Terry Wahls, MD, MBA
My partner, Jackie, asks Grandma if she would like to come with her to watch the dress rehearsal for the Vaudeville Revue. Since my children, Zach and Zebby, were toddlers we have called my mom “Grandma.” I thought it was less confusing to my kids to have me use the term that they used when talking about their grandma.
Grandma turns to her granddaughter and smiles and says, “No. Zebby, I am going to wait for opening night. After all, I am going to every show. I’ll see it plenty of times.” As we depart, she tells Zebby to break a leg.
Arriving at the theater, I go to the green room and pick up the tool box filled with make-up. I take another puff from my inhaler, and start on a redhead girl who sits down at the vanity. It takes us just over an hour to get everyone in makeup and costume.
At seven, the directors, June and Brenda, start the show. As Jackie and I watch the show, we are impressed with how great Zebby is doing, especially since she is only eight. June tells the kids they have a great show. Fortunately, in spite of her excitement, Zebby falls asleep in the car, and does not wake up when Jackie tucks her into bed.
The next morning I am awakened early by someone calling my name. I get out of bed. Following the sound, I walk down the hall, and then down the stairs.
Grandma is on the floor next to the couch, beads of sweat on her face.
I kneel beside her, and put my hand on her forehead. Her skin is cold and clammy. She does not look good.
“Is it like when you had heart trouble?” I ask.
Grandma shakes her head no.
“I hurt...” Her voice is soft, hard to hear.
She needs to get to the hospital, but I doubt that she can get up the stairs. I tell Grandma I will be right back, and turn to run up the stairs. Jackie however, is walking down the stairs, talking on the phone.
I return to Grandma’s side, and ask what happened.
“It started with several bouts of diarrhea, then some vomiting.”
I lean closer to her, trying to hear.
“I did not want to wake Zach, so I got the bucket and lay here. My pain is worse, a lot worse.”
A police officer is the first to arrive, and wants to know what medicine Grandma is taking. He says an ambulance is on its way. I tell him she has had heart trouble and start listing her meds. A couple minutes later, the paramedics arrive. Immediately they begin working on Grandma. One gets the oxygen going for her, another checks her blood pressure, and then starts working on an IV. The third begins cutting away her flannel nightgown, attaches ECG pads, and hooks up the heart monitor. I stare at the monitor.
Jackie pulls on my shoulder, and says, “Terry, go upstairs and get dressed. You need to go with your mom in the ambulance.”
I had not thought of that. I nod, and run up the stairs. When I come back down the hallway, the paramedics are rolling Grandma, strapped to a gurney, into the ambulance. Jackie asks if I can ride in back.
The paramedic extends his hand, pulls me up into the ambulance, and tells me to sit down on the bench and buckle my seat belt. The siren begins wailing, and the ambulance takes off.
I stare at Grandma, my mother. She is young, barely over sixty. What is happening? I decide it must surely be her heart. I cannot reach to hold her hand. Within minutes, we are inside the garage at the emergency room. Doors fly open. Mom is unloaded. The nurses on one side, the paramedic on the other, they grab her gurney and run into the emergency room. I jump down and follow. They take her to the trauma room, filled with people waiting. I stop as the double doors close.
A voice behind me says, “It’s OK Dr. Wahls. You are on staff, no one will mind.”
I’d walked in on the team coding my father when he died seven years ago. I do not need to watch the medical team try to stabilize my mom. I back away, and say, “No, I will wait.”
Someone taps my shoulder, and says, “Are those her medicines?” I see her point to the bag in my hand. That is right. Jackie had given this to me before I left home. I give her the bag, answer a few questions. She joins the others in the trauma room.
I walk back to registration, give them my mom’s name, my name, and tell them her health insurance is still the same. Then I wait. Thoughts race inside my head. One moment I am a doctor, running down the possible diagnoses. Heart attack continues to be my best guess. The next moment, only chaos exists in my head. I want to be with Mom.
I hear the swoosh and click of the automatic door to the outside, and look up. It is Jackie. She was able to get a hold of our friend Tanya, who is now at the house and will get the kids off to school.
The ER doctor comes out. “Her blood pressure was only 60 when she arrived. We gave her a lot of IV fluids, and got an ultrasound down here. Her aorta was 12 centimeters.”
This is bad, very bad news; 12 centimeters is much too big. Vascular surgery schedules people for elective repairs if the abdominal aortic aneurysm (AAA) is five centimeters.
“She is up in the CT scanner now, and will go straight to the OR after. The surgeons were already in house.”
I feel sick. Few people survive emergent repair. My surgery rotation in medical school was in vascular. Hour after hour we held retractors and got yelled at by the surgeons and anesthesiologists.
Jackie asks where we should wait.
“That is a good question. Our day-of-surgery waiting room does not open up until eight.”
Jackie and I sit, and watch the clock. We talk about how fortunate it was that Mom had come down for Zebby’s show. If she had been home alone, she would have died. It was good she was with us, that I could answer her call.
I think about those cases from medical school. They are crystal clear now. I was in on several emergency cases. As the medical student, I stood hour after hour, doing nothing but watch, scrubbed and dressed in my gown and gloves. In my mind’s eye, I see the vascular fellow with a clamp in one hand. With the other, he is reaching deep into the belly of a patient.
“The hard part is the beginning, when the surgeon must clamp the aorta.”
I see the fellow; he reaches, curses, and reaches again. The tonsil suckers, which suck up blood and fluid to keep the surgical field clear, are placed in his belly. Two more are given to me to hold, making three in his belly, but it is not enough. Blood fills the abdomen; runs down the drapes. I see the fellow reach, and reach. He asks the senior resident to try. More cursing, but he shakes his head. I see the fellow put the clamp back on the instrument tray.
“You see, if you cannot clamp the aorta, it is over. The person bleeds to death on the table.”
I return to the situation at hand. I know all too well, that emergency repairs like this are either over, almost before they begin—that is, within minutes—or last several hours; so waiting provides me comfort. Things must be going well.
As it approaches eight o’clock, the activity in the hospital increases, but so does my coughing and wheezing. I look for my inhalers, but my pockets are empty. Jackie says she sent my inhalers with me. I imagine that they must be in the bag with Mom’s medicines, wherever that is. I will have to do without.
It is almost nine. I tell Jackie that they surely must have been able to clamp her aorta. My thoughts then turn to my patients who survived their AAA repair—only to linger in the hospital and, then, the nursing home. Usually there was kidney failure, with dialysis at least for a while. Others had dementia from a lack of oxygen to the brain during the case. Many would have been better off dead.
I pray that my imagined scenario will not be the case for Mom, that being with us and getting to the hospital quickly would be a blessing and not a curse for her.
I cough more, and begin to wheeze. Jackie calls the emergency room, but they do not have my mom’s medicines. Next, she tries the operating room. They do not have them either.
At 9:27, my pager goes off. I call the number. The person wants to know where I am at. Nothing more. I stare at the phone. A few minutes later, a young woman appears, and takes us to the family conference room; the doctor is on his way.
When the surgeon arrives, he first apologizes for the delay in getting to us. “Everything was so fast; we thought she was a hospital transfer. I did not know there was family waiting.”
Jackie holds my hand.
“When she came from the CT scan, she did not have a blood pressure, and they were doing CPR on the cart. Her belly was full of blood. As soon as we opened her abdomen, whatever had been slowing the bleeding was no longer doing so.”
Jackie holds my back. I know what comes next.
“We just could not get control; I could not get the clamp placed.”
I cry short gasps of pain. He apologizes again. My mom had died shortly after 6 a.m. Again, he tells me everything happened so fast.
He says she really was much too young to have an aortic aneurysm. My brothers and I should be screened for AAAs when we are about 50. Then he asks if I have any questions.
The questions racing in my mind are to me, not him. Why did I not see that she was dying? Why did I not hold her and tell her I love her one last time? Why is she dead? How did I not see? I weep silently, unable to speak.
Jackie asks if it is possible for us to see my mom.
“Yes, that is possible. She got a lot of fluid and blood before she died. Her face, and tongue are very swollen. You may not recognize her.”
I nod, and say, “I would still like to see her.”
Next, the mortician arrives. He has papers for me to sign. Then he takes us to Mom. An endotracheal tube is in place. Her face is distorted, tongue is swollen, protruding from her mouth, but she is still my Mom.
Why did I talk to the police officer instead of Mom? How did I not tell her I love her before she was taken from me?
The mortician gives me a bag with my mom’s grey fuzzy sweat night shirt, her watch, a bracelet, and her medicine. I take a couple puffs from my inhaler.
Her hand is cold, but I hold it anyway, staring at her face, trying to remember a lifetime. Finally, I kiss my mom’s cheek and say good-bye. At home, I weep, thinking how cruel this is for Zebby.
“It is opening night; our Zebby has worked so hard!” I say, and start crying again.
Jackie holds me, and tells me she had already called June to let them know why Zebby will not be at the show tonight.
I tell Jackie we need to get Zebby now. She needs time to digest everything, because Zebby should get to decide about the show.
We drive to Zebby’s school. I go to her classroom, and ask for Zebby. However, when I see her, I sob uncontrollably, and cannot speak.
Zebby screams, “No! Tanya said Grandma was fine! No! No!”
When I try to hug her, Zebby howls and begins hitting my back. At home, Zebby runs room to room, slamming doors, throwing books from her bookshelves, and stomping on the floor. She runs outside howling. Jackie follows her.
Zebby comes back inside, runs room to room, wailing, screaming, and then whimpering. Still she will take no comfort from me.
Jackie says, “It is almost three, school is going to be out. You need to get Zach. I will stay with Zebby.”
When I see Zach, I am unable to speak. Tears stream down my face, and he screams, “No! No! Tanya said Grandma was going to be OK!”
At home, Zach runs into the house, shrieking. I do not see Jackie or Zebby and find them downstairs on Grandma’s bed. Zebby is cradling Grandma’s picture, kissing it over and over. Tears still stream down her face.
Our friends, Tom and Barb come sit with us. Kevin and Linda bring supper. After they leave, I talk to Zebby. I tell her we will feel bad no matter where we are.
“It is up to you. Tonight is opening night. We can stay home, or we can go do your show.” I am not sure Zebby can hear me.
Jackie puts food on the table. We sit down; we look at the food on our plates and at each other, but do not eat.
Zebby shouts, “It is not fair!” She bangs the table with her hand, rattling our plates. “Grandma was saving it for opening night. She’ll never see it now.”
This time she lets me take her onto my lap. I hold her, and stroke her hair. “No, it is not fair,” I say softly.
Then I put my hand under her chin, lift her face to look at me and say, “Zebby, if Grandma said she was waiting for opening night, then I think somehow, she is going to be there. Her spirit will wait to watch your show.”
Jackie cleans up supper, while I hold both kids. Then, Zebby stops crying, looks up at the clock, and says, “It is almost six-thirty. We need to hurry.”
We throw on our coats, and go to the theater. Zebby and I run inside, while Jackie parks the car. June is startled when we appear and leans down to hug Zebby. As Brenda whisks Zebby off to get her make-up and costume, June turns to me and says, “Jackie told me. I am so sorry.”
Even in her make-up, Zebby’s eyes are bloodshot and swollen. Thankfully, the other children do not ask her why. Jackie appears with Zach; she tells me that she will keep an eye on Zebby backstage, but that Zebby needs me to be in the audience.
She is right, that is what Zebby needs.
Zach and I go out and take our seats. The house lights darken. As they come back up, kids stream onto the stage.
There is Zebby, singing, smiling through her tears. Zach holds my hand, and whispers, “Mom, Grandma is here somewhere, isn’t she?”
I put my arm around him, and say, “Yes. She told Zebby she was waiting for opening night. She is here.”
Through my own tears, I pray that it is true. That Grandma really is here, watching her Zebby sing.
Dr. Terry Wahls is an Associate Clinical Professor of Medicine at the Roy J. and Lucille Carver College of Medicine at the University of Iowa. She has a joint appointment with the Veterans Administration Medical Center and the University of Iowa Hospitals and Clinics. She is currently the Assistant Chief of Staff for the Iowa City VA. Dr. Wahls is the author and co-author of approximately 60 publications and abstracts, including Up from the Chair and Food as Medicine. She conducts clinical research in patient safety and communication within the healthcare team. In addition to her clinical and administrative work Dr. Wahls is writing and speaking about her descent into severe disability due to progressive Multiple Sclerosis. After four years in the wheelchair Dr. Wahls devised her own intensive treatments using intensive nutrition and electrical stimulation of muscles. She now bicycles five miles to work each day and lectures extensively about her experience. Visit her website at www.terrywahls.com