Duckie Novel II

II

Montaj walked away from the staff meeting feeling an immense tingle of an animated persistent pessimism; it was like a lingering and throbbing toothache. A batch of the Monolith’s Senior level bureaucratic minions, Cyclops and ELFS were frivolous and gay, in their attempts to grasp the productivity concepts of the factory floor. The concept that every machine on the factory floor was to provide critical, added value and efficiencies, so that when it departs and arrives at the pearly gates of the subsequent machines, that it would be ready and gladly processed. This meeting was calendared as “The Gool” and frankly from the ringside angle that Montaj had under the big-top, he enjoyed the circus-like schizophrenic clowns, loony tune cartoons, and stooges caricaturing and prancing about disguised as the Monolith’s Executives. They were Goldratt groupies, all hoping for a sliver of Alex’s divorcing wife. Montaj did not attend every big-top affair, but when he did he personally could only think of the protagonist Alex and his failing life and some wacky-how, Montaj could only think of death and dying and the production of coffins. And so it goes.

Normally Montaj would escape through the back door – there was none – and sprint to the sanctuary of his office. He always felt entertained from the engagement. Looking out the triangle center of the building Montaj could see the comedy of the conference room he escaped from. Montaj watched and could hear, as a loony caricature Daffy Duck look-a-like, took command of the meeting saying with heightened hint of madness, "I've dealt with a lot of wise-quackers, in this organization, but you are all despicable! I want the three wooden nickels!" The triple wooden nickels was the gool! Daffy Duck wanted the three prime numbers of 555 of projects starts and the pot was ours.

As Montaj sprinted towards the elevators to escape to his floor, another senior ELFS, looking as Southern Colonel as Sanders himself, with the manicured and cloroxed moustache and goatee confronted Montaj, “Montaj how does the Deputy Head expects us to maintain a factory through-put expectation, when the floor in not real. It is an illusion!”

Southern Colonel Sanders was an architect of gentlemanly distinctions, credentials stacked side by side would go from the mother earth to the furthest galaxies. Southern Colonel Sanders confronted him with an interesting poser, with gentlemanly decorum, “Montaj, does the gravitation pull effect the District’s abilities fulfill the Bond Program?”

Montaj could only think that it was a trick question, and responded, “No matter how you slice, it comes up nuts!”

Southern Colonel Sanders with eyes straining with red, from his increasing blood pressure commented, “Montaj you are a man of quixotic assembly. My point Good Sir is that the Deputy Head expects us to maintain a factory through-put expectation that belies the theory of gravity. Triple nickel! I say its, I say its merely impossible!”

Montaj responded in the acronym, “SC, if two trains were traveling to the same destination and the first train was 10 miles away going at the speed of 60 mph and the second was 5 miles away and traveled 30 mph; which train would arrive first?”

“That’s a trick question Montaj. I am an architect of distinction Good Sir!” Southern Colonel Sander replied and continued, “Even if I had the answer, which I don’t want to divulge, it’s privileged information. I’m sure you can understand Montaj.” The bureaucratic black-hole of public servitude. No accountability!



Lourdes awoke with her mouth dry and brittle. In a slow motion, she reached for the cold water bottle that she had on the night stand. Her vein-fleeting hands and fingers, weary from sleep and the constant assault on her body from the snake-down ravishing diabetes. He fingers especially ached from the pricking for blood samples to measure the glucose that attacked her body. She was able to generate the necessary strength to twist open the water bottle. She drank several swallows, and began to cry as she further reached out for her glucose meter. Physiologically she could feel that her glucose levels were low and needed something sweetened to drink. Intuitively but for precision of how much insulin was required, Lourdes opened the little black bag that held her curative machinery. Her blood testing machinery included the bloodlust lancets that pricked her fingers; the recipient thin white test strips that hungrily grasped the bloodlust droplet for measurement analysis and the actual Lantis that served as the oracle of glucose exactitude. It was a ritual for Lourdes to reach for some orange juice, if her glucose levels were beneath its limits, she was hypoglycemic. Lourdes paused wiping the moisture from her eyes; she never wanted people, especially family to see her cry. It was the existentialism sensors that evolved from her world that offered little emotional release and cohesion, but required great mental strength. Fiery in sprite, she wanted everybody to witness her Herculean strength and dignity. She boldly cherished her charm and dignity. She was human to very few, and Montaj was one that she nestled her weary and mortal head. Deepened in reflection, the little buzz that cried for attention went unnoticed. It was time some of her medications. Medications that were to grant Lourdes a limited normalcy of life, after she was able to get a pancreas transplant. The pancreas was the culprit organ or gland, situated behind the stomach that had evolved to secrete the digestive fluid into the intestine through several ducts and product the critical hormone insulin.

As her glucose measure was significantly beneath the 100 mark she swallowed some orange juice and within many minutes her blood danced in an energized and festive state within her arteries, veins and capillaries. So to followed Lourdes’ mind with a mensa-like precision, a flickering flame of determination in her eyes and a volcano of energy soon consumed her body. Her mind discarded the worthless stupor that had affected its charm. She took a deep breathe and completed the reach for her glucose meter. The prick of the lancet was the constant in her life. Its machination to measure the unfortunate sweetness of her system. It registered an over 100 reading.

It was only several months ago, that the hope and prayer that her diabetes would be destroyed for the rest of her young and long life. The donor pancreas transplant that was to allow her to create and regulate her body of the necessary hormone insulin was failing. The pancreas transplant was the pendulum of hope that she needed to continue a cheery life of some normalcy. She offered few words when it was becoming apparent that her pendulum of hope was etching an unrelenting angst. She remembered the days of angst – her calendar of dread and insecurity – that was marked by the significant physiological events of her life. The three most life altering days that suspended life’s influences and motion were: the pensive day she was diagnosed with diabetes; the tragic day, that one unknown life renewed another and finally the day that the renewed life was cast backwards into the darkened antiquity world of dread and insecurities.

It was only three years ago, in the winter of 2005, that Lourdes, accompanied by Montaj, visited the Loma Linda Transplant center. Lourdes’ diabetic condition had ravished her tiny life, forced into a mental state of where she needed to understand the medical options that could potentially improve her quality of living. Lourdes had had too many occurrences where she was hospitalized in state of diabetic coma. The very fickle diabetic condition whereby her pancreas was as erratic and destructive as a tornado’s funnel.

That morning in their drive from Walnut Heights to the Loma Linda Hospital was spotted with elements of morality. Montaj who was typically humorously, remained silence and pensive, allowing Lourdes to dwell and dictate in her existentialistic control.

She called out to Montaj, “You want to go shopping after.”

He kindly responded with, “Of course.” She turned to him and said, “Giddy-up”
Montaj smiled realizing she was delicately content and comfortable.

“Montaj you know I feel that this surgery will allow me to not be diabetic anymore.” Lourdes stated seeking a confirmation towards that effect.

“So no more bloodletting yourself like a vampire.”

“I think so,” she stated and continued, “I will find out more today.”

“Just the facts.” Montaj commented.

“After we can get some food?” Lourdes asked and Montaj nodded his head in agreement.

Lourdes turned to Montaj and asked, “I know we were brought up Catholic, but I have misplaced my faith. Montaj, do you believe in God? Or something or some higher power.”

“Lourdes, I think I believe in something. But I don’t know what. I want to think there is that higher power that controls and dispenses good to the good and bad to the bad, but I have not been able to figure it out.”

She starred endlessly at both Montaj and peripherally at the competing freeway traffic as it passed and streamed by, “I want so badly to hold onto something that will offer me hope. But I can only rely on myself to accept all the pain and my course of being!”

“The acceptance of your ethos, especially if it questions your morality is quite frankly humanly essential.” Montaj stated and continued as Lourdes now starred exclusively out the window, “It offers you, Duckie a sense of some control, that if you relied on the spigot of divinity’s ‘take a number’ grace, the listing is long. Their customer services is very poor. Believe me in my own way I would like to go have a duel with the man himself to understand some of his actions.”

“I pray, but I don’t know or understand whom or what I have to pray to for unconditional love and a simple miracle.” Lourdes passionately stated.

“I say just throw them up, because they don’t cost a penny, and can have pious comings. Lourdes, pray to yourself!” Montaj stated with vigor, “Duckie you are the one that must endure the pain and suffering that you have to go through. I can’t even imagine, but I am so proud of your strength and determination.”

“You know Duckie, I constantly have to fight with Divinity to get his attention that you are one of his most loyal soldiers. Moreover than Job himself. Hey I remember that we are created in his image, therefore we are a form of divinity itself, but somehow we still need his blessings.”

Lourdes looked into Montaj’s darkening eyes and optimistically said, “Thanks for bringing me to this introduction. I am climbing on the Organ Sharing listing. Soon I will have to have this surgery.”

“Duckie what are your expectations. I mean will you be able swim and waddle in the pond like old times.”

“Quack, Quack, Quack,” she confidently sounded out.

Montaj responded in kind, “Quack, Quack, Quack!”

“Montaj, I just want to be able to hang around the silly Beacon family for a little longer. I just want to laugh and mean it again.”

They turned off the Anderson street exit from the freeway. As they got closer to the Loma Linda Medical Center, Montaj could see a nervousness emitting from Lourdes. He extended his hand towards hers’ taking hold of it. She tightly held his and said, “I’ve been through so much Montaj, I sometimes wonder if it is worth it.” Lourdes stated with baby-like teary eyes.

“Lourdes, we are here to look into the sky and shout out that you are dammed tired and will not take it anymore. You have to let them, know who is boss!” Montaj stated as his even darker eyes glazed from with cloudy wetness. Montaj even as a man of great determination, but he was as lost as an elephant swimming into the twilight at the very point furthest from land: Point Nemo in the South Pacific Ocean -48°52.6′S 123°23.6′W .

Montaj had evolved into a man of immense strength and determination, learning early on in life that one’s course and outcome is the sum of the experiences quotation’s parts. Montaj was the fortunate son that was laced with an adventurous and sometimes deadly rebellion to societal norms. He grew to meander in natures wilderness and consequences of his stubbornness and grit. Montaj mantra’s that astute growth can only attained through the challenges from the fire and brimstone that marinade and tenderize the soul and mind. And it had to be in that exact order.

He pulled Lourdes tightly against his determined, yet fragile aura, wanting her not only to fully absorb his love for her, but that he could dispense her all the needed strength. Montaj squeezed Lourdes and said, “We will get through this, as you have gotten through this thus far.”

Lourdes buried her head into his shoulder and chest, weeping long and cloistered tears, wrapping her thin arms around his neck. Her strength was the magnetic pull that could rescue life’s drifting wayward elephants from Point Nemo in the South Pacific Ocean.

Montaj wrapped his arms around her saying, “I am here. Everybody that knows and loves you are here. And we will protect you Duckie! We will guide you in!” She was silence, but for the tears that noisily streamed down her freckled cheeks. Montaj connected her tears with her freckles to spell: This way. The way to acceptance of life’s ambitions was this way. This way Lourdes for Montaj’s love and protection. This way would never separate him from his love for Lourdes.

“Lourdes I will protect you.” She held tighter to Montaj.

They keenly listened to a tall and black MD transplant surgeon, named Okechukwu Ojogho MD, as he enlightened his captive audience of less than a handful, of the multiplicity of caveats that all potential patients needed to know. The audience was comprised of both the chronically and terminally diseased. In other words those that had a choice - the chronically that desired a more normal quality of life – and the terminal whose organs were cancerous desired life.

Montaj watched as Lourdes exhibited a gleam of excitement, even as the tall and black MD transplant surgeon started to read word for word from an article from the Journal of American Medical Association.

MD Okechukwa Ojogho spoke with an eastern African accent, “Patients with diabetes who received a solitary pancreas transplant appeared to have worse survival than patients on the transplant waiting list who received conventional therapy, according to a study in the December 3 issue of The Journal of the American Medical Association (JAMA).
According to background information in the article, pancreatic transplantation is a therapeutic option for patients with complicated diabetes mellitus. The American Diabetes Association supports the procedure for patients with diabetes who have had, or need, a kidney transplant. In the absence of kidney failure, pancreas transplantation may be considered for patients with diabetes and severe and frequent metabolic instability, i.e., episodes of very low blood glucose levels (hypoglycemia) or high blood glucose levels with buildup of blood acids (ketoacidosis).
According to the article, solitary pancreas transplantation (i.e., pancreas alone or pancreas-after-kidney) for diabetes mellitus remains controversial due to procedure-associated illness and/or death, toxicity of immunosuppression, expense, and unproven effects on the secondary complications of diabetes. Whether transplantation offers a survival advantage over conventional therapies for diabetes is unknown.
Jeffrey M. Venstrom, B.S., of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Md., and colleagues compared the survival of pancreas transplant recipients in patients with diabetes and preserved kidney function with that of similar patients listed for a pancreas transplant, since they would have conditions similar to those who underwent the transplant procedure.”
Lourdes dilated deep brown eyes collided with Montaj’s. She looked slightly distressed at the article reading. Montaj asked Lourdes if she had heard of this consequence beforehand.

“I believe I had, but I believe that the benefits outweigh the risks. I am in the category of the severe and frequent metabolic instability.” Montaj shook his head.

Nevertheless Montaj asked his sister, “Duckie, you understand the risks? They are as real as you are here.”

“Yes, but Montaj I have to get some semblance of my life. I can’t even tell you the struggles that I have to overcome just to be able to get up in the morning and go to try to go to work.”

Her existentialistic philosophy highlights the uniqueness of the individual experience in a hostile or indifferent universe. Lourdes wanted her life to be a reflection of what she did, not what she could have done. She was going to blaze a trail that emphasized her freedom of choice with the consequences resting fully on her tiny, Herculean shoulders.

Montaj was cold from the tingle of inspiration that consumed his body. He watched as Lourdes with a renewed sense of purpose listened to the reminder of the pre-surgical introduction and disclosure of facts.

Montaj bent over to whisper into her ear, “Where are you on the donor list?” Montaj had frankly forgotten to ask the critical timing question.

“I am near the top of the list. Remember I was called during Christmas week, but the donor pancreas was not compatible.” Lourdes stated in a matter-of-fact fashion continuing, “There was another time in November that the organ was not harvested in time. It was coming from the East Coast, I believe it was New Jersey.”

“The Armpit of America!” Montaj added.

She smiled as she was commenting, “You would know brother, because you lived in the armpit for awhile.” They both laughed and smiled adding,”You must miss the armpit?”

“Home is where you laid your hat. I miss the armpit, but only after it was bathe by the rain.” And so it goes he thought.

It was during the question and answer session, that Montaj sat back and proudly watched his little Lourdes navigate through a deep myriad of emotional issues with dignity and ardor. She dotted the Q&A session with queries of morality and maintenance. She was wanted all facts, good and bad! She wanted to appreciate the complete picture of risks. She knew the potential, she appreciated its shine, but it was a painted canvass that she desired.

Lourdes asked the MD Okechukwa Ojogho, what was the survival rates for pancreatic transplant alone.

“Ms. Beacon with each there is an increase in mortality, but in the first year the morality rate is approximately ten percent. After three years the mortality is approximately thirty percent. Current statistics have shown that at the fifth year there are a little over fifty percent mortality.” Lourdes took notes.

She formally lifted her hands into the air, “So those of us who are Pancreas Transplant Alone in five years could possibly be dead at five years or later.”

“Yes that is possible, but obviously never absolute. Every patient is different and based on the care that one takes towards his or her diabetic condition, it could possibly allow a longer and more enduring life.”

Lourdes, stared right into MD Okechukwa Ojogho’s black eyes, as her continued, “It is critical to remember that this is not a diabetic cure, but a way to minimize your further diabetic complications, as I stated earlier, the severe and frequent metabolic instability, i.e. episodes of very low blood glucose levels or hypoglycemia or high blood glucose levels with buildup of blood acids ketoacidosis. Obviously very both very serious and life altering conditions.” MD Okechukwa Ojogho paused and looked into the eyes of every patient in attendance and added, “But of course I don’t have to tell any of you, including your families, how your diabetic conditions have forced you to alter your lives.”

“And where would you be putting the donor pancreas?” Lourdes asked.

“Remember that while the PTA is more complex than the Simultaneous Pancreas and Kidney or SPK, and it is normally placed in what is anatomically called the retroperitoneum - behind and outside your peritoneum – or the space between the peritoneum and the posterior abdominal wall that currently contains your pancreas, kidneys and associated structures including part of the aorta and inferior vena cava The vena cava are collectively the veins that return de-oxygenated blood from the body into the heart. They both empty into the right atrium.”
Montaj turned and asked Lourdes, “I failed in any of those life sciences, anatomy. I can’t stand my own blood.”
Lourdes flashed a smile towards Montaj and continued writing.
MD Okechukwa Ojogho stated that barring any complications, which he coronary failure, and a host of other medical caveats – medical small print- that surgery would would be between three to five hours.”

MD Okechukwa Ojogho ended with marketing pitch for the Loma Linda University Medical Center and its long and successful tradition for transplantation surgeries. He distributed his calling card, that was filled with his medical credential and certification and bonafications and put us in the hands a charming transplant coordinator.

Lourdes looked content. She Looked pensive. She looked hopeful. She looked optimistic. She looked pessimistic.

There were other speakers, but they were ancillary, fodder of information that patient and family needed to understand, but Lourdes had already tuned out. She finally turned to Montaj saying, “O’ right time for me to get a bunch of test that they will want some information, just in case my situation has changed.”

She was led off by an aqua uniformed nurse.