Why We Need Health Care Reform

Haven't blogged in a loong time. I have adopted an Ethiopian family that hit some hard times. Here's the latest challenge. Names have been redacted in the following letter:

June 26, 2012

David C____ MD

Seattle WA

Dear Dr. C_____:

I am writing about a long overdue bill of $1524.00 owed by M___ G____ to you. I am a friend of the family. In late 2008, early 2009 you were part of a large team that helped save M___’s life after a severe stroke. M___ was seriously ill, and with a lot of hard work, he survived. You absolutely deserve payment for your services. Like any doctor, I know you work long hours, nights, and weekends to help rehabilitate many lives.

I just learned about this unpaid bill from M___’s former wife, A___ T___. A___ held vigil for M___ while he lay in a coma and took care of him during his rehabilitation, as any spouse should. In May 2010, M___ delivered divorce papers to A___ and ordered her to sign them. He then left the country, returning to his home country of Ethiopia. M___ abandoned A___ with 3 children (F____ age 2, B____ age 10 and K____ age 12), a car she couldn’t afford, and a severe risk of becoming homeless.

On Monday June 25, this week, A___ informed me that a collection agency, P______ Credit Bureau, represented by attorney J___ W____, had won a court order garnishing 25% of A___’s wages at the adult family home, P___, where she works, in order to pay your bill plus interest, court costs and legal fees. The total amount she owes is now much larger, $2,743.58, given court costs, interest, and lawyers’ fees. It also includes an amount of $217.50 to Dr. D____ Y____. A___ is paid near minimum wage, and recently had her hours cut back to 2 days a week because P___ does not have a full complement of residents. The monthly payment of $282.43 will be a serious hardship. Since it’s 25% of her total pay, she gets approximately $1,000 from this job to pay the monthly expenses for herself and her 3 kids. In short, I believe it will place the family in grave danger of homelessness

A___ and M___ took care of my Dad, who suffered from Alzheimer’s disease, at the P___ Adult Family Home in Seattle. A___ is the sole source of support to her 3 children. A___ and M___ took care of my Dad until he died in July of 2008 at the age of 87. When M___ abandoned A___ and her 3 children, A___ contacted me to see if I could help. I stepped in and was able to provide some help to get their finances stabilized. I am just a simple software developer who works for a tech startup, but given the care my Dad had been given, I had to help.

At the time that I learned that M___ had abandoned the family, I also learned that there are witnesses to M___ having physically abused A___.

Apparently because A___ and M___ were married at the time of his illness, the debt is considered community property, so A___ and M___ are jointly responsible for the debt, and hence the court order.

M___ returned to Seattle within the past year. Due to his stroke, he is officially disabled, and therefore his Social Security disability payment is apparently protected from garnishment to pay this bill. The collection agency therefore turned to A___’s meager income. A___ does receive $450/month from M___’s social security, $150 per child, as the only child support she receives from M___.

A___ clearly should have addressed this issue far earlier; I certainly wish she had told me about it long before this week. In A___’s defense, she just did not understand the seriousness of the situation. A___ arrived in this country 15 years ago from Ethiopia in an arranged marriage with M___. She has less than a high school education, speaks English relatively poorly, and certainly does not have much of an understanding of American law. She incorrectly believed that the bill was solely M___’s responsibility, since they are divorced.

On behalf of A___, I want to apologize for all of this. A___ is trying, as best she can, to take care of her three children, and is clearly struggling to do so.

Nevertheless the law evidently says that she’s still responsible for the debts of her ex-husband who abused her and abandoned his children. To my mind, although this may be legal, it is not right.

So, as a friend of A___ and her children, I’m writing you to ask if there’s anything you can do to help. If you can, A___, her kids, and I would be most grateful. You would help a family truly in need. I know that you help families in need every day. This is another family that, sadly, also needs your help.

Sincerely yours,

Christopher V. Jones (Chris)

PS: Let me share a story that explains why I chose to help A___ and her kids. My Dad was staying up all night, which is common with Alzheimer’s patients. A___ stayed up with him many of these nights to make certain he didn’t fall. My Dad believed he owned a car, and would get up at night to try to drive this imaginary car. When I asked him where he wanted to go, he replied, “I want to play tennis with Ken Winetrout.” Ken Winetrout was a tennis buddy of my Dad’s who had passed away several years ago. This gave me an idea; geek that I am, I owned a Nintendo Wii. Maybe my Dad could play Wii tennis. I brought the Wii to P___, set it up, and hoped my Dad could play. It turns out he had lost the eye-hand coordination needed even to play Wii tennis, but I certainly tried my best. However, A___’s 10 year old daughter, B__, and I played tennis, which my Dad thoroughly enjoyed, believing it to be a real tennis match.

A few days later, when I next visited my Dad, he was absolutely beaming. He proudly said, “My brother was always the jock. He was captain of the football and baseball teams. I was never as good as him at baseball or football. But I was playing baseball!”

Although it was great to see my Dad so happy, I didn’t believe him. Instead, I humored him, believing that his playing baseball was as real as his imaginary car.  A few minutes later, K_, A___’s 12 year old son, bounded into the room. My Dad pointed to K_ and said, “I played baseball with the boy.” K__ had taught my Dad how to play Wii baseball. It turns out that my Dad could manage to pitch the ball in the game, and K__, at 12 years of age, had shown my Dad how. My Dad was absolutely thrilled. My Dad died one month later, but I will never forget the joy on his face because of K__. When the family hit hard times, I simply had to help.

Mavis

Date: September 5, 2009

__________________
Director

Willed Body Program

University of _______, School of Medicine
Department of Biological Structure

Dear Dr _______:

My father, Robert W. Jones, passed away on Saturday, July 5, 2008, at the University of _____ Medical Center after surgery for a broken hip. As horrible as that experience was, I am writing to you about a series of subsequent unfortunate events originating with your organization.

My Dad broke his hip two days before he died. At age 87, given that he was suffering from Alzheimer’s, my sister and I, his only surviving relatives, were painfully aware of the difficult prognosis. My sister and I were grateful to be able to be with him in the ICU when his respirator was slowly turned off. Although I thought I was prepared, of course, I was not. The staff in the ICU and throughout the hospital were truly awe-inspiring. In the ICU, the nurse played some gentle music, asked us about our father, and shared our tears. At one point, she gently asked, “Did your father express his wishes for after he passed?” We replied, “Yes, he arranged to donate his body to the University.” To which, the nurse replied, “How wonderful! We will take care of it.”

My father was very strong willed, with very definite opinions about end-of-life care. His living will, for example, which he wrote himself, stated in its last paragraph that he wanted his heirs to sue any medical practitioner that did not respect his wishes, though he “left that to our discretion.” One of his key reasons for donating his body was to minimize the pain of his children in disposing of his remains.

After he passed, my sister and I specifically stayed in the ICU waiting area expecting that we would have to sign some kind of paperwork. An ICU staff member came out and gently said, “there’s nothing more for you to do, you can go home.” Despite our profound grief, we were comforted by the fact that my father passed quickly, without much pain, and that his final wishes were respected.

On the morning of Tuesday, July 8, when I had dragged myself back to work, barely functional, I received an unexpected telephone call from Ms. Mavis ______ on your staff. Below is my unforgettable memory of that conversation.

“Hello, this is Chris Jones at ______”

“This is Mavis _______ from the Willed Body Program at the University of ______. Why am I just hearing about your father today??”

“The people in the ICU told me that they would take care of the transfer of the body to the Willed Body Program. Who was actually responsible for informing you?”

“To be frank, you!”

“Oh my goodness. I’m so sorry. That’s not what we were told by the hospital.”

“Well, we might not be able to take your father’s body after this length of time.”

“What do I do now?”

“You’ll have to make other arrangements. We can’t take him.”

I was already in shock from my father’s death. I was now even more in shock by the utter lack of sensitivity shown by Ms. ______.

I began making other funeral arrangements.

I also called the number I had been given by the ICU, in case I had any questions. The very kind person on the other end of the phone, a staff member in the pathology department, said that she would investigate and get back to me. About an hour later, I was amazed and surprised to receive a telephone call from Dr ________, associate director of the department of anatomic pathology at the University of ______ Medical Center. She apologized profusely, and informed me that the ICU staff had misinformed my sister and me. I thanked her, sincerely, for her apology. To make amends, she stated that the University would take care of my father’s body as he wished, though his body might not be usable for the medical school. In any case, the University would respect his wishes. She also stated that, just that day, she had mentioned my father’s case to the students in the class she was teaching, so that in future, the medical center staff would be better informed. I was so grateful. It allowed me to let go of the incredibly insensitive phone conversation I had experienced earlier that morning.

During the next month, I received a letter from Mavis asking where my father’s cremated remains should be sent. My sister and I were uncertain about what we wanted to do about my father’s ashes, so we delayed responding. About two weeks later, I received a second, more insistent letter. If we didn’t make a decision soon, the decision would be made for us: his ashes would be deposited in the common location reserved for donations to the University. My sister and I finally concluded that we wanted to receive the ashes, and chose a spot to scatter his ashes. So, I made arrangements with _______ Funeral Home, _______, Seattle, and submitted the required paperwork before the deadline. After that, I heard nothing, until today.

Today I received the attached letter from Mavis. According to the letter, my father’s cremated remains have been sent to a cemetery in Kalispell, Montana. Neither my father, his ancestors, nor his descendants have any ties to Montana. I completed the required paperwork by the deadline, even though that information was apparently not needed for over a year.

Why are my father’s remains now on their way to Montana?

Evidently Mavis is not only woefully insensitive; she is also incompetent.

What are you going to do to correct—systematically—this series of unfortunate events, so that no other family will have to experience what my sister and I have experienced?

Sincerely,

Christopher V. Jones

_________
Director

Willed Body Program

University of ________, School of Medicine
Department of Biological Structure

September 15, 2009

Dear Dr _______:

Following up on my letter to you of September 5, 2009, and our telephone calls on September 11, 2009, and my email on September 12, my sister never requested my father’s ashes be sent to any cemetery anywhere in Montana. During our first phone call on the 11^th, you stated that your employee, Mavis ______ had written a note in his file, dated August 28^th, stating that my sister had called making this request. You also stated that you have no written request from my sister (or from me) to send my father’s remains to Montana.

In speaking with Mr _____ from ______ Memorial Cemetery in Kalispell, MT, no one had ever contacted him to have my father’s ashes interred there. As I stated in my email on the 12^th, someone else is evidently responsible for my father’s ashes being sent to Montana.

As we discussed over the telephone, at your request, enclosed find a signed letter from my sister requesting that my father’s ashes be sent to _____ as well. Again, she had signed the paperwork in August 2008 to have the ashes transferred to ______ l in Seattle.

My sister’s letter reiterates the statement I made to you in my telephone call on the 11^th, and in the email I sent you on the 12^th. In particular, my sister never contacted anyone in your office about having my father’s remains sent to that cemetery in Montana.

Also, per your request, I now formally request, again, that my father’s ashes be sent to _________ Funeral Home, ________, Seattle, WA 98122. This is the same request made, in writing, in approximately August, 2008.

I am sure that my father’s remains will eventually get to ______ as my sister and I originally requested.

If there is any further information you need from me or from my sister, I am sure you will let my sister or me know.

My question from my letter of September 5^th, remains, however. What are you going to do to correct—systematically—this series of unfortunate events, so that no other family will have to experience what my sister and I have experienced?

Sincerely,

Christopher V. Jones

Postscript: As of this writing, Mavis is still employed at the Willed Body Program.

Skiing at Crystal

Since I got over my blood clots a couple years ago (no more blood thinners for me!), I have been doing a lot of skiing. I went skiing in Argentina in August at a great resort in Patagonia called Bariloche. It was with a NY gay ski group called Ski Bums. Lucky me, I got to sleep with the only straight man on the trip. The hotel room we ended up in only had one queen sized bed. He was cool with it. I was cool with it. No, for the dirty minded, nothing happened (aside from sleep).

Yesterday I got back from skiing at Crystal Mountain, about 2 hours south of Seattle. Below is a video of me at my most graceful (ummm....not that graceful).

I Just Wish You Wrote Better

Since I started this blog, I have received several compliments on my writing. Those compliments are more appreciated than you may realize.

When people find out I was a professor at Wharton for a time (untenured, assistant), they are usually impressed. When they find out I left Wharton voluntarily, they are usually surprised. When I explain why I left, they are usually appalled.

When I joined the faculty at Wharton, I knew that it would be challenging. I had never taught before. I was no longer in the insulated cocoon of graduate school. My research was unusual to say the least. It would take a long time to explain it, except to note that it applied graph-grammars (huh?) to the problem of formally specifying graphical user interfaces. I started at Wharton in 1985. The Macintosh was just a year old, and graphical user interfaces were in their infancy.

Not only was my research outside the mainstream, it required writing a ton of computer programs to demonstrate the concepts. Computer programming takes a long time, requires lots of resources, and for a while, I had no idea how to implement the ideas in my research. After a lot of effort (over 2 years of programming), I had built a prototype system, and had submitted the fundamental paper to a well-respected journal for possible publication.

Since it was taking so long to write the code so that I could write a paper, I had received worried yearly reviews from the more senior faculty. They had noted the small number of publications to date and the unusual nature of my work. I told them that I was working hard on the key part of my research, which I believed would pay off. I suggested, wait until you read the paper. 

I would have had a safer, simpler time in academia if I had simply pursued more traditional research. Naively, I clung to the ideal that academia would welcome the pursuit of novel, non-traditional ideas. 

One faculty member---let's call him "Rod"---would play a key role. When I was an undergrad at Cornell, he was a visiting professor, and I enjoyed his class. Rod and I both had the same PhD advisor, though he had earned his doctorate many years earlier. He was likely instrumental in my being offered a position at Wharton. He was a very colorful character, funny, articulate. 

Before I walked into the review, I had some very positive feedback under my belt. The editor of the journal to which I submitted the paper said that he felt the work was "seminal." Another academic, extremely well respected, former president of the professional society of my field, called the work "pioneering." I pointed all this out to my colleagues, but it didn't seem to matter.

Rod's comment on my paper? "Well, it reads like a great survey paper, but we can't see the contribution." In other words, the kiss of death.

I was frustrated and angry, since this paper represented my absolute best, and had received glowing reviews. I was younger then, I suppose, and stubbornly proud of the work, so I directly informed the committee that if they could not understand the work, given that others had, there was little I could do. Not the most effective strategy, in retrospect.

This pissed them off, of course, especially Rod. He pleaded, "Work with me. I'll help you get a grant from the National Science Foundation. I'll teach you how to write."

I had seen him "work" with others; although he is a wildly entertaining and effective teacher, as a faculty member, he was widely known as a jerk, horribly insecure, taking out his insecurities out on colleagues and graduate students often in ways that were publicly humiliating (e.g., "great survey paper"). When he "worked" with others, he also added his name to the papers as co-author. That was credit that I felt he didn't deserve.

Declining his offer of help, of course, just insulted him. Perhaps I was too proud, but I had evidence to support my position.

At the same time, unbeknownst to the rest of the review committee, but known to Rod, I was also dealing with the aftermath of Stewart's death from AIDS. Such personal struggles carried no weight at Wharton. Another untenured assistant professor was dying of cancer. After they denied her tenure, Rod came to me very pleased that at least they had decided to extend health benefits to her until she died. But they still had to deny her tenure. She died a few months later. How generous.

Six months later, I presented a shorter version of the "survey" paper at a well-recognized conference. The paper tied for best paper in its area, among over 70 papers presented in that area.

When I got back to Wharton from the conference, Rod stopped by my office.

"Congratulations. The faculty are going to think that's great."

"Thanks, Rod."

He was not quite done. "Of course it doesn't mean very much."

"I just wish you wrote better."

Huh? I just was awarded irrefutable outside evidence that I wrote very well, thank you, but Rod was not buying any of it.

Actually, I apologize. I took Rod's comments out of context. It turns out that Rod presented a paper at the same conference that I did. His paper was in a different area than mine, but, of course, Rod's paper didn't win. Moreover, papers are presented in sessions of two to three other papers. At that conference, the chair of each session is responsible for submitting a nomination of one of the papers in their session for the best paper award. Rod's paper was the paper nominated from the session he chaired.

Before I went to that conference, the much longer paper I submitted had been accepted for publication. Actually, I was asked to expand the paper into 2 parts, since they felt there was so much useful material. I was informed during the conference where I won best paper that my NSF grant was funded---the grant that I wrote all by myself.

Given the handwriting on the wall, however, I found another job. It was at Simon Fraser University in beautiful Vancouver, British Columbia. Not nearly as prestigious at Wharton---most people I knew had never heard of it---but I had always wanted to live in the Pacific northwest, I liked the faculty, and I knew I would succeed there. I eventually got tenure, was awarded a teaching award one year, and became an area editor of that excellent journal.

Before I decided to leave, I met with each of the members of my review committee for one last chance. They knew about the award-winning paper, the acceptance (and expansion) of the "survey" paper, the NSF grant, and the fact that I had an active job offer. Here is what they said:

Rod: "Don't buy a house."

Member 1: "The committee was pleased that after our negative feedback, you seemed to turn things around." I calmly replied, "I had completed and submitted all those positively received papers before the committee even met."

Member 2: I mentioned to him that I didn't believe the faculty paid much attention to Rod's opinions (I wanted to say, "since he is such a jerk," but didn't). This faculty member replied quite simply, "don't make that assumption."

Lots of enthusiasm there for having me stay.  Rather than wait around for the inevitable, I chose to leave, a year before the tenure decision was going to be made.

In retrospect, I realize first that I don't deal well with bullies like Rod. Although I have had a successful career as a professor (tenure at two universities, wrote a book, many publications), and a successful career as a software developer (now at Amazon), when a bully has power over me, I have to move on to another position.

Second, Rod was regularly put down by the rest of the faculty in the department. He seemed to transfer all that hurt onto others, including me. We were at a standoff, but he and his colleagues had the power.

Except that I could pick myself up and leave.

My low tolerance for bullies arises perhaps from being a geeky gay kid, like lots of other gay kids, I was picked on pretty often. not beaten up, humiliated, which is more like being beaten up mentally. When someone tries to bully me or others, therefore, I become enraged. Perhaps if I had accepted Rod's offer of help (I felt it would be sucking up), I would now be a respected member of the faculty of the Wharton School of the University of Pennsylvania. On the other hand, my dear, recently departed Dad, was a man of strong opinions, who stood up for principle, even at his own expense. I am proud to have taken my Dad's example to heart.

Two years later, I was back at the same conference where I had won the award. A new paper of mine was again nominated for best paper (I didn't win). 

Of course, I ran into Rod. He complained about the tone in my old department at Wharton, how the rest of the faculty did not respect his research. I guess it's not uncommon for people to project the pain they have endured onto others. I think he tried to patch up any bad feelings by saying, "you would not have been happy there." 

If he was trying to make some form of peace with me, I didn't realize it at the time. When he asked me how I liked my new institution, I had a response well prepared, one that I had practiced many times in my head. It was great to finally let it out. "Well, Rod, Simon Fraser University does not have the resources or reputation of the Wharton School, but at least when a paper of mine wins an award, nobody on the faculty congratulates me by saying, 'I just wish you wrote better.'"

About a year later, Steve, a good friend and colleague of mine in my old department at Wharton, told me there was a position open. I responded, "I have grave doubts as to whether I would ever want to return." He urged me to reconsider, as he would push strongly to bring me back. OK, I would keep an open mind.

I saw Steve soon thereafter at another conference. He was embarrassed.

"Chris, it doesn't look like we'll move forward with bringing you in for an interview." 

"No worries, Steve.  I think I'm probably more relieved than disappointed."

Then Steve added, "you can probably guess who killed your chances." 

"Ummm...yes I can. " 

Thinking back on all of this, however, I think I can appreciate at least some of Rod's hurt and anger. I felt hurt and angry too. Although he was a major cause of those painful feelings, I would hope that I would now be better able to rise above it. I don't know if I really could, but I'd like to think so.

In the end, I hope I was able to explain effectively why I left Wharton voluntarily. If I haven't, all I can say is, I just wish I wrote better.

Flaming Car Wreck

I was driving back from skiing at Stevens Pass with my lawyer and her son. Cold at zero degrees Fahrenheit. Came around a curve and saw the following flaming car wreck. No one was inside, but I could feel the heat through the car. The son took these videos with my Flip Mino HD pocket high definition video camera.

Viruses

In the early 80's, some of my blood was used to verify the accuracy of the HIV antibody test. No, I am negative. I was part of the control group. Before they even knew that HIV caused AIDS, researchers from New York City came to Cornell, where I was getting my Ph. D, to conduct a study on a group of gay men who did not live in a big city. We were the control group in a larger study that compared us to gay men from large cities. Cornell is located in Ithaca, NY, a 4 hour drive from New York City, in the middle of rural, upstate New York, an hour from the nearest interstate.

Every three months a team of doctors collected 13 test tubes of blood, plus samples of urine, saliva, stool, and, yes, semen. Two semen samples each time, collected an hour apart, kept sterile, and refrigerated until delivery. There was a page and half of instructions on how to collect the semen samples. I had multiple offers to help.

The researchers took the samples back to their labs in New York and conducted who-knows-what tests on them. If they ever found something unusual, they would let you know during their next visit.

On their next visit, they told me, "Chris, you've never had chicken pox."

"Oh, really? Is there a vaccine?"

In the early 80's, no vaccine was available, though there is one today.

Two weeks later, I was having a great time at a going away party for a friend of mine. We were playing charades. The kids at the party would whisper the clues in everyone's ears. Midway through the party, the host said, "oh, by the way, my kids have chicken pox. I hope nobody minds."

Two weeks after the party, it was Cornell graduation day at the end of May. I wasn't graduating for another six months, though I had accepted a position on the faculty of the University of Pennsylvania. The weather was beautiful, not too hot and a perfectly clear sky. Walking past the football stadium where the ceremony was held, I just didn't feel right. Sometimes I get allergies which give me a headache, so I went home, took some pills, and went to bed early.

I woke up at midnight and could feel a fever coming on. When I went to the bathroom, I saw a festering red bump in the middle of my forehead, right between my eyes, oozing a clear yellowish liquid. Oh yeah, I was exposed to chicken pox. Oh well.

When I woke up the next morning a swarm of pox had marched down my forehead, marking my face, neck, arms, chest and back. My legs were next. At the height of the horror, I had pox on every identifiable body part. No semen samples that week.

My fever raged at 102 for over 5 days. I would take a pill to reduce the fever, but when the fever broke, I would awaken lying in a puddle of sweat. The sheets were not merely soaking wet. It was a pool, as if the roof had leaked into my bed. I had to change the sheets at least twice a day.

The disease is highly contagious, so I was quarantined in my apartment. My poor roommate, Scott, came home to his pox-coated roommate greeting him at the door. Scott didn't know if he had chicken pox before, so for two weeks, he worried he might get it (luckily he didn't).

You're warned not to scratch; otherwise you leave permanent scars, but the itch is irresistable. I poured bottles of calamine lotion over my head to try to control it, but still ended up with a few scars.

On the worst day of the entire ordeal, in the evening, I dragged myself out of bed to watch Dan Rather on the CBS Evening News. In his distinctive baritone, he intoned:

"The University of Pennsylvania today announced the development of a chicken pox vaccine. It will be available in 2 to 3 years."

In a few more days, the fever broke, the pox scabbed over, and I was able to get out of the house. I hadn't shaved in a week; in fact I ended up growing a beard because it was impossible to shave with all those scabs on my face.

I learned a lot about humanity when I was finally able to end the quarantine. As I walked down the street people would obviously cross to the other side to avoid this scabrous spectacle.

Because of this ordeal, I learned first-hand the power of viruses. These tiny bits of DNA and RNA possess such power. I thought I was going to die. lesson I learned made me very cautious. It's one reason why I am still HIV negative.

Living Will

On July 3, 2008, I got the call. It was 6PM, I was in my car on my way to dinner with my friend Janice. Adi, one of my Dad's caretakers was on the phone. He had fallen and badly hurt his leg.

I got there in 15 minutes, and it was clear he had broken his hip. I knew that at 87, breaking a hip is serious, often fatal eventually. The broken hip doesn't kill directly. It's more insidious. Not being able to get up to walk makes the person a lot more susceptible to pneumonia, and that's why falls are so serious in the elderly. So, I was expecting a long lingering death.

Given that my Dad had Alzheimer's, I had to make all the decisions. That role reversal had occurred several years ago as his mind deteriorated.

After calling 911, the ambulance took him to the hospital, less than half a mile away. He was in a lot of pain, and it took too long for them to finally give him morphine, but, finally, that did the trick. He was at least comfortable. Thank God for morphine. After a painful X-ray they formally diagnosed the broken hip: it was broken in 3 places.

By 4:00AM, they finally admitted him to a regular hospital bed. My Dad was exhausted and so was I. I should have stayed through the night, since he pulled out his catheter when I was gone, but I was back by 9:00 AM with about 3 hours of sleep.

The standard treatment for a broken hip is surgery to pin the broken bones so they have a chance to heal. Given my father's advanced age I asked the doctors a frank question: is it worth it?

My Dad had made it very clear that he wanted no heroic measures when the end was inevitable. For example, when my Mother was dying of lung cancer, he committed a felony for her. He stole a prescription slip from a Doctor, forged a prescription for barbituates, and got it filled by a pharmacy, just in case she wanted to end her suffering early. She never took the pills. After she died, he kept them in his freezer, wrapped tightly, just in case he wanted to use them. Often he would bellow to my sister and I, "you know, I have the final solution in my freezer and I plan to use it when it's time!" He never did, but simply having that option seemed to give him some comfort.

Of course, he had a living will. He drafted it by himself almost 20 years earlier, though he got his lawyer to review it. He was adamant about no heroic measures if the end was inevitable. The third paragraph read:

In addition, I request that the executor of my Will refuse to pay any bill demanded from anyone who violates my wishes above. Indeed, I would hope that my executor would sue such violators; however, I leave this to his discretion.

I made certain every caregiver at the hospital read it.

With a broken hip, though, he likely was going to face exactly the kind of death he didn't want, long and tortuous. The doctors said that the surgery should reduce his pain, compared to doing nothing. If you don't set a broken hip, the bones will eventually knit together crookedly; therefore you'll never walk again, and it will be very painful. After discussing the options with my sister, we both agreed to the surgery, since it had some hope of reducing his pain, but we both believed he would never walk again. Surgery was scheduled for Saturday, July 5.

My sister and I spent July 4th with him in the hospital. Every 2 hours he got another shot of morphine to keep him comfortable. At one point, one of the attending doctors came into the room and asked my dad, "Mr. Jones, how are you doing," to which my Dad simply replied "I'm doing great!" He really was happy and comfortable. Mostly he slept a lot. Again, thank God for morphine.

The hospital had food service at any time. You could just call up and the food would arrive in 30-45 minutes. My Dad's favorite foods were salmon and chocolate. So that's what he had for dinner. Not the most balanced meal, but he ate all the food.

My sister and I arrived early the next morning for the surgery. Since it was a holiday weekend, the hospital was very, very quiet. They wheeled my dad into the empty surgical preparation area. We were the only people there. Finally we met the surgical team. There were three surgeons on the team, an older, experienced surgeon, 2 fresh residents, plus an anesthesiologist. They explained the procedure, discussed the risks, and I signed the consent form.

Then, it was time. My sister and I told My Dad that we loved him, as they wheeled him into surgery.

The surgery took a couple of hours. My sister and I waited in the waiting room reading some books, grabbing a bite in the cafeteria. Waiting like that is awful.

The surgical team finally came back. In retrospect, I realize that they don't tell you bad news directly. They don't tell you straight out that your father is dying. Instead, they said that there was a problem with the anesthesia. They couldn't keep his oxygen level up, and worried that he had gotten some blood into his lungs. So they had transferred him to intensive care.

My sister and I rushed to the ICU, but they wouldn't let us in immediately. The attending physician there spoke with us in the waiting room. He repeated what the surgeons had said and then asked, "he's 87. This will be tough. Had he discussed with us what he wanted to do in this situation?" Thank God I had the living will with me. After reading the will, the doctor almost smiled when he said, "he really thought it out, didn't he?"

Then they brought my sister and me into the ICU. My Dad was still under anesthesia, on a respirator, turned up to the max. Each time the air was pumped into him, it was like a seizure. His body jumped with every breath. There was a tube coming out of his nose, filled with blood, emptying into a large container above his head. There were several IV's, one in each arm, and a couple in his chest, if I recall correctly, with several IV bags hanging above.

It was clear it was time.

The nurse was phenomenal. Did my Dad like music? Yes, classical. Magically some sweet music started playing.

The respirator was slowly turned down and the tubes removed, one step at a time. My sister was on one side of his bed, myself on the other.

There was another patient in that ICU room. Although I never saw her through the curtain, I heard her. Another nurse was encouraging her, "you need to get out of bed and start walking." To which the old woman angrily replied, "I'm not doing any thing until I speak to Dr. Thomas." The frustrated nurse huffed, "well, he will be here shortly." While this minor drama was going on, life was flowing out of my father.

My Dad's nurse asked us about our memories of him. We told the story about the letter to the University of Michigan, the Viagra story, and amazingly, we were laughing, at least a bit, despite the fact that our father was dying in front of us.

One of the young surgeons who performed the surgery on his hip came by. Let me call him Dr. Pitt, Dr. Brad Pitt, since he was that damned handsome. He didn't realize that my father was almost gone, and apologized. He then put his hand on my shoulder, and said, "I don't know if this helps, but my father passed away a couple of months ago too. My heart goes out to you." I was able to choke out "I'm sorry for your loss."

Uncontrollable tears, laughter, and now, lust, all while my father was dying in front of me. My lizard brain was not going to be appeased until it felt every strong emotion known to man.

Then the sweet, beautiful nurse softly said, "he's gone."

I had watched my father deteriorate for years. I had thought I was prepared. You are never prepared for that moment. The pain hits you in every cell of your body. It happened so fast.

I had never seen a dead body before. His body was completely still, though still warm. His mouth was frozen open as if in a big snore, or maybe a silent scream. His color slowly became grey. I guess this is what they mean by "deathly still."

The nurse whispered, "you can stay as long as you want."

When do you leave your father after he dies?

Through continuous tears, of course I told him I loved him. I hoped he was proud of me. I knew that he was in a better place. Over and over.

Eventually, all of a sudden it hit me in the center of my soul. I needed to kiss him on his forehead, say I loved him, wish him goodbye, and then it would be time. Kissing a dead body on the forehead seemed just horrifying, but exactly the right thing to do. So that's what I did.

My sister stayed a while longer. I waited in the waiting area.

When she came out, we stayed there thinking there must be some papers for us to sign. Finally the nurse came out and said, "there's nothing more for you to do. You can go home."

Somehow we got home.

He gave us so many gifts during our life. As horrific as it was, I was glad that, as much as possible, he didn't have a long lingering death. My sister and I were able to give him something like the kind of death he wanted.