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August 28, 2004

'I could be dead when you read this' - Chalmers M. Roberts


Roberts retired as chief diplomatic correspondent of the Washington Post in 1971, at age 60.

Now 93, he wrote an extraordinary essay which appeared in today's Washington Post about how, after much reflection, he decided to say "no" to a lifesaving heart operation.

Most absorbing.

The Decision of a Lifetime

In His Twilight, Facing the End on His Terms

I could be dead when you read this. But I thought it might be worthwhile to put down my thoughts about how I decided to skip a lifesaving heart operation.

I am a 93-year-old man with congestive heart failure. The operation I'm skipping would replace a heart valve that has given up on me with a new pig's valve.

My cardiologist, whom I trust implicitly, and with whom I am now on intimate personal terms as I have never been with any other M.D., surprised me earlier this month.

I had been in Sibley Memorial Hospital for a couple of days with problems caused by my faulty aortic valve. Dr. Ramin Oskoui asked me to consider having this open-heart surgery despite my age.

"If you were 83 and thought Herbert Hoover was still president, I wouldn't suggest it," Dr. Oskoui said.

"But your mind is in amazingly good shape and your body seems to be quite good. Think about it."

He got my attention, of course.

I had a hard time getting to sleep that night, for all my thinking. Finally, my nurse brought me a Tylenol that got me to sleep.

That Saturday afternoon, just three weeks ago, my eldest son, David, who lives in Newton, Mass., flew down to spend the weekend with me.

We kicked the idea of the heart operation around at some length and in some detail.

That Saturday night I woke up around 3 a.m. with my left arm in pain.

It seemed to me that my arm was reminding me that I have a second serious problem; besides the heart valve, my spinal cord is a mess.

The pads between the bones in my back are worn out, exposing the nerves, which caused me, a couple years ago, excruciating back pains.

My back doctor sent me to Sibley's pain center, where another doctor gave me a shot in exactly the right spot in my spine.

This relieved the pain of my spinal stenosis for a couple of years, after which a second shot gave me another couple of years without hurting too much.

But when the pain again began to return and I asked my back doctor about a third shot, he began to talk to me about possible back surgery.

I replied: Oh no, not at my age. I want a second opinion. So he sent me down to another back doctor in one of those K Street medical buildings.

After he examined my MRI pictures, this doctor looked at me and said: At 92, with this back, no surgery. I said: Doc, I love you.

He recommended a trip to the Sports Authority to buy a back pad. Wear it all day, he said, and take it off when you go to bed.

That I did, still do, even in the hospital. In fact, I'm now on my second pad.

I call it my cummerbund, the pad men wear around the middle when they're wearing a tuxedo.

You also see many such pads on men in the Giant who do the checkout jobs, whose backs take a pounding from standing and stuffing your groceries in bags.

Dr. Oskoui thought that my back, while a problem, was strictly secondary to my heart valve problem.

Doubtless true, but still something significant to consider in my deciding about a heart operation.

The next day, Sunday afternoon, all three of my children - David, Christopher, who was just back from the beach with his wife and four kids, and my faithful daughter, Patricia, who'd rushed out to Sibley to see me the first day - all gathered in my spacious single hospital room. Pat's husband also sat in.

We had a great three-hour gabfest. I told stories on each of them as kids growing up in our house.

We reminisced about all those years so long ago, about their mom, and then we got down to the serious business of the proposed heart operation.

Over about half a century I naturally had formed a view of each child's personality and, I was glad to see that during this conversation, they ran true to my opinions of each one.

Some stressed this point, others that one. Their opinions did not differ from what I had expected.

They didn't fully agree, but there was no violent opposition to one another.

And they all agreed that I should make the final decision.

So I started to talk about where my mind had led me at this point.

I said I had no problem with the operation itself - either it would succeed, which I assumed, or I'd die on the operating table.

My problem was with post-op, the recovery, the rehab.

Dr. Oskoui had said I'd be in the hospital for about 10 days, then perhaps three weeks of rehab as an inpatient.

I began to recall what had happened to me during my few days already in Sibley: this test and then that one, the prodding and poking involved, lying flat on my back on a bed cart (a gurney) waiting to be moved from one place to another, then back to my bed.

What would four or five more weeks of that be like after an operation? Plenty of tests, no doubt - and plenty of poking and prodding, no matter how excellent the nurses and technicians.

At 93, too, there's a sort of indignity to men in all that. I'm not being a snob about it, just telling you about the rather human reaction.

When one is younger, a lot younger than 93, one takes it more in stride. But at 93... not so easy.

And then the big question: If everything were to go successfully, operation and rehab, what would I come home to?

Most importantly to me, a house with no spouse. Maybe with all-day, all-night nurses for a spell.

Would I get up enough strength to even be able to walk around again? All that strength I'd built up this summer by swimming in my pool surely would be gone.

The summer would be over, the swimming ended for the year.

No spouse. Today, in August of 2004, I can say I've reached a point of reconciliation over my loss.

You must know that Lois and I celebrated our 60th anniversary on 9/11/01 - yes, that now-infamous day, as our 60th!

The 9/11 when we married was a Saturday, so we could fly off on our honeymoon, but this 9/11 was a Tuesday.

So we celebrated with a family dinner at home on Saturday night, September 8.

All three children, their spouses, and all seven grandchildren were at the table. In a way, we had cheated those terrorists.

So when the attack came the following Tuesday Lois and I were still at the table just finishing a leisurely breakfast when we got word: Turn on your TV.

We saw the second plane hit the tower. We saw it all with awe.

The loss of a spouse - especially after such a long and loving marriage as ours of 60 years - is, I believe, the hardest blow in life.

I lost Lois on Nov. 3, 2001. When she had fallen and broken a hip some years earlier, our way of life was vastly altered.

We moved the bedroom down from the second floor to what had been built as a kid's playroom, then had become my office after retirement.

I had grab bars put up for her in the tiny shower tucked into the corner of the small bathroom, and we made many other adjustments.

In her last few years Lois developed dementia but she knew me to the end.

Honestly, I have been attracted to many women, loved a few but none as deeply, so passionately as Lois - Lopie, as her parents dubbed her and everyone called her once they knew her.

She died at 92 - I married an older woman. My darling Lopie (pronounced Low-Pea).

I could not face the first anniversary of her death alone, so I asked my daughter and son-in-law to have dinner with me.

That helped. Oddly, very oddly, the morning after that first anniversary of her death I woke up feeling that a very large weight had been lifted from my chest.

That was, I think, the moment of my acceptance of what I have called my "reconciliation" to her death. Reconciliation, but no more.

All this came back to me as I thought through, as best I could, the suggested heart operation, the long rehabilitation -- and all to come home to what? A house with no spouse.

Back when I was just 80 I wrote my last book, a lighthearted look at growing old titled "How Did I Get Here So Fast?"

In it I gave my credo: "Keep your heart pumping, your noodle active and your mood cheery."

But I had assumed I'd always have my spouse, and I was wrong.

Not that I feel alone. My children have been superb, my grandchildren most satisfactory, and so have been many of my friends, neighbors new and old, so loving, so thoughtful, so great in rallying round.

I surely do not complain there.

But I would be coming home without a spouse.

So what would happen if I decided not to have the operation? David put that question directly to Dr. Oskoui.

Almost certainly, he replied, one of two outcomes will follow, and the chance of one is about the same as the chance of the second.

One possibility is that my aortic valve explodes with a rush of blood filling my body, ending my life instantly.

Or, I would again suffer from shortage of breath such as brought me to Sibley earlier this month.

I would return to the hospital, and would die in perhaps a couple of weeks as the valve slowly failed.

Without a spouse, not so bad a choice, it now seems to me.

Most of us, contemplating death, hope to more or less drop dead. Quickly, unknowingly, painlessly. And I'd have a 50-50 shot at that. Not bad.

I might say, too, that I feel content. I've done my thing. Raised my kids. Helped each of them get a house.

Did my newspapering, my journalism, as best I could, dammit. Had my byline in The Washington Post since 1949 - not bad, either.

So that's how I came to decide "no" on the heart valve operation.

I'm sorry I took so long to explain.

I do want to add a final word, about the hereafter. I do not believe in it.

I think that the religions which promise various after-life scenarios basically invented them to meet the longing for an answer to life's mysteries.

Indeed, my son David, a professor of astrophysics, tells me that colleagues have spent years listening to outer space for some word of some other life somewhere.

I think we are too much bound in narrow "Earth think." Einstein at least began to think outside it.

I agree with Francis Crick, the eminent Cambridge don, the winner of the Nobel Prize for his co-discovery of the double helix, the blueprint of life, who wrote: "In the fullness of time, educated people will believe there is no soul independent of the body, and hence no life after death."

August 28, 2004 at 09:01 PM | Permalink


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