My Mother

My Mother

The Last Days

I spent the last three nights preceding my mother’s passage at her bedside. I really had nothing to offer except approve the medications which would bring her comfort in her final struggles. Although she had accepted dying, her body’s underlying circuitry fought it and sent signals of alarm to her senses. I asked the excellent staff at the Mike Conley Hospice House to give her morphine and Ativan at doses that would ensure that she would not be aware. That first night, when she would acknowledge my presence with opening of her eyes, I said my goodbyes. I told her I loved her, and I thanked her for all the care that she had given to me to put me in my place in the world. As they were cleaning her, as I was leaving the room, she opened her eyes and locked eyes with me with an intensity I hadn’t seen for months. She nodded her head, and closed her eyes. That was the last time I communicated with her.

The following two days were spent waiting. Her antirejection medications had been stopped and even without a stethoscope, I could hear the rattling of her good lung, the gift from a young woman whose family saw the good in giving life in the midst of tragedy. I thanked them again  for the two and a half years that gift gave us. She was able to see my older son grow from a large toddler to a tall, happy boy only a few years from young manhood. She saw the arrival of my youngest only a few months ago to great happiness. The extra time that gift afforded was priceless.

As the breathing failed, so did the kidneys as she had stopped swallowing, and her blood pressure waned. I knew the time had come on that final morning when I was roused by the oncoming day shift nurse. My mother was beginning the agonal respiratory pattern I had seen so often before in my training and my practice, but this was so different. I called my sister, my father, and my aunt. My father who had been by her bedside every day after her transplant for 4 months, until he himself had a heart attack and needed bypass surgery, who had changed her and bathed her for the better part of a year, told me he didn’t have the heart to watch her die. I hugged him and told him that I would be there, and my sister, and my mother’s sister agreed as well to help my mother through her final passage.

The end came after noon time. Again, I watched her breathing impassively -shallower and more desperate as her head tilted back to gasp at the air like a fish left on the dock. I had to tamp down the urge to jump and start all the motions and actions that I had trained for years to do, and that left me reduced, small, and I was a little boy again. As her last breath came, I could swear she said something, mouthing something, but I couldn’t understand. And then it was over. I felt her pulse and called it at 2:20pm.

The Condition and the Treatment

My mother was visiting us in 2005. We had moved to Des Moines and it was a Christmas visit that was also a medical one. She had a chronic cough and had had CT scans and pulmonary workup in Florida, but wanted definitive care at my hospital where I could be around to help.

Mother, early 20's

I asked one of my partners, Dr. Marnix Verhofste, to perform the lung biopsy which the pulmonologist, Dr. Michael Witte, had recommended. As she was recovering, the diagnosis came back, and it was not good. Idiopathic pulmonary fibrosis -idiopathic because its cause is unknown and its treatment was lung transplantation.

She was started on oxygen and for the following years, it wasn’t terribly bad as her oxygen needs weren’t too taxing and her quality of life was good. She was not keen on transplant, but a conversation with another patient at a pulmonary rehab center in Orlando convinced her. He said, “Just do it.” She wanted to be listed. It was summer of 2007, and she told me that she wanted more life. That she wanted to see my son grow a few more years. At that point, she was on oxygen all the time and panted going from bed to bathroom. We took her to Mayo Clinic in Jacksonville, Florida, where the excellent team lead by the indefatigable Dr. Cesar Keller worked her up and got her listed. Almost as soon as she was listed, she began deteriorating rapidly, and it seemed that she would die while waiting, but miraculously, we got a call in early 2008 that a lung was available. She was given a single lung transplant by Dr. John Odell, and initially it seemed to go well, but she was unable to stay off the ventilator. She required a tracheostomy and it was found that she had an injury to the phrenic nerve, paralyzing her diaphragm. As a surgeon, I understood how fragile that nerve is, and that sometimes, its function would come back.

She recovered slowly but had other setbacks including a decubitus ulcer, loss of continence, and need for tube feedings as her swallowing was deranged. In the span of three months, she seemed to age twenty years. My father never left her side the entire time, and it took its toll. As she neared discharge, he developed chest pains that he ignored until he became incapacitated by it. He was taken to the cath lab and then to the OR. I arrived in Jacksonville with both parents critically ill. As they recovered, it was clear that they could not stay at home in Clermont, and I was at a loss for how we would get them both back to Des Moines. It was suggested by one of the staff that I rent a mobile home. It was a memorable family road trip driving back to Des Moines that June.

She never fully recovered. It started with eating -her teeth fell out that summer and the first set of dentures caused her to gag and vomit. The second set didn’t help and her weight dwindled and we had a PEG placed by Dr. Ryan Cook, interventional radiologist. This brought her weight back and we figured out a liquid diet regimen. That said, she was never the same. When she looked in the mirror, she was shocked at the transformation the seven months had wrought. My dearest memory from that summer as a dai-shikgu -large family, she decided to cook steamed trout with a ginger, pepper, soy sauce that I still remember to this day.

Mom, in high school

The following two years was a series of hospitalizations and medical emergencies that put great strains on my father. When she became jaundiced this past spring, I think she decided that it was time. She stopped walking and became bed bound. We visited her at the end of June to introduce her to her newest grandson. I knew that it was near. I told her, “As long as you eat your formula and drink, you’ll be all right.” She looked at me and I could tell that she was making a decision not to eat so much.

Mom, sewing

A final visit to Mayo brought the understanding to my father who was in a great deal of denial that she was dying. Hospice care was arranged for, which he resisted but assented to after some discussion. She resisted eating, but was fastidiously clean to the end, insisting that after every diaper change that she be allowed to wash up, that every stained clothing or blanket be washed. I visited her twice, the second time with my older son who had a chance to say goodbye. It was the third visit that I knew was a final one, and even then, I almost didn’t come down if it weren’t for the insistence of my partner, Dr. David Chew, who said it was my place to be with her.

Grieving

Grief is not just an emotion but a physical condition. It rains down on you and sticks to you, weighing you down. I understood the images of ancient Greeks who rended their garments and tore at their hair. I wanted to scream but nothing came out but a groan and tears, lots of tears. The spit dried and I felt I was choking. This lasted about ten minutes, and I called my father, who came and grieved as well. My sister and aunt, we all hugged in shared grief. The clinical distance and measured empathy I always had with sick patients and their families -gone. We waited until the hearse came from the funeral home, and then went to dinner. In the distance, over the hospice, we saw a miraculous rainbow.

A Life Deferred

My mother was born from a well established family in Seoul whose fortune came from land that survived Japanese occupation

Mom, age 1

and the Korean War. Her parents generation dissipated that fortune leaving her generation to strive. Her brother went to medical school with my father, who became enamored of her, and after a brief courtship, they married.

The first years of marriage were difficult for my mother who entered my grandfather’s household as the wife of the second son in a large household which required a lot of work -cooking, cleaning, and washing took up so much of her time and she lost so much weight that it was clear that my father had to take her out of that situation. I was born after the miscarriage of an older brother who died soon after birth. We immigrated to America in the winter of 1971 to New York, our Ellis Island was Hawaii where I remember our precious oranges being confiscated. That first year was hard as I never saw my father who started an internship at the Knickerbocker Hospital in Harlem. When my sister was born, my mother went next door to the neighbors to watch out for me and she walked to Roosevelt Hospital. I woke to an empty house and I walked over to the neighbors -the gentleman was a classmate of my father’s, and I had a fried egg and chocolate milk.

Mom, Dad, and me

She devoted her life to raising my sister and me while deferring her own life. My sister and I still discuss whether it was a choice made from sacrifice or from a passivity that we also acknowledge that she had. She was a traditional Korean wife and mother who was firm in establishing priorities -for me, it was to go to Harvard and become a doctor, but also to become a good person -a human being as defined in the old Korean sense of someone worth the title. When I got into Harvard, we went to Korea and there was a reunion of her high school class, and they gave her a standing ovation as she outshone all the ladies who had gotten their sons into Seoul University -I think this was the high point of her life.

While I was growing up, I never wanted for anything because of the sacrifices of my parents. I saw it as a terrible burden, but now in retrospect, it was an incredible gift. She was gearing up to play a similar role for my sons when she fell ill, and I think that my older son will miss her terribly. She took care of him as an infant, sleeping with him to give my wife Jennifer a break, and she made me promise that I would give my sons the same effort and consideration that she gave me.

She did not write great novels or achieve great fame. She never finished college which she was acutely sensitive about, but she never stopped studying. We have boxes of her English textbooks that she studied vigorously, hoping that through effort she could master the one thing that she felt was deficient. And bike riding -she never rode a bike because she was told it was unladylike in the draconian confines of her childhood. So she said, but my sister and I figure it was something that was self imposed. She was rigid that way. Her mother, in fact, was a tennis champion in college. She was the keeper of a very old flame, an example of the old Korea that no longer exists.

I suppose what made her great was that she was my mother -one who could cook like no other and would stay up to make sure I got home. One who read to me every day during childhood and got me to Cub Scouts in a pressed uniform. One who even in her waning days would notice everything about me, who knew my moods and my tendencies before even I was aware of them. I will miss her terribly as I think about all the things she turned down or postponed to make sure that I got to achieve, see, and do great things.

Hope

The rainbow after her death raises a perennial question for me. The scientist in me says it is simply a coincidence, but the human in me marvels at the sight and its proximity to my mother’s passing. It gives me hope and fills my heart with the kind of strength that my mother’s wonderful meals used to. I can only think of it as a final gift from a loving mother.

Mom, 2006

When bad things happen to good people…when things happen…sh*t happens

I have seen sparks fly from my golf shots. Typically, you have to be in low light. The most vivid example of this was when I played Van Cortlandt in the Bronx at 5:30 in the morning many years ago. The ball was dusted in flinty sand found there -the glaciers ground the bedrock which is composed of granite, flint, and some chalk. The impact of the metal driver on this rock caused sparks which were really cool.

Unfortunately, in the instance of the golfer above (link), the spark landed on the tinder of dry California scrub land, and started a 20+acre wild fire. Typical of golfers, they reported what happened, but even more silly is the fact that authorities have to protect this golfer’s identity from a lynch mob.

And this is it -our brains are not wired to accept circumstances of nature as they are but demand an explanation rooted in personal values, usually interpreted as good and evil, sometimes confusingly both. There is the inability to accept a stochastic interpretation of events as series of causes that arise from probabilities. Without this overlay of moralistic interpretation, the self dissolves a little.

That’s just it -in acquiring self awareness, we also get the baggage of self importance. Free will is the other lie that we tell ourselves to assure ourselves of our critical place in nature, because most people freely shackles themselves in the strait jacket of religion, tribal/racial/identity politics or just narrow mindedness.

Shit happens, people. Move on.

Holding your hand in the fire

In some parallel universe of his choosing, Dustin Johnson would be a two time major winner. Instead, by his sin of ommission, he will be burdened with the mark of Cain for the remainder of his career. Dustin Johnson tried to get away with grounding his club in a bunker on national television. That is the only conclusion I can come to after seeing the video yesterday. The players received notification prior to starting the tournament (and it was posted in the lockers) that all of the bunkers, even the ones trampled by spectators, would remain bunkers. On addressing his approach after slicing his drive to the far right, he grounded his club but then stepped away as if he noticed he made a serious mistake. He can be seen considering the situation, and he hit his shot without grounding the cub a second time.

After his round, he was brought upstairs to review the tape in a scene familiar to shoplifters and mall cops. I have no doubt that Mr. Johnson is very talented, but his narcissism was revealed for the scrutiny of the voyeurs. His profession is to compete and uphold the rules of golf. Ultimately, the golf must come from a pure place. The PGA saved itself a lot of controversy by taking care of the issue before any playoff ensued. By signing his card, Mr. Johnson signed his confession. This burden will be his albatross and may end up consuming his swing thoughts, but I doubt it. If he is to compete again at this level, he will have to be continue in his selfish, thoughtless way, with total focus on dominating and winning. Champion golfers are different from you or me, and I think Mr. Johnson will redeem himself in this world.

Golf Passage of the Mysteries

A poem written driving from Detroit to Des Moines after we missed a connecting flight, we were returning from a spring golf trip to Hilton Head, myself and several most excellent golfing companions. As we pulled out of a convenience store lot, I had the vision of a wizened old man, a specter, hailing us with the following words…
Five and One man, on a journey!
Heading westwards, on into the night.
Burdens shared, and sleep neglected,
Y’all crossing the river, and arrive at first light.
Great joy you have found, and more do you seek
Onwards and onwards, for promises to keep,
Hammer on the right foot, no shoe on the left
Still many hours, before you shall sleep.
So go, I say go, and listen No More,
I am an illusion, but so is your labor,
That ball is not a ball, that hole is not a hole,
And that last hasty meal, you will not savor.
And when you are home, and you lay in your bed
Alive you will feel, alive with no dread
And in seeking all that golfin’ pleasure,
You realize the truth that the company is the treasure.

The Perfect Golf Shot

I played 27 holes this weekend. My 9 holes yesterday were played in windy, cool weather and I got a 50 for my efforts. It was notable for a par on the treacherous second hole which has a tilted green. I hit 5 of 7 fairways yesterday but three putts and botched approaches made life difficult.

Today, I hit the reset button and armed with a new 58 degree wedge from Callaway, I set out solo onto an empty course. The picture above is from the first hole. My drive was directly into a 20 mile per hour wind which made the 48 degree weather a touch more miserable -hence the absence of players on an otherwise very golf-worthy Sunday morning. The drive was in the left rough off the first cut, leaving me 200 yards out on a sidehill lie that left the ball below my feet. I tried to play a duck hook around the tree, but I lost my balance and lucked out by having the ball settle on a steep upslope with line of site to the green.

The first hole at Wakonda is officially a par 4, but it really is a par 4.5, and with the wind, it was a stretch to make par. I was 150 yards out and the pin was in the middle of the green -the green tilts to the right and I had to land the ball center or left to get to a makable par putt.

The wind was going a sharp right to left and the green is a good 20 feet above me. The ball is on the upslope. I chose to fade a 5 iron -the upslope would take some of the distance off and the fade into the draw cross wind would straighten the shot, I hoped.

It is always here on number 1 where I have my most intense golf moments -where concentration and visualization becomes very clear and I decided to pour myself into this shot. I set up aiming slightly to the left of the pin and practiced a fade swing, trying to keep my head still and my shoulders in line with the slope. The shot I had in mind was “locked in” and the actual shot became the apotheosis of my mind’s vision.

The ball launched after a clean hit -this is so important on wet, sodden grass, and the ball kept climbing and going straight -this despite my having hit a near slice. The winding motion of the ball that normally creates a slice now was creating more lift with the right to left wind. The ball landed on line with the pin and I knew the ball would be 10 feet from the cup with a straight uphill putt (image -right).

I missed the putt by a hair, but still made a 5 which on this day was fine. I ended up with a  47 on the front -a great round given that I had great difficulties with my initial approach. After 18, I hit 10 of 14 fairways, but made only one green in regulation -this will require work. Despite this, I am still in bliss from the perfection of that approach on number 1.

The Circle of Certitude

The circle of certitude is the area defined by the radius within which you have a 90% chance of making it into the cup within 2 shots. For the average bogey golfer, this is about 10 feet. For the single handicapper, this is anywhere near the fringe. For a tournament pro, this circle is out at the wedges. To win major tournaments, this circle spans the 150 yard marker.

In daily life, we have many such circles of certitude where results are likely to occur. It may be only as far as the arm’s reach, or the driveway. Careful cultivation of friends and communication skills brings this circle out to across town, state, nation, and globe.

Cast your circle of certitude wide. Live with no doubt.