Being Mortal: Medicine and What Matters in the End

Finally, on June 30, 2010, we arrived at the Cleveland Clinic. My mother, my sister, and I gave him a kiss in a preoperative holding room, adjusted his surgical cap, told him how much we loved him, and left him in the hands of Benzel and his team. The operation was supposed to last all day.

 

Just two hours into it, however, Benzel came out to the waiting area. He said my father had gone into an abnormal cardiac rhythm. His heart rate sped up to 150 beats a minute. His blood pressure dropped severely. The cardiac monitor showed signs of a potential heart attack, and they halted the operation. With medications, they got him back into a normal rhythm. A cardiologist said his heart rate slowed enough to avoid a full-blown heart attack, but he wasn’t sure what had caused the abnormal rhythm. They expected the medications they’d started to prevent its coming back, but there was uncertainty. The operation was not beyond the point of no return. So Benzel had come out to ask us if he should stop or proceed.

 

I realized then that my father had already told us what to do, just as Susan Block’s father had. My dad was more afraid of becoming quadriplegic than of dying. I therefore asked Benzel which posed the greater risk of his becoming quadriplegic in the next couple months: stopping or proceeding? Stopping, he said. We told him to proceed.

 

He returned seven long hours later. He said my father’s heart had remained stable. After the early trouble, all had gone as well as could be hoped. Benzel had been able to perform the decompression procedure successfully and remove a small amount of the tumor, though not more. The back of my father’s spine was now open from the top to the bottom of his neck, giving the tumor more room to expand. We’d have to see how he woke up, however, to know if any significant damage had been done.

 

We sat with my father in the ICU. He was unconscious, on a ventilator. An ultrasound of his heart showed no damage—a huge relief. The team therefore lightened up on his sedatives and let him slowly come to. He woke up groggy but able to follow commands. The resident asked him to squeeze the resident’s hands as tightly as he could, to push against him with his feet, to lift his legs off the bed. There was no major loss of motor function, the resident said. When my father heard this, he began gesturing clumsily for our attention. With the breathing tube in his mouth, we couldn’t make out what he was saying. He tried to spell what he wanted to say in the air with his finger. L-I-S…? T-A-P…? Was he in pain? Was he having trouble? My sister went through the alphabet and asked him to lift his finger when she got to the right letter. In this way, she deciphered his message. His message was “HAPPY.”

 

A day later he was out of the ICU. Two days after that, he left the hospital for three weeks in a Cleveland rehabilitation facility. He returned home on a hot summer day, feeling strong as ever. He could walk. He had little neck pain at all. He thought trading his old pain for a stiff, unbending neck and a month enduring the hardships of recovery had been a more than acceptable deal. By every measure he’d made the right choices at each step along the way—to put off immediate surgery, to wait even after he’d had to leave his surgical career, to go ahead with the risks only after almost four years, when trouble walking threatened to take away the capabilities he was living for. Soon, he felt, he’d even be able to drive again.

 

He’d made all the right choices.

 

*

 

THE CHOICES DON’T stop, however. Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.

 

The results of the tumor biopsy showed my father had an astrocytoma, a relatively slow-growing cancer. After he’d recovered, Benzel referred him to see a radiation oncologist and a neuro-oncologist about the findings. They recommended that he undergo radiation and chemotherapy. This type of tumor cannot be cured, but it can be treated, they said. Treatment could preserve his abilities, perhaps for years, and might even restore some of them. My father was hesitant. He had just recovered and gotten back to his service projects. He was making plans to travel again. He was clear about his priorities, and he was concerned about sacrificing them for yet more treatment. But the specialists pushed him. He had so much to gain from the therapy, they argued, and newer radiation techniques would make the side effects fairly minimal. I pushed him, too. It seemed almost all upside, I said. The primary downside seemed only to be that we had no radiation facility near home capable of providing the treatment. He and my mother would have to move to Cleveland and put their lives on hold for the six weeks of daily radiation treatments. But that was all, I said. He could manage that.

 

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