Eleanor, Jake’s wife of 62 years, was our best source. Slow afoot due to Parkinson’s disease, she did not have any problems with her memory, as many Parkinson’s victims do. She never would come with him to his appointments, so I phoned her every time he came in to get a progress report and check his medications. Soon after the first of these checkup calls, she came in for an appointment for her hypertension and Parkinson’s. At the conclusion of our visit, she stood up with the grace that she battled to maintain, looked me in the eye, and advised me in her soft, gravelly voice, “Find out what’s wrong with Jake. Because if he goes, I go too.”
At that moment, I was looking at my grandmother. My grandfather died of lung cancer in 1980 after 50 years of marriage to my grandmother, a female executive in an era when she had few peers. Tall, proud, elegant, and stubborn, she never again wanted to be alive after he died, much to the chagrin of my mother, who was her only child, and the rest of our family. She survived another 13 years before succumbing to complications of a hip fracture.
I knew Eleanor meant what she said. Feeling the eyes of an entire hospital watching me, and remembering Eleanor’s grave warning sounding against my eardrums, I enlisted the help of a local neurologist. He spent two visits interviewing and examining Jake and sorted through the results of the head CT scan, the blood tests I had ordered to check Jake for thyroid dysfunction, vitamin B12 deficiency, and syphilis, all of which were negative, and the hospital records. To be thorough, the neurologist ordered a 24-hour Holter (heart) monitor to be more certain that we had not missed an important heart dysrhythmia during his short hospitalization. We were never able to overcome the obstacles of Jake’s forgetfulness and transportation difficulties to get him into the cardiology office at the appropriate time to get the Holter done.
Eleanor and Jake confirmed at this visit that his condition had not worsened and that he had still not followed through with getting the Holter, which I now wanted for a different reason: I was hearing extra heartbeats when I listened to his heart, so I wanted to be sure that these extra beats were not potentially dangerous. He was not having any chest pain, and his energy level was quite good. I gave him and Eleanor detailed written instructions, in the hope that he would be able to follow through and get his Holter monitor and an ultrasound of his heart done before his next visit.
None of us expected that Jake would die a few weeks later; he was too cheerful for that. Pneumonia remains in the top five causes of death every year, and those who die often succumb to problems in vital organs other than the lungs. One year before Jake’s illness, I got a call from one of my mother’s best friends. She had just taken my mother to a local Kaiser emergency room because my mother was having severe chest pains. She had pneumonia, which stressed her heart enough to cause it to convert out of its normal sinus rhythm into atrial fibrillation, a chaotic rhythm that causes the heart to beat rapidly and pump blood inefficiently. My mother was 15 years younger than Jake, which is perhaps the main reason she is still with us. Shortly after the bacteria invading his lungs proliferated into pneumonia, Jake’s heart had also converted to atrial fibrillation, but his was unable to pump all the blood his vena cava was returning to it, and therefore the extra fluid backed up into his lungs. The combination of congestive heart failure and pneumonia made it impossible for the hospital team of doctors, nurses, and respiratory therapists to deliver enough oxygen through his lungs to sustain his vital organs, even with a ventilator, intravenous antibiotics, and our strongest medications for the heart. None of this had anything to do with what had been wrong with his brain.
Medicine in the 21st Century has created hospitalists to take care of every patient in the hospital, excluding those of us in primary care, so I had not been involved in Jake’s care at the hospital. I called Eleanor when I learned of Jake’s death. “All of those doctors in the hospital, and not one of them could do anything to save my husband,” she began, perhaps implying that I, too, had failed her in that regard. She then gave me the details. I listened, knowing that now wasn’t the time to explain that the death rate for all of us is still 100 percent, and recognizing that I could not repair the defect her partner of 62 years created when he left. She moved to an independent assisted-living facility, where I went to see her once in her apartment after a bad fall, and then I never heard from her again. I assume she followed through on her warning.