AANot So Fast
AA
3/25/02 14:08 Nursing Note: “Patient more alert. Patient is at present unwilling to proceed to surgery. Cardiac surgery, CCU attending in to discuss with pt and family.”
Pam’s maiden name, as they used to say, is Johnson, and as she lay there in the ICU anesthetized and oblivious to the impending bad news, I kept thinking of this joke:
An Army sergeant calls a PFC in to tell him that he’s just been promoted to squad leader, and his first assignment is to tell Private Johnson that his mother died. The new squad leader assembles the company and says “Everyone whose mother is still alive, take one step forward… NOT SO FAST THERE, JOHNSON!”
And at first Pam thought I was joking, the sort of gallows humor that gets people through hospital visits. Here she was expecting to be going home, having gone through a bit of an ordeal, but at least she’d gotten it over with. Her Afib would be better. “Listen,” I said. “There really was a problem… ” The idea didn’t sink in slowly, it just struck, and when it did she crumpled a bit and sank into the bed linens. After a time, she turned angry and her stunned expression turned to grim determination. She would not consent to open heart surgery.
This is a woman who has seen many an oozing chest wound.
“They screwed up a pacemaker, a catheterization and now I’m supposed to let them cut me, open me up? Open heart surgery? No. No. No. I won’t do it.” The bed sheets were knotted in clenched fists over her chest as if for protection against the thought.
And I had to admit she had me there. Except for the looming death sentence implicit in her refusal, her position made perfect sense. A little later we joked about calling an ambulance to get her out of Hopkins and take her over to George Washington Hospital—and boy do I wish now that we had really done that.
To be fair to Johns Hopkins, it was Dr. Grant Simons in Annapolis who screwed up the pacemaker job. He poked a hole—actually in the business they call it a microperforation—in Pam’s heart with a pacemaker lead. They call it a microperf for short. Having worked in politics, I was up on all the government type euphemisms; friendly fire, underprivileged, etc., but I was learning the medical lexicon now. Microperf. One would think that the wall of a human heart would have to be either perfed or not perfed.
Both the microperf and what happened to Pam in the Hopkins EP lab were complications. And, since there was a war on, and military euphemisms were in the air, Professor Calkins would later borrow a phrase to describe Pam’s contribution to the advancement of medical science. He would refer to my wife Pam as collateral damage. I discovered much later that the microperfing of Pam’s heart in 1998 was the complication that lead to her becoming part of the learning curve and ultimately to be classified as collateral damage in 2002.
On the subject of euphemisms, I find that it does not pay to write that someone lied. People don’t like the word. So I employ a euphemism that lawyers use to describe someone who is lying, evading or otherwise withholding the truth. They say the respondent is dancing.
The head of the EP Lab at Johns Hopkins can dance like Fred Astaire.
∞
Pam was serious about not consenting to open heart surgery. Although I never once thought about letting her just die, I had to acknowledge her right to refuse, and to recognize her reasons as legitimate. Because of her experiences in nursing and the drawn out hospital deaths of both of our fathers, we had discussed the rights of people to just say no. No more torture, just let me go. She had that right and I had to respect that. But she also had a son and a daughter and the rest of her family and me – and whatever lay ahead she was just going to have to go through it. She closed her eyes and I went out in the hall to tell the surgeon that she will do it, just give me some time.
He looked me in the eye. “We’re out of time.”
