medical *
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I'm continuing to have some right occipital headaches that radiate into the right eye. I am still taking the basic medications for gout. My exercise tolerance is one flight of stairs. It has been six days since I have had a dose of steroids. I am using one or two oxycontin (12 hour tabs) per day. Since I broke out in a rash a few days ago, I have not used any more ibuprofen. I am sleeping about 4 hours at a stretch and my energy is improving slowly day by day. On Thanksgiving day I was limited to moans and groans when I was actually out of bed. I feel capable of making phone calls this morning.
A Complicated Man
My father died on the day after his 67th birthday after a long illness. At the time, my sister Suzanne and brother-in-law Ed were staying with him as they waited for their new home to be completed. He had company and help. Up until two years before, he had been caring for his mother in his home. She suffered from Alzheimer's disease and did not recognize him as her son. "He's too fat to be Billy!" As his lung and heart disease progressed he was unable to keep up with her needs and he found a board and care home for her in Charlottesville where she had died year previous to his own death.
My mother was finally able to separate from my father in the early 1980's. In spite of her episodes of depression my mother was a very social person. Church was always important to her and she had an ongoing fascination with reported appearances of the Blessed Virgin in places like Medjugorje where she eventually visited.
http://www.medjugorje.com/medjugorje-messages/43-latest-25-message/1259-our-lady-of-medjugorjes-november-25-2011-message.html
Her separation from my father was liberation where she started down the path to a new kind of life free to enjoy her family, friends, and church. She was acquiring a momentum of wisdom. I hope that I have time to say a bit more about my mother, but not today.
If you recall, I was on my way to visit my father's 90 year-old second cousin in Georgia when this lung cancer became manifest. I wanted to know about his life before marriage, alcohol, and combat. Perhaps that won't be possible after all.
Having provided brutal details of his flaws and having portrayed our household as dominated and controlled by his moods and drinking patterns, the word that comes to mind when I think of him is WORK. He generally stayed very busy. Maybe this was a diversion from thoughts about drinking. At some time during his last ten years he told me how tired he was of thinking about alcohol--it was there as his master from the time he awoke every morning. Maybe work was a strategy for keeping it at bay.
Easter 1970 or 1971. Clockwise left: Dana, Molly, Mom, Dad, Kirk, Sue, Kris |
His pattern was was to become very involved in a particular project that consumed most of his energy outside of his government job. I've described the acquisition of hand carpentry tools and the construction of built-ins in 1951. It was likely that there would be at least one focused period a year that totally consumed his time and attention. For example, sometime in 1956 he decided that he wanted a trailer for camping and to haul materials that were too big to fit in a car or on the roof of a car.
The Great Camping Trip of 1957
It had started with his desire for a camping trailer that could be hauled behind the Dodge sedan. The Dodge would move the six people in the family and the trailer would move the "stuff" that the six people needed for camping in comfort.
Fully finished trailers were too expensive. His alternative was to begin with the frame of an automobile. However, that frame was still attached to the automobile, a British Ford, that appeared in our backyard one Summer morning. I remember a professional football player who acquired the nickname "hacksaw" by cutting a car in half. He always reminded me of my Dad who made good use of several hacksaws as he removed more and more of the body of that Ford and took it down to the frame. For years afterwards, our power lawnmower would encounter a fossil from the hacksaw days and spit out a nut or bolt reminder.
Once the steel rails had been exposed, Dad framed in the body of the trailer, essentially a box with various attachments for tying down loads. The final bit was the welding of the tongue of the trailer, the connecting link that held the female portion of the trailer hitch. The welding was done by "Shorty" an old time mechanic from the "old days" of Prince Georges County. He was held in awe by all the local mechanics, a god of the garages who always wore an old, red leather baseball-style cap stained with years of accumulated lubricants.
In July 1957 we were ready to embark on a 2 week adventure, camping our way to the paternal grandparents home in Erie, Pennsylvania then swinging across the state of New York to attend my Great Grandfather's 80th birthday celebration in Kingston, New York, south to Yonkers for more fun with family, and finally, camping on the Beach near Rehobeth Delaware.
We packed up started out around supper time. The first 100 miles were uneventful but then the trailer broke down in a rainstorm in Chambersburg, Pennsylvania. The weld of the tongue had separated and our trailer was useless.
One of my father's talents was the ability to carry almost anything on the roof of an automobile. He was up this particular challenge. He removed the bench seats from the back of the Dodge and replaced them with footlockers from the trailer. Pillows on top of the footlockers would be our new seats. There was no roof luggage rack, but a tarpaulin and additional footlockers were tied into place and then covered with a large tent and tied down again. Mom went through all the the clothing and separated necessary from desirable. Within a couple of hours we were repacked and ready to go. The additional equipment, clothing, and auto upholstery were stored within the trailer which would be parked in Chambersburg for the duration of the trip and dealt with later.
We made it to Erie and camped in the backyard of our grandparents. However, on the way across New York state, we ran into heavy rains. Somewhere around Cooperstown, we noticed that our car roof was gradually sinking under the weight of the load and the accumulated water. We had exceeded the capacity of the auto's roof to support our load and maintain its original shape. Further attempts were made to lighten what was on the roof but throughout the remainder of the trip the sunken roof hid our Dad's head from view from the back seat of the car.
This vacation was one of the high water marks of my childhood. I had never before seen the ocean. There was almost no alcohol use during the trip. Our parents worked together and solved the problems that arose in an efficient and successful manner. Kirk was a year old and everyone seemed to be enjoying having the little guy with us. The caved-in roof was a source of amusement. The only irritable people on the trip were the three older children who managed to get too much sun and were sitting in tight quarters in the Dodge with fairly significant sunburn. Even that snippiness lasted less than a day.
Last Harsh Words
My last confrontation with my father was the summer before my last year of medical school, a few weeks after the house fire. My mother and my two youngest brothers were living with me and he had called looking for them or for information about them. I told him that I didn't have any information for him and suggested that he use the mail to contact her. Apparently he was concerned about the insurance investigation of the fire and he warned me that "her money is at risk as well."
Sometime within the following few months, my mother had made the decision to "try again" and my parents both became very busy with the details of having their house rebuilt. My mother's decision made it very easy for me to separate from their toxic dance. At that point I had determined that my best course of action was to hold each of them responsible for their current position. I was also pretty sure from that moment forward that I wanted some geographic buffer to cushion me from the twists and turns of their relationship. I also realized that to see my younger brothers and my mother, I would have to deal with my father as well.
His Medical Problems
In 1971 my Dad called me on a Saturday morning and told me that he was having abdominal pain and asked if I would come take a look. I told him that it might involve a rectal exam as a bit of forewarning. He was feeling so poorly that he agreed. When I examined him that morning there were still bowel sounds and some left lower quadrant tenderness. Checks for hernia and the rectal exam were negative. I told him that I would recheck him in a few hours.
When I saw him in the late afternoon, he was sicker. There were no longer bowel sounds and he had other symptoms of peritonitis. He needed a surgeon and the nearest connection I had was at Maryland General in Baltimore, about an hour away. Unfortunately, I was driving the International Scout II, hardly a smooth ride. Nevertheless, in spite of his peritonitis, he managed to maintain a reasonable facsimile of a conversation for the entire drive. He had ruptured some diverticuli and there was some fecal spilling in the peritoneal cavity. However, I don't believe that a colostomy was done. When he awoke the pain was such that he was no longer able to sustain a conversation. He looked very hard at me and laughed. The surgical residents who had examined his belly before surgery were impressed with his stoicism and the mess that they found at surgery.
A couple of years after that, he had his first myocardial infarction. He was about 53 and this put an end to his Federal work life and he retired, only to find a low level state job where he managed to hang on long enough to obtain another small pension. As he recovered from his heart attack, I recommended that he see the internist Richard Fisher in Baltimore and he did so.
I am sitting here thinking about Montana which brings to mind horses and cowboys and roundups and it occurs that my father's medical needs and conditions were an important opportunity for us to normalize our relationship to the extent that it was possible. In previous posts I have outlined some of the trauma that I experienced at the hands of my father. But from a reasonably early age I recognized that his own suffering was much greater than mine.
Although I haven't laid out the groundwork for some of the following, I have always believed that my mother loved me to the extent to which it was possible for her to do so. Although there were times when I felt abandoned as a child, they were relatively infrequent and they occurred when my mother was being brutalized.
I didn't see any love coming my father's way from his family of origin and not much from my mother as well. He was the perpetual poor relative who was taken into his cousin's home as a rescued teen-ager. He was a latch-key child. His mother was an alcoholic who would leave the family for days at a time. My mother's family found Dad's parents to be mostly interested in night-clubs and strip joints, less interested in more sociable night spots where you could drink and dance with friends in a social atmosphere.
In 1983 I had the opportunity to spend a few weeks with my father. His heart attack 9 years before had identified the coronary artery disease. He had developed angina that became increasingly severe and by 1981 his doctor recommended that he have coronary artery bypass surgery. I was in Billings at the time where a new team of Cardiovascular Surgeons had set up shop. The physician I knew was Timothy Dernbach who had been trained under Denton Cooley in Houston. Dernbach's team had come to town and created a new, model surgical program. It's not just about the surgery, it's about everything. Their results were very good. I persuaded my father to come to Billings to have his bypass surgery. His cardiologist was Robert Zirpoli. My father was not impressed with Dr. Zirpoli's choice of clothes (too much Sears) and I tried to explain that Dr. Zirpoli's brain mattered more than the fit of his clothes. I happened to like Dr. Z's blissful ignorance of clothing.
(There is a wonderful movie, What God Has Made, that shows Denton Cooley as one of a small handful of Hopkins surgical residents that were willing to assist on a surgery of the heart. The movie also depicts the racism of the 1940s in Baltimore.)
My parents had been separated for a year or more at the time of his scheduled bypass surgery and I received a call from Dad's girl friend the night before his scheduled surgery. She related that she had a really "bad feeling" about this particular surgery being done in Billings, Montana. She wanted to warn him off. I told her this was the last thing that he needed to hear from anyone. I expressed gratitude that she was in his life and that she cared about him, but I told her that I was going to have to pull rank--that I was a physician, that I knew the people doing the surgery, that I knew for a fact that they were as good as anybody, and that he would get some extra attention as my father. I told her he was asleep and needed that sleep.
After several days of tests and at least one insurance biopsy, the fateful day for admission came. My dad was very curious about the procedure, particularly about the way in which the surgeons could suture arteries in a beating heart. I had told him, that they would use a bypass pump to take over the heart's work for a few minutes and that they would cool down and stop the heart while they did what was required. He nodded an understanding.
My dad and I were watching an NFL playoff game and we had agreed to leave for the hospital immediately thereafter. At the end of the game, we both stood up, but when I glanced at him, he appeared very distressed and he stumbled and sat back down. He put his hand over his chest and said, "I need a couple of minutes." I had never seen my father look so scared and so frail. This wasn't the giant who had chased me down Ray Road when I was 15.
Then we were good to go. He never complained. He ended up with two surgeries. After the bypass surgery, he became unstable because he was bleeding into the pericardium, a condition known as tamponade. The pericardium is a cellophane-like membrane that slips over the external surface of the heart. The pericardium does not distend, so when it fills with fluid, there is a corresponding loss of potential space within the heart. With enough fluid in the pericardium, there is a loss of pumping ability and the heart can no longer keep up with demand. The treatment is to drain the pericardium and that was the second operation that he had that day.
When I finally saw him in the recovery room, it was hard to recognize him because of the enormous amount of head and facial swelling. His recovery occurred on schedule. However, about 1 week after his surgery, I smelled cigarette smoke in the bathroom of his hospital room. He never did stop with the cigarettes. He came home from the hospital and stayed in our Billings home for a few weeks until he felt strong enough to head back east.
As he was about to leave he asked if he could buy Molly a gift. I told him that she had said something about wanting a kerosene heater in the basement of our rancher. I felt terrible when he said that he couldn't afford to do that. Would you be surprised if I told you that he settled on a wine rack?
My Dad in West Virginia
In 1977 as I was struggling in Glendive, my father had called and asked if he could help me get the West Virginia house on the market for sale. I agreed and he was helpful in providing a feast and party for friends and family who spent the day constructing a new deck on the portion of the house overlooking the lake and river.
Allowing my father to use the West Virginia house generated one of our favorite family stories.
The Blue Hornet.
My brother-in-law, Ed Rader, and Bill Sohr are going up to the West Virginia house in 1978. They are driving an American Motors Hornet that could have circled the world four or five times. There are only two gears that can be engaged, 2nd (out of three on the steering column) and Reverse. On occasion, they have lost Second Gear as well, in which cases, Bill has scrambled under the car with a hammer and banged around on the transmission with success.
On this particular day, they have exited the mountain road from the A Frame and are on route 340 heading East toward Frederick when they suddenly lose Second Gear again. Bill gets out with the hammer and bangs around for 15 or 20 minutes without success. Bill then directs Ed to walk to the gas station they passed about a mile or so back. Ed is to call Dana and explain that they will need him to come pick them up at the gas station on Route 340.
Ed hoofs it back to the gas station and places the call to Dana. As he hangs up, Ed sees an odd sight. Rte 340 is a divided highway, two lanes on each side. In the leftmost of the West Bound Lanes is a blue American Motors Hornet traveling west with traffic but backwards. Bill has decided that even without a second gear, the reverse gear together with his expertise as a driver will permit him to get back to the gas station where smarter mechanical minds and more tools will increase the probability of success.
The hornet's right rear tail light begins to blink indicating a pending left turn. The hornet moves briskly into the left turn lane and then proceeds across the other traffic lanes and slides neatly into a parking place in the gas station.
His Last Year
During the last year of his life, I lived in Pocomoke City, about 150 miles from Baltimore. I worked as the medical director of a prison in Westover, Maryland. I was required to attend a day of meetings in Baltimore on the first Wednesday of the month. Afterwards, I would drive down to Beltsville and visit with him. He was often talkative and I kept hoping for something approaching an honest conversation, but that never happened.
The following story captures quite a bit about my father's naivete, optimism, and faith in his own ability to get the job done. It's probably my favorite.
Elbow Room or Much Ado about Nothing
If I am correct, "elbow room" was on Daniel Boone's mind as he headed west. For my father, elbow room meant heading down and I don't mean as far as hell.
Our family was living in a two story 1200 square foot cracker box. The 4th child, Kirk, arrived in September 1956. Sue has the smallest bedroom. Geoff and I share the middle bedroom. Mom and Dad and Kirk share the remaining bedroom.
Dad has no money. He graduated from college in 1954 and started a management training program with the Navy Department. His paygrade was a GS-10 before he quit the Veteran's Administration to begin college. He was hired into the Navy Department at a GS-7. In the Spring of 1957 he may have advanced to a point where he was better off as a college graduate than he was without college in 1951.
With no money for an addition to the home, he longed for an unfinished basement that he could convert to more space. However, there was no unfinished basement in our house. There was a crawl space of about 3 feet between the ground level and the floor joists of the first level of the home.
He decided that he needed to turn the crawl space into an unfinished basement. For Geoff and me this project would consume time and energy for the next two years. Artist that he was, my father visualized the crawl space as a unfinished basement that had been filled in. We merely had to remove the dirt, the "we" being Geoff and me.
Dad began digging about 15 feet from the side of the house. He dug a ramp down from this point to the foundation wall of the house which extended about 4 feet below the ground level to the footings. The ramp was about 4' wide, enough to handle a shallow wheelbarrow. The digging was tough Maryland clay. He had an acquaintance, George Daigle, with whom he was doing a project for the Boy Scouts of America. George was a big, strong guy in his late 20's who came by to help with the digging, saying that he needed the workout.
George was there one Saturday as my father had extended the ramp right up to the foundation. The depth was very close to 6 feet. My Dad almost always wore a hat, maybe to hide his hair loss. I could see the top of my Dad's hat bouncing around as he stood at the bottom of the hole.
Something happened that I cannot understand to this day. In my possession was something called an ashcan. It is a very powerful firecracker. Vandals used to light them and flush them down toilets in order to destroy the toilet.
Ashcans: Always illegal in Maryland but highly prized by teen-age boys. |
I waited. The hat kept bobbing around and then KABOOM. The hat jumped up about a foot and my father was out of that hole in a heartbeat. He looked at me and I froze. Then he looked to the left at Mr. Daigle and he managed a faint smile. He either had to beat me to a pulp then and there or he had to let me go. He would lose face if he waited until Daigle was gone before blasting me--I would know that he had been afraid of Daigle. For some reason or another, he never said a word about this incident. A much better sport than I would have been under the circumstances.
Finally the ramp was clear all the way to the foundation of the house. Out came the masonry chisels and an entryway was carved out.
Then it was time to keep digging. Each wheelbarrow was rolled up the ramp and the dirt was discarded on the empty lot next door. As summer came, Geoff and I were assigned a quota of dirt to remove on a daily basis. It was cool in the summer under the house. It was also a good place to smoke cigarettes that I had snitched from my parents.
As the digging progressed, there were a number of obstacles left to overcome. The first problem was running into the groundwater that accumulated in our basement. This required the installation of a sump pump and running power to it.
The second problem was the center support for the I Beam of the house. It was masonry and quite large. My father decided to install steel jacks to replace the masonry pillar. He dug footings for two jacks and installed them 8 feet from the exterior walls of the house. He locked the top of the jacks into the steel I Beam and then he gradually increased the a amount of weight on the jacks by about a quarter turn every week until the I Beam was lifted off of the masonry pillar. At that point, he removed the masonry pillar leaving the steel beam of the house resting on the exterior masonry and the steel jacks.
The house footings and foundatons were engineered for a crawl space, not a basement. A wall interior to the footings would be required. This would need its own footings and a concrete slab floor. A great deal of work remained to be done and my father was running out of steam and had come to the part where money had to be invested. He decided that the project should be put on hold. He put a plywood cover over the opening in the foundation and filled in the ramp space that extended into the side yard.
Fortune smiled on my father at work with a promotion or two and my mother received word that there was a final child on the way. My parents were able to obtain a home equity loan to add on about 400 square feet to the back of the first floor.
If you knew my mother you would know that she would be on top of this project, making sure that the builder provided every nail promised in the contract. Mom enjoyed rough and tumble business scuffles. The IRS found her so outrageous that they audited her several times. She loved that challenge.
However, this time the builder had the trump card. When she complained that the Better Business Bureau might be interested in the progress of the bonus room, the contractor pointed out that several county agencies might be very interested in what was going on underneath the main house. I wasn't there for that conversation, but I think I can guess at the expression on my mother's face.
The basement issue was finally solved when my parents decided to sell that house. Fresh dirt was purchased and shoveled into the basement. The passageway through the foundation was permanently repaired and the house was sold.