Tuesday, December 13, 2011

A Simple Change of Heart (Part One)

     My husband, Brad, lost his real mother to breast cancer when he was only six years old. Although his memories of her are vague, what he does remember are her reassuring hugs and her hearty laugh, and how very loved she made him feel. He also remembers crying every day when he started kindergarten because he couldn't bear to be away from her. Brad was considerably younger than his three brothers, all of whom were already in junior high or high school. His father, Bob was (and still is) exquisitely handsome, and he also happened to be a successful businessman, making him one of Bellville, Michigan's most eligible bachelors. By time he'd turned 16, Brad had lived through one terrible stepmother, three housekeepers, two of which were enamored with his father,  a move to Decatur, Alabama, and countless droves of women who showed up nightly at their door, bearing homemade casseroles, vying relentlessly with one another for the chance to win Bob's heart. One of these women, who happened to be married, had recently befriended an attractive divorcée named Gwen, and thought that Bob and Gwen would hit it off. She suggested that Bob should call Gwen for a date, which he did. They met for dinner a couple of times, and soon Bob invited her over for his specialty, eye of the round, which according to Brad was the only meal Bob knew how to cook. Gwen was a diminutive powerhouse of a woman from Pee Wee Valley, Kentucky, whose warmth, pluckiness, and wicked sense of humor were captivating. Within several months, Bob proposed, and Brad once again knew the love of a wonderful mother. Gwen had two sons from her previous marriage, one whose name was Mark, and was a year younger than Brad. The four of them moved to Kennett Square, Pennsylvania during Brad's junior year of high school, and he and Mark became very close.
     Brad soon went off to college, and later moved to San Francisco. His brothers and their families also lived in California, and every year around Thanksgiving, they would make the pilgrimage to Pennsylvania to spend the holidays with Bob and Gwen. Gwen's feasts were legendary, and Brad and his brothers still tell tales of their late night raids on her refrigerator. One year, in a selfless gesture of love, Gwen put together scrapbooks for each of her stepsons, containing pictures and mementos from earlier years with their mother, and gave them as Christmas gifts. I've often turned through Brad's scrapbook, lingering over the old black and white photos of him wearing a little red cowboy hat and boots, smiling, and being cradled by his mother, simultaneously wondering what his mother was like and admiring Gwen's compassion for Bob's sons.
    Bob retired in 1997, and he and Gwen moved to a modest home on a golf course in Fair Hope, Alabama. Bob was an avid golfer, and Gwen had also developed a love for the game. She organized the first women's golf club in their community, and she and Bob enjoyed an active life with many close friends. In 2001, Gwen was diagnosed with breast cancer, and underwent chemotherapy with a then-experimental drug called herceptin. Like all chemotherapy, the herceptin had toxic side effects, and Gwen suffered severe damage to her heart, necessitating a mitral valve repair.  She recovered quickly from the surgery, and her breast cancer went into remission. The yearly holiday visits from Brad and his brothers' growing broods continued, and by the time Brad and I had dated for a few months, I felt like I knew everyone in his family, simply from the stories he'd told about those gatherings. On Thanksgiving of 2008, I met Brad's parents for the first time; we were announcing our engagement. Brad, a lifelong bachelor who, like Bob is also very handsome, had been a source of consternation for Gwen, and she'd openly fretted over whether or not he'd ever settle down. I immediately felt welcomed into the family, and developed a special love for Gwen. She had a small painting studio in the back of their house, and was dabbling in still life. We shared a passion for cooking and red wine, and I have delightful memories of being with her in the kitchen, effortlessly whipping up delicacies together, our teeth and lips stained purple from cabernet sauvignon.
     Brad and I married in October of 2009, and spent Thanksgiving down in Fair Hope. Gwen had started complaining of some shortness of breath, and her color looked "off." She was getting tired easily. Gwen's beloved 96 year old mother, Dot, lived with her and Bob, and she was a real handful. Dot would frequently go out for lunch to Red Lobster or the Olive Garden with her elderly adopted son, Orval, and the salty food from these restaurants would cause her legs to swell. She had arthritis, which was attributed to her sweet tooth, and Gwen had to be very resourceful in hiding the cookies and candy from her. Dot viewed visits to the doctor as social calls, and Gwen was convinced that she would concoct symptoms out of sheer boredom, just to get out of the house. Gwen continued to feel worse. Shortly after Christmas, she went for a cardiac evaluation, and was told she needed more surgery.
     Gwen, then 73 years old, underwent another mitral valve repair in February of 2010, and never fully recovered. Although the valve was now functional, the operation had taken a great toll on the muscles within her heart. She developed congestive heart failure, which progressively worsened to the point where she required implantation of an intravenous port for continuous administration of milrinone, a drug which helps to improve cardiac function. She was absolutely miserable. Over the next 16 months, she was in and out of the hospital many times. Her normally tiny frame had gone from being bloated with 20 pounds of retained fluid to wasting away to almost nothing. She couldn't cook, she couldn't garden, she couldn't sleep, and she could no longer keep up with Dot. We had many telephone and email conversations regarding each of her new therapies. At some point, her cardiologist had talked with her about destination therapy with a left ventricular assist device (LVAD), a heart pump that could be implanted into the left ventricle to help improve her congestive failure. This would mean another major cardiac operation, as well as daily home maintenance of a complicated device and even more frequent doctor visits, and Gwen was adamant that she did not want any more surgery. She knew she was dying, but remained hopeful that the milrinone would work. In one of our last email exchanges, in her typical "all caps" style, Gwen reported: "NOW AT HOME WITH MILRINONE INFUSION 24/7. THINK IT IS HELPING!!!!!!????  FOUND I HAVE TO REALLY SLOW DOWN AND JUST GET OFF MY FEET EVERY LITTLE BIT.  STILL HAVING FLUID PROBLEMS, BUT HOPING THIS WILL STRENGTHEN MY HEART TO THE POINT WE WON'T HAVE THE FLUID PROBLEM.   I MIGHT BE PIPE DREAMING BUT WHAT ELSE CAN YOU DO?"
     By late May of 2011, Gwen's condition had deteriorated significantly, and she could hardly walk or breathe. The milrinone wasn't helping. Her cardiologist told her she was going to die, unless she got the LVAD. There was very little, if any, discussion about palliative care. If she decided to have the LVAD, she would need a heart catheterization to determine whether the right side of her heart was strong enough to support the device. It was a tremendous amount for Gwen to think about, and she didn't have much time. Accompanied by a close friend, she spent that weekend in Gulf Shores, and when she returned Sunday night, I phoned to see how she was doing. She hesitated before telling me she'd had a simple change of heart: she was going forward with the LVAD.


  1. Kris, wonderfully written. You pack so much information into just a few sentences. I'll be starting Part 2 shortly.

    1. Thanks for reading it, and for your valued feedback, NP