Panama 2018: Minga at the Mall

Yes, you read that correctly. After dialysis, which now ends around 10am if Minga gets there in time to be among the first group hooked up, Lily asked her grandmother if she wanted to go back to Ana’s to rest or should they go to the mall. Minga, to my utter astonishment, chose the mall. 🙂 All the Christmas decorations are up, and Lily says Minga loved them.

As long as she’s in the wheel chair Minga can’t travel by bus. Lily has Uber, and Ana takes her to and from the hospital in a taxi — more expensive, for sure. Raul and Angel get Minga in the taxi, and Ana says there are always people hanging around the entrance of the hospital to help on that end. On Thursday morning a couple of the young men offered.  That is part of the culture; no well-raised younger person would ignore an older woman who needed help getting out of a taxi and into her wheel chair.

Many of you have asked if we know any more about Minga’s leg pain. The answer is no. She had the xray on Wednesday, and it will indeed take 10 days for the results. Minga has seen a variety of doctors, and opinions are conflicted. One nephrologist said emphatically that the leg pain is not a side complication of dialysis. Another said equally emphatically that it is. Everyone she’s seen seems to want her to get up and walk and not become dependent on the wheel chair, although no one seems to  be able to tell her how to do that when the calf hurts too much to support her weight.

I told Minga I’m coming on November 13, and that we’ll have a week together. She said that I have taught her that she is a strong woman and it’s OK to stick up for herself and say what she wants. I think that’s about her move to Ana’s, and her insistence on staying there despite differing opinions among some of her adult daughters about where she should live. I’ve known Minga for a long time, and I think she’s a strong woman who has always stood up for herself, at least with men.

Ana was on the WhatsApp call, and I said I am very grateful for the care she is giving her mother, even as I know how hard it is. Ana is a lovely soul. She said this is her mother, and she will care for her as long as it takes.

Panama 2018: Hanging in There

Here is Minga in her new wheel chair — hanging in, I’d say.

Some of you have asked why the switch to a 6am dialysis slot. I asked Lily: the patients at the hospital where Minga is being treated have no say in when they are told to come, and no means of appeal if their treatment time is changed. Ana is apparently getting up at 3am to get Minga ready to leave at 4am, so they can be at the hospital in time for Minga to be part of the first group that gets hooked up at 6am. This treatment time is really hard on the family all around, as Raul and Angel have to carry Minga down the stairs at that ungodly hour.

Did I mention that it’s rainy season, and pitch dark at 4am?

Given all that, I’m pleased to see Minga continuing to dress in pretty colors — Ana is taking good care of her. Minga is a very feminine woman, and she takes pains with her hair and her attire. Always has. She likes to look nice, even within the walls of her own home and certainly when she goes outside. These bright colors are lovely on her.


Panama 2018: Extra Panama Trip

Sara worked her travel magic and we found a flight to Panama in mid-November that works and doesn’t cost the earth. I’ll be going for a week — five days in Panama City actually, accounting for the full day on either end it takes to go and get home.

At this very difficult stage in Minga’s life, when she is beset by severe leg pain and unable to walk, still undergoing dialysis 3x weekly, all I can give is presence. That is what I am on my way to do.

Somehow her dialysis slot has changed. She’s now part of the 6am group, which means getting up at 4am to get to the hospital in the dark. She’s done, at least in theory, by 10am.

Is there anything about this dear soul’s life right now that isn’t hard?

Panama 2018: Update on Minga

Minga saw a nephrologist on Thursday — another new one, a doctor she hasn’t seen before — and this nephrologist said Minga’s leg pain is a not a result of dialysis or the underlying kidney failure. The doctor did confirm that Minga is unable to walk, and has referred her to a physical therapist and for some Xrays.

As I suspected, the wheel chair Minga has been using is a heavy, old model. I’m going to pay for a new, lighter one which will make it easier for Raul and Angel to carry her down the stairs from the apartment in the wheel chair, and back up again after her dialysis. They were going to try to carry Minga down and up on a simple hard plastic chair, but Lily was afraid Minga would fall off and make whatever problem exists with her leg even worse. Lily has explored the options available in lightweight wheel chairs and has found something that will work.

Minga is largely unable to take pain meds other than acetaminophen, because pain meds negatively affect her kidney disease. The doctor did prescribe something stronger if absolutely necessary, but said Minga can’t take it more than once a day and if she takes it at all it will make her very nauseated. Great.

Flights to Panama any time between now and after Thanksgiving are wickedly expensive, ridiculously so. Sara is going to help me find something workable this weekend. Hoping to go just after a consulting gig I have in Minneapolis in early November and return right before Thanksgiving.

Panama 2018: Minga Not Doing Well

Minga is experiencing leg pain severe enough to keep her from walking. I Googled the symptom, and found that it is very common among dialysis patients — etiology unknown, treatment unclear. Hot packs. There are some drug options. A walker might help.  Oddly enough, I don’t recall seeing very many older people in Panama, either the city or rural areas, using walkers, not the way we do here where older people are numerous. But walkers have to be available. Good ones with a seat cost around $125 in the U.S., but I’m sure in Panama they charge much more.

It’s not clear to me, even after talking with Minga, whether the pain is intermittent or present most of the time. But if Minga can’t walk, it’s a real problem. She has to walk to get to and from her dialysis. She also has to walk to keep her bodily systems functioning. Her decline, if she becomes sedentary, will be quick.

Minga wept on the phone, saying that I am like her mother and that all she has to give me in return is her love and her blessings. The words, and her tears, just about undid me.

Panama 2018: Jari’s Two Little Ones

Jari is Minga’s granddaughter, #2 of Ita’s four Jaris: Janelys, Jarelys, Jarinelys and Jarineilys. Yes, the last two have essentially the same name, slightly different spelling. Jari #3 is called Jarin, and Jari #4 is Neilys.

Jari’s partner and the father of both of her children is Joel — he works for a computer company, and is the youth pastor at the church where Jari’s family goes. That’s how he and she met.

We used to call Jari “party girl”, because she has such a bubbly, exuberant personality — and here she is the very competent mother of two small children. She and Joel bought their own home just on the other side of the Bridge of the Americas, in LaChorrera — more than an hour from where she grew up in Filipio on the other side of the airport. Her mother Ita, Jarin and Neilys still live there, as does elder sister Janelys and her two little boys, Christian and Sebastian.

Jari was studying canal zone management at the University of Panama, but I believe has taken a hiatus to care for her children.

Purely by happenstance, she was at Minga’s ten years ago when I first returned to Panama — she was about 12. She vividly remembers that day, as do I.

Here are her two little ones, Britney and Joelito. Joelito is 2 1/2, and Britney is five or six months old. You can see Jari’s sparkling personality in this pic, yes?

Panama 2018: Talking with Minga

I was able to have a long chat with Minga on Friday. Ana was home with her, and daughter Teri as well. Minga doesn’t quite get how to hold a cell phone a bit away from her face so I was looking at her forehead or hair or an ear most of the time, but it was a wonderful catch up conversation and visit.

She wants everyone to know she is grateful for all of your prayers and concern, and that on September 24 it will be one year that she is on dialysis. She said she feels pretty good, much better than last year when she was brought to the hospital near death. She sends all of you her love.

Minga is a very social person, as I knew from watching her in the village. She sort of “holds court” on her narrow front concrete patio, where she sits and makes herself available to the neighbors going by and to family who pop in to visit. She chats with the lady selling lottery tickets, the junk man going past collecting old metal, the fish truck driver selling fresh catch, the guy on a bicycle balancing a big stand of bananas on his back, the mothers and grandmothers walking their small children to and from school. Her grandchildren and great grandchildren zoom into the yard on old bikes, or on foot, and zoom back out again.

Minga has now created community with the dialysis patients and their families who come to the public hospital for that 10am Tuesday, Thursday, Saturday slot. It isn’t an easy, convivial environment. People are strung out along a very long, narrow hallway on hard plastic chairs. Many of the actual patients arrive not feeling well; they have a hard time walking up to stand in line when it’s time to go into the dialysis suite. There is no coffee shop, so they aren’t able to bond over a cup of coffee or a meal. But Minga goes up and down the long line of chairs, checking in on people. And they come to her. The nurses and orderlies, who seemed rather formidable and unfriendly when I was with her last year, have come to know her and she says they welcome her warmly when it is her time to go in.

Minga eagerly awaits my January visit; she says it gives her something to look forward to. She doesn’t have women friends to talk over aging with, and she doesn’t read like I do. But she’s figured out the basics all by herself: be social, get exercise — walking to and from the bus and up the stairs to Ana’s apartment make that happen naturally — and have things to anticipate that give meaning to life.

I continue to be amazed at her tranquility and grace.

Panama 2018: Minga

Ana tried to call while she and Minga were awaiting dialysis. I was out and didn’t receive the call. Hopefully we’ll connect in the next few days. I recognize where Minga is sitting: on one of the hard plastic chairs that line the long narrow hallway where patients and family members wait their turn.

I think Minga looks generally well, although her face looks a bit puffy. The port through which she is receiving dialysis is lower down on her chest, not so bothersome as when it was higher. I won’t know anything about her spirits until we talk, but once we have I’ll let you know.

Conscious Aging: Acceptance

A friend recently asked me how Minga is doing. I responded that she seems up and down physically, but remarkably consistent in the grace and acceptance she shows relative to living with dialysis.

Acceptance isn’t a word that I embrace willingly, and after the brief conversation about Minga I thought about it more. Minga’s desperate poverty has not offered her many choices in life. The practical effect is that she is long versed in the spiritual discipline of acceptance. She is fiercely proud of those instances where she did have a choice. While the U.S army base was open just outside the village of Rio Hato — during my Peace Corps years and until 1990 — young girls would gain a few dollars by satisfying the sexual needs of the randy 18 year old enlisted men who came to village bars to drink. Minga never did that, a fact she will tell you proudly, even when she struggled to put food in the mouths of her nine growing children and had practically no other ways to earn income.

My life has been very different, at least as an adult. If I read something whose viewpoint I don’t accept, I look for other sources. If I get a bad table, or a poorly prepared entree, or a garment returned from the dry cleaner that is damaged, I insist on an adjustment. If I wonder about a medical recommendation, I get a second opinion. If I don’t like the quote for a new car, I make a counter. Acceptance for me is an “if” not a “must”.

That said, I do greatly admire Minga’s attitude toward her dialysis, which has changed her life in every respect. She always said she would never live in the city; she is now living in the city 5 days out of 7. She always said she didn’t want to live tethered to a machine; she is now living tethered to a machine. She loves her home, her neighbors, the flow of village life. Now she is living with her daughter Ana in a city apartment, rather isolating. Minga is glad to have the welcome and the support. But it still has to be hard for her not to be the center of her own home with extended family popping in and out all day to visit.

Aging has something to do with becoming more practiced at acceptance, I suspect. My choices are limited, somewhat, by energy levels, by a reduced tolerance for commotion, by less steady balance — even though I work at it — which makes it a bad idea for me to climb up on a ladder to change batteries in the high ceiling smoke alarms. Ben and Sara came over last night to help.

I will have to get better at acceptance, and not have a knee-jerk resistance to the word. In this Minga is my role model, which I will tell her the next time we are together.

Panama 2018: Britney

Baby Britney is Minga’s great-grandbaby. Britney’s mother is Jarelys — one of Ita’s four Jaris. Britney’s dad is Joel, and big brother is Joelito. Looks like the baby is thriving, and I am eager to meet her in January 2019. 🙂