The last you heard from me was at the end of February when I shared my life lesson in relinquishing a family heirloom. What also happened on that same day, was that as we emptied the remaining furniture in that downstairs guestroom to make way for my new clinic space to be ready by my move-in date of September 1, we discovered a leak. A foundation leak, to be precise. Thankfully, it was confined to that room, and six weeks later, the room was gutted, the foundation repaired, a sump pump installed, and we had a lifetime warranty.

While the price tag was hard to swallow, one of our life mantras is this: it can always be worse. At least the timing of the repair completion was perfect. It allowed us to proceed with our plans to celebrate our friends’ wedding in Baja and then our 27^th wedding anniversary for seven days in late April.

When we returned, John planned on completing the renovation through May with the help of Adam, a talented handyman. This included dry walling, painting, and installing a wall bed and other office furniture in the guest/clinic room. Over the summer, John was to ready the yard for safe patient access by replacing the two wooden bridges, completing the gravel pathway to the back porch, and installing a railing to the back steps leading to the access road. Yes, my lease at the Bellingham Towers was ending in September of 2024, and in a few years, I hoped to join up with my friend’s new medical/wellness practice. In the meantime, a home-based clinic for me would be a welcome change from the headache downtown had become.

But then came an earthquake.

The Earthquake

Ever been in a massive earthquake?  Having grown up near/on the San Andreas Fault Line in southern California, I’ve lived through some pretty big ones. The thing about this natural disaster is that it comes without a warning. Floods, fires, tornadoes, and hurricanes all have at minimum a 5 to 10-minute warning window. A big southern California earthquake is like the SWAT Team just broke down your door and invaded your house. In the middle of the night.  But they had the wrong house. No one dies, but there is a good deal of upheaval.

April 29^th, 3 days after returning from Baja, John had a massive heart attack, a STEMI. The Widow Maker artery and two other main coronaries were 80-100% occluded. He had a lifetime of normal lipid panels, of eating and living healthily, with no family history, and no warning signs prior. This was a massive earthquake. He survived, but our lives have changed dramatically.

John’s symptoms were sudden. Having carried a heavy piece of furniture in from the garage after dinner, he paused and sat down.  A huge band of pressure around his chest began squeezing the life out of him. Thankfully I was present, 911 was called, and within an hour from the onset of his first symptoms, he was in the hands of the cardiothoracic team. He underwent 2 stents, and a temporary implantation of an intra-aortic pump device to keep his heart pumping. That pump was to be removed within 48 hours but it remained in him for 10 days. Unfortunately, cardiogenic shock, a widespread lack of oxygen, had already begun and compromised his lungs, liver, and kidneys. Remarkably, he never lost consciousness and was never intubated. However, within a few hours, he acquired the diagnoses of cardiomyopathy, congestive heart failure, pulmonary hypertension, and liver and kidney failure. Fortunately, the last two would resolve.

After 3 days in Peace Health’s ICU, he was airlifted to the University of Washington Medical Center, Heart Failure Division, about 80 miles or a nearly 2-hour drive south of us. The team there was better equipped to care for John’s unstable and complicated status. Another reason for this transfer was because of their heart transplant and LVAD program. The LVAD (left ventricular assist device) is a pump implanted into the left ventricle (lower chamber) of the heart and helps the heart pump.  We learned his left ventricle hadn’t deteriorated enough to be able to house the pump for the LVAD. Regarding a heart transplant, he missed the cut-off by 5 years. Nevertheless, being under the UW’s care would “hold a place in line” for him if he ever needed the LVAD.

I asked the attending physician, Dan Fishbein, MD who could fluently quote the literature and had also published extensively, “Have you ever seen or heard of someone whose heart was as damaged as my husband’s walk out of your cardiac center?”  He smiled and nodded. “Over the years, I can count on my hand how many have. It’s indeed possible, and if it would happen to anyone, it would happen to John,” referring to John’s positive outlook as well as healthy history.

Indeed. John had endured a great deal of discomfort with good humor. For a week he had to lie still on his back due to the catheter in his leg that was attached to the pump in his heart. Then he had another stent the second week at the UW, which initially set him back, but was needed. And then there was the catheter in his neck that constantly monitored his heart pressure for three weeks. But unlike the other patients on the cardiac floor, his color remained healthy, and his walking cadence was impressive. Finally, he graduated to the step-down unit for several days and then was able to come home on May 25. Remarkably, he did indeed walk out of the hospital nearly a month following the kind of heart attack few survived, especially at the age of 75.

thrilled to be sitting again

During his hospitalization, I pivoted my clinic and home visit practice to a hotel room in Seattle, (subsidized housing by the UW) treating patients via telehealth in the mornings and evenings while being bedside with John during the day.  Marathon days of great stress, it is impressive what we can do during a crisis.

Also, during May, I hired Adam to complete the renovations, which I monitored during the weekends when I came home for a change of clothes and to look after home and office responsibilities. Office administration tasks were managed by a friend and a former student. And finally, my friend and colleague, Renay generously took over my lease, setting up her clinic in my space, so that in June I was free of my lease and able to be home as much as John would need me. I loved the beautiful space I had occupied on the 6^th floor for the past 10 years, but life was changing rapidly, requiring me to make hard decisions quickly.

Once home, the arduous climb out of the deep pit John had fallen into began.  He was severely atrophied and deconditioned and continued to lose weight through the summer, with a total loss of 26 pounds.  Having never taken medications, he was proving to be quite sensitive to his regimen of 9 medicines and could barely tolerate the microdoses he was prescribed.

Our community came through for us: family, friends, church, neighbors. They made sure we were well-stocked with meals, practically doing backflips in their cooking to find something that John could eat. His appetite was simply gone, and nausea and vomiting were common in that first month home.  People came by for short visits or chatted on the phone to break up the monotony of his inactive days where all he could manage was sitting. Neighbors monitored the house and helped with the yard. Family assisted with house projects. When John was finally able to participate in Cardiac Rehab at the end of June for 3 days a week through July, friends helped take him to and from his appointments. He was able to complete 6 weeks of that. Our community has done some heavy lifting for us as we crawled out from beneath the rubble of this earthquake. We especially treasure the hundreds of thousands of heartfelt prayers, many whispered in the deep of night, being prayed on our behalf during some of our hardest moments. At times we felt like we were being carried on the shoulders of others.

early days of using a walker

…graduated to a determined stride thanks to Cardiac Rehab

Since John’s been home, he’s been re-hospitalized twice and has had an ER visit. The re-hospitalizations have been less than a week and have to do with medication intolerances and adjustments. The last hospitalization caught him diving from stage 2-3 heart failure into stage 4. Following an evidence-based protocol, the slight medication change proved to be too aggressive for him. In hindsight, we have learned to go very slowly and very minimally. During that last re-hospitalization, he was sent back down to the UW for re-consideration of the LVAD, which again he didn’t qualify for, as well as other end-stage heart failure treatments, and then sent home on a low dose constant intravenous drip of an inotropic medication. This makes his heart pump stronger. Since he is responding well to it, the hope is to bridge him off of that onto other medicines.

Since the last hospitalization in early August, we now have weekly cardiac appointments, either up here in Bellingham or down in Seattle. We are fortunate to have two teams working together as one managing John’s complexities. Both teams are smart and well-educated, keep up with the literature, and welcome my many questions. They are compassionate, conscientious, and creative. Truly we are well cared for in this new life odyssey.

Yes. Odyssey. Not “journey” or “adventure.”  This has been epic. And it has required a radical shift in perspective. Initially, there was resentment of having to be on all of these medications, as well as not being as strong as previously. And then there was the fear of doing too much and heading downhill again.  He is accepting his new normal but not completely, which is healthy. I tell my patients to hold their diagnoses loosely and their prognoses even more loosely as we continue to learn more in medicine every year and every day. As for me, I have to tread lightly between being the encouraging, supportive wife to the physical therapist. Fortunately for me, John is  (mostly😊) an easy patient.

My ride has been a rollercoaster. In many ways, I’ve been prepared for this as I have worked in various forms of home health since 1995. I am aware of the rehabilitation required, the medication challenges, as well as the ups and downs.  Rebuilding his strength and endurance at the speed of a snail, while trying to boost his appetite and fluid intake requires patient tenacity.  Nevertheless, accustomed to him bouncing back quickly, this new slog has been frustrating and fatiguing for us both.

Because of my experience, I also am familiar with the pitfalls caregivers can fall into, not realizing their health, and self-care are every bit as important as the patient’s.  Girded with the knowledge and resources, while I continue to see patients, I’ve cut back on my practice volume. My work is a welcome change of pace, and I love what I do. I prioritize sleep as an effective immune and mental health booster. Exercise and/or gardening daily help me de-stress. Plus, I have a wide network of support whom I seek out regularly, and if I don’t, they find me. 😊  Doing this well can’t be done alone.

And speaking of alone, never have I felt alone. Overwhelmed?  Deep sorrow? Of course. But amid the chaos of shifting emotions and circumstances, a steadying, anchoring presence of peace, love, and a mighty strength has walked, climbed, and at times crawled with me. If living a life of faith can be likened to rock climbing, I have lived much of my life gripping and trusting the Source of this peaceful loving strength to get me through.

In grammar lingo, faith has a direct object; we have faith in a what or faith in a whom. And what or whom you plant your faith in will determine the outcome. That anchor you use in rock climbing is only as good as the rock it is sunk into, and how strong the grip of the climber is.  I invite you to practice clinging to God in every circumstance, every day.  The God I have faith in is one who deeply, passionately, and sacrificially loves all of us. He has promised to go ahead of us. And he has promised to be with us. Always.

As always, thanks for reading.

Pic of John anticipating his first long-awaited French Toast at OtherLands Brewery