The Cat’s in the Cradle

My son (who is no longer on Facebook and thus can’t be embarrassed by this anecdote) is not overly-affectionate. As a child, he was a hugger, but by adolescence, a side-armed squeeze of the shoulder was the most I could expect as the Christmas party or hospital visit wound down.

I make this observation not as a criticism, but rather as an acknowledgement that people process emotion differently. Did I miss the little boy who would climb into my lap and wrap his arms around my neck, holding me in his embrace until my heart had re-filled with love? Yes, of course. But I wouldn’t trade him for the insatiably curious, determined, good-hearted young man he has grown into.

That said, about six months ago, after my last serious hospitalization, his hugs began gripping tighter and lasting longer.
Today he came to see me for his final visit before returning to college.

We’re both determined to see one another when he returns for Christmas break at the end of this year–but planned this visit ‘just-in-case.’

He sat down next to me on the bed and wrapped his arm somewhat uneasily around my shoulder. I was so stunned by the unusual gesture that I didn’t know what to do. For a moment, two decades dropped away, and I was certain that–were I to turn and look at him–I would see the churubic face he wore as a toddler instead of the guarded but angularly handsome face that is his now.

His arm on my shoulder made me feel so warm and complete and full of love and I’d just begun to move my hand upward to grasp his when, overcome with the weirdness of it all, he withdrew his arm as I stared at my shoes, too stunned by unfamiliarity to react in a meaningful way.

We talked for a couple hours afterward. It was a good visit. He’s a good man and a good person.

But the whole time I couldn’t help but wonder what it might have been like had I managed to reach up and clasp his hand in time.

You have to act in the moments. They’re all we have.

Never Break the Chain

“Listen to the wind blow, down comes the night
Running in the shadows, damn your love, damn your lies
Break the silence, damn the dark, damn the light

And if you don’t love me now
You will never love me again
I can still hear you saying
You would never break the chain.”

-Fleetwood Mac

So, I was interviewed by hospice yesterday. Two lovely nurses came by and asked questions for about an hour. It was at the behest of my palliative care doctor, with whom I had a video appointment last week. When she had suggested that I be evaluated by hospice, I decided to humor her.

Hospice means you’re imminent–or, if not that, certainly not far from it. If it doesn’t imply a timetable (which, even though hospice people are quick to tell you that it doesn’t, the admittance criteria sort-of suggests that it does) it certainly carries a sort of psychological weight.

“You’re not getting out of this…” it says.

And I’m not. I know that. I am chained to this fate.

But, when your endless-numbered-days bleed from one into the other, and your hours stack indistinguishably upon one another in a macabre, terminal Jenga game, day after day, it’s easy to delude yourself that it will all simply continue, stretched out into a bleak, bland future where you continue to exist, somehow. Your logic and science and medical tests pale in comparison to the undeniable fact that you’re still here, decades after they’d said you’d be dead. It feels as though things can just continue as they are, as they have been.

In short, it’s easy to lie to yourself.

Then, two very lovely nurses come along and brighten your morning with their cheery dispositions and helpful manners and remind you that they’re here to help you die the best way you can, because it is fast-approaching.

And you answer their questions and play along, certain that this is all just a bureaucratic formality–something rushed into being a bit too soon, but which would be rude to interrupt or oppose. You tell yourself that it is insignificant because it will never be approved by The Director, so it is all just a bit of play-acting that we are all going through. Harmless, really. Hospice is for people who are about to die soon. You, obviously, are not about to die soon. Not soon enough to require hospice, anyway. It will never be approved.

As they pack to leave, you exchange parting pleasantries.

“Sorry to have wasted your time.” You say.

The nurses exchange a quick, knowing expression.

“Why would it be a waste of time?” One asks.

“Well, I doubt I meet the criteria.” You’d said.

“Oh, you certainly meet the criteria.” Says the RN in charge. “We’ll take the paperwork back for The Director to look over, but expect to be approved in the next few hours.”

They call you back a few hours after they have left. Your nurse will be there to admit you into the hospice program as soon as is convenient. Will tomorrow be OK?

No. That’s too soon, but you can’t think of a reason why. It’s just too soon.

Tuesday?

Oh no. The home health aid who fetches your meals and washes your clothes and runs your errands and helps you shower and takes out your trash, she comes on Tuesday. You can’t start dying on Tuesday. Too much to do.

Wednesday morning?

Your mornings are usually busy. You nap and dream and pretend you haven’t spent the last seven months in the same room. That won’t work.

When can you start dying? Wednesday afternoon? We need to get started. There are forms and paperwork and examinations. There is an opening Wednesday at 1pm. Can you start then?

You assent.

They put it on the schedule. It becomes real and tangible.

Wednesday at 1. The beginning of the end. You make a note on your calendar. For no discernible reason, the Fleetwood Mac song “The Chain” keeps playing in your mind, over and over.

Never break (the) never break (the) never break the chain…”

Passover

I won’t post pictures, because I’m firm in my belief that most adult males –especially those whose feet have spent many years in combat boots– have no business exposing their toes to polite society, but trust me when I tell you that my feet are grotesquely swolen.

My left foot is much worse than my right –a dead giveaway of the pulmonary hypertension and the heart failure that goes along with my disease. For years, as soon as doctors or nurses would hear of my emphysema, they would immediately start poking around my feet. I always felt so lucky, so gratified, to be able to respond that I didn’t have any swelling.

I also didn’t have much congestion. I would read horror stories about end-stage emphysema patients who battled constant congestion and obstruction, fighting for every breath –drinking pineapple juice for hours a day in a vain attempt at relief.

The thing was, in most of those stories, their lung function was better than mine.

In emphysema patients, the number you’re most concerned with is the Forced Expiratory Volume, or FEV1. It’s a measurement of how much air you can clear from your lungs in a given amount of seconds. Contrary to popular belief, emphysema isn’t about not being able to get oxygen in, rather it’s about not being able to breathe air out and clear the CO2 that builds up. Your lungs are like a balloon that you can’t empty, and thus can’t fill with new, oxygenated air.

Your ability to clear your lungs is measured as an expected value, based on what the average healthy person of your age would be able to do.

For the last 10 years, my FEV1 has never been higher than 23%. I am currently around 14%. You can basically think of that as my lungs function at 14% of what they should, for my age.

But most patients –and doctors– shorten all of that until the FEV1 simply means “lung function”, regardless of age, so that people just compare their raw FEV1 number as if it were a hard metric of what you could expect

For years I would measure myself against others who had my disease based solely on FEV1. I was at 23%. Someone else was at 30%, but dealing with never-ending congestion and hypertension. I dealt with neither. I concluded that, like the Israelites in Egypt, I had somehow been passed over. I heard horror stories about what this disease was from people whose FEV1 numbers were far better than my own, and falsely concluded that I had been spared.

What I failed to take into account was age.

Most emphysema sufferers are elderly. The FEV is adjusted for age. Their 30% was not at all applicable to my 23%. Most 40-year-olds do not have emphysema. I was a statistical outlier.

I thought I had skipped out on the hypertension and the congestion and the burning, ripping pain of it all. But I hadn’t. It just hadn’t happened yet.

And now it has.

My left foot is so much bigger than my right. Every time I inhale it sounds like drawing chalk across a slate. When I cough I sound like a seal barking. I had deluded myself that I was immune to it all, but in the last six months, every month brings a new, cruel reminder that –not only will I not beat this– but that I am fast running out of time.

So I hope I get some stories written down before I go. I hope there is something meaningful left behind. I hope that, when it all comes to a head, and then passes like a summer storm, that there will be something left of me that was worthwhile.

I hope I will have left something that justifies all this suffering; some potentially profound beauty that outweighs all this tragedy.

But even if there isn’t–even if I leave nothing of substance, and am never remembered beyond the memorial service– I hope that those of you who have known me have been touched enough by my existence that you have found some happy interaction, or token, or memory, that is precious enough that you will have judged my life worthwhile.

And if not, at least let it be said that I never wore sandals in public.