Ways To Endure, Part 1

This photo was taken somewhere on the California coast a few months before I met Pat, but it’s a favorite of mine. By the ocean with her dog Felix, she is calm, tough, happy.

In the early evening of November 5, 2018, on the tiny hospice ward of Mercy Hospital in Iowa City, while my 35-year-old daughter Emma and I nibbled our take-out dinner from El Banditos and chatted with my sister Julie and our old friends Ken and Helen, Pat quietly passed away. Her body, diminished in size and energy by the bladder and lung cancer she’d been fighting for the past two years, was dwarfed by the bed in the middle of the large room. The ever-present oxygen machine, which had helped Pat’s damaged lungs to draw breath, was still wheezing away, but Pat had stopped breathing. Pain meds were still dripping into her veins from the IV bag. The screen that displayed her vital signs – heart rate, blood pressure, respiratory rate – was now registering flat lines, but the alarms that would’ve gone off had been silenced days ago.

Heavily sedated with pain medications, Pat had been nonresponsive for the past five days. When Emma had arrived from Virginia and said, “I’m here, Mom,” she replied, “Oh, that’s good.” Those were her last words. She closed her eyes to the world soon after. Her fierce battle for life, which began over nine years earlier, was all but over, and the group of us kept vigil. As many other friends had during that time, Julie, Ken, and Helen had dropped by to visit with us for a while. They’d found the elevator located near a back entrance that provided the only access to the hospice ward on the fourth floor. Now, we were quietly talking by the tall narrow windows that looked out over the bare treetops of Bloomington Street and, a block beyond that, the spire of the St. Wenceslaus church steeple.

Emma was the first to sense Pat was gone. She walked over to the bed, held Pat’s hand for a moment, and let out a soft cry. We all joined her to stand around the bed and say our goodbyes. I had not thought to share a final goodbye with Pat when we were still able to talk to each other, but I’d been whispering it into her ear those past few days. She and I had been rehearsing that farewell for years.

Forty-three years ago, I moved to Iowa City to take classes at the University of Iowa, renting a room on the second floor of the Montessori School on Reno Street, ten blocks northeast of this hospital. That fall, I met Pat when we worked nights alongside each other in the Stone Soup Restaurant bakery on the corner of Clinton and Jefferson streets, eight blocks to the southeast. So this hospice ward room where we were gathered was at the geographical epicenter of the beginning of our lifelong friendship. 

We made an unlikely pair. Pat had just moved to Iowa City from the redwood rainforests of the Santa Cruz Mountains. Her family consisted of a father who died of smoke inhalation in a San Francisco hotel fire when she was seven, a younger sister with whom she never spoke, a stepfather who had sexually abused her, and a mother who struggled with substance abuse. When Pat was seventeen, she’d had to sign the papers committing her mother to a detox facility. To free herself from all that, she married Clifford when she was eighteen, divorcing him two years later to escape that mistake. I grew up in the unremarkable suburbs of Akron, Ohio, the eldest of ten children in a decidedly practicing Catholic family. I could count the number of girlfriends I’d had on one hand. Sporting an imperceptible wisp of a goatee, I imagined myself a neo-Beat poet. Somehow, we discovered common ground on which we could base a friendship that, over time, filled in and deepened and became a loving relationship.

So It Goes

Manic twenty-year-olds

we frantically fumbled in bed

fire engines racing to the blaze

or the clumsy tumbling

and mid-air collisions 

of novice acrobats

making slapstick love

it was never enough

Now forty years later

I'm reading a New Yorker article

and you’re watching The Walking Dead

on your tablet

I lay my hand on your hip

or rub your back 

or hold your hand

to keep you here with me

a little longer

that’s enough

The story that ended on that snowy evening in 2018 can be traced back to April 9, 2009. It was a Thursday afternoon. Pat, the director of nursing at Crestview Care Center in rural West Branch, was cranking a bed when she experienced sudden chest and back pains that knocked her off her feet. Though she was able to stand up and, after a few minutes, was ready to return to her duties, Cheryl, the care center’s administrator, had already called for an ambulance. When a CT scan at Mercy Hospital showed an aortic dissection (that is, a rupture or tear in the aorta’s lining), she was immediately transferred across the river to the University of Iowa Hospitals and Clinics, much better equipped to handle such a case. A message had been delivered to my classroom about Pat being taken to the hospital, and I was on my way, speeding the thirty miles from Washington High School in Cedar Rapids, my mind racing through all the worst-case scenarios.

When I arrived at the emergency room check-in desk, I was quickly escorted into a room full of doctors and nurses. I barely had a chance to exchange glances with Emma and Cheryl, who were standing outside that huddle of hospital staff, before I was informed of Pat’s medical status and the potential risks and benefits of surgery. I was asked to sign a form approving the emergency surgery. I normally defer to my wife on medical issues, but Pat, who had been in perfectly good health that morning, was drifting in and out of consciousness. I signed the form and told her I loved her before they wheeled her out.

The attending doctor, Dr. Robert Saeid Farivar, was a cardiothoracic surgeon who had graduated from the Boston University School of Medicine ten years earlier. He immediately impressed me as competent and reassuring, even though he was aware of the mortality rate of aortic dissections. He would be dealing with two aortic aneurysms – an ascending aneurysm and a descending aneurysm that extended from the aortic valve to the renal artery. As they began to prep her, Dr. Farivar noted that her “pericardium was tense with blood.” When Pat’s chest was cracked open, the doctors discovered “the entire right coronary artery had been sheared off the aorta” and “appeared blown out.” They began cooling her body to 65° Fahrenheit, and she was put on heart bypass. Then began the painstaking repair of a cardiothoracic disaster, a heart in tatters.

As Pat was being wheeled to Surgery, a nurse escorted Emma and me to the Day of Surgery Lounge on the sixth floor of Colloton Pavilion. Emma had just completed a Master’s degree in public health at the University of Iowa, and was working with one of her former professors on a funded research project at the local Planned Parenthood clinic. I called our sons, Sierra and Jesse, who were living and working in Manhattan and Brooklyn, respectively, to tell them about Pat’s surgery. They made plans to get to Iowa City as soon as possible. I also called our closest friends in the Iowa City area, many of whom soon joined us. Pat’s colleagues from Crestview also stopped by to see how she was doing. I found myself recounting the events leading up to the surgery over and over. Based on what little I knew of Pat’s diagnosis, our friend Mary, a doctor, filled in some of the blanks of what might be transpiring in the operating room. 

The Day of Surgery Lounge is a misnomer – we did considerably more pacing than lounging. Most of the scheduled surgeries were being wrapped up and the waiting room was beginning to empty out. I was afraid to leave the lounge, afraid I’d missed an important update, but at some point I went to the Java House station on the first floor to get coffee. With Emma’s help, I created a text message group to make it easier to update folks. We located blankets and tried to sleep in chairs or on couches. I repeatedly forced myself to turn back before descending into the mental cave of horrible outcomes. The surgery began a little after 4:00 p.m., and the doctors didn’t close her up until the early hours of the next day. 

When Dr. Farivar finally met with us, still wearing his navy blue scrubs, the mental and physical exhaustion etched on his face must have mirrored our own. His news of a successful surgery was tempered by his report of the catastrophic and tenuous state of her cardiovascular system. In the intervening years, whenever a nurse or doctor would read her chart and Farivar’s surgical notes in our presence, their response would invariably be something along the lines of “It’s a miracle you survived!”

I can’t overstate Pat’s will to survive. She spent the next week in the ICU, heavily sedated, kept in an induced coma as she fought to recover from the surgical trauma. Her progress was slow, incremental. By then, Sierra and Jesse had arrived. Knowing our three children and many friends were ready to help, and knowing I could do little for Pat in the ICU other than watch and wait, I had returned to teaching. It felt good to get back with my students and colleagues, all of whom were incredibly supportive. I became a master at compartmentalizing, but when the final bell rang, I’d head back to the hospital and spend my evening with her. 

On Day 5, when the doctors were confident she was strong enough, they reduced the sedatives and withdrew the breathing tube. We were ecstatic when she opened her eyes and looked around. Our joy and relief stood in stark contrast to her response – shock, disbelief, and anger. She had no idea why she was there. Agitated and disoriented, she tried ripping out her IV lines, her chest tube, her catheter. She yelled at me, certain I’d given the doctors permission to perform some cruel experiment on her. Unsurprisingly, she had no memory of her medical emergency of five days earlier. We attempted to describe all that had happened, but it took a while to calm her. Meanwhile, one of the doctors led us out of the room and explained “ICU psychosis”[1] to us. By the next day, Pat had gone out of her way to apologize to every nurse in the unit for the way she’d acted. But the disorientation and anxiety lingered for days. At one point, in a moment of contrition, Pat said, “Well, happy Easter I guess.” When I thoughtlessly replied, “Easter was like a week ago,” she burst into tears.

After her chest tube was removed, she was transferred to the general ward and, a week later, was discharged from the hospital with a medication list fifteen items long and instructions to begin physical therapy. As weakened as she was by the surgery, she applied herself to an exercise regimen designed to slowly rebuild her strength and mobility. She was anxious to return to her job at Crestview, which was for her much more a calling than an occupation. But this was just the beginning of a survival story that would last for nine more years.

Footnote:

[1] According to an article in The Atlantic, “The Overlooked Danger of Delirium in Hospitals,” ICU psychosis is “a sudden disruption of consciousness and cognition marked by vivid hallucinations, delusions, and an inability to focus, that affects 7 million hospitalized Americans annually.” The piece goes on to say that “patients treated in intensive-care units who are heavily sedated and on ventilators are particularly likely to become delirious; some studies place the rate as high as 85 percent.”