It’s hard to know where to start right now, so I’ll start with the most emotionally resonant moment and bend out from there.
I’m sitting in a media room with my mom, her long-term partner and her cardiothoracic surgeon in the James Tower of the Swedish Cherry Hill campus, Thursday, October 6, 2011, listening to the surgeon analyze her angiogram. Her angiogram animation loops over and over on an LCD screen. It switches between three different views of the arteries feeding the exterior of her heart and one view of her left ventricle and its valve action. I watch the indicator dye rhythmically surge through her arteries on each pump over and over and over.
He has a model of a heart of his hand that has hinges to show the interior chambers of the heart, but we’re focused on the external arteries as he explains how the arteries feed the heart. He sets the model down and, click, pauses the screen as the angle changes and points at the screen.
“Here, on the left circumflex. About 80% blockage.”
Click. The animation moves forward and jump cuts to another view. The dye surges. Click. Pause.
“Here…and here on the left anterior descending. Also about 80%. We’ll bypass here,” he points, “and here. We won’t do this one, as blood will flow back up and around to the diagonal branch,” points again. Click. Pump, pump, jump cut, surge, click. Pause.
“Here. The right coronary is about 50%.” Pump, jump cut, click. Pause.
“This is the valve in your left ventricle,” click. I can see the catheter that they had threaded down into my mom’s heart and watch it inject dye, “and it’s doing a very good job of pumping. You can see the dye being strongly ejected and the valve isn’t prolapsing.” Click. Pause. “You’re lucky. Your heart doesn’t appear to have any muscular damage yet.” Click.
We all watch a full loop before he starts talking again.
“So, three then?” my mom asks.
“No, four,” he responds.
He beings to explain the quadruple bypass procedure. I’ve done my research prior to the meeting and my role here is as moral support to my mom and to ask the questions that need to be asked as a good medical consumer to understand the full ramifications of the procedure and ensure that what’s being suggested is the correct course of action.
Without ever mentioning it by name, he walks us through a typical CABG procedure. Even though I’ve read and re-read about the procedure, it’s still a bit of a shock to hear it explained in person.
“… We’ll split your breastbone to gain access to the heart, place you on full bypass and then we stop your heart while we perform the grafts.”
This man sitting here in front of me, who I’ve never met before and don’t really know a thing about, is going to cut my mother’s chest open and stop her heart.
It’s two days earlier, Tuesday afternoon.
“Do I need to remove any metal objects from my body?”
Slight chuckle, “No. Lay down here, head on the pillow.”
I sit and begin to lay down. “Is this going to erase my phone? Should I take it out of my pocket?”
“No, it’ll be fine. No; head at this end.”
“Oh. Sorry.” I lay down on the correct end and look up as the platform begins to rise. They have an illuminated photograph set into a ceiling light fixture. I see blue sky, clouds, leafy trees. I can’t place the species. I’m distracted.
“Lift your shirt up around your chest and arms above your head please, I need to attach some electrodes so we can monitor your heart rate.” I mentally sigh. Again I have to expose my chest and it makes me a bit uncomfortable.
He’s obviously done this a million times and is quickly efficient placing the adhesive electrodes. Unlike the treadmill test, it’s only three electrodes instead of twelve. “Have you ever had one of these before?”
“No.” What are those trees? Maples? I’m trying not to cry. My marriage counseling appointment from earlier in the day has left me drained and feeling empty with depression.
He clips on a lead, “A computer voice will tell,” clip, “you when to breathe and,” clip, “hold your breath. Should only take a few minutes.” He checks a monitor. “OK, looks good. Close your eyes for a second.”
My left shoulder hurts from the flu shot I received earlier.
I look up, and there’s a sticker above the dark porthole, “CAUTION: Do not look stare into laser.” I close my eyes as I slide towards the ring. “What a dumb warning sticker and crappy design,” I think to myself as dancing red lights sweep from bottom to top, seeping through my eyelids. It annoys me with its stupidity.
“What the fuck are those trees?” I wonder again.
It’s Wednesday afternoon. I feel like shit. This head cold has me in a vise and I can’t think because of it and everything else going on.
It’s nearing the end of the lunch hour and I luck out, pulling into a parking spot in the overcrowded garage at work and shut the motor off. I’m happy I don’t have to park in a different garage and walk back over, so I sit there for a minute, resting. I wonder, “Why the fuck am I here?” I listen to the radio for a bit, blow my nose and hack up some phlegm. “To get this shit stuff off your plate,” I tell myself.
Mustering my energy, I rally for the hour long meeting and successfully pass the buck to someone else.
“Poor bastard,” I think to myself as I collect my things and head back to the garage.
I drive home and let myself in the house. My wife bugs out and I do my best to watch the kids through my haze.
I check Twitter. I learn Steve Jobs died. I’m instantly profoundly sad and begin to cry. I sit on the floor and cry some more.
“Daddy not happy?” my two year-old asks, “Daddy not happy?” I cry and cry and cry. My two year-old comes to me and sits in my lap and starts to cry too. My five year-old is bouncing off the walls and stops when he notices his brother crying, “Dad, are you sad?”
“Yes,” I finally answer both.
“Why?” my five year-old asks.
I cry some more.
It’s Tuesday morning. I’m in my marriage counselor’s office with my wife.
“All I’ve ever wanted,” sob, “is to be me,” sob, “to not feel confused,” sob, “to not feel like I,” sob, “don’t belong anywhere.” Sob.
There’s a deep silence in the room, except for my racks and blowing of running nose.
“Don’t you want someone to love you for who you are?” our counselor asks.
Sob. “Yes, but I want that to be her.” I nod towards my wife.
It’s Thursday afternoon, September 29.
“I love your hair, who did it?” the nurse asks me.
“Thank you!” I tell her the name of my stylist and the salon he works at. She grabs a Post-It note and writes it down. The nurse, the ultrasound technician and I work out the address and location based on Seattle landmarks. “Thanks! How you doin’?” she asks.
“Pretty good.” I’m on the treadmill, wired up and we’re a few minutes in. It’s still an easy pace and incline, and I can still talk and breathe.
I’m feeling self-conscious. I’m not wearing a shirt and I wonder if women get to keep their bra on during this procedure or if they do it naked on top as well.
“What medications do you take?” she asks.
I mentally shrug and wonder how many times I’ll be forced to out myself to the medical community in the future. “Estradiol, 3mg a day, aspirin, 325 mg a day, b-complex vitamins and vitamin D.”
She doesn’t say anything and just writes them down in her chart. “We want to get your heart up to maximum beats, but we don’t want you falling off of there and hurting yourself, so you be sure to tell me when you’re ready to stop.”
After our counseling appointment, we’re both sad.
“You have to do this. I’m going to make you. You’ll never know until you try,” my wife tells me.
“That means we’re done, right?” I ask.
She’s crying. “Dammit, stop asking that! You know the answer.”
I cry. “What the fuck am I going to do now?” I ask myself.
“OK. You can open your eyes now. The computer will tell you when to breathe and then hold your breath for a few seconds. It should be about three times.” I come to a stop with my chest in the middle of the donut. It has a circular glass window on the inside of the torus. There is a slowly revolving mechanism with multiple armatures that rotate clockwise around me.
I watch it orbit around me and am amazed at how Star Trek this device is.
The platform I’m laying on begins to move further in. “Breathe in,” a disembodied voice commands. I breathe in.
“Hold your breath,” the platform comes to a stop after about half a foot, I hold my breath, and I slowly begin to move back out to where I was before.
“Breathe.” There’s a few second delay and the platform slides back in.
“Breathe in.” Deep breath. “Hold your breath.” Slide out.
A longer pause. The armature begins to spin much faster. I imagine the electromagnetic fields twisting around me, coiling their energy for the pounce through my body to scan for calcium deposits.
I slide in more quickly this time. “Breathe. Hold your breath.” I slide out more quickly and come to a stop.
The machine winds down and the technician appears to remove the electrodes.
If only this magical device could diagnose the rest of my life.
“So why are you here today?” The treadmill is a bit steeper and a bit faster now but I can still talk.
“I was having chest pain a few weeks back and I’m 99% sure it was just a panic attack, but my doctor wanted to make sure. But I just found out yesterday that it sounds like my mom might need bypass surgery, so this seems like an extra good idea now.”
We chat about which doctors are the best at bypass and the speed and incline increases a couple more times before I’m back down on the table with ultrasound waves pulsing through my body. It’s a Phillips machine and I wonder if it was designed in Bothell at the old ATL facility where my ex used to work.
“It’s the most drastic thing you can do out of everything right now,” my best friend tells me Tuesday afternoon.
“I don’t know what to do,” I tell him. “During our session today, it just seemed like there’s no other option. I’ve exhausted the possibilities, gotten the second opinion. Transition seems like the only thing left.”
“Is it something you really want to do?” he asks.
“No, it feels more like something I’m being forced to do. I don’t really want to, but I don’t know where to go from here.”
“If you don’t want to, why do it?”
“That’s a very good question. I’m not entirely sure. There are fears I have that seem real from a distance, but they dissipate when I try to get close to them and my desires to transition are just the opposite. Distinct up close, but diffuse from a distance. It’s nuts. I feel nuts.”
“You’re on the cusp of some potentially big life changes in career, finances and relationships. Maybe you should think about getting through the end of the month and seeing where you end up. This is the biggest thing in your life now when you have a bunch of other smaller things going on too. Maybe you should attend to the small ones before the biggest one?”
“You have a point there.”
“I’m not going to transition any time soon. I’m still not sure it’s the right thing for me to do.” My wife looks at me with a mixture of anger, frustration and sadness.
“I want us to stay together as a family. I love you.”
“Steve Jobs died today,” I tell my wife.
“Oh,” she says sadly.
I cry a bit more. It’s hard to separate if I’m crying this hard because I had upped my dose today to 4/mg and I’m coming down at the end of day or because the man that made my professional career possible and that I strived to emulate at times has passed or both.
“I’m going to stop hormones. I want us to stay together. I love you. I want to find the way for us to say together.”
“How’d it go with your mom today?” my wife asks. I tear up.
“Quadruple bypass, full open-heart, heart-stopping surgery.”
“Oh my god, I’m so sorry.”
“Want to go do a drive-by of a house I found to rent today?”
The next day, after viewing the house with the rental agent.
“What do you think?”
“I love it.”
“You know we really can’t afford it, right?”
“Yes. Why do you have to keep harping on that?”
“I dunno. It makes me nervous to spend money we don’t have. I liked it too.”
“I really think it will help us by giving us all more space that we really need right now.”
“I think so too. I’ll start on the application paperwork when we get home.” My brother texts me, ‘Are u free?’ “I need to call my brother first though and tell him the surgery’s set for the 18th.”
“I sent the application in. We should hear today or Monday, I guess. Are you excited?” I ask.
“Yes!” she replies.
“Me too. And a bit scared.”
I take the kids to the park. My wife takes a day and night off by herself. I talk to my mom. We’re all going to get together some time on Sunday.