A Father’s Passing
Congestive heart failure allows no easy exit
The pain spasms defy anticipation
And medication barely masks
The muscular contractions’ intensities
Each hurt fractures a treasured breath
Hospitals allow a private man few dignities
The nurses’ pragmatic kindnesses
Often drift to tortured interruption
As records policy demands brutal routine—
Wake every two hours for pulse and BP,
Blood drawn twice daily from now hiding veins
Small pains cast upon a greater pain
Yet still he is so patient and polite.
The family (long separated in different lives) gathers for five days
Resurrecting old rivalries, becoming siblings again
Sleeping fitfully on well worn lounge couches and armed chairs
Walking empty hallways long past visiting hours
Meeting over stale coffee, recalling times past
Finally negotiating small truces after they watch over
Their once strong and gentle sire’s troubled breathing
Willing it and the pain to stop.
Each son and daughter and then frightened wife
Has had their own private moments with him
Each hoards the depth and equanimity of his love,
Blessed by so rare a thing in his eyes—
Complete acceptance and unconditioned pride.
On the sixth afternoon in the snow they move to hospice.
The once wayward wandering son (first born male)
Now a man himself past fifty
Stands this last days vigil alone.
The exhausted family gratefully allowed to miss the final hours.
But this son (who has known more of death than the father)
Cherishes the silent moments in the lowering dark
Watching the stuttered rise and fall of his old man’s chest.
Chanting a silent one word request
To all the lost gods he knows: “Soon?”
In the blackest hours of a new day
The dying man’s discomfort force him to one last sit up.
The two manage it slowly, the son rolling the torso
Pulling withered legs over the bedding’s edge
Then hefting trembling shoulders to upright.
He then props his father’s brow against his own to hold balance
They are like two monks bowing to one another
Each striving to achieve the lower homage.
And in their eyes both opened
They say all the silences.
Just before dawn, the old man rolls to his side
For perhaps one final sleep
His breaths so long apart yet strangely strong!
I let go my practiced meditations, my compassioned detachments.
I am good with the deaths of others
Smiling away the fears and honoring their last privacies.
But I would steal a moment of my own with this, my dad.
I sit on the floor and lean against the high mattress
My head just beneath his face and opened mouth
I let my father’s last breaths wash over my face and rustle my thinning hair.
I let myself be little again and hold my daddy’s hand
So wrinkled and yet so soft!
Once more I am finally home safe in his love.
I drop to dozing just before he leaves me.
When I wake, a gray dawn drifts through the windows.
Only a heavy body remains to be gently straightened
And posed for the undertaker’s assistant.
I help him lift this dead weight and watch the cart wobble out.
Then I am alone in this now strange room crying into my dad’s last pillow
A long awaited grief and gratefulness.
My phone vibrates, a ride to the airport lingers for me
I leave his place of passing
Finally wearing my father’s heart with my own.
I wear it still.
His love carries me when my own heart fails.
The Great Hospital Raid
Thank you all beyond limits of words for your prayers, love and support for Sheri and I in these
past few days while I lingered upon the shores of mortality. As you read this, obviously I am still
alive and as coherent as I have ever managed to muster. I started this little episode with a general letter to all of you, and since then I have received several requests to continue my little musings and poetics; so I will present some here. During my stay at Hospital Calderon Guardia in San Jose, I kept a daily journal, partly to keep focused on present happenings and partly to maintain my sanity in the cacophony of noise in the general ward. One part of what follows is pretty much verbatim (sans my creative spellings) from my hand-written pages. No edits, no suppression of “private” intimacies of body or between Sheri and I. The second part of this missive is perhaps more important if quite a bit shorter. It is the reflection, the response after re-reading my own narrative and it is indicated by Italics.
You see much of what almost all of us do moment to moment, is react. Then we take a moment (but not a breath) and proceed to judge based upon those reactions. Here's the rub: 99.999% of all
those reactions and their ensuing judgments are outside our conscious control (unless you've been meditating 14 hours a day for the past 40+ years). Further, the perceptions that prompt those reactions are dictated by our personal histories and cultural training—brain-washing. Succinctly said: we are continually reliving and validating our pasts, most of which have little redeeming value in the gracious acceptance of what life presents us in each and every precious moment we call: now. So, unbeknownst to myself, in my hospital bed, pen in hand, I had been engaging in Byron Katie's, 'the work', an essential part of which is: “if you are going to war, do it on paper”.
So on occasion, you may find passages that sound critical of some of the processes I experienced
and observed, sometimes written with wit and humor (when I'm on my game), sometimes sarcasm
(when I'm not). Unfortunately (in a weak moment) any of us could interpret a phrase or passage
herewith to justify a previously held low opinion of this country, its citizens and its social systems.
To the degree that occurs in this narrative, then I have failed miserably at this task and I apologize for the misuse of your time.
Not only am I led to these after-thought commentaries by Byron Katie's instructions, but also, by a few daily lessons I actually remember from A Course In Miracles: # I am never upset for the
reason I think. # I see only the past. # I could see this differently. # I am determined to see. So, I
am determined to learn from this adventure both from the participation in it as it happened, and
also, from my consideration afterward. I hope you find each to be of some value to you.
Also, know that I harbor no desire to pour love n light, angelic intervention, etc. all over this
report like ketchup at some cheap truck stop diner. I have no Polyannic bone in my body and my
lean is to skepticism when not frivolous. Sometime love's vision delights; sometimes it burdens
heavy, else we never become resilient. And I am no innocent to the darker side of modern
medicine supported and driven by a pharmacological behemoth, hell-bent for profit, managed not
by a small number of sociopaths who would control virtually everything in the universe...except
their own paranoid addiction for control. These are the few who we have allowed, since 1900, to
finance the training of our doctors, nurses and surgeons. These are the few who since 1950 have
filled our electronic signals and printed media with deceptions, deflections and outright lies
regarding a truer nature of health and our own power to grasp and participate in our own
destinies. In many ways we are in an aching world and it calls to us, sometimes for more than our
verbal prayers. Quite accurately, much of the CR Caja challenges I note in my narrative, can be
traced directly to the US government, if one simply takes the time and energy to historically 'follow the money'. Okay, end of diatribe...
...however, if you would like to slide deeper down this and similar rabbit holes, I invite you to
peruse the very last edition of this narrative coming in the near future. After all, I do have a
masters in philosophy; lingered in social/psychological research, as well as corporate America for 40 years. I am fairly well-read and equipped with continually questing thought processes, even if they are all a little bent and rusty. Nuf said.
So to review: standard print equals at-the-time journal entries; italicized print equals after breath contemplation when hopefully a little more sanity rises to the surface.
Lastly: at the request of a few of you, I have added a bit of relevant(?) poetry to this medical
travelogue and commentary. So here and there, I'll add a verse or two. Here goes...and thank you
all again for being in my world and in my heart.
If you would know me: Ask a question I could only answer in the immediate honesty of now
Where all life beckons.
Else you seek only history--the scattered leaves of me already fallen from my limbs.
All these I would gather and offer to you
If you would but leap into such a pile and play
Crushing some and scattering others further
Then let them lie askew at the end of this day
Knowing they are only what I was
Not who I am or who I could be becoming.
Day 1: Monday 24 April
So this here is a coach class planet?
I can order safety or self-expression,
But not both.
I must keep my seat belt fastened,
But the chairs aren’t bolted down.
Many of the outside doors are clearly marked
(Cancer, gun-shot wound, cardiac arrest, etc.)
But nobody knows how long the exit slides are
Or if the flotation devices
(Christianity, Islam, Buddhism, etc.)
All the tickets look the same
But you haven’t a clue
If they are one-way or multiple round-trip.
And finally, no one has ever, really,
Seen the pilot.
Great! Where do I sign up?
Met Dr. B, head of neurology, just outside his office door promptly at 7:00 am. He walked me
around some very long corridors to a sneaky unalarmed outside exit to the sidewalk and the
general din of early morning San Jose traffic. He carefully pointed and directed me to the nearest corner of the block and told me to walk halfway around the whole Calderon Guardia hospital complex to admissions (Note: seems like everywhere I've needed to go on this little sojourn is exactly opposite of where I am...mmm, much like life.)
Once I arrived at admissions, after stumbling into one uniformed minion who could point, I
deposited my admission paper form (received from Dr. B) into a mail slot in a wall. There it
disappeared into bureaucratic oblivion. I took my seat among 30 or so Ticos, but realized 2/3 were family members awaiting arrival of their loved ones coming via ambulance. I waited for my name to be called (this a little challenge as I had been beckoned as Mr. Russell, Mr. William or Mr. Giles —pronounced Hee-liss—announced through an antique speaker system capable of obliterating any human language.)
Waited about 10 minutes—that's right fellow gringos; the caja sometimes works better than the
local banks—and was called to one of four glass windows. Underwent admission processing in
about 5 minutes while having a great time misunderstanding the clerk several instances, then
finally learned via an Iphone translater that the bed supposedly vacant for me, wasn't (not an
uncommon occurrence in any hospital in any part of the world). So would I wait for a few
“moments”, a word in Spanish that defies specific definition.
About an hour later, I was ushered into a dressing cubical where I disrobed, deposited my clothes
into an official black plastic garbage bag, and donned my blue hospital fatigues—drawstring
cotton trousers and short sleeve button front shirt—a vast improvement over the defenseless, rear- opened hospital gowns of yore. Note: you can keep your bagged clothes with you and then secure them in your bedside cabinet. So escape is possible in street togs if you can make it past the half dozen guards among the hallway intersections. 2nd
Note: hospital doesn't supply slippers so bring your own for the long trudges to the bathrooms, ditto for toothbrush and other cosmetic accoutrements.
Arrived at the ward about 10:30. Divine intervention placed me on the bed next to the open
window, three floors up offering some fresh air and a bit of view over San Jose to the distant
mountains. I was pretty much ignored by the ward staff who had three other patients to care for.
(This ward can host 6 beds, but the electrical drain of the vital sign monitors allow only 4.) Never
met the ward Md upon admission, but a nurse once, who checked my pulse, blood-pressure and
temperature. All ridiculously normal. Apparently, I am an anathema here: looking healthier than
my ward mates (1 woman, 2 men), but I also appear more vibrant then the vast majority of the
numerous staff save a couple of young interns.
Around noon, one of those healthy interns came by for a preliminary intake exam. He was so
fluent in English that we joked a bit about the current state of medicine, big pharma and the sad
steady decline in health of the CR population, thanks to US corporate intervention of the soda and snack food industries. We agreed that best approach for either of us in life is to establish rumors that we are retired CIA assassins as bureaucrats rarely consider any consequence of their decisions and/or inaction unless life n limb are threatened. He stayed about 20 minutes dallying through the exam: raise your right arm, your left, you left leg, your right, close eyes tightly, smile broadly, purse your lips like a kiss. We arm and leg wrestled to establish that I had limb strength (he won).
Then he left satisfied I would stick around for the upcoming procedures. Great guy and I hoped I'd
see him more often.
[Ed. Note: The procedures ordered for these two days were all standard pre-op: Chest Xray, Vast
array of blood tests, and Cardiogram. The hospital already had received (via my hand to Dr. B) an
ultrasound of my neck arteries (carotids, right, left, internal and external) and the confirming MRI with special dyes that led me to this little sojourn to San Jose. The upcoming procedure, scheduled for Wednesday, is called an angiograph. For inquiring minds that want to know, you can You Tube any number of cartoon and video files. It's done on hearts and major arteries to the head. The Perez Zeledon tests showed that my right side internal carotid artery was completely blocked and inoperable, but somehow life had found a way to weasel blood through smaller passages into my left brain—remember we're all crossed up there in our heads. The left internal carotid artery was more than 50% occluded and extremely ulcerated. That's med speak for next to lights out. All in all, the unspoken preliminary analysis: “We don't know why this gringo ain't dead yet, let alone walkin, talkin, singin n playing that many songs stored in that blocked brain.” You got it gang, truth out: I have medical proof that I am, indeed, a blockhead. End Ed note.]
I was left alone in the ward, to my new 400 page spy novel and what turned out to be my 7 hour
quest to discover some staff member—nurse, orderly, floor mopper, trash collector—willing to
risk their job and/or total damnation to secure a pillow for me. And yes, I do know how to ask for
a pillow in Spanish (I checked in a book). That's right, a frickin' pillow. Which leads me to one of
my many digressions. This about the unique hospital use of the word “si.” To use, in the general
environs of CR town and campos, the word, 'si' means yes or if, depending on sentence syntax.
Not so in hospital speak. “Si” is not actually a word here. It is an autonomic response. When a
patient requests anything, this vocalized autonomic response, lets you know that sound waves have entered into one of the ears of a staff member, lightly flowed through the brain, and quickly exited out the other ear with just the slightest degree of friction. Therefore, you are assured that you are not talking at a zombie. And with that assurance, what possible need would you have for anything else...like...a pillow?
However, lunch was a pleasant surprise! I have had worse in some local sodas in San Isidro.
White rice, some spiced beef strips in sauce, green salad, big chunk of papaya and guanabana
juice. Notice that I recognized all foods, something that rarely happens in American hospitals.
Also, afternoon snack was an option of coffee, black tea or milk with cookie. I chose tea which
was served with a smile. Then proudly receive 2 sugarless oatmeal cookies. Then the food guy
came back with three bags of sugar for my tea. Pure Vida! I remained abed, buried in my novel
awaiting to be wheeled to the scheduled late afternoon chest x ray and cardiogram. Never
I was visited by Dr. B after a dinner of moist uninspired, but tolerable tuna salad, white rice,
steamed squash, slab of fresh pineapple and unrecognizable red juice. The good doctor seemed a
bit 'miffed' (to my trained NLP senses) that none of my tests had been completed. Note: after
observing an animated conversation on his cell phone as he left, three technicians showed up
within 10 minutes, one after another for x-ray, cardiogram and blood work all delivered bedside.
Thus proving once again an old adage about squeaky wheels and oil, especially if the squeaky
wheel is the head of a major department. During his visit, Dr. B briefed me of the upcoming
procedure of angiografica. He told me the names of the two surgeons who would perform the
procedure of investigating and, if possible, clearing the left artery and placing a stint in the
rebellious vessel. Apparently, like good sex, it's better with 2 players. Dr. B said that in the
intervening day, they wanted a specialist in internal medicine to thoroughly check my physiology
as an added precaution to make sure there wasn't any lurking complication to spoil their party on
Wednesday. Since he was in a chatty mood (for him more than 3 minutes) or because it had been a very long day and he wanted to lean against a wall next to a fresh air window in the presence of a smiling, joking patient who actually understood what he was saying; he let slip that angioplasty
procedures normally cannot be scheduled through the bureaucracy for at least 7-8 weeks. Wow!
Here I am, just 5 days after my first specialist consult in San Isidro, awaiting a procedure in less
than 48 hours. This leaves me with a variety of musings: First, blind luck, or for those of a new-
age spirituality bent, “perfect synchronicity”; Second, positive karmic payback; Third, the surgical team is in need of a rollicking success and given my general health, age, weight and strength, I'm their best hope for an immediate win; Forth, divine intervention. I'll take door number 4 for a 100 points, thank you. Mainly because as final gesture, the good doctor was able to secure a warm blanky and my long sought pillow, either because he is a doctor or he is simply tall enough to see into the high cubby holes where they are sequestered. [See more in commentaries to follow.]
So, I have concluded my prelim tests, eaten twice, passed my first physical exam, been briefed on
angioplasty procedure and back-up options. I have a warm blanky, A PILLOW. Visitors of other
patients have left (apparently, visiting hours especially for one relative, are less draconian than
Perez Zeledon. A cup of warm milk with a few particles of avena (their sedative) has been
delivered. This ward is in the back corner of a 4 wardroom complex and therefore relatively quiet
(heavy emphasis on relatively). God willing and I am not tackled by an over zealous orderly as I
bare-footedly trek to the distant bathroom after lights-out, I shall make it through the night.
Late first night: I had some difficulty sleeping. Now I am used to the sounds of the campos: birds
chirping, frogs clinking, leaves nudging one another, perhaps a falling tree limb. And, of course, a gazillion insects calling. And that ever enveloping darkness, so deep, so safe. Not here in this city ward. Three floors up, even with the window closed, sounds of city traffic tires, horns and sirens.
And the clatter of the ward itself, much like trying to sleep in a commercial catering kitchen just 2 hours before a reception. Nurses and orderlies loud chatter, full ceiling lights flashed on
throughout the night, busy mayhem as patients seem to fall prey to greater pains, greater fears.
For me the big exception: I am not alone—have the intuitive sense I am never alone. And one
further positive: this is the first night in some years I have not been plagued by at least 3 squadrons of flying insects out for my blood. Finally, around midnight, I settled and slept.
[1st reflection (a comfortable easy one): if you breathe back for a moment and consider this
country, this culture; to a very great extent, it is simply LOUD. From the ever present noise of the jungles, to the roar of the rain and its run-off, to the commercial assault of para-fonias (cars with huge speakers atop) that rumble through the city streets and outlying neighborhoods, this country is awash in sound, big sound. People talk loud, listen to loud music, things slam, trees fall. Even half the cell-phoned population listens to their conversations with their external speakers on, my wife included.
So why should one expect the hospitals to be any different, and who said, 'sick' should be silent
reflection: One must realize that virtually all practices of modern western medicine are
“acute” care. That is the direct intervention into 'fixing' what amounts to body interpreted as
machinery (this the 'educated', 'scientific' paradigm since the end of the dark ages). In hospital,
even simply 'monitoring' involves intrusive checking this and that, constant testing. Hence any
stay in any modern hospital does not involve REST nor RECOVERY. It's more: Can they keep the
machinery running (or cease from imminent failure) long enough to get one to another locale—
among family, friends, nature and peaceful environs—in which to allow a body, mind and spirit to
work their own magics that we call: healing. And hopefully, we are not so filled with inappropriate
medications and others' paranoia s to get too much in the way of allowing this magnificent
alchemy, this miraculous community of cells and subtler vibrations to do what they already know:
cure us patiently or let us go easily when the fates decree.]
reflection (not quite so easy): Upon reconsideration of the 'great pillow search', I stumble
upon a not so humorous landscape. It is the landscape of my history, at least since 1950, the year
I was born. Bluntly put:, I showed up in a nation addicted to 'accommodation.' A nation, through
pure happenstance, to have so succeeded in material, technological wealth that I simply cannot
ascertain the difference between a physical want and a physical need in damn near every possible
circumstance in life. Accommodate means 'to make comfortable; to allow space for; to please'.
Since birth I have spent little time in actual physical need. Since my earliest training I find myself a slave to accommodation both in my expectation of it and in my gnawing guilt when I don't immediately deliver it to others who expect of me.
Fact is, in the hospital, I could have ambulated my little bare feet into the ward's grand hallway
and probably scored a pillow at first attempt. But I didn't. I lay upon my bed, pillow-less, trying to
catch the attention of busy medical staff, begging for accommodation. But (your mind may argue):
'Isn't that what the staff is for?' NO! They're delivering acute care (see reflection 1 above). Hell,
some Ticos in the ward may not even own a pillow. To the degree that my fellow patients may
have yearned for accommodation, I saw it limited only to the realm of pain relief—a kind of pain
most people of the world are forced to endure. It is not discomfort; it seeks and deserves far more.
What accommodation may exist in this hospital is provided by...family. And in that, this hospital,
thankfully bends its visitation rules, especially for patients with serious conditions. I saw many
being cared for by a family member, sometimes for hours on end. Such observations were a quiet
blessing when I was human enough to notice.
What this hospital does provide for is needs: a bed—changed daily, fresh air, light, shelter from
the elements—a daily shower (by hand if you are incapacitated); regular checks of vital signs by
staff who actually bother to read something of your charted conditions; and 3 meals of
recognizable, like-home food plus two snacks, then warm sweet milk at night. Far, far, far more
than the vast majority of humanity stumbling around this aching planet; including many poor souls in the US.
In light of this bit of contemplation: I must endeavor to be sensitive to my own addiction to
requesting and/or demanding accommodation; also to unconsciously submitting to my own
programming to accommodate others. It is so easy to be lazy, so easy to say yes whenever I hear:
“Please help me...I need...” So easy to avoid the moral discernment when habit is so comfortable.
But such habit might just be killing this planet and every living thing on it. At any rate it's not
helping the citizens of this country I now call home. However, I should be gracious in this
endeavor to erase easy accommodation. Be gracious to my friends caught in such cultural traps,
be gracious to myself. For the most part we came by these addictions not by choice, but by
manipulation when extremely young or when mesmerized in front of TV or mindlessly listening to the radio. Habit is the great deadener, the great sleep; and we must be gentle with our waking lest we carry our nightmares intact into the day.