Cephas Picker is 62. He has a number of significant health problems that he pays little to no attention, but there was one that was a problem that should have been solved years ago. As far as the initial issue was concerned, the problem was solved. He had a craniotomy in 1999 to remove a meningioma. That surgery was simple and recovery was routine. No biggie.
Until he developed an obsessive disorder that led him to pick at the scalp incision. This is psychiatric disorder in the same category as people who pull on their eyebrows or pull out their hair. A couple weeks ago, he fainted on one of the few occasions he left his home, and some well-meaning person called EMS (he wasn’t pleased).
He fainted because of the infection related to the picking obsession. The area that he worried at with his fingers became infected and the corruption spread into his bloodstream. We are taught not to lose our composure in front of patients. No one has succeeded with this guy. He was all we could talk about in the doctor’s lounge. How could such a problem be allowed to go on for years?( Read more...Collapse )
My young friends who work IT for a large corporation told me that a common interview question is “What sort of a kitchen appliance would you be?”.
I laughed. “Clearly dreamed up by someone who doesn’t cook.”
“The quality of a chef isn’t decided by her appliances. In fact, there are major chefs who use very few. Machinery does not make an award-winning meal.”
“Anyway, which would you be?” asked the husband of the team.
“A chef’s knife.”
“That’s not an appliance.”
“Reference my last statement.”
“Why a chef’s knife?” she said.
“A good chef’s knife is never bought cheaply. It’s properly forged with a well-balanced handle that must fit the hand of the chef. You don’t choose the first one in the store. Some are custom-made.
“It’s a formidable-looking tool, but it’s as versatile as the skill of its user. It can handle heavy cutting or subtle slicing. The more skilled the cook, the more useful the knife – although I wouldn’t try to bone a chicken with one. It doesn’t do absolutely everything, but then, neither do I.
“Furthermore, no matter how skilled the chef, the knife still commands respect. Use it wrong, you will bleed.”
I shrugged. “If your metaphor is a workplace that is under the utter control of one so-called chef, then I’m the chef’s knife.”
“Well,” she said. “That would be considered the wrong answer.”
“It’s a blender,” he said. “You have to say you’re someone who brings everyone together.”
“And removes their identity to make a pulverized mass.”
“I don’t work in that kind of environment,” I said. “One person may be the top dog, and the buck stops there, so to speak, and that person’s me. But every member of my team has a skilled job that he or she knows well and problem-solves independently. Not a feudal system. A lot of people don’t realize that. I won’t put up with such a system.”
They shared a rueful glance. “Good thing you don’t work there,” she said.
“There’s a reason I don’t.” I grinned.
“Wish I didn’t,” she muttered.
“Hey,” I said. “You’re extensively trained and essential to whatever those Blenders there do. You can be a chef’s knife. I’d recommend it. Command the respect.”
They looked at me blankly, clearly wondering how they’d dare do such a thing. I wondered the same. Would I have been that brave at their age?
Sometimes, you really do get to be a goddess.
Called to see a man on Monday, on the “Wellness” unit, which is the name for the unit for people undergoing substance withdrawal. He’d been drinking for 50 years, drying out for brief periods before starting up again.
“That means he started when he was six,” I said.
“So he says,” was the answer.
I decided that exploring that particular parenting issue was not a productive pursuit at the moment. But, ew.
He’d gone through detox three weeks ago, and started drinking as soon as he got out. He landed back in detox a week later, and was now apparently dried out. But he started to get weird again before the weekend. Thinking that for some reason, he’d resumed alcohol withdrawal symptoms a week after he was out of the danger zone, the “Wellness” staff resumed the CIWA (alcohol withdrawal) protocol, but he only got worse.
He was tremulous, with a wide intention tremor that was spectacular. He was hallucinating.
“There are court cats,” he said, pointing behind me.
“Yeah. Cats in ball gowns.” This part was lucky. Usually the hallucinations in this case are hideous visions of snakes and bugs and demons. He lucked out.
But the biggest “tell” was his eyes. Even if he tried to stare straight ahead, his eyes jittered and danced, and when he tried to look to the side, or watch someone move across the room, his eyes juttered in their sockets so violently I expected to hear a knocking sound. (I didn’t. he was hallucinating, not me.)
This wasn’t alcohol withdrawal. This was Wernicke’s syndrome.
Next, I tried instead to establish whether he was oriented. He knew his name. Every question after that produced answers that devolved into word salad and fantasy.
“Tell me where you are.”
“This is a place where they open and close and move and don’t have licorice whips.”
“What year is it?”
“19, 19, 19, two thousand barnacles.”
I point to the sitter who’s been with him all afternoon. “Have you ever seen her before?”
He looks at her in surprise. “No.”
I told the Hospitalist, “You’ve got Wernicke-Korsakoff on your hands, here, and it’s the worst I’ve ever seen.” In fact, it’s the first full-blown case I’ve ever seen. Wernicke’s has all the symptoms this poor man had, but when they can’t remember something for more than two minutes, there’s a nastier problem. A permanent one. I’ve caught a couple of Wernicke cases before the dementia set in that graduated them to Wernicke-Korsakoff, but this guy had been at this for four or five days, and he was well on his way to complete mental breakdown. That worried me. The longer this goes untreated, the more permanent the damage.
“So we put him back on the CIWA protocol?”
“That’s for alcohol withdrawal. He’s not withdrawing. W-K is an acute vitamin deficiency. It’s a malnutrition syndrome. The last thing he needs is more benzodiazepines.”
“Vitamin deficiency?” said a nurse.
“Thiamine. B1. Drunks don’t eat right. And detoxing drunks in alcohol withdrawal don’t eat at all.”
As a matter of fact, W-K isn’t the sole property of drunks, although it’s the reason drunks of old wound up in insane asylums, drooling. Anyone with an acute malnutrition situation is at risk for this. The last case I’d dealt with was a young woman with hyperemesis gravidarum (that’s morning sickness with a vengeance). Poor thing hadn’t been able to keep more than saltines down, if those, for four weeks.
“I’m sure he got a banana bag,” said the hospitalist. That’s an IV with added B1, B6 and folic acid that we give alcoholics as a matter of course.
“That’s nice, but he needs to be flooded with the stuff. A bag gives him 100 mg of thiamine. We’re going to do 1500 mg a day.” And hope it makes a difference.
Hospitalist stared at me and then shrugged. “Well, it won’t hurt him,” he said.
No, it wouldn’t. Thiamine doesn’t build up in the system. You take too much, it gets filtered out by the kidneys into now-expensive urine.
I wrote the orders, warned everyone that sedating him won’t help and went on to the next patient, pretty skeptical that I would make much of a difference.
The next day, I ran into Hospitalist in the doctor’s lounge. “You are NOT gonna believe that guy!” he exclaimed.
“Uh oh. Is he all right?”
“He’s amazing! It’s like it never happened! I didn’t think you’d do it.”
All of a sudden I felt like Henry Higgins.
So I go to the Wellness Unit. And no, he wasn’t completely back to normal. I could still detect some tremor and memory glitches. But he was coherent. He could hold a glass and drink from it without splashing. The court cats were gone. And he was oriented.
Now I felt like a goddess.
I saved a guy from permanent brain damage with nothing more than massive doses of vitamin B1.
I don’t have a good reason for going off on this tangent, but then, tangents never seem to provide me reasons for existing. It really started to gel as I watched a pair of eagle parents work to raise their chicks. Hours of sitting on the eggs in any weather, and then more hours of hunting and feeding two ravenous little babies. Four weeks since hatching and the parents are looking exhausted. It’s one heck of an instinct that drives these two to work against their own best interests to keep these eaglets fed. It’s kinda nuts.
It’s a part of “Nature” that makes no sense except as an abstract.
Every creature is equipped with drives for survival: the procurement of nutrition and hydration, adequate rest, a fight-or-flight response system. Without these, the organism is subject to impaired function or death. An animal that encounters a situation that puts any of these at risk will take action at once to remedy the situation. Absolute biologic practicality. Concrete as it gets.
It’s essential to the perpetuation of a species that each generation produce the next. That’s an abstract, the ideology that for some reason, the planet has some sort of need for more of what you are. This abstract applies to every living thing on the planet, and countless organisms put themselves through horrible trials to satisfy that abstract. Overall, I’m pretty sure that humans are really the only species who appreciate this imperative to procreation as an intellectual concept as well as some sort of neuro-hormonal drive. Admittedly, I come to that conclusion mostly because I have no ability to discuss the presence of abstract thinking with the other organisms nearby. My dogs, my cat, the fish in the backyard pond, the cherry tree above it and the spring peepers in the tree are not entering into that conversation with me.
I simply marvel that the process isn’t easier.
Outside of the abstract concept that the Species Must Go On, procreation provides little to no actual benefit to an organism. As a matter of fact, it’s highly detrimental to a lot of individuals. Plants grow, bud, flower, and produce seeds, and some die immediately after. Some insects also die as soon as they lay eggs, leaving their defenseless young to form, hatch and grow up on their own with no assistance from their forebears. Same with creatures like salmon, that struggle through epic journeys to return from the ocean to the streams they hatched in, there to spawn and then stage massive societal death. How dramatic and counterintuitive is that?
Mammals don’t do a whole lot better. Pregnancy is a hazardous pursuit across species, even for humans. In civilized societies, childbed mortality has dropped dramatically, but it doesn’t take a much smaller degree of societal development for pregnancy to become a risky business indeed. An expectant mother can miscarry and bleed dangerously. (Believe me, when they tell you that a miscarriage causes bleeding, it’s not an understatement. I never had a miscarriage that didn’t make me nastily hypovolemic and sick.) Delivery has a panorama of risks starting with placenta previa, and then eclampsia and moving through breech births, uterine exhaustion, tears, infection and lots of other fun things. Even without the mortality, pregnancy taxes a body in ways that are simply irrational, whether it’s the leeching of calcium from Mom’s bones to build the baby’s (old wive’s tale: a woman loses a tooth per baby, not a myth), or morning sickness, stretch marks, gastric reflux, sciatica, or whatever else. Inspection of anyone’s family tree back as little as 100 years ago shows marriages producing multiple stillbirths, lost pregnancies and so forth, and men collecting wives as their women die in the pursuit of procreation.
Any animal presented with any of these risks from any other cause would indulge in a fight-or-flight response.
Humans should know to do the same. I mean, really, what rational woman would volunteer for such a mission? “Here, sign up to ruin your body and put yourself at risk from all sorts of temporary or permanent damage – including death – from a parasite that will take over your body for the better part of a year, only to further tax your abilities for years after, causing loss of sleep, tons of work, endless worry, and costing you thousands of dollars you may never actually have. Depending on the society you live in, you will have no choice of profession other than this, and if there is a profession you can participate in, there will be several years in there during which you will have to perform an outrageous juggling act that won’t be likely to provide you much professional advancement.” Um, no. And yet, for some reason, we are hardwired to be more than motivated to do this. We yearn for children. We go on and on about how wonderful parenthood is, when rational analysis of the practice shows very little benefit, physical or otherwise, outside of this social and emotional abstract. Women hang their self-esteem on their ability to produce the next generation, and infertile women are labeled less-than-women by themselves and society at large. It makes no sense on a practical basis. And why, oh why, has no one evolved an easier/safer process?
Males aren’t immune to the risks of procreation, either. Male salmon die along with the females. Countless species have their males putting themselves in danger from each other simply for the right to mate with the females, who may or may not accept the victors of those conflicts. Theoretically, the mating-rights battles aren’t supposed to be battles to the death, but still, combatants can be mortally wounded.
Some males will exhaust themselves seriously during mating season. My Beloved grew up on a sheep ranch. He describes putting the rams in with batches of ewes and watching them drive themselves to mate with any female who stood still long enough. They didn’t stop to eat, drink or rest, but kept at it till they were staggering with fatigue, glassy-eyed and panting, barely able to stand, let alone mount the next ewe, but not stopping until they couldn’t smell ewes nearby. One assumes that this practice conferred some pleasure on the rams – it’s hard to imagine a hormonal drive strong enough to push a creature to continue through agony. But even so, it makes no sense. Exactly what is the benefit to the male organism that does all this? None that isn’t abstract.
We watch human males go through all sorts of gyrations to attract sexual partners for no truly beneficial reason. Besides 10 seconds (I’m being generous, I know) of glory, what does he get out of sex? Bragging rights? Abstract. An heir to the throne? Definitely a societal abstract. For a man who is truly able to appreciate an abstract, the deepening of a love bond with a chosen life partner? None, I mean NONE of this is practical. And yet, manhood is measured by the presence, size and proficiency of a body part that has absolutely no practical use to its owner except as a waste conduit. It doesn’t provide nutrition or anything else except 5 seconds (being more realistic) of a nice feeling. And the abstract benefit of offspring, small organisms that are dependent for years, taking the fruits of the adults’ labors for no other reason than to benefit The Future. It’s a weird form of societal slavery in which a combination of future generations and some sort of anonymous imperative steals your time and labor without recompense except with an abstract.
And as a ram will kill himself to get as much sex as possible, human males will go to ridiculous lengths for the same. They will pit themselves against each other, put themselves in physical danger. They will spend untold amounts of money. They will risk their livelihoods (and that of the offspring they have) in order to pursue sex in pastures set as out-of-bounds to them by (abstract) mores of their society, or to pursue sex under circumstances that would not/could not produce the progeny the whole ridiculous system was set up for. I mean, geez, how many millions of dollars did Bill O’Reilly just throw away simply to be able to sexually assault a bunch of women who weren’t his wife? Would he blow as much past and future money to get food? (Money – another abstract.) Men will commit all sorts of crimes, from rape to murder, just to ejaculate. And exactly what is the practical benefit for them? There isn’t one.
I don’t really want to explore the detriment of sexually transmitted diseases.
Even the satisfaction of other basic needs can wind up being distorted by the pursuit of sex. Shelter isn’t just a house, it’s the fanciest house obtainable to impress potential sexual partners, quite often without the intended production of another generation. Transportation (not a biological imperative, but a practical one anyway) isn’t just a vehicle, it’s as impressive a vehicle as obtainable that serves not only as a chick magnet but to put off possible competition. Women aren’t any different, really. For example, clothing is obviously far more than a protection against the elements, and in this first-world society, the target isn’t only a future spouse. Women have their own fondness for 10 seconds of glory, even (especially) without the end result of progeny. I’m still not sure that this is all simply because it feels good.
This drive that informs all adult behavior even into parts of adult life that have little or nothing to do with Future Generations keeps going no matter what the circumstances, even when progeny are not the goal or even a possibility. It’s like the broom in the Sorceror’s Apprentice. It has no “off” switch. The other primal drives have endpoints. A resting body wakens. An eating organism stops when satiated. This primal drive? Endless. It all seems hugely out of proportion to the needs of The Future. How is it that one organ system, a system that really contributes nothing to the established well-being of the body in general, hijacks so much of the organism’s function? Especially for humans, with our prolonged lifespans that extend past the years for producing and raising the next generation, years that would be just as well filled by pursuing other abstracts that would satisfy our vaunted big brains. Brains be damned, we hit 90 and all we want to do is, er, procreate. Just ask my Dad.
It makes no sense.
So we were chatting and all of a sudden he transitioned from his normal speech with occasional word-finding troubles to pure word salad.
“What did you say, Dad?”
“Flurrinasal better bell-bottom sinny sinny biggle.”
I held up a pen. “What’s this?”
“That’s digerrigar blombat.”
I pointed at his watch. “What’s this?”
I hollered for Beloved, who was just draining the pasta for dinner. And in five minutes, we were on the way to the hospital in a driving rainstorm. We hit the ER at the 29-minute mark. We decided that the hospital I used to work at was the place to go, even if administration didn’t like me. (I gave them plenty of reason to do so, but in my defense, they gave me more reason to give them reason. Or something.) They had the stroke program I knew was as it should be. Of course they did. I’d set it up 12 years ago.
The security guard recognized me and had him back in a bed in moments. The stroke protocol system rolled smoothly along just as it ought to, and my old partner showed up less than an hour after his symptoms had started, the Pharmacist had the tPA dose waiting for her and he got the bolus 50 minutes after we hit the door. Not bad at all.
And we waited for his speech to clear. It didn’t.
Then he started to bleed. The venipuncture site just gushed. Pressure dressing. A skin tear from five days ago opened up like it was brand new. Another pressure dressing. And then his cheek started to swell right over the cheekbone. What the hell?
Then I remembered that he’d fallen two weeks ago and wound up lying on that side of his face. But he never developed a bruise or anything at the time. Apparently, he should have. Later we would figure out that another large hematoma had popped up on his right hip, where he’d fallen. His cheek continued to swell and darken and we looked at each other in consternation. Not a place to get a pressure dressing. Hard place to put an ice pack, which he didn’t tolerate anyway. We talked about getting Plastic Surgery to come in in the morning.
We got him to the ICU and got him settled. I left at 10:00 PM. At 10:45 they called. He’d started sundowning and was basically uncontrollable, repeatedly trying to crawl out of bed and hitting at people who tried to keep him from hurting himself. A patient has to keep quiet after tPA, there’s too much bleeding risk and if he falls, there’s hell to pay. And there was hell keeping him quiet.
Beloved talked me out of going to him, insisting that he go himself. I had to work at 5:00 AM, and he insisted I needed to sleep. God, he’s wonderful.
They had a rough night, but of course, once the sun came up, Dad calmed down and was back to his usual cheerful self. His speech is much clearer today and he did well with Therapies and the doctors. The hematoma on his face has shrunk some, but now he has a beautiful black eye. He leaves the ICU for the floor tomorrow. Beloved has gone to get some sleep and then he’ll come back and stay the night again.
The nurses were full of praise for how good Beloved was. “I’m no dummy,” I said. “I married a Neuro Nurse.” And he’s wonderful.
The sun is setting and so far, Dad’s calm, although he’s started with some increased confusion. Pray for a better night.
We did The Boy's high school graduation yesterday, and Dad did really well. I didn't, I teared up like an emotional Mom. So sue me.
The Boy managed to graduate with Honors, which is a huge reward after all the struggles we went through convincing him that even in Honors courses, teachers expect homework to be turned in. But he did it. He Walked in with the Honors group in red graduation robes (everyone else wore blue) and wearing his Honors medal and he looked great!
The trip down could have been worse, but it could have been better. It’s a 12-hour drive, and he did pretty well for the first 9 hours. Then he fell asleep, which I probably shouldn’t have let him do. The last three hours were full of agitation.
“Where am I?”
“How do we get home?”
(Reading the road signs) “I don’t know what these towns are. Where are we?”
“Pull over and ask someone how we get out of this mess.”
I’d review that we were going to my house, and why, and that the Guys and the dogs were waiting for us, and in 10 minutes, we’d do it all over. And over.
He’s adjusted to our house relatively well. I’m poised and ready to get him back home (and what a fun trip that will be) if he disconnects, but we may be able to stay more than a week. Maybe.
Yesterday, he couldn't remember how to tie a tie.
Happy Mother's Day.
I went in to get him up early this morning for a Dermatologist’s appointment and found his bedside lamp in pieces on the floor. Things were moved around the room, most interestingly, both of his clocks were unplugged with their cords wrapped around them, sitting on the chair.
He doesn’t do well when roused from sleep, and he couldn’t tell me what this was all about. I decided to move on, urged him to get dressed and there would be coffee soon.
I went back a few minutes later to find he’d gone back to bed. He woke up better this time. He said he’d had a weird night. That he woke up around two and kept walking around the room. He couldn’t remember why, but he knew he had to take the lamp apart, so he did. And he went back to bed.
I cancelled the appointment.
Later my best friend and I took him to lunch. He ordered a fish taco with pickled cabbage, rice and refried beans and ate everything except the fish. I managed to distract him from ordering a beer.
My best friend’s mother has Alzheimer’s as well, and the family is having a horrible time keeping her from drinking. She was never an alcoholic before, but now if they let her, she’ll drink an entire bottle of wine in one sitting. The results aren’t pretty. She’s got macular degeneration so she can only see light and shadow, she can’t remember a sentence for more than 90 seconds, she doesn’t know where she is or what day it is, she won’t pour her own coffee, but so help her, if there’s a bottle of wine in the house, she’ll find it.
It’s like that at our place. He can’t remember what he had for lunch. He watches the same NCIS episode over and over and insists he’s never seen it. He reads the paper three times over each morning, but by God, he knows the exact level of wine in the gallon jug he insists on buying.
He insisted that he wanted to treat us to lunch. When the bill came, he couldn’t pay attention to it. The folder included a little card that said “Tell Us How We Did” and that was all he could pay attention to. I reminded him to get his credit card out and showed him where to put it in the folder. When the form came back, he looked at a $40 charge and said, “What do you think the tip should be?”
My brilliant mathematician, engineer father couldn’t figure out a tip on $40. I swear he used to be able to do calculus in his head.
I showed him where to write the numbers, and where to sign, and how to put his card back in his wallet. I’ve never had to do any of those things before.
What the hell happened last night?
He lost the year today.
Little bits and pieces dribble away day after day and today, the year went away.
I took him for his hearing aid assessment. He insists that the hearing aids he has work fine. I can’t tell whether he has them in or not. I actually counted, one day. I’m asked to repeat myself the same number of times regardless.
I told the Audiologist that there has been progressively worsening aphasia since fall, and maybe the repetitions are actually a receptive component to the aphasia. At this point, I can’t tell. Which is kind of humiliating.
I was relieved to learn that he did well on word-recognition as long as it was loud enough.
Then he was filling out a form and he asked “What’s the year?” it caught me by surprise. The Audiologist saw me tear up and positioned herself so he couldn’t see me till I calmed down. At least he had the month right. But the year is gone.
We loved her. She loved us. These facts were undeniable. She was a person of great passion about anything she embraced, whether it was her family or cake decorating. She needed and absorbed love like she was the Sahara needing water, and no matter how much love, friendship, adoration she received, she was still the Sahara. It wasn’t that there wasn’t enough – it was more like she hadn’t even started.
Whatever she decided to do – and she did many, many things - she excelled at it. Well, maybe there were a couple of things she couldn’t do. I understand that waterskiing was a bust, but then I can’t say she’d decided to do it, either. As a rule, sports weren’t something that interested her, as a participant. There were sports she enjoyed watching – baseball comes to mind.
She fell off a swing when she was twelve; reportedly it was at its highest point when she fell. She landed in a seated position, she said, and broke three vertebrae. In that era, she should have never walked again, perhaps even should have died. She said that there was a lot of pain initially, and she was immobile for a long time. It’s a testimony to my grandmother’s iron will that she wasn’t a hunchback. Nonna was an old-world Italian lady who knew deep in her soul that a woman with no marriage potential wasn’t a human being at all, and a hunchback certainly would have no marriage potential. She wouldn’t accept anything but a lady’s posture for her daughter, and for the next seven decades, people would have to be told that there was a terrible curvature to her spine. By people, I mean her primary care doctors.
That curve was likely a partial cause of her death. As osteoporosis set in, and she lost height, the kyphosis compressed her lungs so that she couldn’t take a proper breath. In the end, she needed oxygen to keep her well-oxygenated. She needed hospitalization for pain management because of that spine. During that stay, she had a stress test that was negative. I suspect that she was so unable to ventilate that she didn’t exert enough to produce a good result. Less than a week after that stress test, she had a heart attack.
She called me at 7:00 AM on a Saturday morning, four days after her 89th birthday. “Did I wake you up?” she said.
“Yes, Mom. Just like every Saturday.” I think she got some kind of perverse pleasure out of this ritual. I had given up talking her out of it some time ago.
It was a good chat. Newsy. I asked her if the birthday present I’d sent had arrived. Indeed it had: last week.
“You didn’t open it?”
“Of course not.”
I can’t explain why that would be a matter of course. She was like that about presents. Nothing we could give her was ever “right”, and three quarters of our gifts were returned. But if she didn’t receive that gift exactly the way she wanted it, then it was inconsequential. I was away working on her birthday. Therefore, my present wasn’t worth opening. However, if I hadn’t sent one…
Oh, and if I wasn’t sent into orbit by anything she gave me, my life was not worth living. I don’t mean that as in: she’d make my life hell. I mean that as in: I didn’t deserve to live.
If that sounds harsh, remember that she loved us.
I don’t know if she’d have kept this year’s gift. It’s still in its box in the room I grew up in. It’s a soft, soft, soft silk-cashmere infinity scarf in a mouth-watering shade of teal. I imagine I’ll use it; it feels too good.
Three hours later, Dad called to say that she’d fallen in the shower, and the EMT’s were there to take her to the hospital. I could hear her scolding them in the background, telling them how her back hurt. I settled down to paperwork at my desk and waited for the next phone call.
Five and a half hours after that, I did get that call, from an Interventional Cardiologist I’ve never heard of, telling me that she’d taken out her LAD and her mitral valve, and he’d been trying to reopen the vessel all this time, but it wouldn’t take a wire, much less a balloon. He said she’d been in shock by the time she reached the ER and she was in the Cath Lab before Dad could even park. He said that her pressure was too low on three maxed-out pressors, and they’d never been able to get the systolic above 80. He said that she desperately needed a balloon pump, but the scoliosis was so bad, he couldn’t get it in. The curve of the bones pulled the aorta along with them. A balloon pump doesn’t work except in a straight line.
“The whole thing had to have been a challenge for you” I said. I wonder now at how clinical my demeanor was. He allowed as how it had been a long afternoon.
He said that she was on a vent, on three pressors, and he thought they might be able to keep her going until we got there. I fought the urge to ask him if he was sure he’d called the right family.
The rest was an odd, numb blur. I wandered into the living room where my husband was, and just stood there. I didn’t know what to say. Beloved had had a hip replacement not five days earlier. He couldn’t travel. I had to leave him to fend for himself. I fought down a feeling of being torn apart.
I called the dispatcher at work to say I had a problem. He said “If it means you can’t take your shift tonight, I have a bigger one.”
I said “My mother just had a heart attack and won’t last the night. Trade ya.”
My father was alone. I tried to call neighbors, friends. It was Saturday, who would be reachable? My dearest friend had annoyed my mother 20 years ago. She wouldn’t let her name be spoken in her house since. I called her. “Mom’s had a heart attack and she’s dying. Dad’s alone, and I can’t find any of their friends…”
“Hang up” she said. “I have somewhere to be.” She was standing next to him in 15 minutes.
I started trying to reach The Boy at school, but he wasn’t answering his cell. I gave it three tries while I tried to figure out what went into a suitcase. Thank God for all the traveling I’ve done – most of that went on reflex. Weeks later, I found one of the texts I’d sent: “Honey, you need to call home”.
I don’t remember the four-hour drive up to The Boy’s school. Two of the teachers were waiting up with him when I got there at 1:00 AM. He latched onto me, too stricken to cry. We found our way to a little hotel where we could get a couple of hours of sleep, and hit the airport at 4:00 for a 6:00 AM flight. We arrived at 10:00, rented a car and by some miracle, made it to the hospital by 10:30.
I caught sight of her from the door and stopped in my tracks. The Boy saw my face and started to cry. He’s been on rounds with me enough to know. He knew his Nonna was gone. We tried to talk to her, but the body in the bed wasn’t her. She was that stereotypical ICU preparation, a body on a vent, conjunctiva puffed out of her eyes because of the high force needed from the ventilator to keep her oxygen up, eyes drifted in two different directions, and lips and hard palate blue in spite of all the best efforts. But my mother wasn’t there.
An intern showed up and told me all he knew, including her labs. Heart barely beating. Lungs unable to take in sufficient oxygen. Kidneys and liver non-functional. She may have had a stroke in the night, judging from muscle tone and reflexes. “Should I call a Neuro consult?” he asked helpfully.
I smiled and patted his arm. “No need, dear. I can tell you what you need to know.”
The Boy opted to go back to the house before the ventilator was taken away. Dad & I held her hands and watched four partial ventilatory efforts, and the body followed the rest of her.
I don’t remember much after that. There were visits to the funeral home, plans for a reception, even a trip to buy a black dress. A friend appointed herself to come with us to the funeral home and wrote down absolutely everything that was said. I read her notes later and was dismayed to realize that I recognized nothing. Apparently, we’d demonstrated some presence of mind in the decisions we made, but without the notes I would never have known it.
I had had the bright idea of sending Beloved an Edible Arrangement for Valentine’s Day. When he told me that the delivery of that resulted in such a tussle with the door, a walker and four dogs that he fell, the torn-apart feeling finished its work and I lost it. I’m not sure how long it took two friends to put me together.
They say that the service was lovely, and the sermon was sensitive and personal, and all the other nice things you say about funerals. I remember assembling behind the casket in the narthex, and when the music started, The Boy in his trim dress uniform fell in behind the casket as it rolled down the aisle, performing a parade march as smooth as butter, and my heart clenched. The rest of the day is lost to my memory.
The friends that have been part of our lives for so many years surprised me. They showed up with food or invitations to get dinner. They kept tabs on Dad when I had to go home for a while. The next-door neighbors invited us all to their Easter dinner. They proved themselves to be true friends, and I am still overwhelmed.
I had wondered how we were going to process things in the aftermath. Loss of a mother, loss of a wife of sixty-three years, this is a huge hole in our world. I briefly wondered if Dad would turn her into a saint the way she did her own mother (SO not a saint). He said over and over to well-wishers “She was a wonderful, remarkable woman. She was the consummate military wife.”
It wasn’t a week after her death that he put down his dinner fork and said “You mother was a remarkable woman. She was. She was also a pain in the ass.”
“She loved us” I replied, and shrugged. “She couldn’t help the rest.”
She couldn’t. Years after her death, I analyzed my grandmother’s behavior and realized that she had borderline personality disorder. What’s it like to be raised by someone like that? Especially early in the 20th century when no one knew what the hell was going on anyway. Nonna cut a swath through her Italian community outside Pittsburgh with an alternating beneficence and destructive power that I think people still talk about, although admittedly, those who remember are pretty much dead and gone themselves. “Street angel and house devil” said the closer cousins who knew.
Her daughter was predictably neurotic, and was a control freak like none I’ve ever seen. She suspected all her friends of duplicity, or at least of laughing at her. She could count the people she trusted on the fingers of one hand, and I’m pretty sure they didn’t include either Dad or me. I’ve said she could do anything she wanted. I’ve never met anyone as smart or accomplished as my mother. She had a fine scientific mind, a prodigious memory and really good fashion taste. She was funny and pretty. She could be a lot of fun. She had the least reason to be insecure of anyone I’ve known or heard of. And she was the most insecure person I’ve ever met. There was never enough reassurance. Never enough obedience. Never enough of anything.
The older she got, the needier she was, and the very worst thing I ever did was grow up. She was proud of my accomplishments, my knowledge, my profession. But if I dared to display any knowledge that she hadn’t taught me herself, she lashed out with a force that was heartbreaking. At first I was spun around by this. I was only doing what she wanted. She had preached education, success, and my being a doctor all my life. I was doing that. What was wrong? It has taken me years to understand, and I’m pretty sure she never had an inkling of the damage she did.
She and Dad had legions of friends. She ran off any friend I made without her approval. She ran off every boyfriend after high school. Her jealousy was frantic.
She took vengeful offense without warning. I spent my early adult years tiptoeing around her, trying frantically to please her with nothing to show for it but an ulcer. I watched her begging my deeply demented grandmother for the smallest word of approval. She never got it. It broke her heart, and there was no presenting to her that she was asking for something her mother was physiologically incapable of doing. Eventually, I realized that she was repeating her mother’s pattern, and if I didn’t do something, I’d have no life of my own. I couldn’t face the idea of living that pattern for another generation; it would end the same way. I had to find a way to stop it. Programed as I was for obedience, that was a tall order. My med school years and after were a whirlwind of out-of-control controlling behavior. She listened in on my phone calls, she read my mail. When I moved out, she’d come to my apartment and go through my closets, my drawers, my checkbook. The interrogation would start when I got home from work:
“That is a skirt.”
“Where did you get it?”
“Was I there?” Obviously not. “You’re taking it back.”
Dad picked up on the results of this pretty quick. She’d say she was going to see me and he’d say “There goes the bank account”. Funny.
She’d look into my bathtub drain to see if there was male pubic hair in it. It was at that point that I freaked out. Never mind that I knew the Italian attitude that no matter what a woman did – she could get a Nobel Prize for wiping cancer off the face of the earth – if she didn’t have her hymen, she was RUINED. Worthless. Fit for nothing but execution a la Deuteronomy. My entire value depended exclusively on a vestigial transluminal membrane. But this level of paranoia was the limit. That wasn’t a pretty confrontation, but if she continued the freaky spying, she didn’t say anything about it.
I don’t suppose it was a surprise that this situation couldn’t do anything but explode. When I finally married Beloved against her wishes, her denouncement of us was humiliatingly public. She demanded that her friends denounce us as well, which confused many of them. Those who refused this were cut from her society, and even after we reconciled, some she never spoke to again. At the time, all I could think of to do was stay out of town and out of sight. Nosy people would call and try to get my side of the story, but I was too repulsed by the whole scene to play along.
But it all passed. She loved us. We loved her. This was the way she was. And I still believe that she had no power to stop herself.
This is the memory minefield we find ourselves confronting. I started going through her closets to clear away her clothes and decide what to do with them. I’d find a favorite housecoat or sweater and shed tears, and then the booby traps were uncovered. The floors of the closets were heaped with layers of things that hadn’t seen the light of day for years. Old bedroom slippers that should have been thrown away. A bag of Christmas cards from five years ago. And stuffed into a plastic bag and buried under a pile of shoeboxes, my gift from med school graduation, an antique garnet necklace and earring set, and a couple other pieces of jewelry I had received as gifts in college. These weren’t taken to the safe deposit boxes as she usually did with her more valuable jewelry, but shoved away in spite. They’ve probably been there for twenty years. I could almost feel the anger as I opened the bag. Boom.
When we went to the bank with her death certificate and to check on those safe deposit boxes, we found that my name had been taken off the signature cards twenty years ago, and then replaced later. And there was one box that Dad didn’t know about and had been in her name and mine only, but now had only hers. Why did she do that? “Oh, you know, she was angry” said Dad. Boom.
Birthday cards and Father’s Day cards I had sent to Dad over several years, even before the Big Breakup, were tucked in a sweater drawer, unopened. Boom.
There had been things like vacation trips that she told me Dad didn’t want to join us for. I asked him why. He’d never heard about them. Boom.
I found a travel journal from the summer we had our church wedding. She noted that she’d heard that I’d had an anaphylactic reaction and wound up in the ER. So distressing, she said, that they were no longer next of kin. Really? That particular booby trap was almost funny, until it sorta gave me the creeps.
It’s hard to mourn. At dinner with friends, we’ll reminisce, and sometimes the story ends with Mom having been Mom. Dad and I chuckle fondly, and the friends look nonplussed. They’re right, it isn’t funny. But what else do we have? Last week, I patted an old friend’s hand and said “Don’t feel bad. This was my mother. We all know that. And we loved her just the way she was, because she wasn’t going to change. And she loved us.”
My best friend suggested years ago that I have been too forgiving. But what else could I do? To continue to fight was to continue to be angry. I couldn’t stop her. But I could limit the damage she did. I could predict what would happen, and plan accordingly. Sometimes I’d feel depressed that I could predict so well. But the problem wasn’t mine to fix, no matter how much she demanded that others fix her life by doing what she wanted. We tried that. She just wound up wanting more, and she was no closer to happiness. God, I hope she’s closer to happiness now.
Dad says he’s “bereft”. The thing that saddens me is that he seems more to be relieved. He’s much less irritable than he was over Christmas-time, when he’d forget something or mess it up, and she’d snipe at him about it. She blamed him for his dementia, and he knew it. I may not be able to figure out how to forgive her for that. Especially when I see that he’s able to take this in stride so much better now.
I feel guilty that I feel relieved, too. Dear God, if Dad had gone first, this could be unbearable. And I feel guilty knowing that. It’s not very daughterly, is it?
Especially since she loved us. And we loved her.