My father finds it hard to believe that he has a sixty one year old daughter. I find it hard to believe I have a nearly ninety year old father. I almost didn’t, which is story behind the scarcity of Crab Diaries blogs in the last two months. If cats have nine lives, Dad must have ten or eleven. The ninth life flashed before my eyes on April twentieth.
I have a “spiel” for the side effects and late effects of radiation therapy for every disease site. One of the late effects of radiation for abdominal malignancies is the risk of a small bowel obstruction months to years after the treatment. My little speech goes something like this: “Every patient who has ever had abdominal surgery, even for benign disease, is at risk for a bowel obstruction at some point later in their lives. Scar tissue forms adhesions which restrict the bowel—if you’ve had cancer surgery, or an appendectomy, or even, like me, a C-section or two or three—you are at risk. Radiation increases that risk, but if you recognize the symptoms early, and get treatment, there is a high likelihood that you can avoid surgery. So if you ever have a period where you are experiencing abdominal distention, and realize that you are not passing gas, and start to feel nauseated, get thee to an emergency room for quick diagnosis and treatment.”
Apparently Dad didn’t get the memo. In 2004, my mother called me late one evening to report that Dad had been in a car accident. After running a red light, he was broadsided and found himself in the passenger seat when he should have been driving. No, he was not wearing a seat belt. He was taken to the emergency room of the hospital where he practiced, and was found to have a pelvic fracture, but he was “fine” and not to worry. At his insistence, his colleague, the Chief of Plastic Surgery was called in and pronounced him fit to leave the hospital. At four am, I got a second call from Mom, asking me “What does it mean that he got up to leave to go home and promptly fainted.” It meant a ruptured spleen and I told her so. A few hours and a splenectomy later, all was well– until April.
Dad woke up feeling a little queasy on a Friday after a lovely trip to Phoenix a few days earlier. The feeling persisted and overnight the symptoms progressed, but being the stoic and ever in denial physician that he is, he knew that the food poisoning or virus would soon be over and he would be back to normal. But when he described his symptoms to his primary care doctor nearly 30 hours later, she sent him to the nearest emergency room. By the time I was able to get back to San Diego, he had perforated his obstructed bowel and was headed into surgery, two years after his second open heart surgery and one year after hip replacement, two months shy of his ninetieth birthday. Surgeons are different from normal people. At a time when I would have had my arm out for a shot of morphine and hospice, he said simply, “Let’s go for it.” Six and a half hours later, minus eighteen inches of small bowel, he was brought to the ICU where I was asked, as his next of kin and medical power of attorney, what his code status was. You know the answer. Despite all of my previous prejudices against family members who refused to acknowledge the obvious—that 90 year olds have to die sometime, he was a “full code.”
Dad is back home now in his own apartment, feeling a bit tired but generally speaking no worse for the wear. Despite the fact that my sister and I were at his bedside continuously for a month, when he returned home, he sent a long email to all of his friends describing his ordeal and thanking his girlfriend Evelyne for her devotion to his care. His daughters were cc’d on the email. After a serious bout of righteous indignation, I reminded myself that patients NEVER remember their time in the intensive care unit, and that is a VERY good thing. The entire family will be headed to California in ten days for his big 90 birthday, and we couldn’t be more thrilled.
Happy Father’s Day, Dad, and we sincerely hope there will be many more. Your loving daughter—M.