A.A.A. #5

When she was assigned the patient, the nurse was told: “This is a stubborn, brutal old bastard. Abdominal aortic aneurysm, and he pulled through out of pure spite.” 

Because of the numerous complications of his condition, W. had been assigned 24/7 at-home nurse care. An oxygen tank to roll around with him. Home hemodialysis six of the week’s seven days. A new wheelchair. And quarterly emptyings of the tube that now stuck out of the flesh of his stomach. It was always disorienting to the nurse to look at these tubes, see them flush with the skin, know how close the inside of this man was to her.

Looking around the home, at the ash trays and piles of newspapers, at the old mail and the computer from 1995 loading to-the-minute stock numbers, at the TV in the corner blaring Fox News, she wondered about the nature of human endurance and perseverance. To crawl to hell and back for what—for this? 

She hears a buzz; he’s calling her. She pushes the thoughts to the side. The beauty of life cannot be described, she reminds herself. We each must fight for our own solaces and keep them alive. She thought: Who am I to judge an old man? One day, I, too, will be old, and what will I do then? 

A.A.A. #4

The morning of the second day, W. had regressed. Or, rather, the procedures in order to alleviate the initial arterial rupture had led to further complications: fluid in his lungs, acute kidney failure that required a dialysis machine, a gastrointestinal bleed the doctors could not locate. It seemed to the nurses like systematic organ failure.

M., his wife, couldn’t bear to wait around for him to die. When she walked in that morning, she was excited to tell him about the stock market—it had gone up one thousand points the day before. Through his oxygen mask, he offered her a smile at this news. Seeing him there, hooked up to machines, feeling pity and a queasy sickness in her stomach she couldn’t locate or name, she turned away from him and toward her eldest daughter. “Take me home,” she told her. “Let him rest.”

Really, she anticipated the satisfaction lighting a fresh cigarette would bring her. As the smoke tickled her throat, she imagined the queasy feeling in her would dissipate, and the world would feel calm again for at least a moment.

A.A.A. #3

W.’s wife and A.E., his middle daughter, arrived early the morning after the surgery. They had been there the night before at the memorial hospital. The nurses wheeled W. down the hallway, ruptured artery sputtering, and then urged them to say their goodbyes. She coughed up the words to her father, choking on them as they came from her throat; her childhood had been one of difficulty. She kissed his hand, then held it as long as she could, until the nurses wheeled him too far away and he slipped from her grasp.

When she walked into his hospital room the next morning, she thought he was dead. It was difficult to see him as alive with shut eyes and sallow skin. When he awoke, he begged for water. It was not dehydration—he was hooked up to an I.V. with fluids—but post-surgery his mouth had dried out, and his stomach had been emptied. The nurse handed her a sponge the size of a quarter. “Dip this in, and squeeze out droplets into his mouth.” She did so, and watched as three drops of water fell onto his parched tongue. He begged her for more, and she quietly dipped the sponge and gave him three more drops against the nurse’s wishes. He choked on the drops of water, struggling to swallow them. 

She remembered the chief surgeon warning her that he wasn’t out of the woods yet. If he survived the first 24 to 48 hours, he would likely make it. Even then, survivors of the surgery only had a life expectancy of two years. W. begged her for more water, and she could not give it to him. That’s it, she thought as he coughed up the few droplets of water. Only 48 hours more.

A.A.A. #2

D., a paramedic and W.’s grandson, met him at the hospital while he was halfway through the surgery. He had heard the name of the condition, and knew that it was likely his grandfather would die in the night. He spoke with the nurses, and they lamented the situation W. found himself in. A heavy smoker. Stomach cancer. Poor diet. D. had known these qualities of his grandfather, and had little hope that he would make a recovery. When the chief surgeon of the hospital had finished the surgery, he approached D. and said three words: “It’s a miracle.”

D. thought of W.’s parents—two people who immigrated to the U.S. and lived difficult lives. His father had lived to 100. His mother died a week shy of it. There was a strand of DNA in their lineage that strived for life. He thought, too, of W.’s wife, a lifelong smoker with zero damage to her lungs. How bizarre, he thought, to live against all the rules. Perhaps there were other things that encouraged a prolonged life. There was little time to consider the ramifications of this discovery; he had several phone calls to make.

A.A.A. #1

In the afternoon, W. collapsed. An ambulance swiftly carried him to the nearest memorial hospital. First it was low blood pressure, then it was an aortic aneurysm in the stomach. The blood in his body rushed to his stomach, leaving it distended. The ruptured aorta spurted the blood from the cardiovascular system, leaving him gray-skinned and light-headed. After receiving medication for the pain and regaining consciousness, the emergency room doctor gave him his ultimatum. There was nobody else in the room.

“Listen,” he started. “There’s no two ways to say it. You have two options here. I can give you enough morphine to let you pass quietly in the night. Or we can transfer you to a hospital thirty minutes north. They can attempt a risky surgery, but there’s a very high mortality rate. Over 90%. You likely won’t make it. But you have to decide now, there isn’t much time.”

Still lightheaded from the day, and numbed from the medication, W. responded with muscle memory: “There’s only one option. Give me the surgery.”