Free Knocking on Heaven's Door: The Path to a Better Way of Death by Katy Butler Page B

surgically without much benefit, had left him unable
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    knocking on heaven’s door
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    to reach the salt across the table. But he’d adapted. He’d still
    been my dear father Jeff.
    “But this, ” he said, looking me straight in the eye and shaking his head in puzzlement and outrage. This was different.
    “This.”
    Back at the house, I hung up his coat by the door. The hook was
    too high for his now-limited reach, and my mother didn’t want to
    move it down and spoil the clean lines of the vestibule. Upstairs
    in the cold guest bedroom, I sat down at her old calligraphy
    desk, pulling a blanket over my knees. My mind was still mov-
    ing in conflicted ways: I hoped my father would die a natural
    death; I wanted him to be as functional and happy as possible.
    Running my finger down the numbers in the “physical therapy”
    section of the Greater Hartford Yellow Pages, I found a physi-
    cal therapist in nearby Cromwell with her own exercise pool
    who accepted Medicare’s low reimbursement rates. I wrote the
    number on an index card, handed it to my mother triumphantly,
    and started packing my Rollaboard for California, thus setting
    in motion a fix with devastating unforeseen consequences.
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    II
    Fast
    Medicine
    Jeffrey and Katy Butler
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CHapter 4
Fast Medicine
    In early December, my mother called with news. The enthu-
    siastic new physical therapist had sent my father through his
    pool exercises so hard that two gaps had opened up in the smooth
    muscle of his lower abdomen. Through those gaps nosed bits
    of fat and tissue, making painful humps beneath the skin. The
    humps—technically known as inguinal hernias—were easily fix-
    able with the latest laparoscopic surgery, to be performed under
    general anesthesia. Dr. Fales recommended a truss to temporar-
    ily ease the pain, but my mother balked because its two-hun-
    dred-dollar cost was not covered by Medicare. Time was of the
    essence: without a surgical fix or at least a truss, a loop of small
    intestine might get pinched or “incarcerated” in the wall of my
    father’s abdomen, lose its blood supply, and develop gangrene. In
    my ignorance, I figured that a hernia repair was too minor to war-
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    katy butler
    rant my dropping work and making a trip east. Only later would I
    understand that there is no such thing as minor surgery—or any
    minor procedure for that matter—for the very old and frail.
    Dr. Fales referred my father to a local general surgeon, who
    sent him to a cardiologist for a preoperative clearance. On the
    day after Christmas, a little more than a year after the stroke,
    my mother drove my father down to the Connecticut shore for
    an urgent appointment with Dr. Rogan of Middlesex Cardiology
    Associates. Dr. Rogan was fifty-two, a mild-mannered man with
    dark hair and a receding hairline, a graduate of the University
    of Massachusetts Medical School, and a Catholic. His clinical
    notes would describe my father as “a pleasant South African
    gentleman” who “fought for the British in WWII and lost his
    left arm to a mortar blast in the Italian campaign.” Years later he
    would write me a letter describing how much he’d liked him.
    Dr. Rogan saw nothing unusual in my father’s clinical case.
    He ran an electrocardiogram and discovered that at rest, my
    father’s aging heart beat only thirty-five times a minute—a little
    more than half the rate of most healthy young people. Techni-
    cally known as “asymptomatic bradycardia,” my Dad had had
    the condition for at least six years. It is common among the very
    athletic and the very old. Many Olympic endurance athletes
    have slow resting heart rates because their large, efficient hearts
    pump large volumes of