Vows

Her fork sunk into the forlorn cafeteria caesar salad. It sifted through the romaine aimlessly. It turned over leaves. It pushed a piece of chicken from one side of the clear plastic bowl to the other. It descended to the bottom of the bowl then surfaced in a half-hearted attempt to distribute the dressing more thoroughly. Finally, it rested softly on top of the salad. My mom raised her head to look through my eyes.​

Her face appeared melted. Her eyes were red. Her body trembled. 

“Alan, what am I going to do if he can’t get out of that bed?”

I stood up and went around to the other side of the table. Putting my arms around her I said, “I don’t know.” I rubbed her back. She sobbed.

Three years before, my dad was driving his Gator utility vehicle from one of his parcels of land in northeast Missouri back to his main farm. He had grown up in that area and, after graduating college and becoming a very successful salesman and then plant manager, he began buying land near where he grew up. By 2016 he had half a dozen or so parcels of farm land within about a 15 mile radius.

It was dusk and he was extremely drunk. He lost control of the Gator and it rolled into a ditch. He was life-flighted to the University of Missouri Hospital in Columbia where they found he had crushed several of the vertebrae in his neck. He hadn’t broken anything but nerves were damaged. Through months of recovery, he regained some control of his left arm, hand and leg but little control of his right side. It was enough that he could walk, slowly, but primarily he used an electric wheel chair to get around.

The damage to his nerves caused muscle spasms. The way he described it was that his muscles were fighting each other. When he would extend his knee, for example, some of the muscles in his hamstring would extend like they should while others would contract like they shouldn’t. Sometimes, he would have terrible spasms without moving at all which felt like really painful cramps.

With various medications and a lot of physical therapy, he was able to take care of himself by the following year. But my dad is never one to accept the status quo. 

The primary medication that reduced his spasms and made it possible for him to walk could be administered directly into his spinal cord rather than with many pills per day. This, according to his doctor, could give him even more relief from the spasms and possibly make it easier to walk. 

The device, an intrathecal Baclofen Pump, was approved by the FDA in 1990 and had been implanted in hundreds of thousands of patients with serious consequences being rare. 
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“Sold!” Dad told his doctor.

About a month and a half ago, the pump was implanted. A few days later, my dad started to see results. He was walking with more ease. He was excited!

Then the back pain began.

Spasms started in his lower back, which he never had before the pump was implanted. The doctors tried pain medication, ice packs, cream similar to Ben Gay but he only got worse. By last week, six weeks after his implant, he was virtually bed ridden from the intense pain of the near constant spasms.

The doctors determined the pump had to come out. Dad was deflated. He had high expectations of improving his mobility and now he had gone back to, as he told me, “less than square one.”

Friday I drove to Columbia to be with my parents. After surgery, the back spasms continued but more frequent than before. They were terrible to watch. When he had one, his face would turn red like fire, his head would tilt back and his breath would leave him. Sometimes he’d bite down on his lip as he suffered through anywhere from several seconds to several minutes of excruciating pain. We knew the spasms were unlikely to stop the minute the pump was removed but 24 hours after surgery his spasms were even worse than before he went into surgery. No one expected this.

As my mom sobbed in my arms in the hospital cafeteria, I knew, without her saying a word, the thing she was most worried about was losing my dad. He seemed to be getting worse, not better. Doctors expected him to be able to sit up with minimal pain soon after surgery but just raising his head five degrees triggered a painful back spasm. Touching him anywhere caused a spasm. Laughing caused a spasm. Doing nothing at all caused a spasm. If the spasms didn’t subside, we feared he would be confined to a bed which would cause his 70-year-old body to never recover.

Another 24 hours after the surgery, my dad began to improve. His back spasms were less frequent (but not any less painful). I was able to raise the head of his bed to about 30 degrees without triggered a back spasm. This was good enough to get him transferred to the rehabilitation center he went to after his accident in 2016 where we hoped his improvement would continue.

Driving home from Columbia on Sunday night, I reflected on all that had happened. I kept coming back to the images of my dad constantly praising my mom for all the care she gave him and all the work she did in the hospital to help him. I kept thinking about the shell of my mom in that cafeteria who was frightened about losing her husband of 47 years. I then thought of my own wife of 24 years. In 20 years, we will likely be in the situation my parents are in, one way or another. One of us will have to care for the other one for months or years.

I thought about the vow we said when we got married, “for better, for worse, for richer, for poorer, in sickness and health, until death do us part.” Dad’s definitely “worse” and “in sickness”. During these last three years, my mom has leaned into her vow. It has not been easy and I’m sure there have been days she wanted to drop him off at the nursing home and fly off to Hawaii, but she hasn’t. She’s stayed. She’s persevered. And my dad is vocalizing his humble appreciation for all she has done for him. 

I’ve see how gut-wretching this marital vow can be. My wife and I will be my parents eventually. We will have to endure the demands of constant caregiving. One of us will die.  

Unfortunately, I am getting a preview of what to expect. I only hope I can be as strong as my mom when that day comes.

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