2009 flounced out in a flurry of snow and ice. In its wake, a rush of ideas has been flooding into my mind. I'm welcoming it as much as I'm welcoming the new year.

Like the snow, our holidays were soft and lovely, quiet and restful and--best of all--full of moments where my husband and I would look at each other and feel grateful to be in the moment of such magic. Ada and Esme are at the perfect ages to savor the anticipation of Santa, to wonder at the miracle of how he brings just the right thing, and to enjoy the simple gifts we share during Advent. Ada literally cheers when she gets to eat a candy cane!

This year was perhaps the first that I did not feel overwhelmed with the should-have-dones. I scrapped my big "make a perfect Christmas" list, and decided that just being calm might be the most important ingredient for a good Christmas.

A few years ago, I found myself in a puddly mess on December 17 or so, crying because with my overblown expectations--handmade doll clothes, perfectly wrapped gifts, 20 kinds of cookies to be baked and given to neighbors--there was just no way to do it all. Honestly, my mid-December breakdown was a repeat performance from the years before, too. So, to avoid the personal heartbreak, I decided in November to get ahead of myself and just cut the to-do list from my routine for the month. Things that could be done on a small scale--a candy cane for Advent, a new puzzle, or an afternoon spent making salt dough creatures--these were things I could swing. But with Esme in full-on curious 3-year-old mode, baking cookies by the dozen is beyond me at this point. I give. Say it with me: Kirie is not Martha. In fact, Martha is not Martha. She is Martha plus the legion of staff that is Martha Stewart Omnimedia.

The scale-back experiment paid off, and the holidays were as calm as they could be. And still, I found that the day after Christmas I was exhausted, my mind almost blank. It's a strange sensation for me to be without a plan for some new thing to do, something to work on. I took it for what it was: a rest. A time of going fallow for a little while, to just be.

And you know, on New Year's Day, I woke to the snow and the wind and the great sensation that a new and exciting year was blowing into the world. And like the snow-filled sky, my mind swirled, full of new ideas once again.

Happy 2010! May yours bring you delight.

Remembering my friend

Remembering, always, my dear friend Kim, who died a year ago today.

Our family had a lovely few days with her family this past summer. At one point during the visit, D. was looking through one of my favorite collections of poems, and it fell open to this one. We all shared an emotion-laden pause, and then read the poem. Ah Kim, I miss you.

Caroline

She wore

her coming death

as gracefully

as if it were a coat

she'd learned to sew.

When it grew cold enough,

she'd simply button it

and go.

Linda Pastan, from Carnival Evening

Panna Cotta inspired by Top Chef

For some reason, panna cotta appears to be the next go-to dessert on Bravo's Top Chef lately. A few seasons ago, it was the "scallop," whether actual an mollusk or an imitation made from bananas. But this year, chef after chef seems to be making variations of panna cotta. Or attempting them. They mostly seem to fall drastically short of the mark, garnering criticism along the lines of "tastes like a hockey puck."

Having never eaten a panna cotta, much less cooked one, I was nonetheless inspired to make one last weekend. Maybe it was a craving for dairy, or maybe it was just the appeal of such a short list of ingredients: milk, cream, sugar, gelatin, vanilla. Following on Thanksgiving, making something simple and cool felt like a good idea.

Because I've had no experience with it, my notion of panna cotta comes from what I've heard, and some idea that, when done right, it's nourishing in that primal way milk and honey are when mixed together. As for texture, I had the sense that the end result should be a hybrid of gelatin and pudding, with more subtle flavor.

I'll tell you how I made it, and how it turned out. But the most notable thing about cooking this was the peace I found in doing so.

Such a simple thing, stirring milk and cream together. Everyone else was lost in a mid-afternoon nap, and so it was just me and the soft burr sound of the spoon scraping the pan as I babysat the mixture.

I don't often give myself permission to have nothing to do. It's a self-imposed state of frantic, I know. The upside to that is that I am incapable of being bored. One of the downsides is the frenetic thought pattern I make for myself, even when I am supposedly at rest. Ideas, fears, plans, and obsessions flood my mind constantly, often overwhelming me with insomnia. During the day, I feel as though I am constantly moving from one thing to the next. The end result is not a model of productive energy. It's sort of a muddle somedays. Most projects I start never get finished in one sitting, and some never get finished at all.

So finding myself at the stove with a rare quiet around me was a real treat. Even rarer: that silence spread into me, and my mind stilled. I was there, and there alone, just breathing in the cloud of creamy vanilla that rose up around me. The southern window over the stove was filled with winter sun, angling off the glass in a such a way that it fell on half of the saucepan, and made the whorls of milk seem lit from within.

I hypnotized myself into that little pool for the time it took to watch it come to a boil. The watched pot does indeed boil, I thought to myself as I stirred. Leaning on one elbow, I just let myself just give into the whole bliss of doing one thing at a time.

At some point, the milk boiled, and I went into motion to finish it. A stir of vanilla and orange extracts, a quick pour into ramekins, and it was done.

A few hours after dinner, I unveiled the little pots for my family. Ada loved it, which I took as high praise from someone that regularly proclaims "I hate cow milk." My husband and I also agreed it was worth making many more times again, and vied for Esme's abandoned ramekin. (Esme was not a fan--but I'm discounting that, as she is not a fan of most food besides chocolate.)

Top chef or not, I made this version of panna cotta well enough that it is going on my own go-to recipe list because it hit my imagined ideal balance between gelatin and pudding. The cream was neither tough nor runny, but loosely gathered to consistency slightly thinner than a yogurt. It held its shape if you tipped the cup upside down onto the plate and served it that way, but Ada and I both relished scooping it from the little bowls ourselves.

That fragile texture was even better because of the subtle flavor. The orange had cooked off a lot, and what was left was like a whisper. It was hard to place whether it was orange or vanilla I was tasting, and I loved that.

What I liked most was that the whole dessert seemed like a metaphor for the process of making it. How simple it is to imagine taking a few moments to "just be." And how hard it is to do. There's not much to those moments--some sunlight, some stirring--but the subtle flavor of being concentrated on something is something I savor when I give it a chance. And the big thing: it's fragile, it's delicate--like moments themselves. A little something to remind myself...

Here's the recipe I adapted, using a few slightly lighter substitutions from a traditional version:

1 cup 2% milk

3 cups half and half

2/3 cup sugar

3 teaspoons unflavored gelatin (like Knox)

1 teaspoon orange extract

2 teaspoons vanilla extract

pinch of salt

Butter 6-8 ramekins and set aside on a tray. Set aside 1/4 cup milk in a small bowl, and sprinkle the gelatin over the top. Let it sit, with the gelatin floating on top, for 5 minutes.

Mix the rest of the milk and half and half together with the sugar in a large saucepan. Bring it just to a boil, then take 1/2 cup of the hot mixture and add it back into the bowl with the gelatin and milk. Whisk it until it's dissolved, then pour it all back into the saucepan. Stir it all together, add the vanilla, orange and salt.

If you want, you can run the whole mixture through a fine-meshed sieve. I skipped this step, and it turned out fine.

After you strain it, or if you choose not to, divide the mixture evenly among the ramekins. Put them into the fridge for at least 5 hours, or better yet, overnight.

When you're ready to serve them, either leave them in the little bowls or turn them upside down onto little plates. If you do plate them, it sometimes helps to run a sharp knife around the edge to loosen them first. Don't set them into hot water to loosen them--they are too fragile.

That's the basic how-to of it. If you do make it, tell me about how yours turned out. And if you got to sneak a quiet moment for yourself in the process.

Grateful for what might not have been

It's a time of reflection and thanksgiving, and I remind myself again: it might have been otherwise. I wrote this poem at a time when I was almost consumed with longing and anxiety. Among my desires then: to have a child, to transcend my own childhood and be a grownup, to find some way into what I dreamed my life could be.

Doppelganger

We meet between the glass of frames
And photo paper
And the thirty years
That separate us.

And mostly, you seem
transparent--
Blue eyes looking out
from plans and details
and preoccupations with, premonitions of
long and good
days to come.

In your winter coat and muckluks, you are
bright with snow light
on your cheeks and in your eyes.
And I--
I am there, too.
on my sled,
small and red, veloured and fat-fisted,
not yet a miniature you,
not yet aware of the camera
or the spring that follows.

2
There is a chemistry of shadow and light
on certain nights
when the fan above my bed starfishes
itself across the ceiling,
past the rattling cage of
minutia mind
to the rocky beach
of memory.

I stand on the shore
skipping thoughts along the flashing lake
singing in clean strokes across the water
until they sink
like obsidian into oil.

And here you are again,
but opaque to me
This time.
And it's clear to me that
those captured, auspicious moments
left a world of questions
out
of the frame.

What must you have thought,
worried over, as your own night-
beach tumbled into your room
and roared you awake with its waves?


3
I have learned that
if I touch the glass, or
ruffle through papers
or sing stones over water 30 years deep,
I can imagine you as
Another me.
And for a moment,
I can see the world outside the lens.

And as for the me that was then, well,
She
is lost at the bottom of the oily lake,
Waiting
(for now)
for a tide.

K.R.

originally published in Red River Review

Purple and green

Spring this year hang on well into the summer, and, in a fitting symmetry, autumn is doing the same thing.

That translates to some really beautiful surprises in the garden, like the few handfuls of supersweet raspberries and strawberries.

And in wandering around the yard, I've discovered some gorgeous and unexpected color, especially purples and greens. Sometimes the purple is seems just a natural bleed out of the red of the summer color, as it does on the setum flowers. But look at the lamb's ear below, and it's hard to pinpoint the season: it seems almost springlike, the delicate blossoms just peeking out from the leaves like a glimpse of a petticoat.

The combination of green and purples resonates with me, maybe because it's got an interesting complexity--not all sweetness and light, but some beautiful shadow, too. I get an almost tactile feeling thinking about them---they just feel good to carry around together, don't you think?

In a nice coincidence, I've had purple and green on my mind lately. My cousin is getting married next year, and she is contemplating using all sorts of purples and green tones in her plans. What lovely ideas she has! She's started a blog called Bridalhood to document her inspirations--and it in turn inspired me.

So I grabbed my camera, and started looking more intently for purple and green--and found it everywhere this fall, in all kinds of interesting contrasts.

The lavender unfurled yet another crop of stems, too, which my husband brought in for me in sweet little vases yesterday. Smelling fresh lavender in the room in November is a little secret thrill.

The thyme flowers bloomed again, too, in tiny violet whispers on the wiry stems. I love the contrast of the glossy green leaves, the spiky stalks, and the almost orchid-shaped flowers which, individually, are tiny enough to fit onto the heads of pins.

Hydrangeas blend the purple and green so perfectly--not only in their blooms, but in their leaves.

I see these fanning out from the hydrangea stalks, and the word varigated swims into my thoughts and sticks there like a little tune.

In fact, I start noticing purple in all sorts of leaves in our yard:

These mates of our pachysandra (I forget their names) are normally a dark green, with cornflower blue flowers, but they've faded out to a fantastic shade of purple/brown.

The blueberry leaves with some raindrops are even more tenderly purple--maybe catching the color of the sky.

And as the sleepy rhododendrons go dormant--their leaves get dusky as over ripe plums. And it's surprisingly beautiful.

So with all this purple foliage and flowers, I felt inspired to make a flower of my own. Here is a paper hybrid of some sort which I fiddled with recently.

I enjoyed shaping the paper, incorporating different papers and inks. I found some old maps of my cousin's home state, and a few pages of interesting text to add to the petals. Finished with a few beads, some wire, and some ribbon--ta da.

Influenza Series, Part IV: The tricky part for me--making sense of risk

I started writing this series on influenza because I felt compelled to write about my fears--both the reasonable aspect of them, and the more extreme. My goal for each of these posts is not only to show some of the research I've done, but also to let you into the workings of my mind on this. The photos of clockwork gears that you see throughout are my attempt to represent that process.

I said at the outset of this post series that my worries about H1N1/09 are only amplified because of my own tendencies to crave control and fear illness. A fear of illness, is, of course, an ultimate expression of the need for control over chaos. I recognize all of this about myself. I'm constantly grappling with my judgement about risk, questioning whether my worries are based in logic or not.

In most areas of life, I know that from time to time I downplay real risks, as a way of minimizing my worries, and I know that, conversely, sometimes I overcorrect by being too cautious. Fortunately, what was once more of a constant obsession now only surfaces from time to time; when these worries do surface, they don't stay long.

However, in the spring of 2009, the advent of H1N1 brought my anxieties about health into clear, focused energy once more.

I remember I was in our kitchen, cleaning up the dishes from a Sunday morning pancake breakfast when I saw the first footage coming from Mexico City. The headline said something about influenza, and the reporter was wearing a white face mask. My own transformation was extraordinary. A fear that I had set aside years ago came roaring back like a wind in my head, and I abandoned the dishes to follow the story.

As the numbers of infected and seriously ill people in Mexico were reported, I grew more concerned. The new classification as "swine flu" made me think immediately of 1918. I told a few people about my worries for what may be coming down the pike, feeling like a Cassandra.

Meanwhile the world spun neatly on its axis. Spring blossomed in our yard as quietly and gently as every other year. The sky, to my relief, did not crash down. H1N1 continued in its elegant way to infect people all over the world, enough people, in fact, that the WHO declared it pandemic by early June.

For the most part, I kept sane about it. No, I didn't stop traveling, nor going to public places like theaters. But I did have that nagging feeling that this fall may bring a surprise with it.

Now we are well into the fall, and I feel the pull between the reasonable and the extreme each time I consider the "what to do" about the H1N1 situation.

What I'm doing:
I'm attempting to get the vaccine for us. Ada has had one dose, and needs a followup that may come by January. Esme and I have had no luck in locating one, though I check clinics a few times a week. My husband should get one at work, but--like everyone else's--his vaccinations have been delayed.

I'm also practically swimming in alcohol-based hand cleaners. The girls are pretty well trained on washing up after every trip outside, and before meals, and after visits, and on getting in the car...and so on. Ada tries to be conscientious about that stuff at school, as much as she can. And I have her change her clothes when she comes home from school.

When a whopping 20% of her school was out, we kept Ada home for over a week. After 10 days, it was my hope her first vaccine had at least kick started an immune response against H1N1. A leap of faith for me, but...

I beg off shaking hands, saying "Oh, I've got a cold." Inoffensive, I hope--effective? Who knows? But it make me feel like I'm at least doing something...

What I want to do (but don't):
If I think about it too much, I sort of want to hide in our house. I get nervous about going to a big public gathering, especially one where there are lots of other little kids who sneeze, and wipe, and do all that gross stuff kids do (hey, I know--my kids do it, too.) I want to huddle down in our own little nest and just wait it all out. I want to beg or bribe or get that vaccine right now, and cross my fingers and cast some special spell to keep the flu away from us.

You might have noticed that many sensible and rational people, given the same facts, have a less alarmist reaction about getting this year's flu, or getting sick in general. They trust that whatever happens won't be so bad, that either it's no big deal to start with, or, if it does get to be a problem, that someone will take care of it.

Both of these sensible reactions are based on trust, and as I examine my own fears, I realize I don't feel it. At least not in this capacity. My own concern about the influenza outbreak this year is based on fact, yes--but it is amplified 100 times by my own insecurities.

As I've brooded, I've also tried to see my own process of worrying in an objective way. What is setting me off, I've wondered? I've wondered this especially as I find myself watching a newscast and replying back to the television, retorting something a reporter said about influenza. Why am I acting like this? This is not where I want my energy to go--into stridently arguing with a reporter on tv. Or reading every little thing I can about H1N1. When I step back far enough from myself, I can see that what Kirie is doing is called obsessing.


It's hard to admit that. It's hard to say that what I perceive as a real threat might not be as real to someone else. It makes the ground under me feel shaky. But the fact is there: my obsessions might be based on fact to start with, but they spiral way out of reach of normal at some point. And they tend to be related to my own need to control my environment, to create an illusion of impenetrable safety. On so many levels, I crave predictability, because it solidifies that illusion, like a playback loop whispering: all is well; you are safe. all is well; you are safe.


I've said that this year's H1N1 influenza scenario hits all my panic buttons. Essentially, for me it created two perfect storms. One of those storms is, certainly, the reality that this is a pandemic. The other storm is clearly in my mind--the storm of unpredictability and distrust.

The first issue for me is the unpredictability. The virus is unpredictable, and easily spread, even by people who seem well (because it is contagious even a day before symptoms appear). What appears to be one thing: "just flu" or "don't worry, I don't have it!" might be something else entirely. Of course, the flipsides to these (the ones that slip my mind too often) are a) most people who get sick with flu WILL NOT find themselves at death's door, and b)most people who are walking around town are not in a contagious state of influenza.

The second issue for me is the trust. Basically, I don't trust people in general to take this flu seriously. I really don't trust people to wash their hands, to cough in their sleeves. I don't trust that there will be adequate vaccinations for people who want them *before* the virus peaks. I don't really trust that a cold is just a cold at this point. If I hear someone is coughing, I'm assuming it's flu. I don't trust the media to give a clear portrayal of what flu is, or isn't. I don't trust the government to really stay on top of tracking the changes of the virus, to put funding toward a new method of making the vaccine. I don't trust people to believe me. (Ah, the irony!)

I don't trust, I don't trust. I hear these all strung along in my head as I write this and I feel another feeling echoing it: I feel lonely. That Cassandra-like sensation of being disbelieved is, at its heart, isolating. And overwhelming. Feeling isolated and overwhelmed are cues for me that my worries are not completely related to the influenza pandemic alone. Really, my worries are rooted in my past.


A little headshrinking: My childhood was relatively chaotic--my parents, though they loved me, were somewhat absentee. The day-to-day of my life was far from predictable, people's emotions were volatile--my own, my brother's, my parents'. My own physical environment felt out of my control, and very different from that of my peers. I often felt different and alone, and misunderstood by most people. I could not, if pressed, have imagined what my future would look like. I didn't really trust that I would have a real adulthood--because I couldn't imagine what that could be.


Of course, my adulthood did come to be. Sometime in my early 20s I discovered that I could try to shape my own existence a little. And in my grown-up life, I have predictability in abundance. Calm rules the day--literally, it leads the list of our family rules, which we have written out. Sure, there is the messiness of life with little kids, but it is joyful, and welcomed. Trust is the keystone between my husband and me, between my kids and me. I often catch myself saying to them, "You're doing great. You can do that. I trust you." And I do trust them. I have, as an adult, become faithful in a religious sense, and I trust God, too.

So--here is the contradiction, right: With all this goodness, and all this solid trust and predictability in my life, why worry? Why indeed? Because as much good and beauty as I see, I also get glimpses into the underbelly of life, too, and it unsettles me, deeply. There is room for both, I know. A need for both, in fact. I am practicing holding both the beautiful and the dreadful in my mind at once, and letting it be.

It was not my hope in writing this series to spin up fears, but rather to show how the genesis of my own worries about influenza. I also hoped that writing through my own thought process would help bring some clarity to me about why I have become obsessed. If you have gotten this far into my posts, you must see that, as a threat, influenza sits neatly someplace between something very scary and something to be brushed off as inconsequential. When you consider it, it's best to recognize both extremes as unreasonable, and try, as I am, to find some middle way.

Yes, H1N1 is frightening because it does have a potential to become a terrible flu--one that resembles 1918. Actually, that potential is in every influenza. Given those facts, any objective person would admit that flu shouldn't be taken lightly.

But of course, the potential is there for this to NOT become a deadly flu. And the numbers indicate--in fact, they indicated this in 1918 as well--that the vast majority of people who get influenza recover. Given those facts, any objective person would admit that hiding from the world doesn't actually mitigate the risk--the minimal risk.

The scary potential and the benign potential exist simultaneously, all the time, in all actions. Just writing about that uncertainty makes me catch my breath. I refocus, I breathe, I vow to accept that calmly. I have to push myself to remember these things, but I do. I do push past them and go out into the world, send Ada back to school, take Esme to swimming class, make my art, have playdates, Halloween parties, and see my friends and neighbors. To meet me, you would never guess at the contradictions wrestling each other in my mind, but they are there. And someday, I hope, to accept them without anxiety.

If you are interested in catching up with the rest of the series:

Part I: The Introduction

Part II: A Little Primer on Influenza

Part III: The Anti-definition of Flu

Part III on Influenza: What it is not. An anti-definition

It is the negative definition of flu that concerns me.

At its core, influenza is not a simple disease. From an evolutionary standpoint, it's pretty damn elegant and efficient. And complex.

There is a lot that is understood about influenza and its method of evolving, infecting, and persisting. But a huge part remains unknown. For instance, scientists have discovered the "how" of influenza infection, but they are still working toward understanding what actually happens to the human system when influenza infects it.

This surprises me. When I first learned this, I was amazed that that science hadn't answered this long ago. But there are countless mysteries that remain about the human immune system, its response, and the exact process of many diseases.

A particular mystery of flu is why certain cases of influenza have such horrible systemic complications. These complications, usually involving lungs and circulation, can arise rapidly from flu. These are the most troubling, and the most fatal. There is a point of no return when a flu turns aggressive, and the mystery is often this: it is impossible for a doctor to determine at the beginning whether a specific case will involve these complications or not. This is true even with seasonal flu, but predicting outcomes is even more difficult with a novel influenza.

Before you stop reading and accuse me of being alarmist, let me clarify that in terms of percentages, there is still certainly every reason for to most cases of influenza infection to resolve without any serious complications for the patient. Most people who get flu--seasonal or even pandemic flu--recover without a problem.

The numbers are more complicated than they seem, though: To talk about the scenarios of infectious disease is to talk about variables. The outcome of each case is based a whole set of variables, some of which are unknowable. In a regular season of influenza, some of these variables are better understood. For example, a person with a weaker immune system (think of an elderly or immunocompromised person) will tend to be more at risk for a severe case.

With a novel influenza, the scenario is sufficiently different. There are several new considerations, each which influences the potential for poor outcomes:

First, with a novel influenza, the number of people who get sick is much larger than it is in a regular year with "seasonal" flu. This year, some projections from the CDC estimate that up to 60% of the population in the US will be infected with the virus. This is vastly different from the estimated number of people who get flu in a regular season, which caps at around 20%. More people getting sick means more potential outcomes. That's the first variable.

The second consideration regards who is getting infected. A novel influenza affects entirely new groups of people, people who usually aren't as vulnerable to infection in general. 2009's H1N1 is hitting young adults and healthy children pretty hard. The elderly, who are usually the most vulnerable, are not getting this flu in the same numbers as the younger people in our population. There is some speculation that some older people may have been exposed to some element of the older genetic material of this year's H1N1, and that is making them slightly less likely to get infected. With that said, though, when the elderly do get it, they are quite sick--and they one of the larger groups hospitalized for complications related to flu this year.

A particular variable that concerns me regards the elusive nature of flu as a virus. Consider these points:

• Flu is a common illness, but--surprisingly--it's often an unknown quantity. It's not always easily diagnosed at the bedside, as there are a whole host of "influenza-like" viruses. The symptoms of flu can vary widely from person to person, from something that resembles a cold, to something closer to pneumonia. In particular, this flu is presenting with *no* fever in some people. This, again, makes it trickier to diagnose. Even a test for that's done at a doctor's office is not 100% reliable for determining if the patient has flu.

• There are several types of rapid tests used in clinics, but they all operate in mainly the same way: they detect influenza viral nucleoprotein antigen. To put it simply, the rapid tests search the sample for elements of protein from the influenza protein. What these tests can't do is determine specifically which subtype of flu a patient has. Unfortunately, samples vary, and not everyone who gets these rapid tests gets an accurate result. The CDC advises clinicians that they should not rule out flu based on this test because there is a possibility of a false negative (the test says no flu, but you actually do have it). And again, there are false positives, as well. The tests that do the actual subtyping of flu are the ones done by the CDC and by state health departments, and these are accurate, but expensive, and time consuming.

• Flu is constantly using several mechanisms to adapt itself. Antigenic drift is happening all the time with flu. The flu circulating now will not be the flu that circulates next year, or perhaps even at the end of this flu season, in the spring. That constant change just adds to the uncertainty.

All of this--these variables, this shifting, these spaces in understanding--it all indicates flu is nothing if not more complex than it seems.

Which brings me to the next definition of what influenza is not: It's not "just flu." Though it may be a common ailment, it shouldn't be taken casually. It teeters on that edge of dangerous, even in years of regular old seasonal flu. A novel influenza, such as this year's H1N1, falls off that edge into dangerous territory more often.

Because it is a new virus, with genetic components from avian, swine, and human influenza, this year's H1N1 seems to have triggered a very, very robust immune response in some people, especially healthy young people. Pregnant women also have a huge immune response. Unfortunately, there is a limit to what good that robustness can do. There is some speculation that, at some point, the immune response can actually overwhelm to the body, creating what is called a cytokine storm. Think of it as too much of a good thing. One theory about the cytokine storm is that it creates a sort of "feedback loop" among the antibody response, and that this contributes to the collapse of the respiratory and circulatory system.

There is a lot of work being done on this topic right now, and here is an excellent explanation of what a cytokine storm is, and some great discussion of the topic in general, if you are interested. While the jury is out on the exact mechanism of the cytokine storm and how to mitigate it, it certainly seems to be present in the worst cases of influenza infection. Whether the cytokine storm is a cause of death, or a result of the infection itself--this remains unknown. At this time, cytokine storm remains one of the mysteries about influenza infections, but once understood, this knowledge might make a huge difference in changing the outcome of severe cases.

In 1918, the pandemic was caused by a novel H1N1 influenza. The numbers of people affected with serious or fatal cases was (fortunately for us) much higher than what we are seeing with the H1N1 circulating this year. But there are certainly similarities in the populations who seem to be having the most severe cases. Pregnant women and young adults suffered disproportionate numbers of complicated cases in 1918. And this year, pregnant women and young adults seem particularly vulnerable to influenza infection, and more likely to suffer complications once ill. With all that is unknown about influenza, this much seems clear: this year's novel influenza is more dangerous to more people than a seasonal flu.

And that's why my alarm bell has started ringing...

Some more about that, and the personal reasons this might be affecting me, in the next post.