Editor’s note: It has been several years since the story you are about to read took place, but my experiences as a hospitalist have given me a new perspective to this bittersweet tale.
My wife and I never contemplated a future without her. She was a part of our new family. Aside from a few rough black spots that needed to be removed, she seemed in perfect shape. She had been at our wedding, and we had spent countless days sunning on the beach and taking long drives with her through the Texas Hill Country spotting wildflowers. The Hill Country is where she got her nickname. Everyone called her Bluebonnet; the name just seemed to fit her. She brought special meaning to the number 69. People who saw her would just stop and wave. We were proud to be seen with her.
I left the house one fateful morning and found her in the street, motionless. I did everything I could to get her to move. I was sure she was dead. I could not get her to turn over. I ran inside and called for help. It seemed like forever until I could get someone on the phone. It was not long until the emergency vehicle arrived. A few quick maneuvers were made to get her going, but the efforts seemed doomed to failure. My wife and I watched sadly as she was carried away. Driving behind those eerie flashing lights, not a word was spoken.
We spent forever in a cheerless waiting room with antiquated magazines and lukewarm bitter coffee. The television mounted high on the wall blared a moronic game show. Imagining the worst-case scenario was far scarier than knowing the truth. Finally, a young man came to talk to us. His uniform was splattered with stains, and he looked like he hadn’t slept in a few days. He bellowed our name across the waiting room. I guessed there would be no privacy here.
He said that Bluebonnet was not going anywhere soon. He mentioned something about giving fluids and checking levels, but we did not understand the terminology. He said a specimen of fluid looked milky and the differential seemed abnormal and a pressure measurement was high. Was this supposed to mean something to us? He talked so fast, and no matter whether you know the lingo or not, when it’s a loved one it’s hard to concentrate.
Another hour went by. I stared at the receptionist, but she would not let me catch her eye. Sometime later, another man came out to meet with us. He wore a clean uniform and looked less harried. He said he was a Specialist in this kind of problem. What kind of problem was unclear to me. He never told us his name.
He started with the good news. He told us that Bluebonnet was responding now, that her balance was good, though her joints were worn out and that she had no gross motor abnormalities. It could be a disk problem, but probably not. This all seemed like good news. But then came the kicker; he had heard something strange during his evaluation. It was an odd rumbling sound and the Specialist wanted another opinion. He wanted the Expert.
By now we had accepted the fact that we were not going anywhere. We had been absorbed into the system, a fixture in the waiting room. Another set of pale faces was now illuminated by the television screen, searching for information, hoping for good news, but not expecting it. The coffee was starting to seem not that bad.
When the Expert came out he was friendly and invited us to watch while he made his comprehensive evaluation. He seemed thorough and competent. He did not ask us any questions; perhaps his colleagues had filled him in. Bluebonnet was not going to be doing any talking, that was obvious. The Expert’s nonchalant demeanor evaporated as he pulled his hand out from beneath her, his finger covered in something black and tarry. He suggested more testing and hooked her up to an erratically beeping monitor. He told us that his evaluation might take a while, and perhaps we should leave. He would call us when he had a better picture of what was going on. We sadly trudged home.
When we returned the next day we met with the Expert again. He said he had found the problem. Bluebonnet needed her valve replaced. As best I could understand it, there were two problems: The valve would not open completely so flow was obstructed, and the valve would not close completely either. I put my head on my wife’s more stoic shoulder and began to cry. We were not ready to make this kind of decision; Bluebonnet seemed too old for a procedure this aggressive.
We reminisced about the good times and the bad. We considered the cost and risks. There was no guarantee that a valve replacement would do the trick. A time comes in existence when the good memories can outweigh common sense. In the end, however, I had them remove her from the monitors. I drove her home, not knowing what to expect.
The next month was fairly quiet. I made sure she was turned over as much as possible. There were no problems, but she barely went out. It seemed like she was missing her usual spark. One warm Sunday, with much trepidation, I took her shopping. Half way to the mall she started to cough, then shook uncontrollably. I looked frantically around; what would I do if she died right in the street? I was in luck however, there was a small facility right on the corner and I nervously pulled into the entrance.
It was a small, private place. A few friends had gone there and were pleased with the results. It was run by an efficient young woman who immediately helped us. She ran the facility on her own—no big corporation telling her what to do and monitoring her bottom line. She listened to the whole story, and checked out Bluebonnet thoroughly. She patted Bluebonnet affectionately; you could tell she cared. She smiled as she told us that the new valve would last for years. It was not the valve at all, only bad gas.
We had several more years with her, and then she was gone. But we never forgot our time with our 1969 Cadillac convertible, Bluebonnet.
Rust in peace. TH
Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.