Bo Caldwell

My dad taught me many things. He taught me that if you had enough duct tape, you could fix anything, and if you had enough extension cords, you could plug in anything anywhere. He taught me that each day, you should do three things: take care of your responsibilities, do something for someone else and have some fun. He taught me the importance of being myself and of aiming high in terms of what I wanted. With my mom he showed me, by example, how to live a faith-centered life, and he taught me about marriage. And indirectly, I learned from him about something he never meant to teach me and would have preferred not to: how to see someone you love go through heart surgery and come out on the other side.

Nine years ago, with my mom and brother, I sat with Dad before and after he underwent a triple bypass. I was diligent about learning the particulars of the assault that would take place on his body. So last April, when my husband learned he would need open-heart surgery to replace his aortic valve, which was bicuspid rather than tricuspid and had been the cause of a condition called aortic insufficiency, I knew a great deal about what the surgery would entail, thanks to Dad. My mom said, It’s good that you know, and it’s bad that you know. My brother was more direct. You know too much for your own good, he said, and I agreed.

I knew, for example, that to reach the heart, the doctors would have to cut through Ron’s sternum and then open it like church doors, a fact that in and of itself is terrifying. They would cool Ron’s heart down in a potassium bath; if they didn’t, the heart would pump too fast. He would then go on bypass, a life-support system consisting of a heart and lung machine connected to his circulatory system to relieve his heart and lungs temporarily of their normal functions while the heart was being worked on. During surgery, blood would be circulated through the machine, where it would receive oxygen and then be pumped back through the body. When the doctor had finished his work, Ron would go off bypass, and the sternum would be wired shut with sutures that would not need to be removed. Finally the chest would be stitched back together. I knew that he would then go to I.C.U. and after that to a cardiac unit. I knew that even a successful recovery would be slow and painful. His chest would hurt, he would tire easily, he would not have much of an appetite. He would not be able to drive for six weeks, not because the act of driving is strenuous, but because of the damage that would occur if he were in an accident and his chest hit the steering wheel.

And I knew about the things that could go wrong. That bypass was not the only surgery we saw Dad through; six years after the bypass, he underwent surgery to repair an abdominal aortic aneurism; and while the surgery itself was successful, Dad suffered the first of three strokes a few days later. The first stroke left him unable to talk; the second, unable to walk; the third resulted in a coma. He died two months and two days after surgery.

What I did not know I learned on the Internet, late on the night we were told of the date for surgery. I learned that there were two kinds of valves used, tissue and mechanical. The body adapts more easily to tissue valves, but they wear out, usually in about 10 years. So in younger patients, like Ron, they opt for the mechanical valve, which is made of durable metal and is attached to the tissues of the heart with a fabric ring. Mechanical valves last for 100 years; the drawback is that the body never really accepts it, so it causes the blood in the valve to clot, which means the patient must be on an anticoagulant like Coumadin for the rest of his life.

At a little after 5 in the morning on the last Monday of April, a week after Ron had learned he would need surgery, he and I drove to the hospital to begin our waiting. The angiogram would be first, to see if anything else was wrong, so that there aren’t any surprises for the surgeon, the cardiologist said. Surgery would be Tuesday. At the hospital, with the morning still dark outside, we waited to register. Then we waited in pre-op for nurses to take Ron’s medical history, blood and vital signs. Two hours later, he was given Valium, and finally the anesthesiologist told me to kiss him goodbye, which I just barely did without tearing up, and I went somewhere else to wait for the results of the angiogram.

Two hours later, there was good news: my sweet husband not only had the lungs of a giant, but the arteries of a boy, so except for the valve, all was well. Having done my homework, I had hoped this might mean a less invasive surgery, with an incision between the ribs rather than through the sternum. But no, they would still go in through the sternum.

The next morning, I waited again, and at a little after 11 o’clock, almost four very long hours after I kissed Ron goodbye the second morning in a row and they wheeled him away, the surgeon came into the waiting room with the wonderful news that all was well. Ron had done great, no problems whatsoever; he not only looked 30, but had the physiology of a 30-year old, not bad for someone 55. They were very impressed. In the I.C.U., he was alert sooner than anyone expected, looking around the room, taking everything in. His recovery, the I.C.U. nurse said, was as good as it gets. He was attached to more tubes and monitors and I.V.’s than I could sort outa breathing tube in his mouth, a chest catheter, a Foley catheter for urination, a heart monitor, several I.V.’s and while it was difficult to see him that way, I was prepared for it, thanks, once again, to Dad.

I have never been so happy to see my husband; I was relieved and grateful and joyful and a little shaky and overwhelmed with it all, and I felt God’s joy, too.

Through that long day and the other days and nights that followed, with nurses in and out and morphine shots every two hours and Ron’s pain and discomfort clear, and my anxiousness with me like a shadow, I felt God with us, sometimes quietly, sometimes more loudly. But it was on the morning of the surgery, in the anxious hours before the operation when nothing was certain and when the fact of Dad’s strokes haunted me, that God was most present.

It had been a bad night. Ron was in a double room, and his roommate was an older man who was neither well nor happy. The roommate had visitors all day, mostly fellow curmudgeons who talked of Iwo Jima and the patient’s complaints, which were many. He had had his gallbladder removed, and now he had kidney stones. He was diabetic and could not walk unaided. His wife, who was at home and unable to visit the hospital, was also not well. Neither of them could drive. The roommate kept his television on all day, the volume highhe was also hard of hearing.

After all those visitors during the day, I thought the roommate would sleep well that night, but he didn’t. He was awake much of the time, still with the TV on, though with the sound off. He grunted and moaned; he called for the nurse often, for medicine or a drink or help to go to the bathroom; and he described his bodily functions to her in embarrassing detail. At random times throughout the night, he cursed loudly, to no one in particular.

On the other side of the thin curtain dividing the room, Ron was in his bed, trying to sleep. I was sitting next to him, on two chairs pushed together, dozing when I could. We did not sleep much; over and over again, we exchanged looks. We checked to see if the other one was awake; we shook our heads when the roommate cursed, each of us thinking, Can you believe this? We held hands. Nurses and aides came and went, drawing Ron’s blood, checking his vital signs. And I prayed a simple repetitive prayer, asking God again and again to keep Ron safe and well.

Finally, at four in the morning, I knew I would not fall asleep again. We had been told they would come for Ron at 5:30, and next to a guarantee that all would be well, the only thing I wanted was to be close to him. So I took off my shoes and lay down next to him on the hospital bed on top of the flannel sheets they call blankets. Knowing what I wanted, he turned on his side, his back to me, so that I could hold him, and I did. And suddenly God was right there with us, in that simple moment: so very present in the solid feel of my husband’s body against mine, in the press of his strong back against my chest, in the hospital-tinged scent of his hair, even in the sound of the roommate’s loud snoringfinally, in the dark hours of morning.

We did not stay like that for long. As it began to grow light outside, nurses came for one thing or another, readying Ron for surgery, and I got off the bed before anyone saw me. But those few moments helped, in that dark, presurgery uncertainty. Maybe they even got me through that long day. The unexpected chance to hold him, even for a moment, before the ordeal of the next few hours, was graceGod present with us, and getting us through what lay ahead, one moment at a time.

Bo Caldwell, author of The Distant Land of My Father, a novel, lives in Northern California with her husband, the novelist Ron Hansen, and her two children.

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