CHAPTER 21: Heart Failure
“Memente, homo, quia pulvis es
Et in pulverem reverteris.”
Remember, man, that dust thou art
And unto dust thou shalt return.
It seemed to come without any recognizable warning, but perhaps the warning signs had been building up for a while and neither Len nor Trish nor yet Magda (with her acuity in matters that pertained to Len’s health) recognized it for what it was. Magda did mention to Len that he was developing pronounced sleep apnea; too many times Len held his breath while sleeping, and just when Magda was about to shake him to induce normal breathing, he would cough and gasp and sputter into hyperventilation. It got worse. Len himself began to notice it: He found himself jolted awake sometimes with a sudden burst of breathing, gasping and coughing. On the advice of his doctor friends Len consulted a cardiologist, who began seeing him once a month and prescribed some pills. Len’s bouts of weakness and tiredness became frequent. Things were coming to a head.
On a trip to Chicago Len was overtaken by a crisis. Once again Trish was with Len when his health crisis struck. They were in Illinois for Trish to attend another TAPS memorial service: that morale-boosting “Tragedy Assistance Program for Survivors.” This episode of TAPS was being held at Evanston, to the north of Chicago. Once again Trish was determined to attend. It would be a long journey and she had lately developed a psychological condition: An uncontrollable panic attack when she drove on a highway. Commutes along familiar routes in the city were negotiable for her, but not intercity driving with speeding cars and trucks darting or muscling past her. If Trish must attend, Len had to take her, along with Jara as she desired, to Evanston. They stayed two nights in the convention hotel.
Len went not for any keen interest in TAPS but for the sake of his love and concern for Trish. He had little sympathy for casualties from America’s endless imperial wars in foreign lands. He was particularly disgusted by top politicians who sent young American men and women in harms way with brave talk of “America must be strong,” but did their best to keep their own families out of the fray. Whereas the Romans of old fought similarly all over the then world for conquest and spoils, at least their political leaders were often in the forefront of the fighting —but not so U.S. politicians who voted frequently for more arms and more wars, eager to use poor citizens from inner city ghettos as cannon fodder to advance their own financial and political agendas.
Nevertheless, Len came to pity the sorrows and admire the courage of many parents, spouses, and siblings he and Trish met at TAPS —people whose loved ones made the supreme sacrifice merely to enrich the pockets of oligarchs and jingoists. Trish, too, declared that she benefitted from TAPS, that she gleaned solace from talking with similarly bereaved parents at TAPS. So Len usually went. Because he was the pater familias, the manifest father figure for Trish’s family, notifications of TAPS events came to him.
Sometimes he tried to persuade Trish to discontinue TAPS attendance. It began to seem to him like a morbid obsession, an extension of her ceaseless grieving at home and at her son’s grave. She needed to slowly let it go and let healing occur, instead of often prying open the scab. Trish gave no reply to his pleading; she just persisted in the funerary activities. But Len could not really blame her since he had never experienced the throbbing horror of losing a child of one’s own. He shouldn’t judge her without ever having walked at all in her shoes —those shoes with soles studded with nails and broken glass. So he always gave in and took Trish to TAPS.
The acronym was no doubt chosen with care, for Taps also was the name of the familiar and moving dirge played by a lone bugler each time a US service man (or woman) died in service to the country. But Len discovered anew each time that TAPS was not really a dolorous convention of unmitigated grief as the name might suggest. It was often held in a positive atmosphere, with a belief in finding strength through collective grieving, and an uplifting attitude of suspending one’s own grief for a moment to comfort another person whose cross seemed heavier to bear or more recently shouldered than yours. TAPS was subsidized, so room and board were paid by the organizers, but attendees were expected to get themselves to the venue of each activity. Len bore the transportation and logistical expenses for TAPS trips, as he always did when he took Trish’s family on a vacation.
As had happened on three earlier occasions when Len and Trish took a trip out of state, a major health crisis broke on Len this time. In the middle of the first night a fire alarm went off around 1 am. Everybody responded briskly, scurrying down the stairwell. Trish and Jara went quickly down eight flights of stairs, followed by a struggling Len. The commotion was so intense that Trish did not notice that Len was struggling and lagging behind. And then when they hit the ground Len realized he had forgotten his wallet in the hotel room. If it got consumed in a fire they would be unable to pay their bills or drive home (without his driver’s license). Trish could not drive them home, and Jara had just got her first driving permit. So Len announced he was going back upstairs for his wallet.
He set out up the stairs, gasping for breath and stopping several times to rest, with the fire alarm klaxons screaming like banshees in his ear. Like a salmon intent on swimming upstream to reach its spawning site, Len was impeded all the way up by the continuing flood of people streaming down. He got into the room, picked up his wallet, headed down again and passed out half-way down. When he came to, the stampede of spooked guests down the staircase had eased considerably, and Len was able to stagger on slowly down, holding the rails as he went, and gasping from exhaustion. By the time he rejoined Trish and Jara, Trish was in a state of near panic. So Len quietly told her about his problem with apnea and about being under regular treatment from a cardiologist who said his heart was ailing. In the semi darkness he had no idea how Trish took the news of another diseased heart in another man that was dear to her.
Len got them back to Columbus after the TAPS event, and then, all alone, headed home to Cleveland. He had had the scare of his life, not really from the threat of fire but from realization that his heart trouble was escalating. He began to think that when his end came it would be in Trish’s arms. His apnea worsened. Luckily for him, that was the last trip he was to take with her.
He contacted Cleveland Clinic after recalling he had once volunteered for a sleep study being conducted by a doctor —an exercise for which Len had worn a Halter monitor and stayed in bed through two nights and the intervening day. Cleveland Clinic now had several permanent stations for studies on sleep disorder. They found a vacant attendance spot for Len, so he and Magda went there that very night, for he was by then ailing visibly and unable to sleep at all. Each time he fell asleep his body jerked awake with what felt like a kick, and so he had gone for several days without sleep. Magda was worried; Trish never knew anything about it, and she had retreated once again into aloof reticence in any case.
Only a nurse was in attendance at the sleep center, no doctor. They assured Len that a doctor would see him in the morning, but he and Magda doubted seriously if he would make it until morning. Just after midnight things got so bad that Len told Magda to call his sons so he could say his final goodbye to them and to his grandchildren. It was 1 am when Magda started to dial the first number; then she gave up, broke down, and cried. Len hugged her as she sat on the edge of his hospital bed and said to her, between his gasps and her sobs:
“I guess it’s goodbye, Maggie; the end has come. You have been good to me through four decades of marriage. You are a good woman, a wonderful wife. Take care of yourself, and of our grandchildren. Tell them that with my last breath I pass on to them the blessings of our ancestors. A copy of my last will and testament is in an envelope on our headboard; the original is in the safe. Please find the strength to carry on, my dear wife.”
He pulled Magda down to kiss her goodbye and she wailed and sobbed so hard that the nurse ran into the room. But at that moment the nurse in Magda kicked in. She had been a nurse for over forty years and she wasn’t about to lose her head when she most needed clear thinking. She pulled out her cell phone and called 911. She described the desperate situation to them and an ambulance sped up within ten minutes. They quickly took her and Len to the Cleveland Clinic’s Emergency Unit that was only minutes away. On the way they talked to Len constantly to keep him awake.
When they arrived at the hospital a doctor was waiting. He engaged Len in a rather interesting conversation about his origins in the West Indies, his travels, the Nigerians he had met and worked or interacted with, this and that, all the while evaluating Len’s vital signs by palpation and with a stethoscope. It was more like a social chat than a physical examination: That doctor was such an interesting and erudite man that Len stayed lucid and had a pleasant check up. The doctor told Len his lungs were almost full with collected fluids. That was why he could hardly breathe, especially when he tried to sleep.
They punched an IV line into Len’s arm and he slowed down. But he was still sentient enough to experience intense tickling as they intubated him with slender suction tubes passed down his nostrils and snaking towards his lungs. Len did not know what else they did to him: He went out like a light. But Magda filled him in when he awoke from anesthesia. They had pumped much fluid from his lungs, which meant they had reached him just in time (or rather, Len thought, he had reached the hospital just in time, thanks to Magda’s professional reaction). And, of course, Cleveland Clinic was the world’s premier hospital for diseases of the heart. Len knew he was in good hands with the clinic and with the ministrations of his competent wife who had several awards for nursing excellence and diligence. Score one, again, for Magda: If he had been with Trish (again) that night he would not have made it to dawn.
Len’s heart now had pronounced A-Fib and needed to be stabilized. He was held in that hospital for thirty days of treatment and observation. He did not think it possible that one could stay so long in a hospital in these modern days when most patients were discharged within a day or two of admission because the daily costs of being held in hospital wards were prohibitive. It helped hugely that Len had turned 65 just one month before that catastrophic heart failure as it was called in his chart. That meant he could draw from Medicare, and he had enrolled three months before his sixty-fifth birthday. That saved him from paying ruinous hospitalization charges out of his pocket. By the time he was discharged thirty days later and given a portable defibrillator to wear constantly at home, the total cost of his hospital intervention topped three hundred thousand dollars.
After emptying his lungs of water, the rest was a matter of observation, treatment with pills, and a battery of daily tests and checks. Magda returned to work after staying with Len through the first two days; she had to go and oversee matters of the family business. After three days of extensive intervention by his doctors and nurses Len felt strong enough to call Trish and tell her where he had been. Len told her the temblors that jolted him on that flight home from Rome and during their visit to Evanston, Illinois, were warning signs that his heart was failing. And by coincidence, Trish was with him on both occasions. The big quake finally hit him three days ago and knocked him into a hospital emergency service. It was catastrophic heart failure, they told him, and his stay in that hospital was open-ended. He’d really love to see her again, to hold her and kiss her, but if that pleasure was going to be denied him now, she should never forget him: He loved her more deeply than words could tell.
Trish expressed concern for Len’s health and added that she was sure he was in the best place for treatment of heart problems. She didn’t ask for details and Len didn’t volunteer them. They made small talk, and they hung up. Trish did not call Len that day, or the next day; so he called her on the third day. From then on Len called Trish each day, sometimes twice on a day, to fill her in on his progress. During his entire stay of 30 days in the hospital Trish called him only two or three times. It was clear to Len that Trish was losing interest in their relationship. And why not? A dozen years had gone by; she was jaded now and he was sick, to boot, maybe terminally ill, for all Trish knew.
Len was saddened by the lack of concern his grave illness evoked from Trish. If the situation were reversed he would have jumped to her side in a flash. Didn’t he drop everything and rush to comfort and assist her every time she was bereaved or just had a health problem? He didn’t expect Trish to come in person, though that would have really provided a positive fillip to his recovery. Trish did not drive on the highway anymore. Of course Vivica or someone else could have brought her, but all those others were busy with their own lives and errands, full of bustle as any American. Another reason Len did not expect Trish to show up in his cardiac hospital unit was because she had to be wary regarding surprises she might run into. She couldn’t have forgotten the awkwardness caused by the fact that she was with Len in the Cincinnati hospital during his first episode for heart disorder —albeit a presence that was not altogether voluntary on the part of Trish, because she was simply caught up in the flow of events when Len lost consciousness practically in her arms in the airplane.
Nobody could blame Trish for not wanting a repeat of the awkwardness of Cincinnati. But how about calling him? How disappointing that Trish was distancing herself from him just when her empathy would have meant the world to him. Then it struck him one day, after Magda had been to visit him, bringing food, affection, and cheer —that he was silly to take for granted a wife to whom he owed his life and his ease, only to pine for another woman who gave every impression of lacking in empathy. Why did his heart seem to hunger only for what was out of reach? They say the grass is always greener on the other side, but why was it so? He really liked Magda as a loyal, resourceful, and attentive wife, but at the same time found Trish irresistibly lovable. Like the aristocrat who found nothing wrong with feudalism as a way of life, sometimes Len wished he were a Muslim…. But, he sighed, the head likes, while the heart loves!
But why, for that matter, was Trish indifferent to his health, after all he had done for her? It might be due to squeamishness, he reasoned; some people are that way in the presence of illness. Or it might be out fear she was going to lose Len too, so that she wished to cushion herself by staying aloof. There was the fact that her son and her brother both died of heart problems, and now Len had had a close call with heart failure. Trish had lately and repeatedly lamented to Len that, “It looks like all the men in my life are going to die early.” Len had reassured her that he had no intention of dying any time soon, but her fears were perhaps understandable: Nigerians were by nature superstitious, and in Trish’s case it did not help that she had bought totally into the modern version of superstition, called Christian faith.
To distract Trish from morbid fixation on supernatural causes of her bereavement, Len told her of the year he turned eight, when his mother died, and soon thereafter his extended family of uncles and aunties and cousins lost six more members within a span of six months. The family was rocked, but it hung together. But Trish was not reassured. She had a simple mind that was captive to her beliefs, and her world was a theatre of miracles and mysteries and magic and witchcraft. Everything that happened to mortal man was controlled by unseen superior forces, and each unusual event a harbinger of evil or of divine favor. To be visited so many times in such short order by sudden deaths of her closest male relatives must seem to her an omen of judgment from on high. Her ordeal of bereavement might continue till her cup ran over, or maybe the cascade of catastrophes had expiated her sins already and she was in safe harbor at last. She couldn’t tell, and nobody could blame her if she was paralyzed by dread of more bereavement.
On the other hand, it was probably more than her fear of his dying. Len remembered that Trish showed similar dispassion on another occasion, one of the most harrowing times of his life. Two years earlier, both of Len’s granddaughters perished in a tragic fire in the home of his son, along with their half-sister. Though his entire family was plunged into shock and grief, it was left to Len to set aside his sorrow now and then and call Trish to apprise her of developments in the final week when his youngest granddaughter lay unconscious, battling for her life, and finally losing it. It was hard to escape the conclusion that Trish did not score too highly on the scale of human compassion. But still Len loved Trish and longed for her. Love cared nothing for logic.
So, during his convalescence at home after his first discharge from the Cleveland Clinic, Len called Trish daily, if only from force of habit. Her voice still thrilled him and he still longed to touch her, to hold her, to kiss her. He called her at least once a day during the month he spent at home before returning to the Cleveland Clinic for installation of a sentinel in his heart, the Implantable Cardiac Device or ICD. The ICD functioned like the external defibrillator he had worn day and night for one month after his first discharge from the Cleveland Clinic. The only difference was that his ICD was a solid-state device the size of a small wallet, buried in his chest, rather than a radio-sized box that he strapped to his hips, with electrodes snaking up to his chest where they were held down under his shirt with sticky gel. This time, following the implant, he was discharged from hospital after four days.
But Len knew he was still deeply in love with Trish even if she had fallen out of love with him. He went home and resumed calling her daily. It was only then that Len learned that Trish was also distracted by some personal troubles of her own. Her baby sister was fighting for her life against cancer. It was as though some malevolent deity had it in for Trish and was determined to beat her down to the ground.