Intestinal Fortitude: a dirty story


Back by popular demand … My crappiest Christmas ever — a comedy.

Caveat emptor: This is not something to read before dinner, unless you’re as strange as me.

Chapter 1: Welcome to the wonderful world of Isy

I have developed such a number of work-related hand injuries that there’s nothing like it in the medical literature. Leave it to me to make history in such a feeble way.

I had a ganglion removed from the inside of my right wrist, just over a year ago. Subsequently, I developed a neuroma which was related to the surgery, carpal tunnel which was related to the ganglion, and radial tendonitis apparently out of pure cussedness. The tendonitis got so bad the radial nerve itself got involved.

Cue to second surgery — December 23rd, 2001, I got a new wrist for Christmas: my carpal tunnel was released, the neuroma on the back of my hand was removed, and a nick was taken out of my radial muscle to give my irritated radial nerve some much-needed room. The only thing to be worried about, the surgeon said, was if the nerve got trapped in the scar tissue. (You can see it coming, can’t you?)

First, I had trouble getting the post-op pain managed. Since a large part of my forearm and hand had just been flayed, pain was a real issue. The Vicodin made me dopy (which wasn’t too bad), and horribly nauseous (which was.) So my surgeon prescribed Phenergan for the nausea, which made me even sleepier than the Vicodin alone; but, without the nausea to consume my attention, it was clear that Vicodin wasn’t cutting the pain. So he gave me Percocet instead of Vicodin, which made me wackier still AND made me more nauseous than ever. Back on the Phenergan and bye bye brain!

I had a trip planned to see my folks and show off my cast. Linda took me to the airport and had the bright idea of taking Dramamine instead of Phenergan, so I could take my pain meds without alarming the neighbors with wanton drooling and wordless babble. It worked so well that the flight was, in fact, better than the previous two days at home on my couch had been.

Chapter 2: Gumming up the works

Turns out I flew into a horrendous tummy virus the entire DC-area family had, but thanks to my relentless handwashing and disinfecting the doorknobs, I avoided it. That was a miracle, but it may have been my first mistake . . .

Within a couple of days, my insides came to a grinding halt. Stopped up like epoxy.

It was awful. Couldn’t get anything in, couldn’t get anything out.

I stopped taking the Percocet, which had undoubtedly caused it, and tried to hustle things along. Water, fiber, laxatives, Colace, you name it. I used to be a Registered Nurse — ER, ICU, HIV, Home Care; a varied career, but interesting, and it left me with a comprehensive knowledge of how to cope with intransigent innards.

The growing pain, I knew, was partly due to the growing pile of garbage in my gut, so moving things along would solve several problems.

After chugging a few oz.s of a particularly effective cathartic, instead of going Number Two, I wound up FACING the loo and heaving everything I’d eaten for the past 18 hours. Once I could breathe again, in a burst of uncharacteristic sanity, I told Mom (in a bored voice) to grab a book and take me to the ER.

Younger brother Huck, bless his heart, drove over from his in-laws and arrived shortly after I had gotten a gurney and laid my sorry ass down. The three of us kept each other in stitches, and got at least a giggle out of everyone who came into the room. This was a great relief because all I could do in the waiting room was weep with the sheer, all-consuming misery. Once on my home turf, with no tedious shift duties to manage, and with two of my family to entertain and amuse, things improved.

For me, anyway.

Mom was frankly astonished at the way I spoke to the nurses. She was discomposed by what she saw as my dictatorial manner. Coming from her, of course, I thought “dictatorial manner” was priceless, but, more to the point, I was perfectly in my element — I loved working in the ER, and here I was in an ER where I knew exactly what needed to happen but somebody else had to do the messy part. Woo hoo!

My first nurse was new to the profession — perfectly happy for help and advice, especially when it came to starting IV’s. I told her I was a hard stick, and why: tough skin, leathery and highly-innervated (very sensitive) vessels, lots of valves in my veins, and — since I was both out of shape and dehydrated — my veins were tiny.

After one disastrous attempt, she dashed off and got somebody else.

That somebody else listened to my description, took one look, literally blanched, and ran off to get a third person. (I could tell by that that she was a more experienced nurse: never blow a vein needlessly.)

Bless her heart, person No. 3 got it in, first try. She turned out to be an ER technician who’s graduating nursing school this year. That young woman’s got a bright future.

Even the ones who got scared off were entertained. Two or more Aweighs in one spot always seems to turn into a movable feast of unabashed commentary and shameless wordplay. Mom and Huck entertained each other endlessly over my steel-plated veins… Bullet-proof skin… Vacuum-sealed gut… Armor-piercing eyelashes…

Chapter 3: Moving mountains

In the ER, a pleasant, sprightly doctor of sensible years did an unpleasantly thorough exam, with the best manners possible under the circumstances. He said I was not actually impacted, it’s just that things weren’t moving.

So, he ordered some blood work, medication for pain and nausea (YESSS!), some exciting radiological studies, and, once I could bear to move, the most astonishing plethora of enemas. In fact, pretty much every type of enema I had ever used on others, over 8 years of nursing and 4 as a nurse’s aide. We went through the entire list. I counted.

I can’t help thinking I’ve paid off some serious karma.

Once my stomach stopped arguing with me and my arm stopped screaming, I could prepare for the CT scan. I swallowed the contrast dye like a trooper, thinking that this was another thing I’d had to bully people into, so I was going to knock it back and say, “That’s not so bad.” My stomach even held it down, thanks to those marvelous drugs. I also had intravenous dye, just to make sure we got pictures of everything.

It was intriguing to be the subject of all these tests I’d administered to others. I wouldn’t recommend it for casual entertainment, mind you. I’d rather rearrange my entertainment system or clean the kitchen or sit the neighbor’s kid — any neighbor, any kid, doesn’t matter, it would still be more fun. But from the standpoint of pure empathy, really seeing the other side of an experience, this was hard to beat.

The IV dye was kind of fun — I was all tingly-warm, and just high enough to enjoy it. I giggled and tried not to wiggle on the table as the tech snapped away. He broke his grumbly facade to ask rather wistfully if the dye was really that fun? He had “never gotten to try it.”

I said I didn’t recommend needing it, but since I had to have it, it beat a sharp stick in the eye. Or the elbow, which is where my IV had eventually gone in. I added that the dye didn’t make up for the previous three days, a remark that made him nod knowingly and then retreat to his rad-shielding and goodly gruffness.

Then, back to the ER and more enemas, since we hadn’t worked our way AAAALL the way down the list yet. Up went a suppository.

I wondered when I’d start developing hemorrohoids. Or a lean-to.

I have never shoved so much stuff up a single butt in my entire life. Ever.

Nothing, nothing, NOTHING happened. It was awful.

With all that garbage going in at both ends, and nothing coming out, I was beginning to feel a little bit ragged.

As I lay there, sweaty and despairing, the dynamic little doctor swung his fist determinedly and said, “Don’t give up. I’m not giving up. We can move mountains — we can move your bowels!”

I hadn’t thought of it that way.

“Next,” the doctor continued, then took a breath to brace himself to deliver the news. “Next,” he started again, “we’re going to try a soap-suds enema.”

Why the pause? Because … well, you have to really understand what he planned to do to me. A soap-suds enema works like this: You pour a couple quarts of warm water into a bag, add a little packet of castile soap, mix it up, and instill it (nice word, eh?) into the colon in a process that means every leg of your colon gets at least half a quart of warm, sudsy water in it.

Have you ever knocked back 2 pitchers of beer in a span of 5 minutes, and then not been able to get to the toilet for half an hour? It feels a bit like that, I suppose, only without the alcohol or winning a bet.

The rationale behind the soap-suds enema is that the soap acts on the intestinal lining to make it want to contract, and the sheer volume of water reminds the muscles of the lower intestine that they have a job to do. It’s an excellent remedy, normally very mild, and is generally well-tolerated. However, it is definitely NOT something you’d think of when your patient is packed out to the point where it’s standing-room only in there!

I looked at him dumbly, jaw fallen open to rest gently on my chest. Finally, I got my voice box back in gear: “You’re kidding,” I husked.

He shook his head. “I think volume is the trick.”

I didn’t know what to say to that.

If he thought that 5 days’ food and water (and tea and Colace and fiber and drain cleaner — just kidding — and I don’t know what) and then the past 4 hours’ concerted efforts in a well-stocked hospital, didn’t add up to enough volume for any 3 colons, there was simply no reasoning with him.

I stared.

He stood his ground.

Finally, I fell back into the sweaty sheets and said weakly, “Okay. Bring it on.”

The nurse did all the things I remembered doing so often, instructing me in the process I once knew so well but had conveniently completely forgotten the moment I realized I was getting it. When the stuff started rolling in, I did like every patient I’ve ever had who had this procedure, and wailed and bitched and moaned that I couldn’t possibly hold it, she was going to have to stop, wait wait wait it’s coming out!

And she, like the ER nurse that I used to be, was reasonably kind but absolutely relentless, and told me first that there was hardly anything in there (liar!), then that I was doing fine, then that we were nearly done, and finally not to fuss because I could hold it a lot better than I thought I could.

Bitch!

She was done, and all that remained was for me to hang onto that ghastly load for 5-10 minutes by the clock, and hope I could make it to the portable potty that stood by the bed when the moment of truth arrived.

I lay there, breathing carefully in order not to disturb things, trying not to think about exploding.

Five minutes slowly passed.

Five and a half.

Five and three quarters.

And then … it worked.

Boy, did it ever work!

It worked really amazingly well. And I’m happy to say that I made it to the bedside commode, where I hung on for dear life.

I can’t say that I didn’t know intestines could hold all that, because I know they can — I’ve seen quite a lot of intestinal contents in my professional life, and I’d seen more at once than this. Not a lot more, but still, more.

I’ve smelled a lot, too, and it was on that scale that this stuff was impressive. The stink would have knocked over a horse with hay-fever. It cleared every sinus in a 30-meter radius, and may have triggered a couple of asthma attacks. I could hear Mom exclaiming from the hallway, on a rising scale that cracked glass on the final word, “Isy, is that YOU??”

Even as a nurse, you don’t often get to take a whiff of bowel matter that has had the best part of a week to fester and mature before reaching the open air. It’s just not a common occurence.

It really reminded me that the colon is simply alive with bacteria whose sole job is to rot your body’s effluent.

What rot!

What effluent!

It was stunning.

One of my nurses came in as I was recovering from my frankly astonishing performance. I felt fantastic, although I could barely hold myself up and was dangling from the arm-rails.

I said, beaming, “Aaaah, the sweet smell of success!”

Here’s how you could tell she had been an ER nurse for too long, but not quite long enough: she sniffed. Then she gagged, riposting, “Well, I wouldn’t go that far!”

Chapter 4: “Oh, by the way …”

Turns out that, among the other blood tests, the doctor ordered a pregnancy test. Naturally, I tried to suppress a giggle. Mom asked, in amazement, “Why didn’t he just ask you?”

I replied, “Well, he has good manners. It’s not something you want to ask a young lady when you’ve just had your hand up her butt.”

The timing was perfect. She choked on her water. Huck patted her back, once he could hold himself upright.

I got admitted to the hospital, which meant they had to make sure they had dotted all their i’s and crossed all their t’s. Somebody at the nurse’s desk smacked their forehead and realized that they hadn’t checked ALL possible sources of internal distress…

The nurse and doctor trooped in with rather grim expressions, and said we had to do a pelvic exam.

ER docs hate doing pelvic exams. They really think it offends their sensibilities as much as the patients’ own. (Most of these doctors are men, so we really don’t need to comment further.)

They didn’t spend ten years in school in order to stick their hands up strangers’ skirts. It’s gross. Give ’em a messy trauma any day. Blood, guts, bits of bone sticking out, messy burns, plastic tubing everywhere, monitors beeping in every key — they love that.

Pubic hair? EEEEEW!

Consequently, they tend to be pretty clumsy with the GYN stuff. It hurt like hell. And they expected me to be sympathetic.

Chapter 5: Life on the inside

There was a delay in getting me admitted. The only spare bed in the hospital that night was on the cardiac step-down unit (my second-favorite type of nursing work), and they finally put me there for the hell of it. It was like old home week for me, except their beds and machines were much nicer than the ones I ever got to use.

They gave me IV pain medication, but of course they used another narcotic, Dilaudid. (Honestly, my admitting doctor was a turkey.) I could only have it every 4 hours, but unfortunately it only lasted about an hour and a half, and I spent all that time sleeping because the pain kept me awake the rest of the time.

It was another flashback for me to see the expression on the nurse’s face when I called for pain medication with tears streaming helplessly down my face, and she had to say she couldn’t give me any for another 2 hours. I’m sorry to say, though, that I had no sympathy to spare for her. It was all I could do not to plead or snarl. I suspect she cheated as much as she could without fudging the law, in order to get me my next dose sooner. I wasn’t coherent enough to say so, but I know I’ve done the same, and all the thanks I needed was to see those eyes close peacefully that much sooner. Mind you, I think I’d have called the doctor the second time.

Of course, they gave me Colace twice a day. They also gave me Phenergan intravenously, so I got plenty of sleep. But, every time I opened my eyes, I saw Mom sitting and reading in the chair nearby, or I saw her coat draped over the back of it and knew she’d return soon. She’s no mush, which is just fine, but knowing she was there made my dazed and painful world immeasurably better.

I spent 3 1/2 days in the hospital, getting rehydrated (16, count ’em, 16 hours before I even whizzed!) and trying to figure out what was going on. Most of it is a blur.

To start with, I had x-rays of my abdomen on Sunday, which required having a clean colon. I was utterly aghast when the saccharine young nurse brought me a bottle of magnesium citrate. I said, “You realize, the only time in my life I had that, last week, I threw up all over the place.”

She shrugged. “That’s what they want you to take. Your insides have to be clean.”

This, after 3 days of nothing to eat, and the most spectacular bowel cleansing I’ve ever seen not 2 days before. There wasn’t anything left to clean.

I opened my mouth to argue, but then realized that things could be worse. There’s always the electrolyte-based cathartics, like Colyte and Go-Lytely, which taste like a mixture of sweat and window cleaner and come in, I’m not kidding, gallon jugs.

I pinched my nose and chugged the dose. Two hours later, my intestinal tract was cleaner than it’s been since I first saw the light of day.

The nurse twitched an eyebrow, “That was quick.”

I disliked her enough to say, “I told you so.”

Chapter 6: X-ray vision

I was still bloated, but my insides felt as light as air. Sitting in the radiology hallway, with a serious case of bed head and draped in ghostly hospital wear, I felt like a giant marshmallow with a bad hairdresser.

I was fifth in line, but the radiologist, a hunky Italian with a sense of humor, stepped into the hallway to amuse me periodically. At one point, he asked if I was “Mrs. Aweigh.”

I blinked and said, “Something like that.”

One of the things I really like about Black English is the title “Miz,” which is perfectly respectful yet maritally vague. He wasn’t Black and didn’t quite know how to recover from the faux pas, so I said what was on my mind, in order to salvage the conversation.

He wrinkled his eyebrows in a hunky Italian way and replied, “Your arm hurts? I thought you were here for abdominal X-rays.”

I said, “I am. It’s been a helluva week.”

“What happened?” he asked.

I told him, “I had surgery in three places on my arm on Monday. The first pain medication didn’t work and it made me nauseous. The second pain medication stopped me up. I spent ten hours in ER getting cleaned out, and it’s taken two days to get me rehydrated. I also had an abnormal pelvic exam. So we’re trying to figure out what the hell’s going on.”

He blinked, looking stunned. “Well, you sound like just the kind of girl anyone would want to marry.”

“Yeah,” I said, in my bloated gown and bloated face and bloated hair. “I’m a ball of fire.”

Chapter 7: Radical tonsillectomy

On Monday, I got to see two competent doctors: the partner of the idiot who admitted me, and the gastro-intestinal (GI) specialist he referred me to.

The GI guy was clearly one of Nature’s perfect gentlemen. He made a special effort to see me that day, and came in at 4:50 pm looking like someone at the end of a very long day with no rest in sight. I thanked him for the effort, and he waved off my thanks gracefully, saying that tomorrow was going to be a nightmare and he wanted to speed things up for me. It was December 30th.

I told him my adventures of the past week, describing my surgery, my pain, and my adventures with my gut. I added, “My pelvic exam was problematic, too. But it was done by an ER doc — bless his heart, I think he was reaching for my tonsils.”

The doctor’s reaction was one for the record books. His face flickered slightly, like old film footage. He held absolutely still for a very large fraction of a second, refusing to lose his composure. Then, after a short, controlled breath, he snapped right back into the patient interview with a straight face.

I think I saw him patting a few hairs back into place as he walked out, but that was it.

Chapter 8: Potty training

The GI doctor ordered an ultrasound. The nurse came in with a quart of fluids for me to drink, and I, remembering all the times I had had to send patients back because they hadn’t drunk enough, asked for seconds.

Well, I still had a nurse’s bladder, which means I could increase a full dress size before I become all that uncomfortable. They forget that nurses are weird that way, and think that it’s not worth examining you until you’re really uncomfortable.

And then there was a delay.

By the time I got to ultrasound, I was in agony, and the ultrasound technician took one look at my abdomen and expressed serious concern that I might pop. She scolded me, in her best maternal manner, and said that I should trust her to know exactly how big she needed my bladder. She sent me to the bathroom with a cup, telling me exactly how many times to fill it, and exactly to where, to bring my bladder to her preferred volume.

The bathroom. Some idiot had pissed all over the floor. Not just the cute little territorial dribbles most men leave. This guy must’ve been blind, drunk or both. It was appalling.

Incidentally, I’ve got a little rant to insert here. EVERY guy dribbles. I love my men friends, I really do, but I have to mop after every visit. And, just to cap it off, they don’t drip dead center — they ALWAYS put it just where you want to put your feet. Now, I hate vacuuming, so I never wear shoes in the house. I hope I don’t have to spell this out for you.

I mean, really, would it kill them to use a little toilet paper? When the door’s shut, who the hell is going to see? I’ve told them: despite what they’ve heard, there is NOTHING in t.p. that will make It shrink.

And don’t let’s start with the toilet seat thing. The entire lid is always closed except when the toilet’s actively in use, so EVERYONE in my house has to pay attention to the seat — so all of y’all can stop your whinin’!

Boy, I feel better after getting all that off my chest. Back to the bowels of this story.

I was too wonky to really deal with the flood, and too wonky to think much at all. I unfolded paper towels, one by one, maneuvering around my IV tubing, clonking my cast, wielding my other hand scarcely better with its sausage-thick fingers, and piled the towels high, until finally no more leaks got through.

And then I had to wipe off and cover the seat, while not disturbing my carefully-constructed polder underfoot. Pulling the towels, stacking them deep enough to keep my fingers dry, keeping the IV tubing out of the toilet, wobbling cast, one hand of sausage fingers. Then I had to figure out how to wee into a cup while keeping my eye on the measuring marks … and simultaneously keeping the paper cover of the toilet seat in place … while craning over a huuuuugely-bloated belly … trying to keep my IV not only inserted in my arm, but out of the toilet … with my one arm with the hand of sausage fingers.

I still have no idea how it happened, but apparently it did: I emerged with a properly filled cup, dry butt and clean feet.

It was the most athletic activity I had had all week.

It turned out that the ultrasound technician had been waiting for me the whole time, and she was rather afraid I had gotten flushed. It turned out there was a larger toilet down the hall, but she hadn’t wanted to make me walk all that way. Had I thought to complain, it would have saved a lot of time. And trouble. And paper.

I’ll try to remember that next time.

Chapter 9: The sweetest sound I never heard

The tech thoughtfully warmed the jelly before spreading it on my belly, so it was merely cold rather than icy.

I love radiology to start with, but seeing my own inner workings (working innards?) was fascinating, completely fascinating. Once I figured out how the transducer worked, I could tell what she was aiming at, and could interpret the shadows on the screen. It was the most amazing, warm and fuzzy feeling to see my own organs bubbling and sloshing away, going about their work as we peeked in at them. All the anatomy books, all the photographs, all the trauma surgery had not prepared me for how beautiful the organs are when they’re just pottering away.

I’ve seen a beating heart in an open chest before, and I thought that was the most beautiful thing in the world. I’ve felt the warm rush of gratitude to my own busy heart as I feel it going thub-bub, thub-bub (I have a tiny murmur), day after day, never asking for sick leave or overtime. I’ve listened to my lungs — a lot; I’m asthmatic — and am probably more familiar with those sounds than a normal person ought to be, but on the days when the air moves in me as sweetly as the breeze through new leaves, it’s a joy to hear.

But this was the first time I got to see my own parts in action. Each one is extraordinarily appealing, in its own distinctive way.

My liver is a modernist work of art. Jackson Pollock on his best day, working with Miró, after a really good liquid lunch with Stella, might come close. It’s an arrangement of seriously artistic disorder, with a sense of gorgeously strange method to its apparent madness.

My kidneys are so adorable you just want to cuddle them. Honestly, they are darling! If they were people, I’d want to ask them out, because anything that looks so sweet has got to be worth some time. I never thought of kidneys as being cute before. Who knew?

The weird thing in my pelvic exam turned out to be picture-perfect ovulation (and a classic example of how poorly-understood “normal” is in women, thanks to the centuries-old bias in medicine.) The ovarian follicle swells up as it ripens, forming a cyst; this pops to release the egg inside the cyst. A follicular cyst was in full bloom, opening like a chrysanthemum, the egg possibly visible as it started off, tumbling downhill toward the fallopian tube. It was a garden in bloom.

The tech enjoyed having an interested and educated audience. She gave me a complete guided tour, and, as a sidebar note, I noticed how she used acronyms where most nurses use the whole terms. I guess, if you look at that many things 6 times a day for 15 years, acronyms are a lot easier to deal with.

Chapter 10: Free at last!

The GI doctor with the beautiful manners discharged me just in time for a New Year’s I was in no condition to enjoy, with strict instructions to follow up with my gynecologist and a GI doctor at home. Once things were moving, there wasn’t anything visibly wrong with me, but everyone was a little worried. So I have the rather unpleasant prospect of comprehensive GI and GYN workups ahead of me.

I hear the horrified screams: “That wasn’t thorough??”

On the up-side, my arm pain is finally managed, without drugs. I’m using this wonderful thing called a TENS unit. It sends a mild electrical current through the relevant part of your body, interrupting pain signals sent by your skin and subcutaneous tissues. Love it. There are a couple of downsides: the cords are affectionate, and want to hug everything in reach; and if one pad gets slightly pulled off, the same current gets concentrated over a smaller area, and that HURTS. So I can’t use it every time I need it, but it is there for when I can.

I have one on loan right now, but when I get one of my own, I think I’ll name it Panacea. Or possibly Heroine, since it does save me, and it takes the pain away. Nice little double entendre.

While I was still in DC, though, I couldn’t get a TENS unit. I made the doctor’s day when I said emphatically, “I don’t want narcotics. Give me Toradol.” (Toradol is like Motrin on steroids. The one downside is that the healthiest person has no business taking it for more than 10 days, because it will rip a hole in your stomach.)

He blinked and said, “I don’t hear that very often.”

I’m susceptible to stomach ulcers. I still got Toradol for 10 days.

I was so relieved not to be suffering that that alone must have reduced the level of stomach acid, as the drug did no apparent harm.

Next, I had a couple of days of lying around the house and recovering, drinking up the ginger ale mom hadn’t finished when she was sick with her tummy bug. It was absolutely delightful to be warm indoors, have the run of the best private book collection I know of, and have Mom being as sweet and attentive as she could be.

On the downside, I wound up overhearing far too many of her conversations with our nearest and dearest about my recent situation. I had to spend my limited social time trying to explain events tastefully (because of course they all asked me to tell them about it anyway), after knowing for a fact that my mom had been very free in using words like “bowels”, “enemas”, “pelvic exam”, and other ghastly, pitilessly explicit terms to everyone she spoke to. For goodness’ sake, you’d think someone with a vocabulary like hers could come up with something better.

But then I knew I would not be misunderstood, using terms like “insides”, “cleaned me out”, “female exam”, and the like, because those I spoke to had gotten the inside dope — sorry, the poop — that is, the facts of the matter, from her in such unmistakable language beforehand. Besides, it made me look all kinds of classy by comparison.

Chapter 11: Need a hand?

Yes, the nerve did get trapped in two of these scars. However, after weeks of hard work, I’ve made a lot of progress in busting it loose. With any luck, all should be well in a few months.

… That was written in early 2002. Since then … well, you know it didn’t end there.

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4 Replies to “Intestinal Fortitude: a dirty story”

  1. Cold bricks can be used just like an ice pack or freezer pack. Like ice, however, it is important to wrap up the brick in a towel. The chill from the pack will still come through, but it is not a good idea to put the pack directly on the skin of the affected area. Given all of these uses by individuals, ice bricks are most often used by businesses for packaging purposes.

    [Blogger’s note: Thanks to WP’s ability to edit comments, I could strip a whole bunch of commercial garbage out of this and leave the one good tip. I have to spend hours away from home, myself, and I think sticking a brick (or any non-shattering rock, if you know what to look for) in the freezer is a fine idea for keeping my lunch cool. As we know, ice and the like can be hell on CRPS and trigger flares, so be mindful.]

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