Missed call

FigureI had just finished my morning workout at the YMCA, logging an hour's worth of laps in the pool. When I exited the building, the cold winter air stung my face as I reached into my pocket for my phone. Three missed calls had come in from the hospital over the previous half-hour. I slid into the seat behind the steering wheel of my car, touched the first number on the screen, and connected with the nurses' station on the third floor of the Conklin building. "Hello," I said, identifying myself. "I'm returning your call. I assume this is in regard to Mr. Alder?" "Yes, we've been trying to get in touch with you. He took a turn for the worse a short while ago: heart rate dropped down suddenly into the 20s. He's been transferred to CCU for emergent care. They're looking to have a word with you." Mr. Alder was a good friend of mine. I had known him for over 30 years through our local church. He had taught French at a private New England prep school for 3 decades and was an accomplished vocalist. A confirmed bachelor and an only child, Mr. Alder had no immediate family in the area. Years ago, shortly before his open-heart surgery, Mr. Alder had approached me one Sunday after services to ask if I would consider standing in as his healthcare proxy. I consented, he had the papers drawn up by his attorney, and the legal documents were scanned into his electronic medical record. I drove him to the hospital the morning of the surgery. The aortic valve replacement was a success. He did well post-op and returned home to his beloved dogs, his books, and his extensive classical music collection. We would meet periodically for breakfast with a mutual friend to discuss politics, books, theatre, film, the arts. On one of these occasions Mr. Alder casually remarked that he couldn't understand why he had gained so much weight over the previous month, given that he had little appetite and ate even less. I glanced at his lower legs and documented 4+ pitting edema. "You've got to see your cardiologist tout suite," I said. "Like today." Although the doctors were able to stabilize his congestive heart failure, Mr. Alder went on to develop cognitive decline. He consulted his lawyer and granted me power of attorney to handle his affairs. Once a week I would drive to his home to make him Saturday breakfast. The dogs were gone by then; each had aged out of existence. Mr. Alder called me on New Year's Eve to say that he had fallen and couldn't get up. Somehow he had managed to drag himself from the kitchen down the hallway to the cordless telephone in his home office. Immediately, I drove to his house, made a quick assessment, called an ambulance, then followed them down to the hospital to arrange for a midnight admission. Three weeks had elapsed; arrangements were being made for his discharge to a nursing home. And now here I was, sitting behind the wheel of my car in the parking lot at the YMCA, talking on the phone with the charge nurse on Conklin-3. I hung up, took a deep breath, and touched the highlighted number of the final missed call on the screen of my phone. The chief resident in CCU picked up. "You're the healthcare proxy for Mr. Alder?" he asked. "He's severely bradycardic, down in the 20s, needs a pacemaker. We've alerted the OR, we may need to go into his chest—got to act quickly—" "Excuse me, but could I please have a word with your attending?" Silence, a long pause, and then a new voice came on the line. "Hello," I said, "no disrespect to the resident, but I wanted to speak directly with you. I've been a clinician for 40 years myself. I know Mr. Alder well; I know his medical history, I've witnessed his cognitive decline over the past year. Honestly, I don't believe he would tolerate this proposed procedure well. I don't think he would want to go that route. He's 86 years old; it's just—" "I understand fully. If I were in your position, faced with the same scenario, I would likely do the same thing." Mr. Alder was transferred back to Conklin-3 for palliative care. I had the chance to sit at his bedside for several hours over the course of the next couple of days. The hospital chaplain paid a visit; the nurses were supportive. Late in the evening on the third day Mr. Alder died peacefully in his sleep. To this day I sometimes wonder what might have happened if I hadn't made that final missed call.