The Last Year of My Father

After receiving a lung and transforming himself into a grand old man, my father slipped suddenly from this world.

When I lost my mother, I met grief for the first time and I ran. I thought grief would be dignified and monumental like a black tower shrouded in mist or quiet days spent weeping in a dim room. Instead I discovered that grief is a relentless feedback loop, a wash of static riddled with fractured images, creepshow dreams, and broken questions that can never be answered. How could this. Why didn’t she. If only I. This wasn’t supposed. Science tells us that grief is a biological necessity, a Darwinian driver that teaches us to protect the ones we love—or at least, the ones who still remain.

My father’s breathing became labored in the years after my mother’s death, as if staying alive had become too demanding. He was diagnosed with pulmonary fibrosis, which meant his lungs were stiffening due to a patchwork of scars that covered the precious tissue which translates oxygen into life. The doctors could not point to a specific cause beyond a crossed wire somewhere deep within the machinery of his cells, a faulty line of genetic code which sent his immune system on a terrible mission that rejected the logic of life: his body was attacking itself.

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We tend to die when we are not working. A stroke at the dinner table, a car wreck on a Saturday night. We like to die on weekends or during the holidays. This is something I learned while waiting in Wisconsin with my father for a lung, a factoid gleaned from hours spent sitting among gnarled old men waiting for their telephones to ring with news of fresh hearts, livers, and lungs—men who cheered when they learned that Wisconsin does not require motorcyclists to wear helmets. Each night they gathered with their oxygen tanks, heart attack vests, and grisly math, eager for the weekend or the next holiday to come. “Might get some lungs now,” they said before Easter. “Thousands of drunk drivers can only be a good thing,” they said as Memorial Day approached. “Alcohol and explosives are better than Christmas,” they said on the Fourth of July.

One of these men approached my father when we first arrived in Wisconsin, our nerves still buzzing with the speed and heat of the interstate after a sixteen hour drive from New Orleans. He was the kind of man most people ignore, the lonely soul puttering at the margins of a discount superstore with uncombed hair like a cloud, or the blurry retiree doing the crossword on a bench at the mall—but here in the rooms where we would wait for a lung, he was an authority, and he leaned towards my father and asked, “What’s your blood type?”

My father took a drag from the oxygen tube that circumnavigated his head. A puff of compressed air accompanied his answer. “O positive.”

“Me too.”

They nodded at each other, enjoying this primitive bond. The same brand of blood flowed through their bodies yet they would not hinder each other. My father needed a lung and the white-haired man was waiting for a heart. The wheels of my father’s oxygen tank squeaked down the hall as he shuffled towards our room. The white-haired man picked up a butter knife and grinned as he hopped to his feet and followed my father, making swift stabbing motions towards his backside, mugging and jiving for the others in the lounge. “He’s the right blood type and I need a heart.” Everybody laughed. He would play this gag dozens of times in the months to come. At first I did not think this was funny, but in a few months I began to understand.

The tribalism of our bodies is profound. If one of our cells encounters another cell that does not share the same DNA, the body launches an attack. It’s the scene in the science fiction film when an interloper’s retina or barcode fails to scan and red lights flash through corridors to the beat of a klaxon alarm while men with guns hunt down the intruder. Organ rejection is the enemy of transplantation, a defense mechanism that has only been brought to heel in recent years.

The first recorded attempt at installing an organ in someone else’s body dates back to the third century BCE, when Bian Que, a Chinese physician and author of The Yellow Emperor’s Canon of 81 Difficult Issues, claimed to have used anesthesia to swap the hearts of two men, one with too much willpower and another who was too passive. Hoping to achieve balance, he “cut open their breasts, removed their hearts, exchanged and replaced them, and applied a numinous medicine,” according to a Daoist text. “And when they awoke, they were as good as new.” Some Catholic histories describe the replacement of Emperor Justinian’s gangrenous leg with the limb of an Ethiopian man, a surgery performed by the twin physicians Damian and Cosmas, for which they earned sainthood. Such accounts are improbable yet the idea of saving someone’s life with the parts of another is rooted in our most ancient notions of healing, In the early twentieth-century, a series of successful transplants were performed on dogs, chimpanzees, and convicted murderers, and the increasingly refined use of immunosuppressants extended the likelihood of survival—yet the procedure remains haunted by rejection. (A sixteenth-century doctor in Italy attributed this phenomena to the “force and power of individuality.”) Transplantation is particularly risky for lungs because this is the organ that connects our bodies with the outside world, its dust and heat and microbes.

Whenever my father’s telephone rang, we jumped, knowing that if a voice on the other end offered him a lung, we would have one hour to get to the hospital where they would cut a slit along his ribcage, pull out one of his bad lungs, slide in the new one, and attach it to the trachea—sort of like changing a vacuum bag. The other bad lung would remain in his body. Something needs to fill the space.

One lung is fine. People can run marathons with one lung. The pope has only his left lung, due to tuberculosis when he was a boy. In terms of daily activity and life expectancy, one lung is just as good as two.

Two years ago my father underwent a battery of tests and procedures while they determined his suitability as a candidate for a lung transplant. The word ‘candidate’ lingers in my mind as I recall him shaking the hands of dozens of doctors and administrators, a man running for the strangest kind of office as they peppered him with questions about his drinking habits and propensity for depression, about his lifestyle and future plans. Would he go back to work if he received a lung? Would he exercise and eat sensibly? These queries were polite variations on a single question: Do you deserve to live?

They inspected my father’s heart with a camera and biopsied his lung tissue. They removed all of his teeth to reduce the possibility of infection. He spent hours chewing on an elaborate mouth guard attached to a screen, a dystopian video game that refined his swallowing reflex to minimize the possibility of food or liquid entering his trachea. A series of social workers interviewed me, evaluating my fitness as a caregiver.

We sat in the cafeteria of the Veteran’s Hospital in Madison, one thousand miles from home. We watched snow cover the windows while we killed time until his next appointment, a test to confirm that he could still walk at least nine hundred feet in six minutes. If not, they would remove him from the list, classifying him as a lost cause, a body unworthy of someone else’s organ. Yet I never saw my father express even the faintest glimmer of anxiety. Even as his breathing grew worse and he maxed out all of his oxygen machines, he would alway smile, dutifully taking his daily trips to the Dollar Store, and we would spend long afternoons by the Wisconsin River, where he would pretend to fish. “If I’m going to die,” he said, “I might as well die outside doing something.”

Watching him calmly munch a cheeseburger in the hospital cafeteria, I realized that this distant figure throughout my life had become a grand old man and a reassuring friend while I was not looking. Only now do I see how hard he worked at this. He had traded his scotch and high blood pressure for a grey beard and a fishing hat, and he would wake before dawn to meditate and highlight passages from a book by Thich Nhat Hanh, a Buddhist monk whom he referred to as ‘Nathan’. Going through his files after he died, I would find folders labelled Sears pension, Telephone bill, and Buddha. He went to all kinds of churches with anyone who wanted company, and he began talking about the godhead, how everything is connected. He loved the water. He loved boats. “When I die, toss my ashes in the nearest body of water,” he would say. “Even if it’s a puddle.” Rather than watch game shows and gossip with the other patients, he bought an old canoe and began refinishing it in the parking garage beneath the hotel. The fumes from the paint thinner and varnish were ferocious, but he figured a new lung was on its way.

And then the doctors called. They told us there was an organ drought—a grisly phrase that conjured apocalyptic scenes along dried riverbeds.

At first we believed in math. We spent the month of March researching blood types and averaging wait times, hoping to calculate the odds of receiving a lung. Did the odds improve with each passing day or was it like getting struck by lightning? In April we passed through a superstitious phase of gut feelings and prophetic dreams. We sensed vibrations in the air. “I’ve got a feeling the call will come today,” we said. But the phone never rang and we ended the month believing in bad juju and jinxes. We began playing long quiet games of chess in May, keeping an ear cocked for the phone. Summer came and we watched our neighbor down the hall return from surgery with two new lungs, his face nearly unrecognizable without his oxygen mask. Another man gave up after nine months of waiting and flew home to Arizona. Time became elastic and calendars stopped making sense. In June we switched from chess to backgammon, thinking we might as well include an element of chance.

At a pizza party for the transplant patients, a man took me aside. “People don’t know how to pray for this,” he said. “You only get an organ if somebody else dies.” I learned a lot about prayer during the ten months we spent in Wisconsin. In the laundry room I listened to a woman describe the night that Jesus Christ said her husband would get his heart next Tuesday. When I awkwardly tried to comfort the family of a man who passed away during surgery, they smiled and said everything was okay, this was part of God’s plan. I met a Marine who was visiting the parents of the boy whose heart he received, and they would put their ears to his chest, listening to the sound of their son—I imagine them posed in pyramid formation, a distant echo of the Pietà. I envied this faith that comforts so many people in the face of uncertainty and tragedy, yet I did not know how to find my own.

Instead, I drove. After midnight I would hit the interstate and speed west, fantasizing about space and light yet never daring to go further than thirty miles from the hospital. When the lights of the city faded away, I would pull to the side of a county road and look at the stars while making my usual ambient promises to be a better son, a more patient man. Then I drove back to our room, where I would fall asleep to the sound of my father’s oxygen compressor, a burst of air hissing every six seconds through the night.

“With falling gas prices and a beautiful holiday forecast on the horizon, a record number of Americans are expected to hit the road this weekend. Experts are predicting an increase in auto accidents, so be careful out there.” I smiled at the radio, no longer caring that I was rooting for death.

My father’s telephone rang at six o’clock on the Friday before Labor Day, a weekend filled with car wrecks just like the radio had advertised. “Will you accept the lung of a recently deceased individual?” asked the voice on the phone. Oh god yes, he said. “Be at the hospital in one hour.”

After the surgery, I watched his lungs on a monitor, a camera rooting among glistening pinks and reds, tracing the dark purple slashes of a suture. For days he teetered between life and death, and I watched the numbers and quizzed the doctors, absorbing a brutal lesson in the language of blood, gases, and tubes. At night I dreamt in the beautiful slang of nurses. “You only have a true mixed Venus when you insert a swan,” they said. I learned that a patient who insists on standing up despite repeatedly falling down is called a ‘jack-in-the-box’. But my father did not stand up, not at first. Each time I looked at him I wept, thinking about the life he had in front of him. When my father opened his eyes, I took his hand and told him that he was safe, that he made it. “It’s coming,” he whispered.

After nine days of bloods clots and collapses, of atrial fibrillation and intubation, the doctors removed the tubes and wires from my father. With one hand on his IV pole and the other wrapped around my arm, he took his first walk towards the nurses’ station. “King for a day,” he whispered. “I’m ready for the world.” We took dozens of careful walks through hospital hallways in the weeks that followed, and each time he went a little further than everyone expected. When I told him I was proud of him, he would give a small smile and say, “It’s coming.” Each night when I left the hospital, he would turn off the lights in his room and wave a flashlight in his window while I stood in the parking lot, watching his little show.

Every Saturday we would explore Wisconsin, looking at its hills and Main Streets and lakes. Six weeks after his transplant, my father and I drove towards a spot on the map that advertised a scenic waterfall. When we arrived, there was a two-mile footpath through the woods. I didn’t want to walk it and I didn’t expect my father to manage it. “Let’s do it,” he said. Watching my father walk among the autumn trees, kicking leaves without any tubes or machines, I felt a sensation that I can only describe as grace. No matter what happens, I thought, this moment was worth everything we’d gone through. I told him I was proud of him. “It’s coming,” he said.

After 301 days in Wisconsin, we packed up the phenomenal number of spatulas, paintbrushes, floor lamps, and other things my father acquired from the Dollar Store, and at seven o’clock on a Sunday night we pointed the car at the Mississippi River so we could follow it home. We were hungry but we would wait to eat until we were in a different state. And there’s my father and me, sitting in a parking lot on a hill overlooking the river, munching cheeseburgers and watching the lights of Dubuque.

In one month a doctor would tell me that he was the sickest man in the hospital, and I remember thinking my father would take a strange pride in this fact later on, when we took another drive.

Septic shock is as fast and brutal as it sounds. On New Year’s Day my father said he had a sniffle. The next morning he could hardly stand. I poured him into the backseat and rushed to the nearest emergency room. They said his body was too weak to build a fever, that his blood had turned toxic. Following the protocol for all septic patients, they flooded his body with antibiotics and fluid, which crippled his breathing. Soon he was on dialysis and intubated with a swan in his neck—his vital functions once again outsourced to machines. At dawn a nurse brought me a telephone, a rerun of the day I lost my mother, as a doctor’s voice told me that my father was going to die, that he was the sickest man in the hospital and all they had left to offer was prayer. “If I had brought him here twelve or twenty-four hours sooner, would it have made a difference?” I wanted absolution. “Theoretically yes,” he said. “But he was also very sick and weak, so theoretically no. I’m afraid this is a question you will carry for the rest of your life.”

I held my father’s hand as I watched the numbers on the monitor like an altar, whispering please don’t go while his blood pressure quietly dropped into single digits. The red and blue numbers for his pulse and oxygen saturation flicked to white. A nurse shut off the screen.

Here is an endless bayou with lots of birds and interesting clouds in the sky, and there’s my father in a little tin boat with my mom sitting next to him and his dog in the front, a breeze blowing through its fur. This is what I hope heaven looks like for him.

I kissed my father on the forehead and told him that I was proud of him, and for the first time he was quiet. I told him that he was the kindest and gentlest person I had ever known and he was leaving this world very well loved—which in the end, might be the best any of us can hope for.

After my mother died, I drove her ashes from Michigan to the California coast because she always wanted to see the ocean. And I kept driving for six weeks, thinking I could outrun my grief at seventy miles per hour, hoping I could escape it by hiding in unfamiliar towns and anonymous motels, by becoming a stranger who sometimes marveled at the terrible thing that happened to an old friend named James.

Now that my father is gone, I want to run again. My first instinct was to point my car into the Yukon or the Mojave desert. But this impulse faded as quickly as it came, for my old man taught me a valuable lesson in his final years. In the days after his death, I received calls and visits from so many lives that he had touched, even when he simply took his dog for a walk or futzed with his boat. I discovered that he had a ladyfriend and they were making plans to live together. (“Don’t hang up any pictures in the new house,” he wrote her. “That’s my job.”) Despite losing the ability to breathe without gasping, my father remained present in the lives of others, and I can hear him telling me to do the same.

I see him standing in the woods on that October afternoon with his quiet little smile, a simple gesture that reflects an entire life—a constellation of love and regret and loss and dogged faith in taking one more step no matter how shallow our breath might be. His smile radiates through me as I write this, and I know there is a lesson here yet it evaporates as soon as I draw close. Much like the impossibility of looking into the sun, perhaps it is better to simply enjoy the light.

Further Reading

The Shock of Nevermore

Each time I pick up a pen these days, I am reminded of Ingmar Bergman’s admonition that “the only worthwhile subject is man’s relationship with god.”

Philosophy is an Ambulance

Grief can arrive on a gust of wind, a glimpse at a calendar, or a half-heard snippet of conversation on the street.

Pneumonia Notes

When the body rebels, the mind realizes it’s been preoccupied with the wrong things. A Greek word for the inflammation of the lung, Hippocrates described it as “the illness named by the ancients.”