​Tuesday, June 5th, 2018

We live in an old farmhouse, built by the Moore family. The Moores also established another homestead, on the other side of the mountain, around the same time they built ours. The Moores are currently making their sixth generation of Kneelanders, one of whom will be in Kindergarten with Tristan next school year. Point is, our homestead has been around for a while.

There are things inherent to a farm six generations-old. These include lead paint, shards of glass and pottery that get churned up to the surface by gophers, and shit tons of sharp, rusted objects. There are some really neat things, too, like arrowheads. Since we moved in six plus years ago, we’ve collected a big pile of rusted metal things– saws, tools, yokes of horse harnesses, horse shoes, horse bits, parts of plows, and gobs of nails, some of them square – as well as a bowl of arrowheads. Gary and Phoebe have a special, maybe slightly weird, collection of broken glass and pottery.

Given the frequency with which rusted metal shows up, combined with Tristan’s recent spate of mishaps, it’s not enormously surprising that we went to the ER again Sunday evening. AGAIN!

Tristan spent most of Sunday hunting a lizard around the tall stump of a dead tree near our house. This lizard is particularly cool because it’s black, to match the soot on the inside of the stump, which burned at some point. And he’s got a bright blue belly, brighter than most. He shares the tree with a flicker. Definitely worth spending the day trying to catch. Maybe even worth a trip to the ER.

A bit after five, just when I was about to pour a glass of wine, Tristan came sobbing and screaming in the door. “I’m going to get tetanus,” he wailed. He was so upset, tears streaking his face. What are you talking about? I asked. He turned to show me his side. “I got scratched on barbed wire, Mom,” he screamed. Indeed. There was a ten-inch, ugly, curved scratch covering one whole side of his torso.

Tristan knows what tetanus is, because I frequently remind the kids to be careful around rusted stuff. Mostly I remind Tristan, who has no immunity to tetanus. When the Infectious Disease doctors at UCSF tested his titers to a bunch of things about a year ago, they noted his susceptibility to tetanus.

After confirming that his organs weren’t spilling out of his body, I was instantly gopher-bite level of pissed off. Ugh, how could this be happening? In vain hope that the wire might be fresh and shiny and rust-free, I grabbed his hand and demanded that he show me exactly where was the offending metal. Totally rust-covered, of course.

I marched him back inside, plopped him on a kitchen stool, and began to clean the scratch with soapy washcloths. Phoebe, who is super solid in an emergency, brought me fresh, wet, soapy cloths. With the other hand I speed-dialed the oncology hotline at UCSF. I swear they know me by now. I definitely recognize the voices of the folks at the answering service. It was the nice lady this time (there’s one who’s kind of unfriendly), and on a later call that night, the British guy.

Eventually I got the doctor on call on the phone. It was Dr Hamoudi, who was a Fellow assigned to Tristan at the very beginning of his treatment. I remember him sitting with me in the OR before Tristan had is port placed. On the phone, I related the lizard hunt / wire encounter. His response was an elite, highly-educated, best-of-the-best, “Um.” Then he explained that, while brushes with rusted wire happened frequently enough in tetanus immunized kids, and also in immune-solid unimmunized kids, he didn’t have much experienced with immune-compromised tetanus-susceptible kids. He’d have to make some calls…but a trip to UCSF wasn’t out of the question.

ARRRGGGGGGG. Are you kidding? Please don’t make us come to the city…again, I begged. He couldn’t estimate that likelihood, but said it was real. He’d call me back after making some calls.

While I waited anxiously for his return call, Tristan shifted from distraught to joyful. I had reassured him that, no, he would not get tetanus because we would go get him some medicines to make sure that didn’t happen. But, I said, we might have to go all the way to UCSF. “San Francisco,” he said. He jumped up. “I’ll go pack the movie player and the DVDs!” The thought of six hours of unfettered movie-watching in the car was enormously appealing to him. He bounced around while I sat with my head in my hands. I looked up and yelled, no way Buddy. You’re not packing up any movies. THIS IS NOT FUN. There is NOTHING fun about this!!! No movies. No player. I stomped upstairs to pack my usual hospital stay gear.

And what about Tomas and Phoebe? Gary was away for this, of course. I mean, why would things be easy? I packed an overnight bag for Phoebe, sent Tomas to pack his own things, and made some phone calls to neighbors. No answer at the first two, but, in the end, sweet, kind Betsy and Ann said no problem, drop them off.

After a series of calls that lit up the UCSF switchboard and zipped back and forth to my cellphone, Dr Hamoudi called back with the word on what Tristan would need: the DTAP vaccine, which would give him short-term protection against tetanus (soon to be erased by the chemo), as well as tetanus immunoglobulin. But, he said, he wasn’t sure if we could get the latter locally. We began our trip down the hill while we waited for him to check with our two local hospitals, and I dropped Tomas and Phoebe, who were just rolling with it all like it was everyday stuff…which it kind of is.

It turned out the St Joe’s had the goods. We had only a brief wait, made only slightly uncomfortable by the presence of a seriously messed-up tweaker, and then the ER staff greeted us like regulars…which we kind of are. We were treated by an ER doc / karate mom whom we’ve known for years, and we breezed through in a record time of 1.5 hours. Betsy and Ann fed me a delicious vegetarian dinner when we stopped in to pick up Tomas and Phoebe, and we were in bed at a reasonable hour, Tristan’s side smeared with bacitracin and covered by a clean hand towel.

So, here’s the big question: are we done for the summer? Let’s recap. Since Tristan’s diagnosis in 2015, we’ve had a massive emergency every summer. In summer 2016, it was having Tristan’s left hand crushed by a boulder during an intense tadpole catching exercise. That was a horror show. In summer 2017, it was an inguinal hernia, but that was first diagnosed as a solid tumor and testicular relapse. That one really stunk. And, over the last two weeks leading into summer 2018, an avalanche of smaller, yet harrowing incidents: a med-evac to UCSF nominally for pneumonia, but really because our St Joe’s is understaffed and undertrained; an attack, or really just a stern reprimand, by a grumpy gopher tired of being harassed young human trespassers; a broken arm suffered in a valiant, and successful!, attempt to block a soccer goal; and, now, unable to further avoid the scads of rusted crap found on an old Kneeland farm, a gnarly ten inch-long scratch from hip to lower shoulder blade inflicted by a rust-coated wire fence during the hot pursuit of a Western fence lizard. I think we’re done, don’t you? I’m knocking wood right now.