“Edward Grady Patin was a big, rugged guy who could charm a snake off a rock.”Jimmy Hoffa in “Hoffa on Hoffa,” 1975
A lot was on my mind when my airplane touched down in the Baton Rouge airport at 7:37pm, April 3rd, 2019. It had been too dark to see outside of my window on the approach, but I knew we had flown directly over Granny’s home under the flight path, where Wendy had grown up, a 680 square foot, three bedroom, two bath house with a generous yard surrounded by a small drainage creek and three gumball trees and two stately oak trees where Wendy and I learned to climb as children. About every 20 minutes, a landing or departing jet aircraft passed so closely overhead that the whole house rattled and the bottles in Granny’s tightly packed liquor cabinet would clank together, and we’d stop talking for about 20 or 30 seconds until the plane passed, and as a kid climbing Granny’s tree I could see their faces peering down at us.
A few blocks away would be Grandma Foster’s old home, closer to the train tracks, and where my dad had lived when he was estranged from Big Daddy and how he came to meet Wendy; and, as Judge Lottingger wrote, where, about nine months later, I came to be.
About two miles away was a giant stately oak tree planted eighty years ago by James “Ed” White, my PawPaw, near his humble two bedroom home that had been packed tightly with his wife and daughter and her husband and their daughter, and, of course, me. Behind the house was a small pond and ramshackle barn, seperated from the house by a cattle fence and an eight foot tall rusted metal gate. About a mile from that was Glen Oaks High School, where Wendy and my dad had attended and dropped out of to have me, and where PawPaw had been the custodian, and why the trees of Glen Oaks looked as if someone who loved them cared for them. Between PawPaw’s farm and Glen Oaks was a 200 year old stately oak tree where PawPaw had taught me how to climb.
Directly under the airplane a second or so before it touched down was where the world’s first geodesic dome had been built and used as a lawn maintenance shed, where architects from all over the world would fly in and see just to have seen Buckminister Fueller’s idea put into action until, I had read not to long before, the Baton Rouge airport tore it down, not knowing it’s historical significance or value to collectors, and added a much larger, more modern, lawn mainteance shed. Even that day, with everything on my mind, I recalled that I had know about the dome when I studied engineering at LSU, yet had never set aside time to go see it. The obvious punch line to the metaphor was painfully obvious to me.
Nearby was where Lee Harvey Oswald had trained in the Baton Rouge Civil Air Force under the name Harvey Lee, part of the reason so many people suspected Big Daddy of having known him. The nearby runway was where Audie Murphy took off after having met with Big Daddy on behalf of Hoffa and Richard Nixon, a week or so before Audie died in an airplane crash in Virginia. As a joke that may only make sense to you if your recalled that I was a paratrooper and Audie was not, even though his photo adorned the walls of the 82nd Airborne’s leaders, many of my colleagues had pointed out that Audie would still be alive if he had been a paratrooper: H’uah! Airborne All The Way, Sir! But, none of those colleagues had remembered or connected the dots that Edward Grady Partin Senior had been a leading suspect in Audie’s death. I sure wasn’t going to mention it.
Of course, we all know what happened to Nixon after he pardoned Hoffa.
I really don’t know that much about the whole Kennedy thing. It was a side hobby, nothing more, perhaps like being a tree surgeon had been PawPaw’s side gig. I’ll share what I know and how I learned it in another part in the story, if you’d like to keep reading. Everything’s a choice.
Baton Rouge had grown in modern times, and instead of a cab I took a rideshare to Wendy’s room in one of the new hospitals built along I-10, built to be closer to the planned subdivisions that had been all the rage the past few decades and had about as much character as a modern lawn maintenance shed. But, life had improved for many people, like the driver, who used her rideshare app to make a little extra money while she was attending Baton Rouge Community College. When I last lived in Baton Rouge, it would have been surprising to see an African American woman attending school and working traditional jobs back then, especially one so so cheerful. She automatically began chatting and asked cheerful phatic questions that I avoided until she noticed where I was headed, and then she let me ride in silence. No one goes straight from the airport to a hospital in the suburbs after 8pm, when visiting hours usually ended, unless it were urgent, and Wendy’s hospital didn’t cater to babies being born so something urgent was probably not a pleasant story.
I sniffed quietly and rode in the front seat, an old habit of sitting up front in vehicles so that I have a clear view of what’s ahead, but I regretted it. My mind was full of thoughts and I didn’t have the energy to distract them. I was sniffling because I had been crying, but also because of the springtime pollen floating in the air and was activating my allergies and irritating my sinusitus; that part of Baton Rouge hadn’t changed, and was partially why I didn’t return home as often as I could have. Wendy suffered immensely from allergies, and I had probably inherited my slight case from her. I hadn’t asked her how they were the last time we spoke, and I wished I had. Maybe I could have learned more by listening more; I don’t know why that’s harder for me with some people, though it’s probably related to emotional attachments driving my thoughts.
We arrived at Wendy’s hospital and parted ways without speaking. She had been a wonderful driver, driving safely on the slippery roads in the light thunderstorm and lowering her radio to a polite volume that allowed me to stare out the window. After I’d dry my tears and wipe my eyes, she’d discretely offer me a sanitizing tissue. She didn’t know what I was thinking, but she was empathetic and knew I was lost in thoughts that wanted to come out.
I had been staring out the window, watching her windshield wipers slapping time, and my mind began hearing Janis Joplin’s “Me and Bobby McGee,” recorded just before she died and released posthumunously the year I was born, and I always associate that song with Janice’s voice being ‘busted flat in Baton Rouge, waiting for a train” and how she and Bobby McGee watched the windshield wipers markin’ time. I always got that lyric backwards. And my first memories are of that song, which was played all the time on everyone’s radio back then, and Wendy and her friends laughing and singing along with Janis and dressing a bit like her and happy. I was trying to attach to that memory and the feelings I had associated with it, but I failed. I still heard Janis singing in her rhaspy, tortured voice, but I couldn’t find joy in my thoughts. Instead, my thoughts raced from worry, angst, and regrets while Me and Bobby McGee played on my mind’s radio with as much clarity as if she had been turned on by the rideshare driver. Perhaps she had. I can’t be sure. I remember listening to that song on a radio as the windshield wipers slapped away raindrops, and I was sobbing louder than I would have liked in such a tight space. Between sobs, my lips moved as I sang all the songs that driver knew.
The review section of the rideshare app doesn’t have an option for a truely empathetic person, one who lets you be as weird of a passenger as possible and still rates their experince five stars. I don’t recall if I rated her or not. I got out with my backpack and shut the door and she drove away and probably picked up another passenger. I realized that I had left my yoga mat in her car, and sighed and walked into the reception area and stood behind a red line in front of the receptionist’s desk.
I wiped my nose with a white handkerchief I usually carried while traveling, just in case a kid is upset and would be cheered by a quick magic trick, and asked the lady at the front desk if the hospital had a yoga mat. I realized for the first time, surprisingly, that handkerchief is also useful for wiping your nose after crying. I had never flown into the south during allergy season when my mother was in a coma, so I had never had the need to wipe my eyes and nose in front of strangers before. I was surprised, and surprised that I noticed that. It was better than ruminating, I thought, and managed to smile at the receptionist.
“A yogart matt?” She asked. “Like a yogart machine? We got one over d’er…” she pointed her improbably long fingernail immaculately decorated with purple and gold flor d’ lis towards a vending machine. Her arm was as large as a ham and wiggled a bit as she pointed, and I was pretty sure we hadn’t communicated. I didn’t want to keep talking, so I thanked her and asked if there were a meditation room.
“No, we ain’t got that here,” she said. “They use lawyers offices for that.”
Not mediation, I thought with an uncharacteristically arcid feeling. I saw myself judging her and her flabby arm and stereotypical focus on fashion over education; of course someone like her wouldn’t understand me what I said when I clearly articulated “yoga” and “mat,” and of course she had probably never meditated and had family drama that needed a mediator. It’s no oncer I left Louisiana.
I was being an asshole in my mind. I was tired, I knew that. I needed to relax before seeing Wendy. I wanted my thoughts to be kinder, more gentle, because I knew they would probably be the last thoughts I’d have while she was still alive. I didn’t fight my thoughts, because I wanted to relax, and I was surprised at how mean I was being to a woman I had never met.
I asked if they had a chapel or prayer room.
“Over d’er,” she said, smiling broadly, pobably happy to help, and pointing her New Orleans Saints fingernail towards a small door near the vending machines. In all fairness, they were gorgeously painted with meticulous detail. Purple and gold is a classic color combination, and in context with the receptionist, her fingernails were a cheerful combination of Baton Rouge’s LSU Tigers purple and gold and the New Orleans Saints black and gold. She even had a faint silver line around the black flor de lis on each fingernail. I could probably learn a thing or two about how to improve my own shabby appearance from that lovely lady.
I thanked her and limped over. The vending machine had lots of sweet cakes and candies, but no yogurt, and the chapel was small and barely held the dozen chairs and a small pulpit. I entered and moved a few chairs so I could at least stretch out in downward dog. But, I’ve been slightly claustiphobic since 1983, and I couldn’t imagine relaxing in a small room with one door.
People are surprised when I say that, because I scuba dive, but that’s because we all have different definitions of slightly claustaphobic. For me, scuba diving is floating with freedom, not confinement, though, in context, I’ve been trained more than most people and have already experienced surrendering to death and yet somehow still swimming to safety. For me, it’s accelerated daily life with a focused, logical attention to breathing, an obvious metaphor for meditation and even shown as that in many Youtube videos, and I’m sure many Christians share similar analogies. It’s floating with freedom to choose. For me, I can’t be claustophobic if I have a series of choices, including how much I pay attention to my gages vs enjoying the moment, as they say in those videos. Regardless of the reasons, I’ve never felt claustophoboc diving or even riding in submarines, perhaps because there’s such a shared fate that I never horror of that situation in my mind, which is surprising given that I felt slightly claustophobic in the small chapel.
I couldn’t relax in any cramped room, not just the chapel, and this one room was very cramped. It had no windows and only one door for escape, and the route to that door was partially blocked by folding chairs. Some where haphazzardly aligned and had some had intertwinded legs. For me, claustiphobic is a feeling of being trapped, the proverbial beast with its back to a wall, a strong sense of flight or fight, and not wanting to hurt anyone but quickly loosing my ability to not do whatever is necessary to walk out of that door. Clautophobia, for me, has always meant running out of choices. The faster those choices are being eliminated, the more intense the feeling. I was always slightly claustaphobic, and the feelings always increased f I was fatigued or had been in physical discomfort for a long time.
I moved a few more chairs and paced back and forth and concentrated on not limping. It’s a type of meditation. I hoped the focus on something, anything, would slow my breath and calm my pulse and help me be prepared for seeing Wendy. But, the small room overrode my effort, and my growing sense of urgency disrupted my concentration, and I was becoming more aggitated and anxious to go upstairs and see Wendy. Frustrated at myself, the universe, and everything, I strode briskly past the small pulpit and turned towards the door hastily, knowing I was about to walk out and wanting to do it quickly and without tripping on anything, when I noticed an open book on the pulpit. In a brief moment, curiousity got the better of me and I paused.
Even before I focused on it I knew it was probably a bible – I was in was a chapel, after all – and what sparked my curiousity was the possibility of syncronicity. I neither believe in it nor do not believe in it, and I know I’ll never know for sure unless I start paying attention to possible signs. Even if not taking my own fate seriuosly, and wondering if the book were open to that spot intentionally, for me, I would have been curiuous to learn what someone would read to a room full of presumably sad people crammed into that godforsaken small space. There wasn’t space for a decent downward dog, so I can’t imagine any words that would improve the situation. What would you say to comfort someone who knew they were about to lose their mother?
I was not closed minded to a sign from anything in anyway, in or out of my mind, and I stood behind the pulpit and concentrated on my posture in lieu of a yoga pose and picked up the bible and glaned at what had been left open, whether intentionally or not. It was open to the final pages of Matthew, and I browed the words restlessly, beliving I knew well, until a short bit caught my eye. I read it and reread it, surprised that I hadn’t recognize it. I checked the bible’s version and publisher and was satisfied. I reread the line that had stood out.
“Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.” Matt 6:34
My smiled returned, surprisingly, if only for a moment. I realied I had been slouching with a slight twist, and I unwound myself and breathed a few times and replaced the bible as I had found it and concentrated on walking without a limp to the elevator that led to Wendy and her room on the 3rd floor ICU.
Visiting hours had ended at 8, but we shared the same last name and it was clear that we were related and an exception could be made: people in ICU often don’t have much time remaining. The night shift nurse told me the physician had gone off duty at 8, but he had heard I was flying to Baton Rouge from San Diego and the long flight and time zone change meant I’d arrive late, and he had waited to speak with me because people in ICU often don’t have much time remaining. She pointed me towards Wendy’s room and went to the physician’s office to let him know I had arrived.
I walked up to Wendy’s ICU glass door. Her lights were off, but I could see her lying on her bed with a respirator tube down her throat and several IV tubes in her arms. I saw my barely perceivable reflection in the glass door, standing next to her. I locked eyes with myself. I looked like shit. My eyes were puffy and narrowed by my effort to not cry. My lips were quivering, and my jaw was so clenched that my neck muscles bulged. I took a few deep breaths and watched myself exhale and then I focused on my breath until it was steady. I glanced at Uncle Bob’s watch and counted my breath and pulse in a fifteen second arc of the second hand and multiplied by four: 8 breaths and 54 beats per minute. I could see Wendy’s respirator and heart monitor: she was being forced to breath at five breaths per minute, and her heartbeat was coincidentally 54. I pushed the door open slowly.
The beeping of her machines and the familiar smell of hospital disinfectant and the cold air conditioning combined to overwhelm my senses, and I almost broke down and cried. I recalled my reflection and resolved to not have Wendy hear or sense me like I had looked, so I watched my breath as I approached her bed. Her hands were outside of her blankets, and I had been mistaken: the IV tubes connected to the backs of her hands, not her arms. Her inner arms were bruised from multiple IV’s that had been attempted or had failed in the hidden veins, probably exasperated by her low blood pressure; her heart monitor told me her blood pressure was 90/50, low enough to legally apply drastic measures if you were a paramedic responding to an emergency; or at least that had been the law when I worked as a paramedic for three years while at LSU, and that’s the type of random thoughts that were flying through my mind as I watched my breathing and tried to focus on being there fore Wendy.
“I’m here, Wendy,” I said as calmly as I could. I reached out and gently rested my big right hand on her tiny one, carefully avoiding the three IV needles stuck there, and rested my left hand by her head where, out of habit, I could see Uncle Bob’s watch.
“I’m here, Wendy,” I repeated now that I had touched her. “I’m here, and I won’t leave you.”
My actions were automatic at first. I confirmed her respiratory rate and pulse by watching a quarter arc of Uncle Bob’s second hand, and in doing so I sensed something deeper and more complex than any medical device or pulse rate can tell you, something I’ve done hundreds of times with people who were unconscious or on the verge of becoming so. I sensed. I felt. I knew Wendy would die soon, and there was nothing anyone could do about it.
My thoughts swarmed. She would have been 64 years old in a few more months. We would both have regrets that would never be resolved. I should have called more often: at that, I could no longer hold my facade, and I collapsed onto both knees with my right hand still on Wendy’s, and I bawled at the sky more loudly than I would have ever imagined me bawling and I cried so hard that my asthma kicked in and I gasped for breath and lowered my head and tried to bawl more but could not take in enough air to make any noise other than a wheezing from every attempt to inhale. She was almost 64. Uncle Bob had been 64. Granny 63. Auntie Lo 65. I would be the last of them, the only Rothdram or Desico left alive now that Wendy was about to die. I became angry.
“Why, Wendy, Why!” I demanded rhetorically.
“Why didn’t you tell me?” I asked sincerely.
“I would have visited… I could have helped,” I said pointlessly.
Of course I wouldn’t have gone galavanting off to Cuba if I had known, I thought rather than said. I was still wheezing, and without the overwhelming emotions forcing air into words I was unable to speak. That was good, I thought, because it meant I was regaining control, in a way.
I tried to stand up but my legs were weak. I used my left hand to grasp Wendy’s bedrail and help myself up. I grunted loudly, a sign that the physical pain was like emotional pain and overwhelmed my actions. I didn’t want her sensing how I felt. She had never forgiven herself for abandoning me as a baby, and she carried that regret over to my emancipation and service in Desert Shield and Storm; because of that, I never told her the other things that happened in my seven years of service, and I had tried to downplay my symptoms when I had visited.
In hindsight, I could have visited more, and at that thought I began crying quietly. Tears dripped down my cheeks and landed on her blanket.
Her door opened and her physician stepped in to meet me and discuss our choices. I wiped my eyes and focused on him, mostly. I knew what he’d say and my mind raced around the room and my thoughts came without effort.
He was a young doctor of dark complexion, what would have been unheard of and remarkable when I left Louisiana decades before and is probably a deep seeded bias, an old habit that my thoughts notice on their own. He was professional but emotionally detached. He focused on facts and choices, probably from years of experience in ICU and dealing with emotional people who, legally, had to make a choice.
He summarized her liver failure, and said that she had chosen to not go to rehab or see a psychologist about her depression, and had kept drinking even when on the liver transplant list. If, by some miracle, a donor liver that matched her became available, she would probably continue to drink and that liver would fail, too. She had gone to the hospital for a simple hernia, but the hospital wouldn’t operate because her failed liver couldn’t process the anathema. She had, coincidentally, passed out at the hospital and entered a coma; he did not claim that was a lucky coincidence. The IV tubes dripped pain killers and nutrients and a few other things that I didn’t hear – I have a 15% hearing loss at different frequencies in each ear – but I didn’t ask him to repeat himself. He said that her respirator was keeping her alive, and that if it were removed she would probably pass away either immediately or within a few days. If it stayed connected, she could live weeks or months or indefinitely. As her only heir, I was able to decide whether or not to remove her respirator.
As he spoke, my thoughts laughed at me and the coincidences in Wendy’s room. Her respirator was a 2018 Philips Respironics machine with the eSys – exhalation system – added on at an extra cost of approximately $8,000. With the software options, her machine had cost somewhere between $36,000 and $54,000, depending on contract negotiations with the hospital system. Most people I knew felt the eSys was a useless and costly addition, a system meant to monitor exhaled breath oxygen levels. Wendy had been inhaling oxygenated air that was slightly higher than the 21% in the hospital room and exhaling approximately 16% O2; to the best of my knowledge, no one would use that information to improve her situation. I didn’t tell the doctor, but I had coincidentally led the team that finished the eSYS design and transferred it to manufacturing at the Respironics plant in San Diego. Similarly, Wendy’s IV tubes were connected to an IV pump that I had had a hand in almost a decade before, a Carefusion branded pump after Carefusion bought a San Diego company that could be traced back to some of America’s first IV pumps. Carefusion had just purchased the company and spent millions of dollars repackaging the old technology in their unique off-white color and bundled it with other products to sell to hospital systems at an ostensibly bargain value, like a bulk deal any consumer would be excited to see, especially with such bright, new, color coordinated packaging that spoke to quality assurance but belied the faults in the system; I had led on an improvement that was shuttered by Carefusion after their European version was recalled and several failures in the U.S. had led them to the business decision of keeping the older system and repackaging it with modern prices, but at a discount when purchased with the other off-white devices cluttering Wendy’s room. At the very least, I was happy to see that her IV bags had been made in Tijuana, just across the border from San Diego, at a plant where I had trained the management on FDA and EU-MDR quality assurance and continuous improvement methods. I knew the people who had signed Wendy’s bags only three weeks before, according to the labels I noticed as I listened to the doctor speak, and I had no doubt the IV bags were as good as anyone on Earth could have done in 2019.
He finished speaking, and said he’d be back at 8am to hear what I decided: we would either remove the Philips Respironics respirator and let nature take its course, or keep hoping for a miracle. Those were my words, not his. I can’t recall how he phrased the second choice, but I do recall that he said it as kindly as possible and without trying to influence me. He never even mentioned the cost or that Wendy had ensured she had the most generous healthcare program money could buy. But I knew that, ironically, it was in the hospital’s best interest to keep Wendy hooked up to the machines and be paid. Coincidentally, I had just read a NIH funded study of 51,009 patients in 253 diversely located hospitals across the United States. The statistics were clear: “Mechanically ventilated patients were older (63.5 yrs vs. 61.7 yrs, p < .0001) and more likely to be male (56.1% vs. 51.8%, p < 0.0001), compared with patients who were not mechanically ventilated, and required mechanical ventilation for a mean duration of 5.6 days +/- 9.6. Mean intensive care unit cost and length of stay were 31,574 +/- 42,570 dollars and 14.4 days +/- 15.8 for patients requiring mechanical ventilation and 12,931 +/- 20,569 dollars and 8.5 days +/- 10.5 for those not requiring mechanical ventilation. Daily costs were greatest on intensive care unit day 1 (mechanical ventilation, 10,794 dollars; no mechanical ventilation, 6,667 dollars), decreased on day 2 (mechanical ventilation:, 4,796 dollars; no mechanical ventilation, 3,496 dollars), and became stable after day 3 (mechanical ventilation, 3,968 dollars; no mechanical ventilation, 3,184 dollars). Adjusting for patient and hospital characteristics, the mean incremental cost of mechanical ventilation in intensive care unit patients was 1,522 dollars per day (p < .001).” Another report summarized it more concisely: “Between 2000 and 2010, annual CCM (Critical Care Management -JP) costs increased 92%, from $56.6 billion to $108 billion. The 2010 costs represent 13.2% of hospital costs, 4.1% of national health expenditures, and 0.72% of gross domestic product. Intensive care unit (ICU) costs per day in 2010 were estimated to be $4300 per day, a 61% increase since the 2000 cost per day of $2669. In short, my thoughts laughed at me and told me the incremental cost of keeping Wendy on a respirator was approximately $1,522 per day. Without it, she would die, and I had had a hand in designing the one attached to her at that moment. My mind was grasping at coincidences and ironies and trying to make sense of the world and the fact that at 8am I’d decide whether or not to allow my mother to die a natural death.
All of those thoughts are what allowed me to ostensibly keep listening to the doctor. He left for the evening, and as soon as Wendy’s door drifted shut I collapsed again and bawled and bawled and bawled.
“Fuck!” I shouted “Why, Wendy? Why?”
Her IV pump began beeping an alarm. It was behind me, out of sight, and I pulled myself up by Wendy’ bedrail and turned to look at it just as an ICU nurse rushed in. She glanced at the display screen and then at Wendy, checked the lines for air bubbles that could enter Wendy’s blood stream and cause an embolism – IV pumps are risky – and, satisfied it was a false positive, reset the alarm.
We chatted for a bit. She was a young nurse, just out of LSU’s nursing program, and chose the ICU because she was a night owl who enjoyed helping people.
“Miss Wendy’s so young and pretty,” she said, carefully moving a loose lock of Wendy’s hair off of her face. When I first saw Wendy through her glass door, I had noticed that her hair was surprising neat and braided in a way I had never seen before. It was one of the many things my mind noticed but had not put into words. Now, watching the young nurse care for Wendy, I surmised that she had braided Wendy’s hair. I asked, and was correct. I assumed that the nurse felt that feelings were deeper than words, and that small things like nice hair would mean more to Miss Wendy than lengthy descriptions about her chances for survival that the doctor had somewhat callously and probably ignorantly discussed in front of my mom. I liked the nurse, and we chatted and she said that of course I could stay the night. She left and returned with a cup of “nurses coffee,” made extra strong for the sparsely staffed night shift. I was the only person staying there who wasn’t a nurse or patient, and I silently acknowledged the nurse’s risk and compassion. I thanked her for the coffee, and she rebranded Wendy’s hair and gently patted her arm and repeated, “She’s so pretty. Miss Wendy, I can see where your son gets his good looks!” She patted Wendy’s arm again without looking up at me. She was smiling at Wendy; whether Wendy could see it or not was irrelevant, she was sending positive feelings towards my mother. She told me Miss Wendy had been so sweet the past few times she had been there, and at that I learned that Wendy must have been in ICU and woken up at least once or twice before. I chewed on that as I sipped coffee and chatted with the nurse. After a few minutes she said she had to check on other patients, but was on shift until 9am – many medical shifts overlap to prevent too much confusion at one time – and would be back in a few more times throughout the night.
The steaming hot coffee in the cold room and the unsubtle taste of styrofoam from the cup kept me focused on being there for Wendy. I told her that the nurse must know what she was talking about, because she thought I was good looking. I took off my LSU baseball cap and rubbed my balding head and said that the nurse hadn’t noticed my hair or the massive scar on my scalp. I brushed my thinned hair and joked that it was just like Uncle Bob had said, “Hair today, gone tomorrow!” I was trying to do what the nurse had seemingly done without effort, project feelings towards Wendy, and the thought of Uncle Bob making that joke as he rubbed his balding, grey hair had, for a brief moment, allowed me to speak from a place of good feelings. Unable to maintain that feeling and not wanting to speak freely, I sipped the coffee and paced around the room.
The IV pump false positive was one of the things I had tried to solve for Carefusion. It’s difficult, because one false negative would likely kill a patient and bring so many lawsuits upon everyone involved that no one would take that risk. The down side was a feature that demanded attention from caregivers and added to healthcare costs and frustrations in ways that researchers were unsure how to calculate. By FDA law, any software change, no matter how minuscule, required revalidating the entire system, often at a staggering cost, and many companies either chose to not make changes or to ignore the law. By 2017, 75% of recalls for medical devices with software were because of no revalidating the system, not just the software, and Carefusion had tried to modify the physical hardware and sensors and software but could not reduce the false positives. Instead, they had taken the redesigns and sold them to European countries not yet influenced by the new EU-MDR that wasn’t supposed to take effect until late 2019, which would have prevented the sale and prevented the failures and recalls in Croatia. But, the vice president who had authorized the launch after I left received a $125,000 bonus for meeting deadlines and had gone on to another company before the results would show that may have not been the best thing for society or Carefusion’s bottom line.
I sighed noticeably, old feelings of frustration frothing up and affecting my body. I could feel my muscles tightening along with the tension in my mind. Determined to focus on Wendy, I turned towards her and released that tension in a another bout of bawling, barely holding my coffee cup without spilling it and bawling so long that the dregs went as cold as the late night hospital room, even in the styrofoam cup. When I finally grasped the bedrail and glanced at my watch, I saw it was only 11:21 pm. I had almost nine hours left.
The IV pump alarm sounded and I automatically and simultaneously saw Wendy, her IV lines, and the pump’s computer display. I reset the alarm and rested my right hand back on Wendy’s and put my left hand by her head. The nurse was right: she was young and pretty. She was only 16 years older than I was, and at our age that meant less each day, and I could recognize what was pretty in my 63 year old mother who had had a long, rough life by almost anyone’s standards.
I should have visited her more often.
I spoke with Wendy the best I could the rest of the night and drank several refills of nurses coffee, which seemed to wake me up a bit and send me into bouts of bawling every time; though that may have been the emphasized loneliness of a late night room after the nurse left with her brief reposes of another soul in the room who knew my mom as a person, not just a patient, and filled the air with kind words that were noticeably absent as soon as she continued her rounds and Wendy’s door drifted shut.
The rest of the night I tried my best to focus on positive thoughts, but I may not have succeed. I could not stop feeling that I was killing my mother, that my choice to remove her from life support was the same as choosing for her to die. Intellectually, I knew better, but emotionally I was conflicted by conditioned beliefs that we should keep fighting to the end, even if research studies showed that fighting too long may cause unfathonable suffering in patients.
I had recently read follow-up studies on CPR showing that only 3-5% of patients receiving CPR live. In my experience, that was accurate. I had worked as an EMT on an ambulance service in rural Louisiana, near Wendy’s home, while in college from 1994 to 1996 and had performed CPR on three patients on the 30 minute drive to the nearest emergency room: an elderly man in cardiact arrest after straining for a bowel movement on the toliet, an elderly woman in cardiac arrest on her bed for no discernable reason, and a six to eight month old baby girl after her parents drank too much and her mother rolled over her in their sleep and she suffocated when they were too drunk to notice. All had died. Before that, I had been a medic of sorts in what most people call special operations, and a soldier in the first Gulf War, and I had seen about a dozen people die after other people tried to save them with CPR. The report suggested that CPR maintained some brain activity, and put into perspective that dying people’s final moments, which we’d hope were peaceful, were often full of terror of someone pounding on their chest, often cracking ribs in the process, and forcing air into their lungs. If only 3-5% survive, that means 95-97% died with thier final moments being full of terror. After reading the report, I pondered my actions and the actions of my colleagues, all of which had been altruistic, and knew that in many instances patients were already dead. As a medic or EMT, laws required us to perform CPR unless a body was obviously dead, like with a severed head or rigamortis, and we often performed CPR on a corpse to prevent being sued by families. In those instances, I and my colleages felt that it was a corpse, that there was no life left. In other instances, like two of my patients, the old woman and the baby, we felt there was life and fought with all of our heart and muscle and mind to save them; we always felt the life extinguish, and somehow sensed the difference, even though the EKG may show the same assisted heartbeat and breaths because of our effort. After reading the report, I wondered if they suffered because of CPR, and by default because of me, fighting to die peacefully but kept trapped in their bodies as someone pounded on their chest and forced air into their lungs with the force of a pit fighter.
My career had been shaped by a desire to help people by inventing, designing, and overseeing medical devices. That night, I realized that it’s possible I had simply extended the suffering I had caused wtih CPR to hundreds of thousands of people, including my mother, who are kept alive by machines that breath for them. I had no idea if Wendy’s spirit or subconscious was suffering, or if she could be aware of her suffering, or if she knew I was somehow involved. All I knew is that in a few hours I’d choose between two options, killing my mother by removing her respirator and allowing her to die naturally, or allowing her to continue suffering without any rational hope of her waking up and hearing me tell her I loved her and us having a happy ending like some movie or advertisement from a medical device company. Until that night with my mother, I had never considered the implications of my work, or the finer details of a design that may not have accounted for a conscious mind inside of an unresponsive body, because I’m human and empathy for unknown situations is rare if not impossilbe without the right effort and thoughts that override what we have experienced with information of what other people experience. I was a college faculty of user-centered design, trying to get engineering students to empathize in ambigious situations, and yet I was still learning. I was on national healthcare standards committees, trying to make medical devices more user friendly, yet I had never considered a devcie from an unresponsive patient’s persepctive. I had a lot to learn, even at my age, and I was learning by standing by my mother’s side as she breathed becasue of a device of mine, and that was more potent than all of the statistics and case studies I coudl read the rest of my life.
I was too tired to choose my words carefully, or even to make a choice using intellect. Without effort, I only spoke of what I knew to be true and avoided any theories, especially anythign associated with religions or philosophies on what happens when we die. By then, I had seen so many deaths and fought to save so many lives and held the hands of people taking thier final breaths that what I believed to be true was that no words helped, but feelings did. I had seen thousands disembowled and burnt bodies litering the highway to Khamisiya in the first Gulf war when we followed the air assault in the first few days and dozens more in battles as we took the airport, a village of hundreds of Kurdish elderly, women, and children killed in front of us by Iraqis seeking retribution against our allies after the war ended and we were told to not fire upon them, 26 men in the Middle East on our peacekeeping mission, and many of men, women, and children who were beyond CPR after car accidents, usually after drunk driving, in rural Louisiana. I had dripped blood and sweat onto many people as I tried to save their lives, usually by stopping bleeding on a breathing person, bandaging and connecting IV lines to replinish blood volume, not unlike the IV drips attached to Wendy. And I had been there with Uncle Bob, the first human death I witnessed, and had held his hand and listened to his Rolex wind down as he took his final few breaths. Though I have no evidence to support what I believe, I believe that I felt every life that left a body, even when I continued fighting.
I also spoke with many people after they survived and listened to the final words of many people who did not. I eventually grew to believe that, like Uncle Bob, most people had doubts when they realized death was inevitable. Those doubts came from many places, but all were rooted in the difference between believing and knowing, hearing and understanding. Most people I had witnessed die clutched a wide range of books in their hands or minds, or replayed words told to them or overheard in film and radio, and wondered what was true. Every opinion or philosohpy overheard or pondered resurfaced as doubt, except for a few who had pondered with an open mind or had somehow come to peace with their version of the truth, and those people never needed words from me or anyone else. For all others, practicing the right to remain silent was the kindest thing I had learned to do, and to focus my effort on sensing the moment rather than aliviating anxiety with words. It was for Wendy’s sake that I witheld anything I may have believed up until that point. Besides, the one issue I had never resolved in myself was an often quoted but never explained commandment, to honor thy mother and father, and I had never learned to do that and felt guilty holding my dying mother’s hand and wouldn’t pontificate what I didn’t know to be true, and at that moment all I knew to be true was the first Nobel Truth according to the Buddha: life is suffering. Wendy had had a rough life, and Mrs. Abrams had long ago taught me the power of forgiveness, but I had never learned how to honor my mother and I knew I could have visited more often; if Uncle Bob were there, he’d say that I was regretting the past and not focusing on the present, and I was trying my best to be there for my mother on what was probably her last night on Earth, because in the morning I knew what I’d do, and as Matthew said tomorrow’s worry’s will come on their own.
The doctor arrived at 8:34am and I authorized removing Wendy’s respirator. I never saw the young, kind nurse again; the shift changed, and shortly after 9am the new nurses began disconnecting Wendy’s respirator. It took longer than I wanted for them to extract the long corrugated tube from her throat; to this day, I can’t shake the sound of corrugated plastic being pulled from my mom’s body – that’s not something I ever considered during the redesign. She gasped for breath and breathed on her own a few times at about five breaths per minute, but without supplemental oxygen. I rested my hand on hers, still with the IV needles, and my tears covered her hand and pooled around the tape covering each needle Her heart rate monitor beeped in since with her pulse and spiked as her body went into shock, but I knew what was happened before the machine did. She gasped a few times, choked, and her heart stopped and the machine flatlined. I leaned over her and kept my right hand on hers and my left by her head. The doctor pronounced her time of death as 10:14am; I believe it was six minutes later. When I felt she was gone I stood upright and let my hands fall by my ides. I don’t know how to describe how I believed she had remained with us fir six more minutes, nor why I had believed that with other people when the machines said they were gone, but it’s what I felt and I had told Wendy I wouldn’t leave her and I didn’t until I felt she was gone. I had mindlessly repeated the word “love” until I could no longer speak through my wheezing, and then I mouthed the word as if something deep inside of me was fighting to get out and ensure Wendy knew how I felt, even if I had not visited as often as I could have.
I collected myself and sighed subtly and made a list of everything I’d do to prepare for Wendy’s memorial service. I had, per her wishes, asked the hospital to oversee her cremation. It would take at least a week, and that’s how long I’d stay in Louisiana.
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