You will find short stories on this site. Most are autobiographical. Some are fiction.

A TRIBUTE TO RUTH

“I’m going to take…” Ruth said, in a barely audible whisper. She paused while her ventilator filled her lungs so she could complete her sentence, “a little nap.” She then covered her head with her shawl to escape the sunlight. I said “OK” and continued driving. We crested a hill and started down a long grade on our way to Portland. Miles flashed beneath us. While she slept, I thought back to the way we had met at the Unitarian Fellowship in Astoria.

Over her twenty-year career as the middle school librarian. Ruth had known every child who went through the Astoria School System. She had also met most of those children’s parents. She was well-known and loved in Astoria.

Ruth possessed many admirable traits. Among them were her capacity for tolerance of difficult people and perseverance in the face of personal difficulties. In the five years that Ruth and I lived together I never saw her become angry, nor express a negative feeling toward another person. I’m not saying that she liked everyone, but if she didn’t, she would not let her feelings be known. You may Upon reading this, you may think that Ruth was holding it all in. That she was a pressure vessel on the verge of explosion, but she seemed to be the opposite. She simply let negative feelings flow out of her consciousness. When seeing my frustrations with the difficult situations, she would tell me “Accept it, Tod, this is the way it is.”

I was thinking about the past five years. There were good times, with our friends and our travels to Guatemala, Spain and Algeria. Ruth loved to travel. But our situation had changed about a year and a half earlier, when Ruth had been diagnosed with PSP. (Progressive Supranuclear Palsy) The first indication of a second health problem occurred when she and I were leaving Dooger’s Restaurant, where we had enjoyed a “Senior’s night” dinner with friends. While crossing the parking lot, she fainted. I caught her and helped her into the car thinking it was the wine with dinner. But she drank only one glass? Perhaps this had something to do with her PSP. She quickly recovered and as quickly, I forgot about it.

A week later, Ruth had twisted her ankle. She couldn’t bear to stand on it. I took her to the Urgent Care Clinic. I waited in the lobby while she was taken to an exam room. About 10 minutes later two men wheeled her out through the lobby on a gurney. She was unconscious. A male nurse was pushing the gurney. Another was compressing the bulb on a manual ventilator attached to a mask strapped to her face. “We’re taking her to the ER,” he said as he passed me. I ran to catch up as they crossed the parking lot. While one nurse continued pumping. The nurse pushing the gurney asked “Did you know she has central apnea?” “No” I answered, wondering what central apnea was. “She has sleep apnea,” I said. He continued pushing and did not respond to me.

In the ER the doctor examined her while an intern pumped the manual ventilator. The doctor turned to me and said “Ruth has central apnea. “Central apnea is a condition where the central nervous system no longer stimulates autonomic respiration.” He explained, “She will die without a ventilator.” He paused. He then asked, “Does she have a living will?” “No”, I answered. “Are you her husband?” he asked. I explained that we are domestic partners. “Has she ever expressed her desire regarding resuscitation?” “Not to me,” I told him. “Would she want extraordinary measures to prolong her life?” “Yes!” I answered emphatically, thinking that she would want, what I would want.

“Central apnea, Prolong her life”, I was thrown off balance by all of this. What was going on? Less than an hour ago she seemed fine and now I am being asked if they should “prolong her life”.

“We will have to sedate and intubate her,” the doctor said, “to stabilize her on a ventilator for the ambulance ride into Oregon Health Sciences University in Portland where then will provide her with a portable ventilator.

Upon arrival at OHSU Ruth was taken into surgery for a tracheostomy. This is a surgery in which a tube is installed into her trachea through a hole in her throat. A ventilator is attached to the tube.

After three days in the hospital, Ruth was transferred to a residential intensive care facility where she was under continuous supervision and where I went for training on taking care of her and maintenance of her portable ventilator.

Over the month while she was in the care facility, when I wasn’t in Portland with her, I was in Astoria preparing our house for her return. It was inspected by two women from the Visiting Nurses Association. They had given me a list of recommended changes to accommodate her condition. These included a ramp up to her front door, and rearranging her furniture to provide clear paths for her “vent cart” and wheelchair. I contracted with a home health service to provide a nurse for Ruth during the day, while I would be away remodeling my old house. A month later, Ruth was ready to return home. She was transported by ambulance back to Astoria. Since that time, we had made monthly trips to Portland to attend our PSP support group meeting. Other trips were occasionally necessary for her to see the respiratory specialist.

The PSP support group was one bright side of the, otherwise, burdensome trips to Portland. I had started the group a year earlier when Ruth was diagnosed with PSP. OHSU generously provided a meeting room. The six couples in the group had become special friends through sharing experiences, difficulties, and successes while living with PSP.

I drove on thinking about Ruth and what her life had become. With PSP she faced the prospect of physically deteriorating until she could no longer communicate in any way. Before she died there would be a period where she would not be able to move any part of her body. Or, with central apnea, she faced the prospect of sudden death at any moment if her ventilator were to become detached or if it had a mechanical malfunction. Yet through it all, she remained composed and dedicated to living as fully as possible. She did not complain. Only once did I hear her express a sense of despair at what was happening to her body. No matter how careful we were with her health, there were aspects of her situation that were beyond our control. Her ventilator did not provide her with natural sustaining breath. Whether because of the PSP or the inadequate oxygenation in the year since she went onto the vent, Ruth’s alertness was slowly deteriorating. I carried the overwhelming responsibility of keeping her alive. Under the stress of managing her illnesses, her caregivers, and the constant fear of her machine failing, I felt that I was declining along with her. I had been warned, “Take care of yourself Tod, it is common for caregivers, to die before the person for whom they are giving care.” As we drove through Longview I wondered if this was how my life would end. I was also concerned about what would happen to her, should I die before her. I drove on with such grim thoughts haunting me.

Roughly 45 minutes after she said “I am going to take a short nap.” the alarm on her ventilator began to beep a warning tone. I looked over to see how she was doing. Her shawl covered her face. I pulled it aside and saw she was cyanotic. I touched her forehead, it was cool. “OH NO!” “RUTH! RUTH!” I called out. I then called 911 for help. I was told to pull over immediately get her out on her back and apply chest compressions until emergency team arrived. I said “I am on I5. There is no shoulder. Cars are passing at 70 miles per hour. I can’t pull over here” I replied “But there is an exit ahead. I will take it and pull into the Walmart parking lot. This I did. Fortunately, the weather was warm and the pavement dry. I eased her out of the car and began chest compressions. She lay next to the open car door. Her ventilator hose was just long enough to reach her. It continued beeping. Soon a police car drove up and then emergency team arrived and took over her resuscitation. Ruth lay there, bare chested, with several men working feverishly to try to get a response. They worked for more than 20 minutes before the lead EMT came to me and said that they had not been able to revive her.

The coroner was summonsed. When he arrived, I told him that OHSU had requested that when she died they wished to do an autopsy. OHSU sent a van for her body. I called the doctor’s office and a member of our support group to tell them why we wouldn’t be coming.

A minister was there also. He insisted on talking with me and suggested that we leave the scene and meet for coffee in Kelso. I met him there. We talked about the loss of a loved one and dealing with grief. After a half hour of this unwanted conversation, he took a call. It was the Coroner. When he was done talking to the coroner, he told me that Ruth’s body was being transported to Portland. I suspect that the conversation with the minister was a ruse to keep me around in case the coroner had any suspicions of foul play. He wished me well. I left the restaurant to face the long drive back to Astoria alone. I was swept with intense sorrow, emptiness, and guilt, for having not been more attentive to Ruth as I drove. I was also aware that I now had the answers to my haunting questions of the previous hour.

Ruth’s daughters came, Laurie from Idaho and Sue from Canada, to clear out her house for sale. I was packing the things in her kitchen when I discovered, on top of her refrigerator, her living will. It was a form on which she had placed a bold black X indicating her desire, “Do not resuscitate.”