Personal History: Mom should have died around 1970

Thinking about mother's day (despite the fact that my mom died about a decade ago) and thinking about what I said the other day about the various traumas in my childhood reminded me that I may not have told what is perhaps the most impressive Man of Concrete story there is.

You've got to remember that MRI is a very new technology, from my point of view. I can't remember exactly what year this happened, but I think it must have been 1970 plus or minus a year or so, and back then, they had only four tools for finding out what was wrong inside of you: palpitate for masses, examine the blood chemistry, run x-rays, or, if all of that failed, open you up and directly examine any organs they were suspicious of. It was called "exploratory surgery." I gather that it's very, very rare now, but when I was a kid, an awful lot of the time it was all that they had. But around the time that my mom went into the hospital with symptoms of an inflamed or infected gall bladder, the big name hospital she went into was under pressure from regulators over their reputation for wanting to do the exploratory surgery first, without even trying to figure out what was wrong from patient history, physical examination, blood work, and x-rays. So the hospital administrators had passed down word: no more exploratory surgeries this month. Period. Not until the regulators get off of our backs.

Mom's medical history, symptoms, and blood work all made it clear that there was something very wrong with her gall bladder. However, on the x-rays, her gall bladder looked perfectly normal and healthy. Her doctor wanted to go in and see what the x-rays missed, but got turned down. Every day for several weeks, he went back and applied for permission to do exploratory surgery, and every time he was turned down. He was told to put his patient on antibiotics on the assumption that whatever it was was probably bacterial, continue trying to figure it out, and wait for more evidence to come in. Finally he broke it do my dad: at the rate her blood was rising in toxicity, and no more than she was responding to the antibiotics, the next evidence to come in was going to be when she died. Which, he said, was going to be in no more than two weeks, absolute tops, and that's assuming the problem didn't accelerate for some reason.

So my late father, the Man of Concrete, did something absolutely amazing. But first, to understand how amazing it is, you need to know this: both of his parents had been hard-core alcoholics during the Great Depression, and they spent most of his childhood in jail, mostly for public brawling (that is to say, what we would call domestic abuse). Incredibly, nobody went to check on their kids, my dad and his sister, ages 7 and 8. Maybe they thought (wrongly) that other family members were taking care of the kids while their parents were locked up. So Dad decided that it was absolutely essential for at least one Hicks to complete a high school education. One sibling was going to have to drop out of school, scrounge enough food and money to feed them both, maintain the apartment somehow, and make it possible for the other one to finish school. So he dropped out of school in the middle of 3rd grade, because his little sister's grades were higher, and he spent the next 8 or 9 years making absolutely sure that she graduated high school. He stayed up all night to keep the rats from biting her in her sleep; all day, he did something (but he went to his death bed refusing to say what) to bring in money to pay the bills. From 3rd grade on, any education my father got was entirely self-taught out of books. He was very broadly read, and learned even more in the Navy after his sister graduated, and learned yet more on various jobs. But the flat fact remains that there were inescapable gaps in his understanding of the world from the fact that his formal education ended at about age 8.

But when he figured out that nobody at this highly prestigious teaching hospital was even trying, any more, to figure out what was killing his wife, he decided to do something about it. He made some kind of arrangement with a teenage girl, I think about age 14, who lived across the street to come over and make sure that my sister and I got breakfast and dinner. (Fortunately, it was summer vacation.) He then told my sister and I that he was going to be gone for maybe as much as two weeks. He couldn't promise us when he was going to come back, only that he was going to come back, once he had done everything he could to save Mom. For two kids aged roughly 10 and 5 (I'm the older), this was pretty distressing stuff to hear on top of having already had one parent in the hospital for two weeks. Up to that point, I'd taken it better; after all, Mom hadn't been in the hospital anywhere near as long as I'd been a couple of times, not yet, so it never dawned on me that she was sicker than I'd been. I pressed Dad to explain why he couldn't come back even once in that two weeks. He said that he might be back once or twice in that time, to get more clothes, but if he did it would be in the middle of the night when my sister and I were asleep. He promised he'd look in on us, but he flatly refused to negotiate when he said that he was not going to wake us and we were not to try to stay awake for him.

What I found out later that he did was drove his pickup truck down to Washington University medical school's library, and asked the librarian there how to look things up in the latest medical journals, and to recommend a good medical anatomy textbook. As an artist (among other things), he'd already made a thorough study of gross anatomy, so he blazed through a course textbook that routinely kicks to the curb college juniors, Anatomy and Physiology. He then started to work his way through every medical journal, most recent issue to least, searching specifically for anything about gall bladder diagnoses. When they locked the library at night, he went out and napped in his truck, with an alarm set so he could be there when they unlocked the library in the morning. God only knows what, if anything, he ate. On day six, he found what he was looking for: a description of a patient whose gall bladder was just slightly off from the normal position, enough that one of the bile ducts was obscured by ribs from every standard x-ray angle. Having found this problem through exploratory surgery, the surgeon who wrote that article had worked together with a radiologist to come up with a set of alternate x-ray procedures that would catch this problem in any similar patients. Dad walked out of there with that journal, and drove straight down to the hospital.

When he got there, he walked into the lobby and flatly demanded that he see, right now, his wife's surgeon. The receptionist told him to make an appointment, not knowing that in the intervening time Mom had long since slipped into a coma, was not expected to ever wake up. He stood there and yelled, in the lobby of the hospital, demanding over and over again at the top of his voice that he see Dr. Whatever right now. They called security. Security took one look at him, turned right back around, and said no way; he would have kicked all of their backsides. (He would have, too. I call him the Man of Concrete for a reason.) So they called the cops. Who turned out to be old friends of Dad's from when he was on the force, and so they turned right back around and left him still standing there yelling. Eventually, to shut him up, the hospital paged the doctor. Dad demanded a consulting room, and Mom's file. They turned him down. He threatened to repeat his performance. They gave him a consulting room, and Mom's file. He slapped all of her x-rays up on the light screen and told the surgeon exactly where the blocked bile duct was, and showed him why he couldn't see the gall stone on the x-ray. He then said that since they wouldn't let him operate without x-ray confirmation, here are the instructions to give the x-ray technician, right out of the journal. The doctor said he couldn't do that without a radiologist. Dad made one step towards the hall, started to draw breath to start yelling again, and the doctor cut him off and went out to get a radiologist.

They had Mom in x-ray in 20 minutes, had her film back minutes later, and had her in emergency surgery scant minutes after that. (And when they were done, they sewed her back up with a pair of scissors still inside her that they had to go back in for a week later when they got infected.) They then told Dad what he didn't give them time to tell him ... that they'd been trying to reach him off and on all day, because Mom's blood had gone so toxic that she was not expected to make it through the night. Had this grown-up 3rd grade drop-out taken one day more to find that journal article, had he caved in when the hospital receptionist told him to come back tomorrow, had he not been willing to bully whoever he had to bully to get them to get the job done, my Mom would have died when I was about 10, not when I was about 40.