T. FITZGERALD, MD
This is a tale of presumption, which I tell so the young can hear what older
doctors know: that the human spirit will always find a way to astonish. It
is, for the most part, a true story.
He was a retired union leader, tough and
blunt and charming. She was bright, small, agile. Both were golfers, and
when he retired he built his wife her dream home in a golfing community near
Sacramento. She was 80 and he was 84 when my story starts.
They'd been married over 60 years and were one person: they moved together
with practiced grace, sharing dozens of small physical gestures of
endearment. He called her "the Boss." She called him "He," as if there were
no other men. I learned early in our 15 years together to see them both at
once, no matter who had the appointment, for they answered for each other
better than they did for themselves.
"How are you doing?" I'd ask her. "She's getting clumsy," he'd say. "Any
problems with you?" I'd ask him. "He's going deaf," she'd reply.
If I called their home, they'd both be on the speakerphone, each telling me
their concerns about the other. He'd had a childhood osteomyelitis that left
him with a limp; he also had asthma and had had a coronary bypass at age 76.
She'd had some arthritis. But they were mostly robust, golfing every day.
Then her game got worse—and worse. Her left hand grew weak, her speech soft
and slurred. She began to fall. Her animated face stilled, became masklike—
except for her frightened eyes. Within a year of her first symptoms, she was
in a wheelchair. Her body stiffened and was racked by cramps, which he would
try to massage away through endless painful nights. Swallowing became
deranged, and she was repeatedly hospitalized for pneumonias.
Her neurologist was not sure but guessed she had an odd form of Parkinson
disease. Multiple therapies gave no pause to her inexorable decline, and we
finally resorted to botulinum toxin injections when she ripped her hip from
its socket in one great spasmodic contraction of the muscles of her upper
Each time she was admitted, her husband came in with her. He sat and slept
in a big chair by her bed, never leaving her side. He fed her, bathed her,
turned her, talked to her. The busy nurses loved him for his love of her and
nonintrusive helpfulness to them. When I told him how much the staff admired
him, he was nonplussed: "Isn't this what husbands are supposed to do?" he
He modified their house for her: ramps,
grab bars, stair lift, bed sling. And when even this was not enough, he
reluctantly persuaded her to leave the home they had built together ("Just
until you're better," he told her—and she, seeing his despair, pretended to
believe him). They moved into a single story house near their granddaughter,
who checked on them each day. Home nurses visited, did what they could. Yet
he still himself would lift her, bathe her, help her to the toilet. Often
now they fell together, each taking the other down. His arthritis worsened,
and his heart began to fail. Over his prideful protest that he could take
care of his own wife, the family hired a full-time live-in helper, a strong
Tongan woman. She was deeply sympathetic, as sometimes is the gift of those
themselves oppressed. She was the sole parent of a 6-year-old girl, and
finding a job that allowed them to stay together had been hard. However, the
old couple welcomed the active child, who brought joy to them both with her
radiant vivacity and affection. Still, the old man continued to lift and
turn his wife at night, though the live-in helper slept near them. "The
helper needed her sleep," he said. He refused hospice when the nurse told
him that he'd have to promise not to rush his wife to the hospital in an
emergency, but call the hospice nurse instead. Neither he nor his wife
wanted to be in the ICU or to have CPR, but he'd too often seen her pulled
back from the brink by intravenous antibiotics and pulmonary toilet in
hospital to surrender these options yet.
The call finally came as I knew it must:
She looked bad, he said. Should we get the paramedics? "If you want to," I
told him, "or you can wait for me; I'll come now."
"It's hard to know what's right," he said.
"Yes, it is. Call your family. I'll be right there."
"It's really bad this time," he said, and hung up. I drove like a fury, but
when I arrived, the ambulance, siren screaming, was pulling away. He and his
granddaughter were in the driveway.
"She had trouble breathing," he said, "so I called 911. I thought maybe they
could just give her some oxygen here, but they said they couldn't do that,
that they had to take her to the nearest hospital." He and his granddaughter
got into her car to follow the ambulance.
had no privileges at the hospital to which she'd been taken, but the triage
nurse knew me from a lecture I had given and let me into the emergency room to
see my patient. She'd had massive aspiration, was febrile, pale, and obtunded.
The pulmonologist was an older man who—once he'd heard the story and spoken to
the family—readily agreed to palliative care and antibiotics only.
She died 3 days later, her husband holding her hand. Although there were many
family with him in that hospital room, at that moment he was truly alone: it was
in his face as he stroked her hair. I knew then that he would die soon, and that
it would not be his heart but his aloneness that would kill him. Half of
him—her—was already dead. For 60 years the other half had been, above all other
things, her husband, her protector. It was his role in life, and it lay dead
with her. What was left?
week after the funeral I phoned him. "How are you?" I asked, and was
unexpectedly startled to hear his voice reply—not hers, as had always been the
"Okay," he said.
"Just okay?" I asked.
"Well . . . my arthritis is better." No surprise. He no longer lifted her.
"And the swelling in my ankles is gone."
"My breathing's better, too." His heart was being less stressed by exertion now.
"Doctor?" he said.
"Do you think I could try that Viagra that everybody's talking about?" I was
"Yeah. Will my heart take it?" I thought perhaps he was confusing Viagra with
some new anti-inflammatory.
"Viagra—you want it for . . . ?"
"What else? Performance! You know . . . it's been a long time, what with the
Boss so sick and all. Now a lady's asked me out to dinner, and I don't want to
embarrass myself." "Do I know this lady?"
"Don't think you ever met her. She came up to me at the Boss's funeral. The Boss
and I used to play golf with her and her husband a long time ago. She told me
she'd decided way back then that if her David died—he keeled over last year—and
the Boss died, that she'd come after me." He laughed. "Isn't that something?"
"That's something!" I said. Then I just had to ask, "How old is this lady?"
"About my age," he said.
I prescribed the Viagra. A week later, I called again. He answered.
"How are you doing?" I asked.
An unfamiliar female voice came loudly over the speakerphone: "Great!" she said.
"He's doing great!"