour and bitter blended in the soup of Wu.

O soul, come back and do not be afraid.”

Okay, so “ribs of fatted ox” wasn’t exactly on my diet, but I’m fond of ginger in all it’s varieties, shredded, pickled, or fried.  As I recouped, I graduated to roast chicken and salmon. As long as Ann did all the crouching, pulling pots out for under the counter or vegetables from the crisper, I was okay.  I could slice thin bits of salmon and pour the congee over it to cook.

As my tastes grew more adventurous, Ann supplemented meals by picking up an order of xialongbao from Sang-kee Bistro in Wynnewood. These soup dumplings were one of the highlights of our China trip. They’re like traditional steamed dumplings, only they’re filled with broth as well as the obligatory ball of pork and chicken.

Soup dumplings are tricky to make yourself, and they are emphatically not the kind of thing you should learn to cook from a book.  But since I never found anyone in Xi’an to teach me, and since I had a lot of free time on my hands, I turned to  Brian Yarvin’s, A World of Dumplings.  This probably isn’t the most authentic source, but it taught me the two key things I needed to know. 1) Do not, under any circumstances, use store-bought wrappers.  Home made ones are far more pliable, far easier to seal than store bought wrappers, and that’s important if you’re going to be filling them with soup.  Besides, the dough is fun to work with.  You start with a simple mixture of flour and water that you endlessly stretch by hand. You form a ring of dough, and you gradually pull it through your hands like prayer beads. The loop of dough gets longer and longer, until it brushes the floor, at which point, for sanitary reasons, you stop and section the dough for rolling. 2)  You do not actually wrap soup in your dumplings.  I feel like a magician revealing a secret here.  You probably think that for centuries, Chinese chefs have been deftly injecting soup directly into premade dumplings with diminutive turkey basters. I hate to dispel that fantasy. But the trick is simple.  They use a stock that is so rich in collagen that it is solid at room temperature. It’s like jello and only melts into soup when the dumplings are steamed.

I was happy enough with the results, but Yarvin’s recipe convinced me that Xiaolongbao was best left up to the professionals.  It’s just too much work.  I could even put up with Sang-Kee’s vaguely obscene translation “steamed juicy buns,” if it meant not having to spend a whole afternoon rolling out dough.  That said, cooking was clearly a uniquely pleasurable form of occupational therapy.  If my home OT had taught me to make Xialongbao rather than giving me remedial lessons on buttoning my shirt, I probably wouldn’t have kicked her out the door.

My stomach and mood did not recover as deftly as the rest of me.  Long after my daily constitutional reached the grocery store and back, my stomach started to kick.  At first, I was just one of the 40% of patients that brochures say will have difficulty with digestion for up to a month or six weeks after surgery.  My doctor was not at all surprised that my adjustment might be slower than that due to my diabetes and everything else I had been through. He was more concerned with the rolling headaches and monitoring my Warfarin dosages.  But my stomach didn’t get better.  It got worse. It vibrated with a low voltage current, like a car battery was clipped to either end.  Whenever I ate, it fibrillated. Mornings were the worst. Breakfast led to cramps and other unmentionables. For at least a few hours out of each day, I felt clammy and depleted, as if I had motion sickness.

By the fall, I returned to my GI.  His first thought was that my gastroparesis had deteriorated.  This was unacceptable.  I had worked hard to get him to concede that I might not have gastroparesis at all. My stomach problems were supposed to disappear along with my gallbladder into a jar of formaldehyde somewhere, right?  So why was he insisting on this diagnosis now? I accepted diagnosis number two: bile salts.    Gallbladders don’t do very much. They moderate the flow of bile into the digestive tract, which aids in digesting fats.  Without it, bile keeps on flowing but haphazardly.  A small percentage of patients have ongoing problems with excess bile and bile salts after their surgery. That seemed appropriate somehow. I’m bile-impaired.  Doctors from Hippocrates through the middle ages associated an excess of yellow bile with sleeplessness and irritability.  Even today, “biliousness,” refers less to projectile vomiting than to those who are petty, snappish, ill-humored, or given to grumbling.  Now that I think about it, I’ve probably been bile-impaired since the age of four.  Can I get a disability card for that?  It would probably come in handy at work.

The problem is permanent, but easily treatable. All you need is a daily packet of orange resin, called Cholestyramine.  It looks and even tastes a little like Tang.  Sadly, that loose association with astronauts was the treatments only positive result. After a few weeks, I was back to square one. I supplemented my Protonix with new medications, started to eat steel-cut oats for breakfast, and things just seemed to get worse. Ann bought me a Vitamix for Christmas, hoping that if I couldn’t eat raw vegetables, at least I might be able to drink them. I was ecstatic to have a shiny new toy, but my first vibrantly green smoothie made me sick for days. I almost sent it right back to the store, but that was too much to bear.

I avoided milk for several weeks, then wheat-gluten, then fructose.  Each time I tried a new diet, I felt certain I was on to something. But a few days would pass, and the engine in my stomach would slip out of gear and grind.

Better is a lie.  We want to tell stories that lead from cause to effect, from conflict to resolution.  This is what makes stories coherent.  This is what makes us coherent.  I want to say that illness is an “out there,” kind of problem, and I want to tell a story about how I solve that problem.  By this reasoning, becoming better and becoming a better person were one and the same thing.  But chronic pain doesn’t submit easily to our expectations for narrative form.  There’s no beginning, middle and end, no peak action, no resolution. It’s about as likely to make a good story as watching waves break on the Jersey shore.

(To be continued).