Decision Tree for a Possible Surgery

Even after forty years of marriage I was still trying to figure out our lives and our relationship.  When Pam was healthy before her medical issues cascaded through her final four years, before her breast cancer and her broken fibula and her diverticulitis and her lung cancer, I tried to visit one of Pammy’s childhood sweethearts with her.  Pammy and I were driving to visit her sister in Rochester, NY.  My plan was purely altruistic,  I  told myself.  I really hoped that this boy who’d become a good man, this man who apparently was still in love with the idea of Pammy,  would meet her and ultimately be better for her.   I saw it as a real possibility and hoped to see if it could work.   I thought quite a lot of myself, didn’t I?   Throughout our marriage I believed that the reason Pammy was still alive was because I had shepherded her through some depression and much drinking and destructive behavior. I feared for her life on occasions and even after forty years I still did believe there might be someone who was better for her.  There were many times I was utterly exhausted and without hope myself. Sometimes I was too tired to sort out whether I was looking at Walter as a remedy for Pammy or for me.  I had to believe it was for both of us. 

Early in our marriage when we fought and talked of separation I would darkly say, “Why would we divorce and ruin two other peoples’ lives?”  There has always been a slightly twisted side to both of us and it was not diminished by our marriage.  It was born of our parents, their dark side denied.  Their darkness was poorly clothed in altruism and religion.  Even after nearly forty years of marriage there were times when I still wanted a “good out” for both of us. 

I need to bring this to the forefront because that childhood boyfriend has contacted me supporting my current travels and lauding our marriage.  Walter has an enhanced view of our marriage.  My goal is not to destroy his view but I need to be honest and clarify here.  In Walter’s message he thanked me thusly for my blog writing:

“.....My whole life, I’ve been disappointed that I never had the courage to talk to Pam in high school, wondering how different things might have been. But for the past few years I’ve been happy I didn’t, because I can see what a meaningful and joyous life she found with you. Thank you for that too…..”

Our life was extremely meaningful and at times joyous but it was fucking hard, too. Enough about the hardships though.  We all have them, right?  You know that I am not speaking ill of Pammy or Walter here, right? 

The real reason I wrote this now is because Walter is a very real person. I love that he is sharing himself with me.   I did ask Walter if I could share his reply and this window into his past.  Walter wrote back,  “I fully trust that whether plain or embellished upon, you’ll do it with the highest regard for Pam and for integrity.”  I do have the highest regard for Pammy. I loved her but I could not provide for all of her needs. Now I know that nobody can provide everything for another.  We can only do our best to listen, to love, to challenge and to compliment another.  We all do our best given the hand we are dealt. There were times that I simply had hoped that Pammy and I could have had different hands dealt us.   Maybe it is simply my romanticized notion about Walter and Pammy being better together than Pammy and me.  It is also possible that I was simply lying to myself.   I do believe I only wanted the best. We can’t win with a losing hand and bluffing does not work for long in poker or in relationships.  Pammy refused to stop and see him on the trip to upstate New York much as she refused to listen to my advice regarding how to best live her life. 

Regardless, there is so much that I have received from old and new friends since Pammy died two years ago.

Several friends have messaged me to say how important this discussion has been for them.  They remark that now late in life they need to be honest with themselves and with their parents as well.   Two very dear friends sat down with me to discuss real plans not to prolong their own deaths. Even as they watch her father  prolong his death beyond anything humane and or even remotely positive,  they want it to be different for themselves.   I only listen. I am no expert. 

One of Pammy’s dearest friends who has fought bout after bout with cancer with some success now watches and suffers as her husband suffers from a different illness.  She has extended her life with a fierce determination.  Treatment is her choice as it is for everyone. I simply believe that we do not need to allow the medical system to make these choices.  I hope to make a different choice, my choice.  This friend does not want her children to watch her deteriorate into a dank, meaningless life in a care facility.  She is being honest about the conversation and asking what she will do when the next “other” shoe drops.

I’ve texted another FB friend who reached out to me.  She is  living her best life and has voiced support for my blog and Facebook posts and my attitude.    She wants me to continue traveling and posting and living well. I’d like to meet her someday to go for coffee or a hike or both.  Her attractiveness shines brightly in how she is living her life.  She wants more for herself at the end of life as well. 

A childhood friend of Pammy’s who helped me so much in the months before her death is still looking for a misplaced picture of Pammy smoking a cigar at our wedding. We both loved that picture of Pammy.  Lin is so supportive.  As a nurse she sees death in all of its sordid forms. Lin does not want a drooling existence for her or her husband. She has witnessed far too many. We agreed just a day ago that we do not really need to find the photo because it is burned into our memory. Still finding it would be nice.

Pammy’s brother now confides in me about how much his sister meant to him and how she helped him through some tough slogging in his life. Only rarely did I ever see Pammy on the phone talking with him. Texting was their M.O. Their family has always had quite an aversion to the phone.  We walk together and talk now and share about Pammy and end of life choices. 

Pammy’s sister and my own last remaining sister have come around to accepting my brashness and expletive-laden posts.  They now talk more about death but also about life and living it fully.  They believe me a bit unhinged, I believe.  Being north of seventy they are both talking of what they’d like their death to look like.   I believe they may even find my delivery and my words slightly less offensive.

My daughters, Molly and Annie, react a bit differently  to my life now without Pammy.  That is good. They are very different women.  I wish I could be there for them as Pammy was for them.   I wish I could be talking, joking, sharing about motherhood and careers and working and dogs.  Always dogs.  We have discussed what I want for my curtain call. Before Pammy died she made it apparent what she wanted at the end of her life. 

I cry sometimes when I think about my loss.  The reality of our lives together has some fine memories.  We did the best we possibly could given who we were.  What I have gained during our marriage and since is monumental.  I have gained a creed and also a tribe of sorts. I am not a christian even though I pretended to be one for some time. I am a much kinder atheist than I was before.  I was not so kind in much of my life.  I could be quite a bully at times. 

My family-of-origin was rife with progressive liberals. We children were raised to fight the nefarious forces of religious, political conservatism in our church and christian schools.  I grew up with disdain for the people who were not as smart and not as aware and who lived with their idiotic ideas about education, politics and religion.  “Who could think that not having a Sunday newspaper delivered to your home was mandated in the Bible?  Really?  Playing cards and dancing are the gateway to addiction, fornication and the lake of brimstone?  Fuck that, you idiots!”  I became a master of arrogant disdain and sarcasm.  As I have grown older I’ve become much less fond of it.  I have gained a little bit of softness and understanding and I like myself much more now.  My sharp criticism is still there. There are some people who deserve satire and sarcasm.  However, I don't feel a compelling need to dole it out as often.  I  thank Pammy for helping me become more understanding of others.  I also have to thank those friends and strangers whom I have met who share, who give and who are kind. Not all of what I talk about now though is death and dying.  It is about extending a good life, enhancing the quality of living.

An old friend, Grise, from my christian school days shared with me a story on one of my road trips.  We had dinner.  I parked my trailer at her house north of San Francisco. I was there for the Hardly Strictly Bluegrass festival at Golden Gate park.  Grise told me that I had changed her life with one event in high school. She wanted to thank me.  I was shocked. According to her, one day in the back of a classroom there was a small crowd of us sophomores just talking.  Grise interjected something into the banter.  She does not recall what she said but I turned on her and mockingly belted out, “Yeah, well you were probably stoned out of your gourd at the party.”  I do not remember saying it but it does sound like me. Why would she lie?  When she told me the story I apologized for being such an arsehole.  Grise stopped me short. With a wide smile she thanked me. According to Grise my insult pushed her into being even more of a pariah amongst the kids at our christian high. I told her I do not think that I meant harm.  Apologetically I admitted that I probably was high myself at the party.  However, after that event she became adamant with her parents to allow her to attend public high school.  Grise continued by saying, “Thanks to your comment, Hank, and my insistent cajoling I got to attend public high school.  I became popular.  I don’t know how it worked just like you are not sure why you said it but I excelled in public school.  Hank, it seemed to give me the confidence I needed to later run my own company and be comfortable and confident. My parents allowed me to move away from that crowd of christianity which was dragging me down.”   Grise is a wonderful person and her candor was invigorating to me. I did not pat myself on the back. It was not my doing that helped her.  However, it was her honesty and her support of me that now is so wonderful.

I am not a christian.  I think that my religion, if it is anything, is “Ietsism”.  Ietsism is a Dutch thing but not a mythical-now-made-real  religion.  I was unaware of it while growing up.  Now my simple reply to those people who question me about my beliefs and an afterlife is, “Well, there must be something.”  That is what I believe.   There must be something.  “Iets” (pronounced eats) in Dutch means “something” and when people ask us “zealots of something”  what we think about the afterlife we give a full throated response, “There must be something.” 

I firmly believe in the now.   Being present is what I know and what I love.   I do thank my parents for working hard and for caring enough to make sacrifices. They sent me to a christian school.  Christian school for me was throwing good money after bad though.  What I did learn in christian school was that I love the outcast, the prodigal, the reprobate.   I could have learned it in public school though.   I now know that we all have a good measure of that inside ourselves.  In some it shows vibrantly while in some it is well hidden. We all have it and it is loveable.  At  times it can seem ugly and distasteful but when recognized in everyone it is utterly embraceable.  It is an integral part of being human and to embrace it is humane.

Let me return to Kate and Val, my first romantic encounters after Pammy. They are both solid examples of it.  I now see that Kate was helping herself as well as me by helping  to get rid of Val in my early, post-Pammy dating life.  I shared with Kate that I felt like Val was creeping under my skin by co-opting my dream of building a retreat in the Yucatan jungle. I expounded with Kate that I was lonely and I was having a tough time cutting ties with Val. I could not say no to her and set limits because I felt so needy in my grief. I felt further imbalanced because of my infatuation with and growing desire for Kate and her attention. I was utterly confused.  I also shared with Kate that Val had invited herself into my travel plans for Europe.  It was too much. 

When I shared my feelings about Val  with Kate she coached me on ending the relationship now, quickly and not getting mired in the split. Kate walked me through it and actually edited my written, planned phone call to end things.  Kate helped me to resist re-engaging with her when Val sent back a salvo of replies.  Val wanted me to  explain myself.  Kate coached, “Do not answer her calls or texts.  You have to be done with her if that is what you decide you want.”  This was before I found out how interested Kate was in me. It was good advice from Kate but now it seems obvious that her advice also had a self-serving side to it.

However, I myself had manifested a relationship with Kate through her sister, Ceda.  Was I any more honest and transparent with Kate in my maneuvering than she was in helping me end my relationship with Val?  Not really. I was human with all the selfishness that is involved in being human. 

Eventually I explained to Kate how I had manipulated the circumstances to get close to her and become a friend first and eventually a lover. When we slice and split open an avocado, however, we often see some less than perfect flesh.

On the other hand, it is true that Val seemed less than fully ethical when she took acid before her session with that couple in therapy.  Looking back after our relationship ended though I found that I believed she was doing it for the good of that couple.  Reasonable people can argue about it.  I’ve done some far flung things in counseling that I’m sure would have seemed suspect and questionable from others’ perspectives.  I believed I was doing them for the good of the patient.  Could I have been stroking my ego a bit, too?  Some of them turned out well and some likely did nothing good for the client. I am human.  We are all a little bit broken.   As long as we understand that we are all doing our best it should be good enough.  Most of us are making it up as we go along. We all should show some grace.

I love Kate for what she helped me with no matter how self-serving and I can love Val for being a hurt person trying her best to help people put themselves back together.  Both were helping people embrace life. Accepting the uncertain and questioning and even dark side of life helps me see that there is light there as well.  They were helping me, too, in my grief.

Now I know that  I am getting ever closer to my end.  I feel healthy but I look around and know my health will not last a long, long time. To me it is important that I do what is right for my daughters and myself as I get older.  I do not want to prolong my death. I want life as much as anyone but I want my death on my terms and not based on the medical community's solutions.  Procedures and operations and medications which suck the life out of most people are not in our best interest.  Pumping poison into my body to kill every bit of life with the hope for another six months is not in my best interest.

Three days before my birthday I had a doctor appointment.    I am 70 years old.  I awake at 4 AM and commence reading articles about Tibialis Anterior tendon ruptures and surgical treatments and outcomes. My diagnosis is not horrible, nothing terminal, but it will change my life in some rather large ways. The tendon in the front of my ankle which attaches the tibia to the foot is ruptured. In November I caught myself and avoided a faceplant but instead landed with my full force on my right ankle while it was dorsiflexed. Since my injury four months ago I cannot walk the way I did prior to injury. My gait has changed and it will not get better without surgery. However, there is the risk that it may not improve much with surgery. The surgery and rehab will likely last a full year.  At 70 years old I believe that I  am looking at only about five more really good years. Losing a full year is worth some worry.   Regardless, my ankle will not keep me from going swimming in two hours. I can still swim and swimming has always been the best for my cardio and meditation.  Swimming a mile helps to release the most endorphins. I can still ride my bike, also. So no tears for me.   It is said that worry accomplishes nothing but I wake early regardless of what they say. I do need to educate myself.   I want to hike up the Hollywood Hills, the North Cascades, the Sonoran desert and elsewhere again if possible. Will I do it again?  Decisions.

Much thought has to go into my decision.  I have already begun reaching out to people who may know doctors who have actually done this surgery. My injury is rather rare and I’d prefer that if I choose to go ahead with the surgery that my surgery is not my doctor’s first rodeo with my injury.   I can see a surgeon rubbing his hands in delight saying, “Oh, god, I’ve been waiting to do one of these and now here is my chance. God, I thought I would never get the chance.”  Some friends have said that they think it’s a no brainer for me.  “You’re active, you’re healthy, you’re on no meds and you certainly want to keep hiking and doing what you do, right? How will you maintain your level of exercise and activity without the surgery?”Well, I am unsure if I can return to anything near what I have been able to do even with surgery. Now I can still swim and ride my bike and I still walk. Maybe I just have to walk slowly and less often and not risk a poor outcome resulting from the surgery. The surgery has  very real chance of an outcome not to my liking.  I simply want to be informed and consider outcomes and not play into a doctor’s wish to perform a procedure.  Once I make the choice I will live with my decision but I want it to be my decision and not the default decision of the medical community.  The norm for the medical community typically involves cutting and patching and stitching and medication.   When you’re a hammer everything looks like a nail.  I do not want to bre mistaken for “just another nail.”   I will make the choice. I will live with the outcome. 

Enough about my injury.

I may never meet another Val who hikes the hills above Hollywood meditating with her ravens.  Val  paints her life broadly with a surrealistic palette.  The therapy she offers her patients I found to be utterly fascinating even while I thought that it seemed potentially quite dangerous.  Sure, Val has the one couple in therapy who makes her terribly anxious and so she has taken a half hit of acid twice before a session with them. So what!   I love thinking outside the box but I do wonder about her thinking outside of reality. So what!  Maybe thinking outside the box is what I need to do now with my surgery decision. 

One long, autumn day Kate went with me for dinner. Before our meal we took a 9 mile hike along the coast of northern California. After basking in a hot tub we lay on a gypsy-like daybed talking and sharing.  Kate has lived a far flung life across different continents and amongst people with all kinds of lives.  Kate seemed as different to me as anyone I had ever met and then I met Val who matched her in a weirdly beautiful way.  Both women helped me immensely in my quest to tackle grief.  

Kate and Val are fascinating women.   I am awestruck by the company that I have been keeping.  I have met so many new people these past two years. There are others who fascinate me as much as these two ladies. However, I have not courted any of the them.  At times I am baffled and honored that so many people choose to befriend me.  Sure there are risks involved.  I grew to be frightened that Val wanted to inhabit me.   At times I felt that Kate wanted me to inhabit or, at least, channel her.    What happened in the Hollywood Hills and along the craggy northern California coast was mind-boggling to me at that point in my life grieving after Pammy. Their worlds were fascinating to me and they helped me handle my grief in small doses.  They both were very understanding of me.   It is not the end of my wonder though

Soon I have a decision to make about surgery or not.  After I ruminate, read and talk with friends and a few experts, and ruminate a bit more I will make my decision.  Then I will take some mushrooms. I will make my decision before the mushrooms and I will be satisfied with my decision afterward.   If I weigh the options and the mushrooms carefully and get an adequate amount of psilocybin I will be excellent. Val gave me the mushrooms. I know they are excellent. I’ve tried them once before and I know they are helpful. The psilocybin does not help me make the decision.  It seems to help me to sort things out.   I become at peace with the decision made.   I no longer need to ruminate after the drug.  I do not take a heroic dose.  I experience some synesthesia and some mild visual and auditory hallucinations. Before I use the shrooms  I have already weighed my options and made my decision. With mushrooms I welcome a peaceful resolve and balance. I  believe it is this quiet peace that I seek. The more-relaxed mania satisfies me.  

Little Bit Broken…… Wood Brothers,

“The more I look the more I findThere's no perfect heart like you see on a valentine the more I see the more I notice Everybody is a little bit broken”

I’ve gone to several of the Wood Brothers concerts the past two years. Kate introduced me to this band, a wonderful roots music trio and a great concert band. They are touring now and I am attending another of their concerts in Chicago at The Salt Shed this May.  Check them out if you like to move to your music. Listen to The Muse,  IMO one of their best songs.