Heart Fail-her

When I met her in high school, she was the freckled girl with the broad smile and convertible red Mercedes – always fun and lively. I had no idea that before my 40th birthday, I’d take her life.

In school she was a grade younger than me. We met when my friend Wendy brought her into our fold. It was a wild night, one Millicent and I both remember… CAF, as I’ll call her, handled our teen girl craziness with aplomb.

After high school, when most of my friends went away to college, CAF and I remained in San Diego to study. We hung out quite a bit and, one fateful night, met the two men we’d eventually marry. They were best friends. This could, on occasion, be a real pain in the ass.

Five years before CAF gave birth to her first child, I had mine. CAF and her husband were (for the most part) supportive of this change in group dynamics.

Three months after CAF became pregnant with her first child, I became pregnant with my second. It was nice to go through it together. CAF went on to have two more children. It was shortly after the birth of her third that our lives were forever altered.

I was at the office. I worked full-time back then. I was Director of Administration for a real estate development firm here in San Diego. The call came through from my husband saying CAF was in the hospital. She’d had a heart attack. As CAF was a year and a half younger than me, I had a hard time believing this. She was 33. She’d been taken to the hospital closest to her house. I rushed there and heard the impossible news: Not only had she suffered a heart attack but the hospital (once they’d harvested her artery) realized they were way out of their league. They needed to ship her to a hospital that specialized in her type of rare cases. Rare cases?! We were baffled.

It turns out CAF suffered what is called Spontaneous Coronary Artery Dissection, a rare condition that occurs after the birth of several children. This was three months after the birth of her last child. All arteries leading to the entire left side of her heart were shredded. She had also suffered a stroke.

She was flown to a sister hospital, which was unable to do more than poke at her. They, too, were out of their league. Next she was flown downtown. We all drove down separately, a somber, disbelieving group. After many hours, they came out to tell us that they’d put CAF into a medically induced coma. They would put an LVAD (Left Ventricular Assist Device) in to replace the left side of her heart. We could go in and see her if we wished. I waited until her husband had already left the room before I went in. CAF was suddenly the Bionic Woman, lying there with a metal rod sticking out of her head, and her entire chest cavity cut open, covered only by what appeared to be Saran Wrap. This image still haunts me. I saw the inner workings of the human body. I wish I could forget it.

Because she was a strong woman, she came through that all right and was put on the heart transplant list. In the years she had with us post-LVAD, she learned to adapt to life with the heavy outer battery pack strapped to her waist. The thing weighed 4 pounds and the power cord went in through a hole in her side. We always had to carry a spare battery when we left the house in case of emergencies. At night CAF was plugged into a power source, not the batteries. CAF forever wore the scars of her trauma, a slice from her neck all the way down to her left foot. When I’d remark on how brave or strong she was, she’d say she was just grateful to be able to raise her children, to get to know her baby and have him know his mommy…

The rhythmic ‘whoosh whoosh whoosh’ of her blood being pumped by the LVAD was jarring at first but then became a pleasant aspect of life with CAF. We made plans to celebrate our 40th birthdays in Paris. Just us two. It was something to cling to. CAF was a brilliant interior decorator and her house was always ready for Architectural Digest. Whereas mine looked like a bomb had exploded… Sometimes she’d remark upon this but not with as much frequency as she had before her LVAD. Perhaps we both realized what was important?

CAF and I routinely hung out, as usual. Dinners, drinks, movies, shopping. If it wasn’t just us, it was my family of four and her family of five. This would be the last time my husband and I would share similar friends.

One day years later, the call came that CAF had been put in hospital with severe pain. When I called to check up on her, she said she had been in pain and feverish for a few weeks but waited until her insurance could cover it before going into the hospital. She couldn’t afford to go sooner… By then, her appendix had burst, blowing away a good part of her intestines. This was indeed a setback. Her pain and fever increased. They loaded her up on antibiotics to make sure bacteria wouldn’t affect her heart. After testing the appendix, they found something alarming: it was riddled with cancer. She couldn’t catch a break. They needed to take her off the heart transplant list now that she had this disease. It had spread to her lymph nodes and, as such, she would now be incapable of taking the immunosuppressant necessary to prepare her for a transplant. Had she taken the medicine, the cancer would have run riot. As it was, the cancer was a wait-and-see measure. This particular kind goes away when the affected host organ is removed. And so it did.

It was several years later that CAF suffered a massive stroke. She was wheelchair bound and needed to learn to speak and eat all over again. She would grow frustrated, as you can imagine, yet still had a twinkle in her eye when we’d sit and watch movies together. She was still in there. She lost energy quickly, however, and I guess I didn’t want to think that another stroke was imminent. Months later, it came.

There were no more cognitive moments for CAF. She’d suffered this stroke while asleep. It was one of her children who’d found her. CAF had always doted on her children. That it was one of them who discovered her makes the story that much more brutal. Every day for weeks (maybe a month? maybe more?), I’d go down to the hospital, Red Bull in hand, and sit for hours at her bedside. Sometimes her husband was there, sometimes he’d just left. When we’d pass, he was always positive. He believed each day that CAF had blinked in response to something he’d said or squeezed his hand. This always puzzled me as I never got responses. Never.

One day as I was leaving, I was waylaid in the corridor by a nurse and the lead cardiologist. They explained the facts: CAF was brain-dead. She wasn’t in there anymore. They’d tried explaining to her husband but he wouldn’t listen. He clung to the belief that he’d have his wife and the mother of his very young children back. According to her medical team, she would never come back, and he needed to pull her life support and move on. Could I please explain that to him? they asked. I said, “No. I’m vegetarian. I don’t even kill ants or gnats.” I wouldn’t be the one to tell him he needed to kill his wife. I wouldn’t tell him he had to kill my friend. They, however, were adamant. I was the only one they could prevail upon, the only one he’d listen to. CAF’s biological family was scattered and didn’t get on with her husband.  They stopped coming after the first day. They knew what we’d failed to acknowledge. There was no coming back. And his family seldom came to the hospital. It was just the two of us every day.

On the agreed upon date, I brought CAF’s husband into the hospital conference room to meet the team of cardiologists, neurosurgeons and neurologists. There they explained the facts to him. He turned to me in a state of denial and I did what needed to be done. He took my advice. I felt like the Grim Reaper.

Days leading up to it, he’d bring the 3 kids in to “Say bye to mommy.” It was horrible to witness. On the 3rd day of this trauma, the head on a ceramic angel sitting on a nearby table fell off of its own accord, rolled across the tabletop and hit the floor. I told him then it was enough. Just pick a damn day and stop bringing the kids in! They’d said their goodbyes. They needn’t be permanently scarred anymore than necessary.

It was decided we wouldn’t let her go on Memorial Day because he’d always remember that. He chose June 1st. We went and picked out her coffin together. We picked out her plot together. It was very near her mom’s…

The day dawned brutally hot. I remember worrying about after school care for my kids as I drove to the hospital. Who’d watch them? I knew I’d be in no shape to care for them. Thankfully I needn’t have worried. Friends and family are exceptionally kind in circumstances such as this. CAF’s husband was there waiting for me along with his mother. No one from CAF’s family was there. The doctors came in, the nurses were unobtrusive. The machine was turned off, stopping the rhythmic ‘whoosh whoosh whoosh’ that had been such a part of our lives for years. It took about two minutes before CAF’s husband fled. The sounds of her body gasping was more than he could bear. His mother ran out to care for him. I continued to sit there, holding her hand and talking to her in my stupid inconsequential way that I’d always done. Blathering away. Saying nothing of import. I told her I was sorry that I’d done this to her. I told her I loved her. And I told her I’d wait a good while in the room after she’d gone so she’d know I was there. When I looked up, I realized even the nurses had fled. I was alone. It took a long time…

I came home, went to my room, drank four beers in rapid succession, and fielded texts and calls from my best friends. By the time Andy phoned, I was fairly incoherent. I get the feeling he’d been rehearsing his comfort speech all day, bless him. It didn’t help but whenever I think of that day, I think of him trying so hard to spare me what I wouldn’t spare myself. What I still haven’t. I think of him standing in the hallway outside a convention in Las Vegas telling me I did a good thing. If anyone could get through to me, it would have been him. It didn’t work. I haven’t been the same since that day, as you can imagine. I refer to it as “The Day I Killed CAF”. I think of it in no other way than I killed her. I convinced her husband to do it and I alone remained to watch her final gasp. I figure when I make it to the other side, the enormity of my transgression will be too great to get me a pardon. I’ll have to come back in my next life as a downtrodden soul… Or perhaps a factory farm animal.

I think I’ve referenced the memorial service for CAF in another blog post on here. It is one of the few times I can honestly say I was proud of myself. There were well over 100 people in attendance at the church, CAF was very loved and respected for not only her interior design work but also for having fought so hard for so long. I stood before them and talked about my friend. I dug my fingernails into my palms to prevent myself from crying, and I concentrated on the lovely caws coming from the crows just outside the door. People still remark on how I stood there tear-free. They’ve no idea how those crows saved me.

I was talking with Wendy and Millicent this morning on Facebook about our old fun times. It made me cringe, reminding me of my deed. CAF’s birthday is fast approaching. I never do well this time of year. I need to go visit her grave but the thought of doing so makes me physically sick. And it’s worse because I’m the only one who does visit. Two years after her death, it had to be me that reported to the maintenance crew that her grave had started to slide down the hill due to heavy winter rains. I haven’t been out there in years. I know I should go…

One of the things I’d told CAF as she passed was that I’d make sure her children were all right. I failed her in that as much as I failed her as a friend. Thankfully, my assistance wasn’t needed for more than 3 or 4 months after her death. CAF’s husband met a charming woman with 4 kids and they were married soon after. I like to think CAF played a part in that. The family continues to do well.

My guilt remains.


8 responses to “Heart Fail-her”

  1. You released her Denise, a gift I would also want in the same situation. The guilt should be let go but I know you won’t do that.


  2. I know you already know all of this, but it still bears repeating…

    You didn’t kill her – her body failed her, and there were only machines filling her lungs with oxygen and pumping blood through her veins. I imagine she never discussed her wishes in this sort of situation, but I also can’t imagine she would have wanted to drag out her family’s and friends’ suffering any longer than necessary. You gave her family a great gift: the opportunity to mourn her properly, and move forward with their lives while remembering her for the woman she was.


  3. Don’t shoot the messenger — meaning yourself! You did a good thing for your friend (as hard as it was) and you stayed with her until she left this life and into the next. Consider it a priviledge that you were fortunate to help someone when they needed help the most. Bless you!


  4. Denise, you gave her what she needed when nobody would, because they were not as strong as you. She was very lucky to have a friend like you, at her side, till she could not be here any longer!


  5. Denise – I had to go through this same process with my baby sister when she died at age 37. She could still speak (barely) and she told me she was only hanging on for her husband. He was a doctor and wouldn’t give up, authorizing surgery after surgery until they finally left her open like you described with the saran so they didn’t have to cut the next time they operated… talking to him about letting her go was the hardest thing I’ve ever done, even though I had already helped my mother, father and best friend die.

    I guess I’ve been letting go of this for years, in my own way. I have never felt guilty. I believe in what I did. But I do feel intense pain that I know will never go away. I also feel strongly that we never die, and I feel her presence all the time. She leaves me messages in funny ways. Last week, for no reason at all, I picked up a book I hadn’t noticed on my shelf in years. I didn’t remember where I got the book but, when I opened it, there was an inscription inside from her. I know I needed to hear what she had written… I so needed it.

    I wish you space and comfort and healing, whatever you may need.


  6. oh, Denise…. you have referenced being with your friend as she died, but i don’t recall knowing the impossibly difficult position you were put in. of course, you are entitled to feel whatever you need to but it breaks my heart that you feel you committed an unpardonable transgression. you gave a priceless gift to CAF, her husband and her children. you may always feel the guilt {knowing how sensitive you are and the enormity of your heart, i’m sure you will} but at the same time i hope you can at least reach a point where you don’t fill you committed a sin. i have been the person who had to make the decision to end the loves of two people and two cats {which you understand when i say the decision was just as difficult for me to be responsible for} and i was with them all through and after their last breaths. i don’t believe the pain will ever go away. i can never have another pet ~ i’m not strong enough. but hearing your story eased my guilt {not eliminated} because i have to believe the same of myself as i do of you ~ you are not a bad person nor did you do a bad thing so i must not be/have either.

    i miss you! i miss our DM conversations and chats on twitter. i often think about your bug vacuum. {smile} though i can’t be online much these days, i hope you’re still my friend ~ i know i’m yours.
    *Love* & *Super Squishy Hugs*


  7. Honey, You have it all wrong. You didn’t take her life, her spontaneous CAD did. What you did was give her peace.

    When that kitten wandered into your garage it’s fate was already determined too. You didn’t kill the kitten, you opened your heat to it, took care of it the best you could and were there to help it pass. That is the work of angels.

    May the peace that you have brought to others bless you as well.


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