Resilience

I sat with Susan just after waking her this morning.  In the quiet of the early morning, I asked her how she was feeling...and if she was really, truly certain she wanted to continue in the clinical trial.  She felt "fine," and without hesitation, she answered "yes."

Armed with that assurance, I determined that I was prepared to advocate that Susan be allowed to stay in the study should the need arise.

Based on our discussion, the on-call doctor had e-mailed me the criterion under which a study subject would have to be withdrawn.  A study subject must be withdrawn from the study if the investigator feels that it is not safe for the study subject to continue receiving treatment.  

Examples include:
  * - significant side effects from the study drug (any Bock’s criteria grade 3 reaction that is associated with hypoxia (less than 92% oxygen saturation) or blood pressure changes (greater than 20 mm Hg drop in systolic or diastolic blood pressure)
  * - serious or unexpected adverse event
  * - serious intercurrent illness
  * - progression of disease that requires alternative treatment

Or, if the study subject:
  * - desires to discontinue participation in this study
  * - is unwilling or unable to comply with the protocol

  * - becomes pregnant

  * - misses more than 2 consecutive study visits

The on-call doctor opined that she did not think Susan met the criteria unless the Principle Investigator and/or the doctors in Boston (who oversee the entire clinical trial) felt Susan should not continue due to safety concerns.  That last sentence was the part that worried me, and as the day wore on and I did not hear anything back, I worried more and more.  She asked if we could be at the Clinical Research Unit (CRU) at 1:30 pm the following day.  I agreed.

Any time.

Any place (even though it is always the CRU).

  Really -- we are committed, and what could be more important?

As the day wore on, I reminded myself that it was Sunday -- but, I also know just how engaged these doctors are.  I had no doubt that e-mails were being exchanged while a plan was laid -- and I worried that the plan did not allow for Susan's continued participation in the clinical trial.

I would not describe myself as a pessimist.  I do not generally believe my glass is half full, nor do I expect the worst of people or in life.  I have spent my professional career working with people accused of some of the most heinous crimes against other human beings, and even having seen some truly horrific things, I generally believe things will work out...even if I cannot always see the logical progression.

That said, by Monday morning I could see the problems unfurling in front of me as I contemplated the possibility that Susan might not be allowed to stay in the clinical trial. 

I knew if Susan was discharged from the clinical trial, it would be because the Principle Investigator or the doctors in Boston felt it was not safe for Susan to continue.

If that were the case, I could not see how those same doctors would be comfortable working with us to develop a plan for Susan to continue taking a daily peanut dose.

If that were the case, I could not imagine any (credible) doctor agreeing to follow Susan if she continued taking a 2000 mg dose of peanut protein...and then where would we be?

I didn't know.

I couldn't imagine walking away from the (hard-fought) ground Susan had gained.

And so, I prepared myself to advocate on Susan's behalf, just as I had in the past.

And then I got an e-mail from the clinical trial coordinator asking if we could go in earlier -- as soon as possible, in fact.  She said they wanted to be sure they had physician coverage, which I tried to take as a reassuring sign, even though I was fairly certain they would want physician coverage if they were discharging Susan, also (and I knew there would be paperwork and surveys involved, too).

En route to Ann & Robert H. Lurie Children's Hospital, Susan and I talked.  She remained clear -- she wants to see the clinical trial through.  She does not want to stop eating peanut.

She will embrace the deadly beast.

She said, "Mom, if I don't do this, who will?"

  (That's right, Susan -- if you want something, make it happen.)

We talked about ways to decrease the risk of an adverse (read:  anaphylactic) reaction.  Susan and I agreed that there are things we cannot control -- seasonal allergies, an under-the-weather (but not obviously so) immune system, hormones -- and to focus on that which we can control.

-- We agreed that she would pick a food that did not have to be cut, split or otherwise divided for her dose.  That narrowed the list of options dramatically -- Nutter Butters, peanut butter or that Reese's Peanut Butter Cup that I have been desperately wanting her to try (but not like this, not under these circumstances...).

-- We agreed that even though Susan was cleared to eat foods that potentially carried trace amounts of tree nuts (read:  cross-contamination, cross-contact) several years ago, I would research the safety of the three options -- seeking a peanut food product that does not possibly come into contact with any tree nuts other than almonds (which she regularly eats without issue).

I shared wisdom generated by many parents of children living with food allergies regarding the differences between the EpiPen and the Auvi-Q.  I explained that there are people who believe the Auvi-Q is less traumatic because the needle is shorter and the duration of the injection is significantly shorter.

Susan said:  "MOM -- I still have to inject myself."  (Slowly, but not unkindly -- a bit as though I were a young child requiring patience or someone cognitively impaired.)  She added, "Once the needle is in me, the hard part is over."

While Susan carries 2 EpiPens and an Auvi-Q, she is like me in that she is all about the tried and true.

When we arrived in the CRU, it was immediately apparent that the plan was for Susan to take half of her dose (that meant cutting that dreaded peanut half in half again.)  Really???

I did it -- getting 1 pretty good looking half of a half while shattering the rest.

The clinical trial coordinators and doctor overseeing Susan's dose examined Susan and then Susan took her dose.  It was super-official, in a plastic baggie.

We hung out for an hour, talking about the best food product for Susan to use in dosing and marveling at the fact that -- while anaphylaxis like what Susan experienced yesterday should not happen at this point in the clinical trial, it still does.
(There is so much yet to learn.)

And then, after an hour, when Susan was totally fine, we went in search of our favorite nurse from Susan's recent hospitalization, who sadly, was not working.  Then, we played with the buttons in the elevator -- Susan made it be "night."  [That's just one of the many things I love about Ann & Robert H. Lurie Children's Hospital -- there are countless opportunities for kids (and adults!) to just be...kids.]

After, I took Susan out to lunch.  I hadn't packed her a lunch because I intended to pick her up before lunch, and I knew she would have missed lunch by the time I could get her back to school anyhow.

As we walked, I made her stop so I could photograph her cheeks -- which, while decidedly not hivey (even though there was a time when I would have said they were -- one of many things I have learned while in the clinical trial) were definitely...red.

As we sat at our table -- over baked potatoes stuffed with broccoli, tomatoes and cheese -- I asked her how she felt knowing that she was going to be allowed to stay in the clinical trial.

Susan replied benignly that she was "glad."

Something about her response made me ask her if she had been worried that she would not be allowed to remain in the clinical trial.

She said, with a calm and quiet clarity:  "No." 

I gave her a questioning look.

With certainty, Susan said softly, "Yes, things usually work out the way they are supposed to."

While I could certainly have given Susan plenty of examples to the contrary, I decided instead to say, "I am so glad that you know that about life."

There is time for her to learn otherwise, and I am going to hope beyond hope that Susan does not learn otherwise as the result of her experience in the clinical trial.

The Bravest Kid I Know

I am shaky.

And my heart is racing.
  (Epinephrine will do that to a kid...and to that kid's parent, too...)

My thoughts are whirling as I write this.

(I am not sure I am going to be able to concentrate well enough to finish it, but I want to try.)

I feel like (I hope maybe) writing will help me process what happened.

Writing usually helps...

This morning, Susan had an anaphylactic reaction to her peanut dose, which is 2000 mg of peanut protein, or 8 1/2 Peanut M & M's. 

Susan took her dose a bit later than usual (but not outside the dosing window), because she had an early-morning viola lesson.

She was reading in her bed when, nearly an hour after her dose, her sister walked into her room and observed that Susan's face was really, really red. 

Susan went downstairs to see my husband, and then the two of them went up to the third floor, where my home office is, to see me.  By the time Susan got to the third floor, she was wheezing and said that she was "having a hard time breathing."  She had felt fine (and didn't even know her face was red when her sister observed how red she was).  I could see how red Susan was, and also observed that her nose was really drippy...and that she had beads of sweat standing out on her forehead.  I handed Susan two Benadryl while she pulled out her EpiPen.

We both knew Susan needed epinephrine, although for a split second I had a hope that she might not need it.

I wondered about Susan's future in the clinical trial if we had to administer epinephrine, but I knew that would not stop me.  While I hoped -- for a split second -- to see something that would reassure me that Susan did not need epinephrine, I knew -- from looking at her, from listening to her breath, that she needed epinephrine.

We did not hesitate in our decision to administer epinephrine.

We did not have to discuss whether or not Susan would self-administer -- she took the EpiPen in her hand, removed it from the case, uncapped it and then pressed it against her leg, crying.

She didn't press it hard enough -- I could tell as she did it, and I knew for certain when I did not hear the auto-injector release...that she hadn't pressed it with enough force.

She looked at me and said "I am going to do this."

Susan pulled the EpiPen away from her leg, to allow for more momentum and counted "1, 2, 3, 4, 5, 6."

I said "NOW," her hesitation scaring me...and she jabbed the EpiPen into her leg, holding it there, crying all the while.  As I held Susan, I could feel how hot she was, and hear the rasp of her breathing.

Food allergies are scary.

Food allergy treatment options are scary, too.

I am beyond thankful for epinephrine...

And while all that Susan has gone through since she was enrolled in the clinical trial saddens me...and scares me, too -- mostly because I have seen again and again how quickly an allergic reaction can escalate -- I am also thankful that she has learned first-hand (again and again) how quickly epinephrine helps her.

I am thankful for the multiple opportunities Susan has had to self-administer her epinephrine since she was enrolled in the clinical trial.

The epinephrine helped immediately.

With shaking hands, I paged the on-call doctor for the clinical trial (under any other circumstance, I know that I would need to call 911 -- and I don't want how we handled this situation to ever cause anyone to do anything other than call 911).

She called back right away, and knew it would be me on the other end.

She recognized my number.

I wish that weren't the story of our journey in the clinical trial, but, it is.

We talked -- about how Susan was right then, about what had happened, and about Susan's dose -- working to understand what the cause was.

As usual, there are more questions than answers.

Is it hormones? 

  Certainly, at 12 1/2, Susan is at an age when hormones are changing, when "cycles" are not yet cycles...

What about the way Susan's skin looked yesterday?  Was that related?

  Yesterday, Susan's skin looked red and slightly irritated.  I hadn't seen it that way in a long time, so I took note of it.  I reminded the doctor of how Susan's skin had looked early in her home-dosing -- red, irritated -- "hivey" to the me who had never seen a true hive -- and told her that Susan's skin had been the same way the previous day.  Could that be related?

Was that 1/2 of a Peanut M & M not truly a half?

  There is no way to know -- but I will say that it isn't easy to split a Peanut M & M in half (and, it was never the intent of the study coordinators that we have to split a Peanut M & M, as the dose for 4000 mg of peanut protein -- the original goal, which Susan could not tolerate -- is 17 Peanut M & M's).

Was there a problem with that particular batch of Peanut M & M's?

  Interestingly, the eight Peanut M & M's that Susan took came from two snack-sized packages that her sister and my husband purchased from some boys who were selling them for a fund-raiser (they came in a package that had six snack-sized packages -- which contain a mere five Peanut M & M's each) yesterday.  She had been dosing with pastel Peanut M & M's.  

I sent my husband dumpster diving.  (In our own garbage can -- is it less gross to go dumpster diving in your own garbage?  I'm not sure...but I absolutely wanted the wrapper to the package, as I will be calling M & M Mars...)

**

Is Susan sick or getting sick?

  Not obviously.  She did have a slightly sniffly nose yesterday morning, but nothing had come of it and she was fine this morning -- no sniffles, no temperature, nothing obviously wrong.

Just the other day, we stocked up on pastel Peanut M & M's -- at 50% off and in colors Susan enjoys.  Before we made the purchase, I asked Susan if she was sure she wanted to keep eating Peanut M & M's.  She assured me she did.

Did I tempt fate in some crazy way?

The on-call doctor agreed -- more questions than answers.
THAT is such a frustrating part of this journey.

Before we hung up, I had two questions I had to ask the doctor.

  (They were related in my mind, even though they are not actually related...

   I somehow had them jumbled up together.)

I prefaced my first question with an assurance that I already knew the answer (and I did).

(I know I will always err on the side of epinephrine -- I do not want to have to live with the regret of hesitation.)

  Do you think Susan really needed epinephrine?

  Yes -- yes, if her breathing was affected, she did.

  Of course, I knew it all along...but then I had to ask the second question -- the one I knew Susan wanted me to ask but was afraid to voice.  I saw her watching me solemnly as I asked...

I prefaced my second question with the statement that I knew Susan wanted to know the answer...and I could tell by the look on her face that I was right...even though a part of me wondered how -- after all that she has been through -- she could still want to see the clinical trial through.

  I asked...What will Susan's adverse reaction to her dose mean for her continued enrollment in the clinical trial?

  The doctor was less reassuring than I had hoped.

  She said she wasn't sure.

  She said she would have to check the protocol. 

  She talked about what might happen if Susan had to withdraw from the clinical trial.

  I valued her honesty, but I wished for something different.

  I advocated a bit, saying that if there was any room for consideration, any "gray area," Susan wanted to see the clinical trial through.  Even minutes after reacting to her dose, Susan was nodding her head YES -- she wants to keep eating peanut. 

The deadly beast she knows and lives must, at least for Susan, be scarier than the deadly beast that lurks.

We talked about next steps, and agreed that Susan would likely follow the same course she had when she had the adverse reaction to her 1/2 of a Snickers Bar in February, although the doctor wanted to check with the other doctors involved to be sure about the plan.

While I waited to hear back from the on-call doctor for the clinical trial, I reorganized our plan for the day.

-- I found a substitute goalie for Susan's soccer game.  (I talked to three sympathetic mothers of goalies who subbed for Susan during the winter indoor season...each of them taken aback when they learned Susan also lives with food allergies...)

-- I handed off preparation for and running of an important Webelos I den meeting to my husband -- I was not comfortable leaving Susan (even with him, and that's on me, not him)...and I couldn't imagine effectively leading four 10-year old boys through the last pieces of the Citizenship badge requirements...

-- I cancelled Susan's plans with a friend (she felt she would be too tired, and we did not want to disappoint her friend at the last minute).

-- I sought (and received) permission for Susan to attend her sister's post-season banquet (the team is strict about RSVPing and paying in advance, and I had not been planning for Susan to attend, but since she was not going to be with her friend and since staying home alone was absolutely not an option, I had to sort that out...).  Thanks, Bev Beck.

-- I got out of pre-event volunteer commitment for said banquet.  Thanks again, Bev Beck.

I watched over Susan.

I took deep breaths.

I wondered aloud about the difficulties we have had trusting our "halves" as I handed Susan the document entitled Getting Your Daily Peanut Doses at Home.  I acknowledged that she would likely have to eat Peanut M & M's for a while longer while proposing she look at the options to see if there was something that might be easier to measure accurately.  (And trust me, this is NOT about the "ease" of things...for if it were, we wouldn't still be in the clinical trial...)  Susan looked carefully at the list of options, and wondered about dividing 3.5 teaspoons in half...and then spied the Reese's Peanut Butter Cup option (for her, the dose would be a single full-sized peanut butter cup -- my favorite peanut butter product ever and something I have gently suggested countless times...always reminding myself that since Susan is the one eating her dose, Susan should be the one to pick what she eats.

I should be secretly pleased that she is thinking about eating a Reese'sPeanut Butter Cup.

But I am not.

(I loved how happy she looked with her hands full of Peanut M & M's and I loved the idea of those being her "forever" dose.)

I looked forward to working with her doctors -- post clinical trial -- to get from 8 and the dreaded 1/2 to a full 9...but if today's anaphylaxis was caused by a "too big" peanut or peanuts, we are far, far from increasing Susan's daily dose to 9 Peanut M & M's.

I am watching over Susan now.

I am taking deep breaths.

I am marveling at the fact that Susan wants to stay in the clinical trial.

I am tired, and this has been an incredibly difficult year.

I do not believe in quitting, but, honestly, if Susan said she wanted to be done, I don't think I would even try to discuss it with her...we would just simply be done...having given her best go at finding a treatment (no, not a cure) for peanut allergies.

I cannot imagine ever trusting Susan's daily peanut dose...

  (and perhaps this is what I was meant to learn this year -- that while Susan might be safer in some ways as the result of the clinical trial, she will always need to carry epinephrine, she will always need to be ready to self-administer in the case of an anaphylactic reaction, she will still be allergic to peanut...)

Today, Susan is the bravest kid I know.

I struggled with whether or not I could say that, for I have witnessed children fighting incredibly difficult battles with cancer and I know children who live with terribly difficult medical and psychiatric conditions.

But, for today -- Susan is the bravest kid I know.

She could walk away from this all -- no more daily dose of a food that could kill her, no more sleeping with her EpiPens on her pillow, no more dosing-related exercise and/or showering restrictions, no more missed school for clinical trial appointments -- but she has chosen not to do that.

And as I reflect on Susan's conviction, I find myself thinking that maybe it isn't really so much that she is so brave -- maybe the fears and restrictions she lives with now are "better" than those she had to live with before we started the clinical trial.  Maybe not flying, not seeing movies, almost never eating out and not eating anything that hasn't been thoroughly researched and checked for risk of cross-contamination is also pretty scary.

In fact, I know it is, for I remember that life well.

The deadly beast she knows and lives must, at least for Susan, be scarier than the deadly beast that lurks.

One Year Later

Easter weekend was bittersweet.

We spent Easter with my brother-in-law Carl, and his wife, Kaybee.  I wrote about her last year.  While it took Auntie Kaybee a few years, she now totally and completely "gets" Susan's food allergies, and delights in being able to walk Susan through the kitchen and tell her that absolutely everything is safe for her.

Kaybee takes equal pride in walking me through her pantry, where even this year -- now that Susan is eating 8 1/2 Peanut M & M's a day -- she had bagged and then moved absolutely every nut-containing and questionable item to the very top shelf of her pantry -- out of sight, out of mind, out of reach.  (I even spied a bag of Peanut M & M's up there...)

Incredible.

Awesome.

Let me say it again.

Incredible.

Awesome.

I feel blessed and fortunate that Susan has an auntie who "gets" her food allergies, who goes beyond out of her way to ensure Susan's safety.  

I know Susan feels the same way because she absolutely adores her Auntie Kaybee.

(They made Funny Fruit Bunny together!)

While Easter Day was bittersweet (for me), we had fun all weekend long, really.  Kaybee and I left her oldest, James, in charge of my three (!!!) on Friday and they had a blast together.  At 18, my nephew is one of the kindest, most patient teenagers I know -- indulging while gently corralling my children every step of the way.

James took my kids to Oh My Lolli! -- a locally owned and run candy shop that hand-makes "lollirocks" and lollipops.  I don't think I can fully explain how pleased Kaybee was to discover a candy store safe for Susan in her hometown.  I have spoken with the owner, Keith, several times, and I am beyond impressed by his understanding of food allergies -- which is rivaled only by his genuine care for each and every one of his customers (he expedited a package of mini lollis to us while Susan was recovering from her surgery last month -- they were the perfect dessert to serve during the "Flat Party" we threw for her...only I had the idea late in the planning process).  No trip to visit Uncle Carl and Auntie Kaybee is complete without a trip to Oh My Lolli!  My kids love the free samples, watching the candy-craft process -- and, of course, we never leave empty handed!  (Susan's new favorite is Saturday Morning Cereal, which tastes JUST like Cap'n Crunch -- a cereal she has never had the pleasure of eating, due to cross-contamination concerns...)

My nephew then took my crew to Great Harvest Bread Company -- where a friend of his was working.  Apparently they give away free samples of their breads, and James was pleased to be able to ask for four slices of their pizza bread [a no-go for all three of my children -- because it contains pepperoni (and we are vegetarians), and for Susan because of cross-contamination risks].  When we met up with them for lunch, they were laughing as they recounted the tale of their trip to Great Harvest Bread Company and the abandoned samples.  My children laughingly explained that James, who had forgotten that they are all vegetarians, requested four slices of the Pizza Bread -- containing pepperoni.  Susan immediately recognized the risk of cross-contamination and opted out (GO SUSAN!).  Susan's siblings, who are ten, immediately spied the meat in their slices, and although they weren't sure what it was, they were pretty sure they shouldn't eat it (well done, vegetarian kids!).

James took good care of my younger children and then requested samples of the very same Cinnamon Swirl bread that was present last Easter at Kaybee's house (notably not present this year).  They enjoyed their samples immensely, and Susan smiled when I pointed out to her that she would likely be able to try such a sample "next year."  I believed it, and did not think much about it until later in the weekend.

It wasn't until we found ourselves at the buffet at Carl and Kaybee's club that the reality of this Easter hit me.  Last year, Susan and I were confident that this year would be different.  

And while it is in some ways...

In so many ways, it is not.

This year, we are still worried about potential cross-contamination of peanut in anything Susan eats.  (The buffet still presented immeasurable risk...)

This year, we are still worried about the risk of an accidental exposure to peanut (after all, if a peanut-heavy half of a Snickers Bar -- when her medically prescribed dose was half of a Snickers Bar -- was "too much," what else might be too much?)

This year, Susan is still just as restricted as she was at this time last year...and while I do believe I see a future with fewer restrictions, less risk...and greater freedom, I see it through a different lens than I did at this time last year.  I know the battle Susan has waged to be able to tolerate peanut.  When I reflect on the road she has traveled, with us by her side, tears well up, unbidden.  For -- if a year ago I had had even an inkling of what the coming year held, I sincerely doubt I would have been able to believe it, let alone imagine living it.  I had no idea at that time how important Susan's optimism and steady certainty would be.

A year ago, Susan was still (only, just) in the "build-up" phase of the clinical trial, receiving bi-monthly injections (of Xolair, we hoped...although I now feel relatively confident that was not the case...).  We were starting to think about her rapid desensitization to peanut, which was on May 21, 2014.  We were confident that Susan's future would be better.

The "me" from a year ago saw "better" in much more black-and-white terms than the one-year-wiser me sees the term "better."  When I reflect on the past year, and on the blog post I wrote as my husband drove us home from Michigan last year, I cannot help but linger over the conclusion.

  

While I understand that we have what is likely to be a difficult (at least at times) and surely stressful journey in front of us...it is Susan's optimism and steady certainty in the face of what could be paralyzingly frightening that steadies me. 

While I understand that this journey is likely to change our entire family in ways we cannot yet even begin to imagine...it is Susan's optimism and steady certainty in the face of what could be paralyzingly frightening that steadies me.

While I understand that there are no guarantees in life -- I read the sixteen-page study document and fully understand the magnitude of the risks...it is Susan's optimism and steady certainty in the face of what could be paralyzingly frightening that steadies me.  Always.

Splitting Peanuts

There is a lot to keep track of in life, especially these days.

And as much as I wish it were not the case, when I am stressed, my memory is less good than usual.  It seems like it would be better if it were the other way around, but...it just isn't.

Sometimes I make mistakes, sometimes I misremember things...and sometimes I simply get something absolutely and completely wrong.


I knew Susan did not like the Nutter Butters -- even when I offered them dipped in chocolate, or with chocolate "fondue" on the side...or stuck together like a giant Oreo -- Nutter Butter-Chocolate Frosting-Nutter Butter.  I knew it was just a matter of time until she asked if she could change her daily dose to something else.

I wanted to really rally behind the idea of a single full-size Reese's Peanut Butter Cup...no cutting, weighing, measuring -- like the Nutter Butters -- the peanut butter cup was appealing to me for these reasons.  And let me be clear -- it is NOT that I was not willing to weigh, measure, cut and then check.  It was that not one step of the weigh, measure, cut, and then check process ever felt quite accurate enough for me...so I wanted Susan to pick something that she could eat in whole, pre-measured parts.  

But, I am not the one taking the daily dose (although how HAPPY would I be if I "had" to consume a Reese's Peanut Butter cup daily?!?)...and I have always maintained that Susan should pick a daily dose that she likes...and that she feels good about taking.

So...when Susan announced that she wanted to change her daily dose to Peanut M & M's, I happily agreed -- because I had in my head (for some reason) that her daily dose of Peanut M & M's would be 9 whole Peanut M & M's.

We agreed that Susan would change her dose during a clinical trial visit (the appointment did not require that she take her dose -- it was for blood work and to gather the logs we keep on a daily basis).  It wasn't until she had her hand in the bag that the clinical trial coordinator pointed out to me that I would need to cut one of the Peanut M & M's in half.

What?

I am sure I looked dumbstruck, because that is exactly how I felt.
And while I didn't want to DOUBT the clinical trial coordinator, I was so so absolutely certain that I was correct that I asked her to (gulp) double check.

[Looking back, I'm sort of appalled at myself -- but, that's the truth -- I asked her to check -- which she did, very (very) kindly.  I was wrong.  A 4000 mg dose of peanut is 17 Peanut M & M's, so we were back to having to cut part of Susan's dose in half.  The room sort of tilted.  I so, so, so badly did NOT want to be cutting Peanut M & M's in half.]

I put a good face on -- after all, this is Susan's daily dose, and while I have to prepare it, she has to live with it.  But, I had no words for how distressed I was by the idea of splitting a candy and chocolate covered peanut in half.

Really?

Have you ever split a peanut in half?
Because I can say with the authority of someone who has been splitting peanuts in half for weeks that there is rarely an "even half."  
There is a nub on one side of the peanut "half" and an indentation on the other -- almost guaranteeing that a half will be beyond hard to come by.
There is rarely an "even half."
Maybe never. 



Oh -- and Susan has also been instructed to be sure she eats half of the candy and chocolate coating.  
Right.

As chief cook and head-of-the-kitchen, dose splitting duties typically fall to me.  That said, my husband has a very steady hand, so, he has been pressed into service more than once.  

(He finds the concept of half of a Peanut M & M about as easy to wrap his head around as I do...)

Having decided that, unfortunately, while we can divide many parenting tasks by ability (he is the go-to guy for Chromebook issues, iPhone problems and anything even remotely "techy" whereas I am the go-to for relationships, party planning and anything social), the splitting of the peanut is simply not something either one of us is good at, whomever is around and available splits the Peanut M & M for Susan's daily dose. 

A few weeks ago, I got it into my mind that I would "pre-split" a bunch of Peanut M & M's and gave up after about 15 minutes when I only had 2 acceptable halves.  I'd rather deal with the issue on a daily basis (or every-other-day basis on the rare occasion when we get two perfect halves), I decided.

Susan's brother, Carl, always hangs around when he knows I am preparing Susan's dose.  While he's picky about things like germs, he doesn't care how his Peanut M & M's come -- and I happily feed him the bits.

While visiting my husband's brother and his family for Easter, my husband offered to prepare Susan's dose.  Susan's Uncle Carl tried his hand at the art of "splitting peanut" -- and he decided it is easier to eat the bits than it is to split them equally.  Our son, also a Carl, was more than happy to help eat the bits!

While we would never do anything to jeopardize the clinical trial, I am more than a little serious when I tell Susan that if she is going to continue to take her daily dose in the form of Peanut M & M's, once the clinical trial is over, we are going to find a way to increase her dose to an even nine, for I am all too aware of the dangers of an "uneven half"...