When it Mattered the Most; My Mother Came Through
A Mother's Day tribute to my mom who made difficult decisions about love.
My mom and dad didn't have an easy marriage. And it ended. But It didn't end their relationship. This is the story of how my mom made a difficult choice. A choice that I respect.
My father has been drinking for years. He was secretive about it. He wasn’t abusive physically. But he was absent. We are all sick of it. My mom asked him to move out after 30-odd years. He moved to a tiny cabin by a lake. Alone.
This decision was a long time coming. It took place two weeks before I took my step one USMLE exam.
My father was in his 70s, and my mother was ten years younger. I had been in favor of this decision for a long time. I was proud of her for making it.
David Foster Wallace wrote a story about John McCain. In that story, he highlighted, despite all the bullshit about politicians, that at least in the case of Senator McCain, there is one moment in his life when we know he wasn't full of shit.
He had been shot down as a pilot over North Vietnam. Subsequently, he was imprisoned and tortured. And the North Vietnamese leadership learned that he was the son of the admiral of the American fleet. He was offered release because they wanted the PR Win. The then Air Force pilot declined release from captivity and torture. The rules for the Air Force were that prisoners of war were to be released in the order they were captured. And he was not willing to go out of order.
In his short story, originally published in Rolling Stone, David Foster Wallace identifies this moment, in which a choice was made, which was about self-sacrifice, as a moment in which we could understand who someone really was.
For my mom, that moment came two days after my Step One Exam concluded.
My dad, living in that cabin on a lake, had a stroke. It wasn't his first. It wouldn't be his last. It was horrific.
A stroke occurs when there is a blood clot that forms in an artery, which is the kind of blood vessel that brings blood full of oxygen to an organ. The generic term is infarction: the blood flow gets cut off, and without blood and the oxygen inside it, our cells die. When this happens in the heart, we call this a heart attack. In the brain, we call it a stroke—the location of the blood clot matters. A lot of your brain? You can do without. Some of your brain you can't. The most high-end real estate in the brain is towards the back, and the closer you get to the brainstem, the more important that real estate is. Deep in the brain and towards the back, we have the neurons that connect your brain to your body. If you get a stroke in just the right spot, it cuts off the blood flow—and cuts off the oxygen—to the part of your brain that is able to tell your body what to do.
When a stroke happens here, you can become paralyzed. Your brain remains intact. But you can't make it move your body.
The most horrific version of this is called locked-in syndrome. You can be left with a completely intact mind, locked inside an immobile body. The book, The Butterfly and the Diving Bell was written by somebody who could only blink after this happened. He wrote that book by blinking.
My father had a stroke, creating an obstruction of blood flow in just this part of the brain. He had it on one side. So only half of his body was paralyzed. He was able to use the cell phone at his disposal to tap out nine. And then one. And then one again.
An ambulance came. It brought him to the hospital. He could barely speak. Half of his face was paralyzed. Half of his tongue was paralyzed. This was a bad one.
He couldn't swallow. The rear of the brain has two crucial structures. One is called the pons, and a stroke here leads to locked in syndrome. Below the pons is the medulla, and that's where my dad's stroke occurred. When a lateral medullary stroke happens, it paralyzes your vocal cords too. And your vocal cords protect your airway. Without this crucial protection intact, your own saliva can slide down your throat and, instead of going into your stomach, go into your lungs.
You can't drink water anymore. You can't successfully route it to your stomach. It has to go somewhere, but you can't control that anymore, so if you drink water, it also goes into your lungs.
You can no longer eat. You can no longer drink. You can barely make a sound.
My mother had left this man. She had decided their relationship was over. He had made his own choice, many years over, to act in a way that led to this decision. My mother got a phone call from the hospital. Arthur Muir has been brought in by EMS. His ID indicates that you are his wife. My mother had to make a decision all over again.
“Yes, I’ll be there right away,” she said. I was the next phone call.
I got into a car crash on the way from Rochester to Torrington, Connecticut. She was pretty “relaxed” about that too. When it came down to it, Vita made the decision that her husband was her husband. And that his bullshit was his bullshit. And that the moment to abandon someone? It was not the moment when they needed you the most.
The irony is that they went through with a divorce. They worked together to do the math, as it were, on the likelihood of a subsequent stroke. What happens when somebody is disabled is that they end up needing to go into a nursing home. The government forces you to spend all of your money. Then, Medicare and Medicaid both kick in and pay for the rest of your stay. My father did remarkably well and had stroke rehab. He was the goddamn king of stroke rehab. He was an inspiration to all those recovering in that skilled nursing facility. Art Muir was Mr. Get It Together when it came to rehabbing from a stroke.
He never had another drink in his life. He stayed sober for the last eight years.
Legally, my mother took him for all he was worth in that divorce. Were he to ever end up in a nursing home again, it wouldn't be on their dime. The government is not dumb, and they know people will try to pull this sort of nonsense. They can go back three years and take your ex-spouse’s money to pay for your skilled nursing care.
So my mom and dad got divorced. They lived together not just for three more years but for eight. I think this is one of the better decisions my mother ever made.
My father was many things. But not recognizing that he had the best fucking wife that anybody could ever have over the expanse of his life was not one of them.
He never drank alcohol again. He started going to AA. The PEG tube was removed. He regained the ability to swallow. He still didn’t drink. He worked his recovery hard. Frankly, after he stopped drinking, as somebody who had had a couple of strokes and was not totally together, he was a delight to be around. I think the last eight years of my parent’s relationship, and my mom is free to correct me if she likes; were probably the most joyful they shared.
All it took was a catastrophic lateral medullary stroke and a decision that was about love, grace, and realizing that difficult decisions are the important ones. My father died of metastatic bladder cancer eight years later. My mother was with him, and the last night of his life, and he died without tremendous suffering because she loved him.
She’s my mother, and I’m very proud of that. It’s Mother’s Day, but she was more than a remarkable mother. She was a remarkable wife. Even after she wasn’t.
—Owen Scott Muir, M.D.