“Fuckin’ Partin, I should have killed him that night when I had the chance.”Chucky O’Brien, Hoffa’s adopted son, told to Chucky’s adopted son, Harvard law professor Jack Goldflake, in “In Hoffa’s Shadow.”
Over the decades, Wendy and I became close friends with a shared history that so few people knew it endeared us together. And without needing anything from her, I was less critical of her nervous breakdowns. But, like with many of our high school friends we lose touch as time passes, especially when living on the other side of the country and traveling abroad a few months a year. Each year we called each other less frequently, and each decade I visted less often. All of that was on my mind when my airplane touched down in the Baton Rouge airport on April 3rd, 2019.
But Baton Rouge had grown, and instead of a cab I took a rideshare to Wendy’s room in one of the new hospitals built along I-10. The driver began asking cheerful phatic questions until she noticed where I was headed, and then she let me ride in silence. I sat in the back, sniffling because I had been crying, but also because of the springtime pollen floating in the air and activating my allergies and irritating my sinusitus; that part hadn’t changed, and was partially why I didn’t return home as often as I could have. We arrived at Wendy’s hospital and parted ways without speaking. I was trying to focus on what I’d say and how I’d try to relax my aching body – sitting on long airplane rides always hurt – and I realized I accidentally left my yoga mat in the rideshare.
I wiped my nose with a white handkerchief I usually carried on flights and asked the lady at the front desk if the hospital had a yoga mat.
“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 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.” I would have smiled at the
Not mediation, I thought with an uncharacteristically arcid feeling. I was tired. I needed to relax before seeing Wendy. I asked if they had a chapel.
“Over d’er,” she said, pointing her New Orleans Saints fingernails towards a small door near the vending machines.
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’m slightly claustiphobic, and I couldn’t relax in the cramped room, so I moved a few more chairs and paced back and forth and concentrated on not limping. I hoped the focus would slow my breath and calm my pulse and help me be prepared for seeing Wendy. But, the small room and my growing sense of urgency overode my concentration and I was becoming more aggitated, anxious to go upstairs and see Wendy even if I weren’t ready. I was about to leave when I noticed an open bible on the far side of the pulpit. It was obviously a bible, the type with a soft and flexible leather cover and a purple ribbon attached to the binding to use as a bookmark. Out of an old habit, I glanced at every open book or piece of paper I saw, and I saw that the bible was a New Testament with relatively large font and was open to the book of Matthew.
I was not closed minded to a sign from any thing and in any way, and I stood behind the pulpit and concentrated on my posture – my neck and back have a slight curvature from old injuries – and picked up the bible and read what had been left open. I was surprised by the last sentence on the page, because I didn’t recognize it. During the war, I only had a small, pocket-sized copy of the New Testament NIV given to me by.Mrs. Abrams, an elementary school math teacher who had taken me in with her family after I was emancipated and had driven me to the New Orleans outprocessing station before I left for the army. I had read it diligently, just like I had read different versions in the Abrams’s library, and by 199 I’d be cited as an expert of world religions and sent to the Middle East with a diplomatic passport, and I was currently teaching engineering courses at the University of San Diego, the only Catholic university in America not under diocsese oversight and focusing on multi-disciplinary outreach, so I was surprised that I didn’t recognize the last sentence in Matthew, the book in the New Testament I had cited most often over thirty years, matching its verses with Luke and John and showing simularities between what they said and what was said in the Koran and Pali Cannon. I flipped to the front and looked at the version and it was a NIV, and I flipped through a few pages and recognized everything except Matthew 6:34, which had been left behind the pulpit as if waiting for me to find it.
“Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.” Matt 6:34
It was similar to what The Buddha had taught and what was inscribed across the Tibetan University, where I had just been on sabattical the year before: “Don’t worry about the future or dwell on the past; focus your mind on the present.”
I stood there pondering signs for a few moments until I sensed Uncle Bob’s Rolex ticking and noticed that my breath had calmed and my pulse had slowed. I was breathing mostly normally, albeit still sniffing a bit from allergies, and my pulse was at 54 beats per minute. I smiled a genuine smile at the irony of having calmed down by being distracted searching for a clue, and I was ready as I could be to see Wendy. I replaced the bible as I had found it and concentrated on walking without a limp to the elevator that led to the 3rd floor ICU and Wendy.
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. 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, 26 men in the Middle East on our peacekeeping mission, and hundreds of men, women, and children in my years as an EMT during college. I had dripped blood and sweat onto many people as I tried to save their lives, and I had lived with countless failures and performed CPR on corpses because, by law, an EMT cannot pronounce someone dead as long as their’s still hope. 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. I eventually learned 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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