The Final Chapter



Cross-posted from the heenastat blog.


He had loved her with all his being for more than 6 decades. In the last 2 years of their 61 year marriage, he had watched helplessly as dementia wrapped its noose around her, slowly tightening its grip on her mind and pulling her away from him.

When I met him I knew the injury was irrecoverable. Her brain was consumed by hemorrhage that had filled the space (cerebral atrophy) left behind by progressive dementia and then some, deflecting the midline between the two hemispheres nearly 12mm.

I asked him what had happened. She had tripped and fallen. For all her mind’s frailty, her body was still strong and agile for her 83 years; how she stumbled in the small living room they had shared for more than 50 years remained a mystery.

She was still breathing on her own but her brainstem’s ability to preserve this vital function was succumbing quickly to the pressure building from above. She appeared to be peacefully sleeping. He had not yet grasped that she would not be waking up.

I asked him what life was like at home before today. She was no longer aware of who, what, when, where, and how. A nurse would come daily to help her bathe and dress. She would then spend most of her day in a trusty old recliner. He would cook and feed her, then put her to bed every evening. They had no children. They had outlived their siblings.

Theirs was a story of two lifelong friends and lovers. Every Sunday he would take her for a drive. He wanted her to see the sun and the trees and the world outside their home. This was romance in the denouement of life. And here I was, suddenly a supporting character in the final chapter of their love story.

He cried quietly as I explained the magnitude of the injury. Like too many of my octogenarian patients, she had no advanced directives. None of the providers who knew her far better than I had thought a discussion of code status was worthy it seems. So this was my role.

We talked for a long while. After reviewing what all the technology in my critical care armamentarium might do and not do for the love of his life he said to me, “I don’t know I what will do without her. I don’t know any other life. I don’t have anyone else.”

His heartache was palpable.

There was surprise and some expression of dismay at the administrative hassle I caused when I planned to send her home with hospice services directly from the ER that day. I am grateful for the ER physicians, nurses, and social workers who helped me execute that plan even though it would have been far more convenient for us to simply admit her to the floor.

That she would die peacefully in her home of five decades with her partner of six by her side is the kind of medical outcome that looks poor on paper but feels good to the surgeon’s soul.

Love Songs: A 15th Anniversary Play List

I happen to share my birthday week with my anniversary week. It honestly makes for streamlining celebrations. Today I celebrate 15 of the most wonderful, amazing years of my life with my husband.

We perfectly balance each other’s personality traits; my rambunctious, outgoing type-A is settled by his quiet, contemplative type-B (or is it C–boy is he a shy, introverted type). We bicker like it’s a competitive sport and always (ok, well almost always) make up before the day is over. Yet, we have similar senses of humor, common interests in sports and pop-culture, and shared political leanings.

Beyond the ‘we’ though, there is the ‘he’. As cliche as it sounds, he has been my rock (I could not have gotten through medical school, surgical training, and bringing two children into this world without his support and multiple sacrifices) and is my true soul mate (I felt at ease with him the moment that we met, as if we had known each other in a past life). He has truly brought out the best in me. I am honestly getting emotional writing this (as I do every time I write him an anniversary, birthday, or father’s day card) because I shudder to think about the kind of person I would be today if he had never entered my life.

Many songs also remind me how lucky I have been that he gave me chance and thus changed my life.  Today I wanted to share a few them and thank him. One song for each year of our marriage so far.

(NB: yes, I apply my own personal interpretation to some of these songs, so what–for whatever reason they remind me how enriched my life is with my partner)


1) The Rose (Bette Midler) “Far beneath the bitter snows. Lies the seed that with the sun’s love. In the spring becomes the rose.” Thank-you for helping me bloom. 

2) I Will Not Take These Things for Granted (TTWS) “You offer reassurance….you offer warm asylum….you offers visions dancing” and “I will not take these things for granted.” Thank-you for everything that you do; I may not always say it but I promise you I don’t take it for granted how lucky I am.

3) You Picked Me (A Fine Frenzy) “I was difficult to reach. But you picked me.” Thank-you for persisting 19 years ago when all signals told you to get lost. So glad you picked me to pursue.

4) Concrete Sky (Beth Orton) “Save my soul… I feel like I’m falling” Thank-you for picking me up when I have been down, for giving me the strength to tackle obstacles that felt too formidable to go it alone.

5) I Choose You (Sara Bareilles) “I could live by the light in your eyes.” “We are not perfect. We’ll learn from our mistakes.” Thank-you for forgiving me my mistakes and admitting yours. (And also, for those blue eyes!)

6) Lovesong (Adele) “Whenever I’m alone with you. You make me feel like I am home again.” Thank-you for always making me feel safe and unconditionally loved. I am home with you no matter where we are.

7) It’s Friday, I’m in Love (The Cure) “To see you in the middle of the night. You can never get enough. Enough of this stuff. It’s Friday. I’m in love” Thank-you for not complaining about how many Fridays I left you all alone so I could do my job (and Mondays, Tuesdays, Wednesdays, Thursdays, Weekends, and Holidays as well.)

8) Unison (Bjork) “Domestically. I can obey all of your rules. And still be, be” Thank-you for living up to my often unrealistic expectations about how neat, tidy, and well-organized our home should be.

9) I Won’t Give Up (Jason Mraz) “For us to work we didn’t break, we didn’t burn
We had to learn how to bend without the world caving in.” Thank-you for your willingness to change your ways and grow with me as I also learn to change mine.

10) All of Me (John Legend) “[I] Love your curves and all your edges. All your perfect imperfections.” Thank-you for reminding me to love myself and unload so much lingering self-esteem baggage. You’d think that by age 40 I could embrace all of me as much as you can but I still need your reminders.

11) The Nearness of You (Norah Jones) “It’s just the nearness of you” Thank-you for just being there whenever I ask, even if it means subjecting yourself to another shopping trip or boring work event with complete strangers who give never-ending speeches.

12) Goodnight and Go (Imogen Heap) “It’s impossible to ignore you. Must you make me laugh so much.” Thank-you for making me laugh so very much. I look forward to saying goodnight to you for every night the rest of my life in person or from afar.

13) In Your Eyes (Peter Gabriel) “In your eyes. I am complete.” Thank-you for thinking the best of me despite my weaknesses and flaws. Your rose colored view is often needed.

14) Something in the Way She Moves (James Taylor) “And if I’m feeling down and blue or troubled by some foolish game. She always seems to make me change my mind.” Thank-you for allowing me to cheer you up on the days you would rather be sulking.

15) Who You Love (John Mayer) “Oh, you can’t make yourself stop dreaming
Who you’re dreaming of. If it’s who you love.” Thank-you for sticking with me even when it seemed that no one else who loved me would ever accept you. 

Thanks for a great 15 years babe. We don’t listen to enough music. And, of course that is because these songs just make me sob hysterical tears of love-filled joy.



Spouses before louses and 4 other bits of marriage advice

Disclaimer:  I am not an expert on marriage.  I am however, half of a couple whose relationship has spanned almost 14 years with admittedly lots of ups and downs.  And I mean real adult-sized-roller-coaster “ups and downs” where sometimes your stomach is left in your throat.  I also unfortunately have witnessed several extremely close friends go through terrible, heart wrenching divorces.  So, here is my advice to any and all couples contemplating marriage.


  1. Get off the hamster wheel and learn how to fight.

Fights happen.  And this can be a good thing … If you learn “how” to fight, productively.  Fights and arguments are a way to work through problems and differences together in order to get on the same page about real issues.   The thing to understand is that we don’t always fight the same way, often leading to non-productive fighting, which is the same as being on a hamster wheel.  The same problems and fights happening over and over again, without any forward progress.  The goal of any fight or argument should be to be in a different place than where you started.  It might not be over, you may not have the solution in hand, but ground should have been gained.  And this is accomplished by understanding how to argue with each other, respectfully.  For instance, I’d rather have a good, knock down, drag out fight immediately when the problem arises and then I’m over it when the conversation closes.  My husband?  Not so much.  He likes to think things through first…and this takes time.  We prefer to argue with much different styles and on different timelines, which used to lead to more frustration and anger until we figured out a system that works for us.  Disagreements will occur and you have to find a system that works for both of you, because hamster wheels suck – and lead to emotional baggage as the number of unresolved issues and emotions begin to pile up.


  1. Beware the shiny toys.

Remember your favorite childhood teddy bear?  It was soft, snuggly and oh so comfy.  But over time, it became a little raggedy and a little worn.  Then your 6th birthday came and you got that awesome new Peaches N Cream Barbie with that fabulous stole that you could style soooo many ways.  You became obsessed, she was your Favorite new toy ever and not raggedy like that ugly old teddy bear.  But then there was that really stormy night and the walls of your bedroom practically shook with the thunder.  I’m guessing it was that raggedly old teddy bear that you reached for, and not that new Barbie, that made you feel safe and comforted.

Well, guess what? Your spouse can become like that old raggedy teddy bear.  Your spouse is comfortable, knows everything (good and bad) about you, and sometimes can feel a bit “worn in” after fights about bills, potty training, and who stunk up the bathroom have taken their toll.  New plastic shiny toys are still all around when you become an adult, except now they work with you or are at your gym.  She/he doesn’t nag, is “fun”, and oh so exciting.  This person is just like that new Barbie, but I’m guessing, when s*&t hits the fan, you are going to want that warm snuggly old teddy bear, not the Barbie with the hard plasticy pointy boobs.  Lesson:  Real life will not always be sexy or new, but don’t give up or ruin your relationship with the person who knows and loves you the most, for some Barbie or Ken doll who won’t stand the test of time.  Although that affair might seem pretty tempting at the time, it is not worth the emotional havoc it will invariably cause.  Save the fooling around until after the divorce if you so choose.

  1. You married an iPhone.

Okay, not really, but I promise there is a point to this.  You know how the iPhone has all those software upgrades periodically and you never know when they are coming?  Sometimes they are pretty minor changes, and you don’t even notice.  And sometimes, those changes are major with all the colors now a little psychedelic and your phone looking and acting totally brand new.  And then to top it all off, they change the outside as well – the shape, the size, and even the color.  Well, when you walk down the aisle, you are marrying Spouse version 1.0.  The next day this version no longer exists and is replaced with version 1.01, and so on and so forth.  And this is a good thing.  I don’t think any of us want to be the same person, without changing, or growing, or learning for the rest of our lives.  Now, do I wish I had the same figure as my 25 year old self?  Hells yeah, but I’m glad I’ve changed and “hopefully” become a bit wiser and yes, a bit older as well.  You marry your spouse for their essence, not for the person that they are on the day you get engaged.  Sometimes the changes are minor, some may be major, and you probably will never know when they are coming, but that is the commitment and promise of marriage.

4.  Spouses before louses.

Maybe I shouldn’t compare children to lice and yes I know that the plural of louse is actually lice but a) children are a bit parasitic and b) you come up with something that rhymes with spouse.  In other words, your marriage should always come before your children on your priority list.  I realize Giuliana Rancic caught some heat for this sentiment, but I totally agree with her.  Your children will absolutely benefit from a strong and respectful marriage, and marriages based solely on the children will never last.  Because when your children grow up and leave your home, you will all of a sudden find yourself living with a stranger.

  1. Babies make the worst Band-Aids Ever.

Your thoughts regarding children should never include “we’ll talk about this later” or “maybe he/she will change his/her mind”.  This is an important issue you have to discuss prior to marriage – whether or not to have children and certain aspects of how you want them raised.  Because once you have that little screaming bundle of pooping joy, life becomes infinitely much more complex.  Also, having a child will never, ever, ever fix a marriage, because see #4.


So good luck out there to all those young happy couples in love, I hope you at least think about some of this advice, and if in doubt, wait it out!  A broken engagement is better than a broken marriage.  And for the rest of us already married folks, you have to have the downs so you can have the ups, and it’s also nice to have a little reminder every once in awhile to love on “our old teddy bear” a little bit more and more every day 🙂