Category Archives: Panama

Traveling with Emma

We are going to Northern California tomorrow for my brother’s wedding.  Emma is very excited to see her Uncle Andy and because we rarely travel anywhere new, this is a particularly appealing trip.  Other than visiting her Granma in Colorado, we have only traveled to places that required us to travel because of medical treatments for Emma.  Panama and Costa Rica for Emma’s three stem cell treatments and Boston to meet with Dr. Timothy Buie, a specialist in autism and GI tract issues.  When we flew to Boston a year later for one of my cousin’s wedding, Emma was convinced we were returning to the hospital where they’d performed a colonoscopy and endoscopy on her.  It wasn’t until we actually got to the wedding and she saw the guests did she relax.  We use to go to Cape Cod every August for a couple of weeks, but haven’t been, since we got Emma’s diagnosis.  In fact it was on that last trip almost seven years ago that we came to the conclusion we needed to get her evaluated.  Even if it were easier to travel with Em, Cape Cod sadly, holds painful memories for me and so I’ve not been eager to return.

However this trip is one Emma is anticipating with great excitement.

“Sleep, wake up, get on airplane, go see Uncle Andy!” Emma said this morning, while bouncing up and down.

“Yeah, Em.  We’re going to have fun!”

“No.  Not going to go on the school bus.  Going to see Uncle Victor, Grandma, Uncle Nic, Gaby, Lili, Liesl …”  she went through the list of all the people we would undoubtedly see at my brother’s wedding.

“Are you excited?” I asked.

“Yes!  So excited!”  Emma shouted and then ran out of the room.

There’s a certain degree of anxiety that comes with traveling with Emma.  Though she rarely has melt downs any more on the airplane, in fact she’s become a wonderful traveler, we always brace ourselves for the unexpected.  Because we aren’t allowed to pack any liquids or her yogurt (she’ll only drink Mott’s apple juice or Apple & Eve Apple juice and only if it comes from a plastic bottle, not a can) we have limited options when it comes to what she’ll drink and eat.  Usually she doesn’t eat anything other than her Pirate’s Booty, though last time we flew back from Colorado I did manage to get her to drink a small amount of the apple juice they served on the airplane.  It felt like a victory.  She use to eat fruit leathers and as they also helped her ears during landing and take off, we used to pack about ten of them.  She has recently been refusing to eat them, but I’ll bring some anyway on the off chance she’ll eat one.

We will be staying in an inn and thankfully the entire place has been taken over by my extended family.  Even if Emma does lose it, at least the people effected by her screams know of her situation and will hopefully be patient and kind.  Even so, it’s tough not to worry.  Richard scoped out the different day trips we can take while there this weekend and there seem to be a great many of them.  He found a pool she can swim in and an amusement park.

“Well we’ve got Saturday and most of Sunday until the wedding covered,” Richard announced earlier.

We’re sitting in the back of the plane, which is a good news/bad news situation.  The good news is, we’re next to the bathrooms, the bad news is we’ll be the last to get off and Emma has a difficult time sitting still after the plane is at the gate.  She wants to get off the plane NOW and can’t understand why we have to wait to let everyone in front of us off first. But who knows, maybe she’ll be able to tolerate the wait this time.

So while Emma is ecstatic and without any anxiety about traveling to see her Uncle Andy, Richard and I are anxiously making sure we’re well prepared and haven’t forgotten anything.  I use to be a very casual traveler, often late to the gate, the last one on board before they shut the doors and pulled away from the gate, winging it when it came to where I might stay the night.  In my twenties and thirties I often traveled alone, to all sorts of places all over the world.  But since I had children, I am a nervous wreck when traveling.

I’ll try to take a page from Emma’s book.  Relax, look out the window, chew on a fruit leather and enjoy the journey.

For more on Emma’s travel adventures through a childhood of autism, go to:


When Richard, Joe and I took Emma to Costa Rica for her first round of stem cell treatments this past March, we arranged to have Alycea stay with Nic.  Alycea is one of those people who is multi-talented; a musician-singer- songwriter, terrific with both children, with an unbelievable upbeat-can-do attitude.  So when we explained to Nic he could either come with us to Costa Rica or stay in New York with Alycea, he didn’t hesitate in saying, “I’d rather stay with Alycea.”

And he had a blast, though there were logistical hoops we had to go through to get him to Denver where we met up with him and Alycea before we continued on to my mother’s.

Upon our return from Costa Rica, my mother said, “Next time you must leave Nic with me.” She said it more as an announcement than anything else.

“But Mom, are you sure?” I asked.  After all she is 81 years old with degenerative disk disease and though she and Nic have a special relationship, I wondered just how she would manage.

“Yes.  I’m sure,” she said, with the authoritative tone used by someone of a certain age – in other words – there would be no further discussion.  “He might like to go visit your sister Toni,” she added brightly.  “I thought we’d drive down with the dogs after you leave,” she said.

My sister operates a working ranch with free-range pigs, sheep, lamb, chickens, a number of ornery roosters and that’s just naming the non-domesticated animals.  In addition she has four dogs, horses and I’m sure, upon this post she will have acquired new animals I have failed to mention.  I can just hear her as I write, “Ariane!  I can’t believe you forgot the __________________!”  (Fill in the blank of some rarely heard of species belonging on a ranch.)  In summary her ranch is a ten-year old boy’s version of heaven.

About a month after it was decided Nic would stay with his Grandma, I heard from one of my three brothers, Victor.  He and his wife, Susan had decided they would also come out, “to help with Nic”.  As it turned out another brother, Andy and his fiancé were planning a trip to Colorado during the same period.  Andy is on Nic’s top ten list of favorite people.

So it was with a certain amount of mental freedom that I boarded the first airplane on my way to Panama to meet up with Richard, Emma and Joe three weeks ago.  I knew Nic would be well taken care and the removal of that particular concern was deeply appreciated.

When we returned from Panama, Nic greeted us with countless tales of Wilbur the several hundred pound boar, the pigs, the lamb, the dogs and all the various adventures he had had while we were gone.  Not once did he mention missing us.  Why would he?  He had been surrounded by my siblings, their significant others and my mother – who should be sainted – for the entire week.  If anything, Nic had a difficult time adjusting to our return as his carefree week of animals and family came to a screeching close.

Victor and Susan extended their stay so they could be here for my birthday festivities, which meant Emma was able to spend a week with them upon our return from Panama.  Emma has always loved Victor and Susan and they return her love. During the winter we over lap for the Christmas Holidays and Victor and Susan make sure they spend a few days skiing with Emma.  When we return to New York Emma asks after them for several months.  We know she misses them.  To also spend time with them during the summer was an added bonus.  Emma was overjoyed, as was I.

“Victor and Susan tomorrow!” Emma said after they left a few days ago to return to their lives in Illinois.

“No, Em.  But we’ll see them over Christmas,” I said.

“See Victor and Susan later,” Emma said. Her way of conveying how much she wants to see them and wishes they were still in Colorado with us.

“Yes, over Christmas.”

“Ski with Victor and Susan,” Emma said, showing she understood.

“That’s right, Em.  You can ski with them.”

“Victor and Susan tomorrow?”  Emma said sadly.

“Do you miss them?” I asked.

“Yeah,” Emma said.

Later that day as my mother, Emma and I were out walking the dogs, Emma said, “Say hi to Victor?”

“Sure Em, good idea.  I’ll send him a text and you can say hi to the camera, I’ll text the photo to them.”

Below is the photo I took as Emma said, “Hi, Victor!”

Richard and I realized early on we needed help if we were going to give Emma the support she needed to make ‘meaningful progress’ as Stanley Greenspan use to say.  We realized her needs were greater than our ability to provide them on our own.  When we made the decision to start doing stem cell treatments, the help we required multiplied.  My family jumped in unasked, voluntarily and cheerfully.  My siblings and mother joining forces so Richard and I could take Emma for her second round of stem cell treatments without worrying about our son was an act of kindness above and beyond the call of familial duty.  It is my family and our close friends who have helped us help Emma.  We could not have done or continue to do as much were it not for them.  Because of my good fortune in having such an amazing family and friends who have given of themselves so selflessly time and again, I feel all the more determined Emma should be given the opportunity to have a life, which includes deep friendships.  That she may one day know the indescribable joy of connecting with family and friends is my hope for her.

Back Home

We arrived back in Aspen late Saturday night.  Even Emma, who is the world’s best traveler, was feeling tired.  By the time we arrived in Denver, having missed our connecting flight to Aspen she said, “Go see Granma?”

“Absolutely.  But we missed our connection so we have to wait a few hours.  Then we’ll see Granma.”

“Go see Granma?” Emma said again, anxiety creeping into her voice.  Which is her way of saying – NOW!

Concepts of time are difficult for Emma, if not impossible.  The idea something will happen tomorrow is not something she understands.  If one says, “One minute,” she will patiently wait as she knows from the kitchen timer we use, one minute is a length of time she can count.  Beyond five minutes it all becomes muddled.  Emma will often answer the statement, “tomorrow” with “You have to wait one minute.”

To which we respond, “No Emma.  Tomorrow.  Much longer than one minute.”  We might as well have said, “Next year.”

As we had been traveling for the entire day, having woken up at 6:00AM in Panama and were still traveling at 9:00PM, the idea we would catch a flight at 9:30PM and be back in Aspen by 10:15PM did not lessen her anxiety.  Still, Emma was terrific and did not make too much of a fuss.

I took this photo in the Denver airport.  While waiting for our next flight, Emma grabbed Richard’s newly acquired Panamanian hat and put it on her own head.  Muzzy is in her lap and she is holding her cokie.  (Evidently the Ecuadorians are to be credited with making the first hat we now think of as a Panama Hat.)

One of our faithful readers commented last week she had noticed how Emma was making eye contact in all the photos I have recently posted.  She is right.  Of course I didn’t post the dozens of photos I took when she wasn’t looking at the camera, but that I was able to get any photos of Emma looking at the camera is nothing short of miraculous.  And of course my immediate thought has been – is this the stem cells?!  Is it possible her terrific eye contact since she had her second round of stem cells could possibly be due to the stem cells?  Impossible to know, but it is a striking difference.

Friday night Richard and I went to a wonderful restaurant in Panama City – Manolo Caraccole.  It was absolutely terrific with no menu.  The chef wields his magic in a kitchen one can see from the dining area and produces 11 tapas courses which are brought out – one more delectable than the next.  As we were dining, a young American woman walked in with the attending physician who treated Emma the day before.   It was Dr. Hernandez who spoke to us at length, patiently answering our questions, giving us his opinion and generally making us feel calmer about the entire procedure as we waited for Emma to wake up from the anesthesia on both Tuesday and Thursday.  So when he walked into the tiny restaurant we were happily surprised.  The young American woman said, “This is the man who saved my life.”  She told us she had MS and he was the doctor who had taken care of her.  She was overcome with emotion, her eyes filled with tears as she told us about coming to Panama to have stem cell treatments.  She said she had had to stop working and now was able to go back to work.  She was taking Dr. Hernandez out to dinner to celebrate her recovery.  It was a bizarrely serendipitous meeting on our final night in Panama.

We can only hope the stem cells are doing their work in Emma’s small body as I write this.  It continues to be quite a journey.

It’s good to be home.

Panama – Day 5

We are in the clear.  Emma made it through the second treatment with no side effects.  She stayed in the clinic for two hours after the procedure was over to ensure she didn’t develop any complications.  Our biggest challenge was not worrying about her reaction to the procedure, but in keeping her occupied since she was feeling so terrific she wanted to:  swim, go back to the mall, ride on the carousel, find a water slide, go bowling, all of the above.

Emma waiting to have the stem cell treatment.

Emma awake.

I took this photo and Emma said, “Now go back to sleep.”   Then she closed her eyes.

I asked Richard how he was feeling, now that we were through the second round of stem cell treatments.

“It’s strangely anti-climactic and I’m tired.  It’s not as though I was expecting her to begin quoting Shakespeare, but there’s a kind of post-partum depression feeling.”  He stopped talking for a second then said, “Do you feel it too?”

“Yes, very much so.  I feel as though I’ve been given a sedative.”

“And now we wait,” he said.

“Right.”  I said.   “We wait and try to stay in the present.  I think that’s the hardest part in a way, trying not to think about the future with a lot of fantasies and projections.”

A couple of noteworthy things…  Emma’s recent interest in Muzzy, her green stuffed monster is a positive sign.  She brought Muzzy into the operating room both times and used him to express some of her fears and anxiety.  She has insisted on taking him out with her whenever we’ve gone anywhere during this trip.   In addition to her growing affection for Muzzy is the more elaborate pretend play she is engaging in with more frequency.   She has not wet the bed for 18 nights, even has gotten up in the middle of the night to pee on her own without prompting.  Since we’ve been in Panama Emma has been sleeping in her own bed.  All of these things are positive signs!

Panama – Day 4

Emma began yesterday with a long swim.  She has devised a game where she leaps into the pool with a towel wrapped around her waist.  For some reason this strikes her as the height of hilarity.  Then she drags herself, still wearing the towel, out and onto one of the lounge chairs where she sits and announces to anyone within listening distance that in fact, she has just jumped into the pool wearing a towel.  Regardless of the listener’s reaction, Emma breaks into peals of laughter before leaping into the pool again – with the soaking wet towel.

After Emma’s swimming pool escapades, we ventured off to La Vieja – the old city.

Emma in the ruins discovered in 1519, only to be destroyed by Henry Morgan in 1691.

After visiting the Artisnal Market exhibiting local crafts and going to La Vieja museum we drove to a mall where we were told was a carousel and some other children’s rides.  Emma was ecstatic.

However once she had taken four rides on the carousel, we suggested we look for some of the other rides we had been told of.  There were three.   Two, which she was too big to ride in and one, the teacup ride, which she was the right height for but was empty and they wouldn’t let her on unless another child showed up.  Emma took the first disappointment in stride, “Too big,” she said, nodding her head, the smallest frown appearing on her forehead as she tried to reason this out.  But when she was not allowed to ride inside the teacups because of a lack of other children she began to fret.  “Go on cup ride?” She whimpered.

“Yes, but we need to wait until some other children come to ride too,” We tried to explain.

Our explanation was weak and we knew it, but there was nothing to be done.  Joe and I went to plead with the “supervisor” to see if we could convince them to let her ride on it anyway.  They were resolute.  Emma began to cry, “Go on cup ride?  Go on ride.  You have to wait.  I said no!”

“It’s okay Em, we can wait and see if another child comes, then you can go on the ride too.”

Even while saying this to her, the weakness of the argument was all too apparent.  Why one other child should make a difference was not something any of us could explain.  Was there a balancing issue, weight distribution problem?  Who knows, but our Spanish being what it was, even Joe’s fairly good Spanish, would not sway them.  Meanwhile Emma became increasingly distraught.  All the joy from the carousel was now replaced by a kind of frantic, perseverative mindset.  Eventually another child did come along and Emma was able to ride in the teacup.  It was not a joyful ride. It was as though she no longer could obtain any amount of actual pleasure from the ride.   It had fallen into the “must do” category, an action, which must be taken, but with no enjoyment attached.  There was an addictive quality to the desire.  It was as though she were caught in a rut of thinking, nothing could be said or done to quell.

Emma riding in the teacup.

Once the teacup ride was over Emma went back to the other two, which she was too big for and insisted on riding in either of those.

“Ride in train?” She asked, anxiety creeping into her voice.  “You’re too big, you have to wait,” she said.

“Em, let’s go see if we can find the big indoor playground.  You can bounce,” One of us encouraged.

“No.  Ride?” Emma said.

“Emmy, we can’t go on these other rides and only on the teacup ride if there’s another child.”

“Ride in cup?”  Emma said.

Eventually we were able to pull her away and began to look for the indoor playground.  Emma was unhappy and sucking her thumb, clasping Muzzy to her and repeating the same phrase over and over again.  “Ride on carousel?”

“Okay, let’s ride on the carousel,” Richard said.

It was decided Richard would scout ahead to see if he could find the indoor playground while Emma rode on the carousel a few more times.  Once Richard was out of sight, however, a train came by stopping at the carousel.  So we took the train which runs the length of the shopping mall.  Immediately Emma perked up.

Emma in the train with Muzzy & me.


Back to the carousel and then to a round elevated platform where Emma made up a game she called:  “Swing game”.

The Swing Game went on for quite some time, with Emma running around the parimeter of the elevated circle with Muzzy as one of us tried to catch her.

Today we go into the clinic for the second stem cell treatment.  We have been preparing her.

Emma:  Take Muzzy to hospital.  You have to put the mask on. Last time.

Richard:   Yes.  Today is the last day of the hospital.

Emma:  Then bye-bye hospital.  Sleep, wake up, go to play swing game!  Go on airplane, go see Granma!

Richard:  Yes, that’s right.  Tomorrow we rest and then Saturday we go on the airplane to see Granma.

Emma:  I’m so excited.

As are we all.

In Panama (Day 1)

It’s the rainy season here in Panama.  We’ve been told even by Panamanian standards this has been an unusually rainy one.  In fact, we just saw lightening and heard thunder close to the condo we’ve rented for the week.  To which Emma said, “Ohhh!  It’s thunder!  So scary.  It’s raining bubbles.   Now go swimming.  The swimming pool’s closed.”

All of this was said quickly without a pause.  I managed to confirm it was raining, but Emma seems to have the entire situation under control.

This morning we go into the clinic and speak with the doctors.  When we were in Costa Rica for round one they interviewed us, video taped Emma and then we went to the hospital to have fluid removed from her spinal column and blood drawn.   I believe this is the protocol for today as well.

When I arrived last night, Emma was sitting at a table in the living room listening to music on her ipod.  She turned and saw me enter the room, “It’s Mommy!  Mommy stay at Granma’s house,” she said.

“Emma!  Hi!!” I said.  I ran over to her and knelt down, “Emma!   I want a hug.”  I put my arms out and she leaned into me with a huge smile on her face.

“It’s Mommy!  Mommy stay at Granma’s house,” she said again.

“Yes, but now I’m here with you,” I said as I held her tightly to me.

“It’s Mommy!”  Emma whispered to me as she hugged me.

“I’ve missed you!” I whispered back.  I stood up with Emma’s arms still wrapped around me and twirled her around.  Emma laughed and wrapped her legs around my waist, gripping me even tighter as we twirled around and around.

It was a lovely welcome to a long day.

Later as we brushed her teeth she pointed to the reflection of me in the mirror and said, “It’s Mommy.”

I pointed to her reflection and said, “It’s Emma!”

Emma laughed.

As I tucked her into bed she said, “Night Mommy.”

I said, “Do you want me to lie down next to you for a minute?”

“Yes!”  Emma said, smiling.

I cuddled up next to her and put my arm around her waist.  She grabbed my hand and pulled my arm around her.  “Emma’s sleeping,” She whispered.

“I love you, Emma,” I said.   I waited for her to say, “So much.”  But she was already asleep.