(author’s note: I wrote this essay shortly before my dad’s death, in 2007; can’t believe I was only 39—I’m 52 now. It’s been hiding in a file on my desktop for years; I’d forgotten about it, until I was reminded of it tonight when I went looking for photos to share for Father’s Day. It’s a long one, guess I have a lot to say about my dad. He was a good man, with a rough exterior, the product of his era and upbringing. For all of our differences, sometimes infuriatingly so, there was never a day in my life that I didn’t believe my dad loved me. Happy heavenly father’s day, Pappa D. xo)
I’ve become obsessed with the act of breathing. I ponder the mundane: the scientific, mechanical, repetitive act of gases exchanging via the various components of the respiratory system, replacing carbon dioxide with oxygen by inhalation and exhalation. I marvel the divine: a wondrous, miraculous, cyclical act of filling up then wringing out the lungs; waves of refreshing, renewing oxygen rushing in to dispel dirty, spent carbon dioxide, like washing clothes in a good old fashioned wringer-washing machine. In and out, all day, all night, over and over. An involuntary, monotonous act I’ve performed without previous consideration, much less, gratitude, for 365 days a year for the past thirty-nine years of my life. That’s roughly 14235 days (not figuring in leap years), and counting. A thoughtless act, so to speak, the ability to breathe. You don’t have to think about it to be good at it. Until your lungs start to fail you, and you can no longer breathe on your own. Then, all you think about is: how the hell am I going to catch my next breath?
My father was diagnosed with Chronic Obstructive Pulmonary Disease nearly thirteen years ago, at age 51. COPD is an umbrella diagnosis that includes emphysema, chronic bronchitis and asthma, I read in the literature that describes my father’s disease. I break down the acronym: Chronic – unremitting. Obstructive – disruptive. Pulmonary – the lungs and all that is connected to them, from the mouth down to the alveoli, the tiny air sacs deeply embedded in the lungs, at the very end of the line. Disease – an impairment of health. The opposite of ease – dis-ease. My father has been in a state of dis-ease for over a decade. His condition will never go away; he will never recover from this. His lungs and the components that make up his respiratory system are deteriorating, disrupting the exchange of oxygen and carbon dioxide in and out of his lungs. In other words, he is slowly, very slowly, suffocating.
The diagnosis of COPD was traumatic, though not a real surprise. At conservative estimates, he was a three-pack a day smoker at the height of his smoking career, which lasted over thirty years. He told us that he started smoking when he was 13 years old. I recall sitting shotgun in his red and white Ford pickup as a child, trying to catch the packs of cigarettes that slid across the dashboard and tumbled to the floor when he turned a corner; the smell of his truck that filled my nostrils and clung to my hair and wool coat was of dust, grease, smoke. Cartons of smokes stashed on the kitchen counter alongside the Rice Krispies and Cheerios boxes. Full flavor, 100’s: Kools, Winstons, Marlboro. My father was an indiscriminate smoker, impartial to any particular brand. He bought whatever was on sale. Over the years, the colorful boxes were eventually replaced by the bland packaging of generics he switched to when the prices of smokes dramatically increased.
Regardless of the brand, he was never without a cigarette pinched between his lips or dangling dangerously from his fingertips. My father could work on a car engine, pitch on his summer softball team, fix loose bicycle chains, haul five kids in his black-green Chevy Impala to the lake to drop a line in the water, with a smoke in hand or in mouth. He would do everything he could without putting his cigarette down, as though it were as necessary as his hands to completing any action. On the rare occasion that he simply couldn’t perform the task at hand with the cigarette attached to him, he’d turn to whomever was closest, adult or child, and say, “Here, hold this—I gotta tighten this bolt,” passing the burning cigarette like a torch. He’d finish the job and in a singular, fluid movement, retrieve the smoke, take a long, deep drag to make up for lost time, drop the burning butt on the gravel, crush it with the heel of his dusty work boot and reach into his shirt pocket for a fresh one.
When we were young, he’d send one of us kids down to the grocery store or gas station with a fistful of bills, calling ahead to let the clerk know one of the Hildebrandt kids was coming down for his Kools. Arguments erupted over the task because there was always change left over for a Baby Ruth, a can of soda, or a pack of candy cigarettes that puffed chalky “smoke” from the end when you blew on them.
After a double shift at the Land O’ Lakes plant in town, my father would crash on the sofa in front of a “horseshit-and-gunpowder” show blaring from the TV, a cigarette burning down to the filter in the ashtray that spilled over onto the armrest with stubbed out butts. The armrest of the sofa was pock-marked with blackened holes, edges hard and rough like a scab, from cigarettes or ashes that didn’t quite make it to their final resting place in the ashtray. The fact that my father didn’t kill the whole family in a cigarette-initiated house fire is itself a miracle. Often, after he had nodded off, I’d quietly and carefully pick up the smoldering cigarette and push it deep into the pile of ashes and lifeless butts until the smoke disappeared. I’d carry the ceramic ashtray to the bathroom, dump the dead butts into the toilet and flush, then scrub my hands with the bar of Zest at the sink before returning the dish to its rightful place on the armrest of the sofa.
If he could have, my father would have smoked in church. Maybe that’s why he didn’t attend. On road trips, my mother sat in front with my baby sister in her lap as the smoke from his cigarettes trailed to the back seat where three of us kids were lined up along the black Naugahyde seat of the Chevy Impala and later, various station wagons, as the number of kids increased. Winter was the worst, with windows closed and the heater on full blast—at least in summer, the open windows carried some of the smoke out into the countryside whizzing by. We complained loudly, with well-rehearsed dramatics thrown in for effect: coughing and gagging, opening windows, falling across one another’s laps. He’d holler back, “Close those damn windows, for crissakes—I’m not heating the goddamned countryside!”
Four out of five of my father’s children became smokers as adults. I started smoking when I was about eighteen. Smoking was my appetite suppressant, my stress-relief, something for anxious hands to do. Funny, that the act of smoking mimics the relaxation breaths of yoga or other holistic practices. Deep inhalations, long, slow, intentional exhalations. I was a “real” smoker for nearly ten years – through my college years and beyond, though I never thought of myself as a real smoker. I never had to have a cigarette, never graduated to more than a half a pack a day, except during finals weekend or a weekend of parties and bar hopping. I had many excuses for my smoking: I’m not a ‘real’ smoker—I can quit any time, I just don’t want to yet. . . I don’t need a cigarette, I’m not one of ‘those’ smokers who is running out for a cigarette every other minute . . . I enjoy smoking.
August 2005
For the past few years, my father has lived in a subsidized apartment complex, a non-smoking development, dictated by the city of North Mankato. Violators of this law can be evicted after three warnings. My father is the most vocal complainer of the smoking transgressions that occur at his building. “Those goddamned smokers sit right outside my window – the smoke drifts up into my apartment. I can’t even have the windows open in the summer. They’re supposed to be out back, twenty-five feet from the building – that’s the rule.”
We’re having lunch in his tiny, one bedroom apartment– pizza delivered from a local joint. I’m sitting on a stool at the kitchen counter, looking across the tiny, cramped apartment at my dad, who sits at his cluttered desk where he’s cleared a place for his plate and coffee cup.
“—and I know that that horse’s ass, Jerry from down the hall, sits in his apartment and smokes – I can smell it when I walk by. Too damn lazy to go outside. Thinks the rules are for everybody but himself.” He shakes his head. His breathing becomes more shallow and labored as he gets worked up about the situation.
Dad, chill. Take some deep breaths through your nose, out through your mouth. Remember that ‘pursed lip’ exhaling exercise your therapist taught you—
“I’m having my doctor send another letter of complaint to the managers,” he ignores my directive and continues to rant, stabbing into the air with his fork. “If they don’t do something about those smokers soon, they’re gonna be sorry they didn’t listen to me the first time.” He takes big gulps of air through his mouth while fumbling for the inhaler he keeps in the pocket of his shorts. A few quick shots and he settles down for the time being. Perhaps too many years have passed for him to realize the irony of his statements.
It was Easter, 1994, when my father was diagnosed with his illness. My parents had been divorced for over ten years. It was our holiday ritual, at that point in our lives, to celebrate the holidays with each of my parents separately; all five of us kids had traveled to our tiny hometown in southern Minnesota, Mountain Lake to be with him. When we walked in the front door, I was startled by his appearance. He was sitting backward on a dining room chair as usual, propped up agains the backrest, but his skin was ashy-grey, sagging like burlap bags under his eyes. He could hardly keep his head up or his eyelids from dropping, as though he hadn’t slept in days. I cried out when I saw his blue-purple fingertips. Almost in unison, we insisted he be seen by a doctor, now.
“It’s just that rib bothering me again,” he weakly protested, referring to a rib that had been dislocated in a car accident several months prior. “I’m seeing my chiropractor again this week.” We weren’t convinced. Instead of helping him with the holiday ham dinner, we helped him into the car and off to the ER.
~~~~
Take your hand and place it firmly over your mouth and nose. Make sure it’s clamped down good and tight. Now try to breathe. Take in deep breaths and fill your lungs, if you can. Then, try to expel all the air from your lungs. ALL of the air. It can’t be done, not without enormous amounts of straining, not without starting to feel lightheaded, maybe even a bit panicky briefly, until you remember, feeling kind of silly, that you don’t have to breathe this way and you remove your hand with relief.
This is how your father breathes all day, every day, one of my father’s nurses tells me. He can’t inhale enough oxygen to dispel the carbon dioxide that is taking up precious space in his lungs, nor can he completely empty his lungs of carbon dioxide when he exhales – the alveoli, tiny air sacs embedded into his lungs, where the gas exchange occurs, are weakened, the elasticity gone. If left to his own devices, the carbon dioxide would build up in his lungs and quickly kill him. That is why he has a tank of oxygen at his side all day, every day.
If he exerts himself at all, if he simply becomes agitated or excited, he has to work even harder to try and get air into a respiratory system that simply won’t allow for it. Even if he simply breaths through his mouth instead of his nose, his breathing becomes even more labored and challenging. Circumstances that leads to panic attacks, vulnerability to every virus and bacterial infection floating around, revolving-door trips to the ER, week-long stays in the ICU at St. Joe’s until the medical team can re-regulate all the affected systems in his body. He is then released from the hospital to go home and wait, until it starts all over again. It’s a slow suffocation that can last for years.
~~~~
The fact that my father lived with this disease for this long is nothing short of a miracle, though, I feel “miracle” is too holy a word to describe my father’s experience. Miracles happen to people who’ve suffered unfairly; miracles are an unexpected interlude after struggling with circumstances beyond one’s control. Miracles are for those receptive to suffering, because they’ve acquired the knowledge that suffering is necessary in order to create change and move to another, higher, purpose in life. My father’s suffering has not been unfair or necessary, nor is he receptive to the opportunity for change being demanded of him. It is the result of lifestyle choices he made over the years. He has done nothing to change his lifestyle after his initial diagnosis of COPD. How many near-death experiences is one allowed before God decides enough is enough? Maybe God doesn’t decide any of this.
Maybe I am mistaken about my father’s role on this earth. Instead of student, perhaps he is an unwitting, accidental instructor. Maybe we, as his children are his students.
~~~~
My father continued to smoke after his initial diagnosis of COPD, even after being prescribed continuous oxygen administered through a tube in his nose, and a laundry list of prescriptions to treat his symptoms, symptoms of his symptoms, and side effects of medications, as well as to keep him alive. He’d simply unhook his nostrils from the nasal cannula and step outside for a quick one. He continued to smoke until he wound up in the hospital, shortly after his initial COPD diagnosis, this time hooked up to a ventilator. A long plastic tube entered his body like an alien tentacle, through his mouth, down his throat, to his lungs. His eyes were closed but his eyelids fluttered spastically, his facial muscles contorted continuously in what looked like painful grimaces and winces. His limbs, bound to the bed frame with buckled straps, shook and shuddered periodically; his large, swollen abdomen sharply contracted then released, over and over. Occasionally, a nurse appeared to mop up blood and saliva that pooled, then spilled from the corners of his mouth. They constantly reassured us that he was in no pain, that he was on very strong sedatives to keep him in this induced coma until they could regulate his oxygen and carbon dioxide levels and fight the pneumonia infection raging in his lungs. The wincing, grimacing and muscle contractions are coughing responses, they told us, his body’s attempt to expel the mucous and phlegm built up in his lungs. The straps were necessary because even in a highly sedated state, a reflexive reaction to coughing is for the hands to go to the mouth and try to pull out the ventilator.
The other end of the tentacle led to a box at his bedside, a collection of dials, buttons and red LCD numbers that changing constantly, lines that jagged up, down, sometimes spiking sharply before leveling off again. The numbers and lines meant nothing to me, but told the hospital staff all they needed to know about my father’s condition. For the time, this machine had to take over my father’s ability to breathe on his own – forcing oxygen into his lungs, drawing out carbon dioxide. Carbon dioxide had built up to dangerous levels in his system, the doctors told us. He doesn’t have the strength or lung capacity to expel the CO2, nor can he draw in enough oxygen to dispel it on his own. The CO2 was slowly suffocating him. The machine will do the dirty work until my father’s body can take over the job again, if possible.
During one of his early hospital stints, my father had an other-worldly experience that he’d only mentioned once, a visit by his deceased mother, which set him on the not-exactly straight and narrow. He was eventually awakened from an induced coma and taken of the ventilator, almost a week after his admission. Once coherent, he asked about his mother coming to visit him in the hospital.
Dad, you know Grandma isn’t alive — she couldn’t have been here. He looked at us each of long and hard, then looked away, shaking his head. What is it? What did you see, Dad? “Nothing. Never mind.” He quit smoking for good after that visit.
~~~~
Since that first extended ICU visit so many years ago, my father has been to the ER and to the hospital in Mankato more times than I could ever try to count. Some have been quick, in-and-out visits, to adjust medications, to treat a new symptom of his illness. Others have been repeats of that first extended stay, with the ventilator taking over his body until the CO2 levels can be controlled and his feeble breathing ability can take over again. We joke that he has a frequent patient’s club membership, that they know him by first name and greet him like Norm on Cheers. He winks and says he does it on purpose, so he can have those cute little nurses at ISJ fawn over him and give him sponge baths. I am told these health crises are just a part of dealing with COPD, and that as the disease progresses, the visits and stays will get longer, more frequent.
The National Emphysema Foundation tells me that emphysema is the fourth leading cause of death in America. An estimated 16 to 30 million people suffer from the disease – the vast discrepancy in those numbers is because emphysema is a silent, slow-moving yet stealthy invader, symptoms stay well-hidden until the disease has progressed to a debilitating degree. In other words, by the time a diagnosis is made, the disease has taken a stronghold on the respiratory system, and symptom management is all that can be done. A cure is not available. The only hope is to find temporary relief, to find ways to catch one’s breath, or in my father’s case, to simply get by.
My father is a pro at getting by. He has trudged through the past decade-plus with a portable tank of oxygen at his side and a pocketful of inhalers. He sleeps with a mask strapped to his face that is connected to a machine which delivers a strong, constant stream of oxygen into his respiratory system at night. I’ve learned to call the machine a Bi-PAP like he does, though I don’t remember what the letters mean. Another acronym to add to the alphabet soup sloshing around in my head. The machine hisses and whirrs as it forces oxygen into his compromised lungs while he sleeps. I have read that breathing with a Bi-PAP is like trying to breathe with your head out the window of a fast moving car. How this method of vigorous, mechanical therapy can possibly help anyone with compromised lung function breathe better makes me short of breath just thinking about it. Yet, without it, my father would unlikely survive the night. When he is reclined, in addition to the lack of strength in his lungs and diaphragm, it’s quite possible his airway could collapse under the pressure of his huge belly. Sometimes when I call him in the morning, when he’s just woken up, I can tell that the mask is still strapped to his face. The person who answers sounds hollow, nasally and raspy, nothing like my father’s clear, booming voice.
~~~~
My father is nothing if not tenacious, which is probably why he’s so good at getting by. Everything he has done in his life has been done with the gusto and ferocity of a pit bull. He is barely five feet tall, but despite his short stature (or perhaps in spite of it), he was a Golden Glove boxer, bantamweight, back in the early sixties. In a photo album stashed away somewhere is a yellowed newspaper photograph of my father at nineteen, his stocky, muscular frame draped in a baggy suit, arms squared up, fists curled, his hair greased to the side in a perfect coil at his forehead. He is standing next to a man who towers over him by nearly a foot, clad in similar attire. The caption, if I remember correctly, reads something to the effect of, “The bigger they are, the harder they fall,” a quote by my father, taken from the article that accompanied the photo.
Several decades later, his reputation still holds strong. I met a man at my salon a few months back, the husband of a client of mine. Late 50’s, he’s a few years younger than my father. His wife told him that I’m also from southern Minnesota, near where they were originally from. When he asked what my last name was, I replied, “Hildebrandt.”
“Hildebrandt,” he cocked his head to one side and repeated the name slowly. “Say, are you related to Duane Hildebrandt by chance?”
I smiled. “That depends on what you know about him.”
“Is that your old man?” He broke into a wide grin. “Well, by God! Me and your dad used to run around with the same crowd back when we were a few years younger, got into a little trouble here and there.” He chuckled and slipped into reminiscing about my dad, mutual buddies and the good ol’ days as I continued to cut his wife’s hair.
“He was a Golden Glove, wasn’t he? I tell you, nobody messed with Hildy back then, that’s for sure, not unless they wanted to get a beating they’d never forget. I remember one time, outside of the Fox Lake Ballroom—” I smiled as he continued his story. “—a bunch of rowdies decided to pick on your dad, not sure why anymore – knowing your old man, probably a woman involved,” he paused to wink at me before he continued. “Anyhow, they didn’t know he was the Golden Glove champ of the area,” he chuckled, talking more to himself than to me. “Man, three guys against your ol’ man – they thought they had ‘im, he was so damn short, but your dad came out swinging like the Tasmanian devil and no one could stop him till those three assholes were running for their car . . . those were some good times.” He looked back at me and asked, “Say, how’s he doing these days?”
I asked my father why he quit boxing after a few years, when he seemed to be so good at it, and had such an impressive reputation.
“I woulda had to give up whisky and women,” he says with a wink. Boxing was replaced with booze and carousing, both of which he approached with the same gusto and bravado of his former athletic pursuits.
After his short-lived glory days in the boxing ring, my father retreated to the world of blue collar workers – working hard and playing hard. He got my mother, a seventeen-year old high school student, pregnant, and they married in June of 1964, after she graduated and my oldest brother was born. Four more children in less than ten years followed. My father was the embodiment of the “good ol’ Midwestern work ethic.” He worked in factories his entire adult life, where racking up overtime was a worthy cause. He worked at the local Land O’ Lakes plant for nearly twenty years, throughout most of my childhood. But weekends were for getting out, cutting loose, losing control. For a short while in between the factory gigs, he farmed. After seventeen years of marriage, working hard, playing hard, cutting loose and losing control, my mother divorced him. He responded by quitting drinking, but working even harder. Left the farm to work at a local meat processing plant, where the wages were rumored to be the best in the area, with plenty of overtime. That was followed by a gig as a materials handler at a paper product plant.
He took masochistic pride in the fact that he worked 60-plus hour workweeks, racking up as much overtime pay as his employers would let him get away with. He continually had the biggest overtime check of all his co-workers, he’d proudly tell me. Ten hour days were a light day; he preferred double shifts, when the overtime really piled up. He was constantly exposed to chemicals, dust, vapors, powdery substances, fumes, paper fibers, pollens. If the smoking didn’t get to him, environmental conditions would surely to do their work eventually.
We’d come to visit on weekends home from college. You kids are spoiled – you don’t know the meaning of hard work, he’d chastise us through the cigarette pursed between his lips when we’d shuffle downstairs nearing the noon hour after a late night out with old friends. Other times, in more introspective moments, he’d tell us, Keep up the studies, finish that degree. You don’t want to end up like me, working in some goddamned factory the rest of your life.
~~~~
This is the man who taught me to fight. When I was ten years old, I came home crying because a neighbor boy had hit me. I was seeking sympathy from my dad, hoping he would march across the yard and give the kid hell. My father sat me down and said, “Listen. If you’re gonna to run with the big dogs, you gotta piss in the tall grass, Jen.” He held my head with one hand as he wiped the dirty tears from my cheek with the sweatshirt sleeve of his other and continued, “Don’t ever take the first swing, but if it comes down to it, make damn sure you’re the one who has the last hit.” And one last bit of advice, “Next time, whatever you do, don’t ever let that little bastard see you cry again. Ever.” That bit of advice carried me well into my college years, when drunk, groping young men in the bars would grab my ass as I passed by. I considered that “taking the first swing,” and usually answered it with a swift, stinging crack across the face.
This is the man who took me to take my driver’s license test when I turned 16. After I passed, I drove to the insurance agent’s office so he could add me to the policy. I was giddy with thoughts of road trips with girlfriends and carting carloads of friends to football games as I floated along side of him into the insurance office. I must have been thinking of that and the many other riches my license would bring me when we got back into the car to head home. In other words, as my dad would have put it, I had my head up my ass.
I slowly pulled out of the parking space at the agent’s office, carefully checking my rear-view mirror as I backed out. Ignoring what was going on to either side of the car, I heard the crunching of metal on metal before I realized the front end of our station wagon was carving out a deep gouge into the passenger’s side door of the car next to me. “Stop the car! Stop the car! STOPTHEGODDAMNEDCARJENNIFER!” My dad’s booming voice filled my ears, but I had lost all mental and physical functions at that point. The car kept rolling. Dad flung his cigarette out the window as his foot shot over to my side of the vehicle and stomped down hard on the brake. He grabbed the wheel and jerked it to the left, then jammed the transmission into “park” and emitted a long string of expletives.
“Ohmygodohmygodohmygod!” My hands covered my face, I began to hyperventilate. “I can’t believe this – I just got my license! Ohmygodohmygod, I can’t believe this is happening!”
My father lit up another cigarette, took a deep drag, then exhaled long and hard, sending a stream of smoke swirling inside of the car. “Stay right here.” He glared at me with the fury of a Baptist minister. “Don’t touch anything. I’ll be right back.” He got out of the car, slamming the door so hard that the car shook. “Christ almighty, can’t even leave the insurance office without getting into an accident,” he muttered as he marched across the parking lot toward the agent’s office. When he returned, I was sitting in the passenger’s seat, still sobbing into my hands. He yanked my door open and barked, “Get the hell out of that seat.”
“No!” I shook my head furiously. “I’m not driving – ever again! You drive home.”
“Jennifer. Kay. Hildebrandt.” He said my name slowly and deliberately, each word driving a spike into my heart. “Get your ass back behind that wheel. You will drive home and you will get us there in one piece, if it’s the last thing you do.”
He stood at my door until I finally slid out of the car and slunk around to the driver’s side. When I got in, I turned the ignition on with trembling hands, tears burning my eyes.
“Now. This time, check all your mirrors, check behind you, check to the side of you. Check your blind spot, and do not pull out until you’re absolutely, positively sure there’s nothing in your way, on all sides. And when you’re think you’re clear? Check again.”
This is the man who gave me a tool belt and power drill for Christmas the year my husband and I bought our first home, who eagerly dispensed DYI advice whenever I’d call. When he’d come to visit, he always honed in on something that needed fixing—a leaky faucet, a temperamental light switch, a door that didn’t fit quite right in its frame. Instead of doing the work for me, he’d stand off to the side and tell me which tool to use, how to hold it, and guide me through the process. He always asked for photos of projects I’d done when he wasn’t around—the new storm door I’d installed, the kitchen cupboards I’d repainted, the pedestal sink we put in.
~~~~
In my early days as a hairdresser, I read in a trade magazine that one of the top ten reasons clients don’t return is a stylist who reeks of cigarette smoke. Made sense—even for a smoker, the idea of working so close to others, breathing dragon breath on them was a huge turn-off—I’ve been subjected to the funky breath of fellow hairdressers of which this article spoke. I wanted to succeed at my new career, so it was enough to get me to quit smoking at work. Money making pursuits, not my father’s struggle with getting through life with a tank of oxygen, became my initial motivation to cut back.
~~~~
My father was diagnosed with his lung disease shortly before I was married in 1995. My husband was not a smoker, but never hounded me about my smoking, even though he was a childhood cancer survivor. The only thing he said to me, early in our relationship, was, “I would have a very hard time feeling bad for you if you got sick because of your smoking, because it would be the result of a lifestyle choice you made, not some random illness that you had no control over.” I never smoked at home, and only rarely around him, maybe after a few cocktails with friends.
My dad’s diagnosis and subsequent dependence on forced oxygen were still a new adventure for all of us. He was extremely self-conscious of the breathing apparatus he now had to lug around, and he experienced frequent anxiety attacks that morphed into terrifying episodes of gasping for breath, that could be triggered without warning, sending him to ER and Urgent Care. My sister, Jill, quit smoking right after my wedding. I cut back to “social” smoker” status (which meant I became one of those annoying people who wouldn’t buy cigarettes, but bummed them from others), and kept that act up for another several years. Just a few with the girls when we meet for after-work drinks isn’t “real” smoking, I easily convinced myself. I can go weeks, hell, months without a cigarette. I’d feel like shit after a night of drinks and smokes – short of breath, dehydrated and tired—but I exercise and eat well on days and weeks in between, so I could easily ignore the errors of my ways.
In spite of my father’s precarious condition, lung capacity and quality of breath are topics that didn’t occupy my thoughts or enter my conversations with others to any great degree over the past decade. Until recently, I’ve been blissfully and voluntarily ignorant of my lungs and their monumental occupation until recently. Why this newfound curiosity and obsession of a bodily function that jump-started humankind? Why now, when I’ve watched my father trudge through the past thirteen years with a portable, two-liter tank of liquid oxygen slung over his shoulder, liquid oxygen that is pressurized into gas which travels through the tubes to his nose, and forced down into his lungs, administering life-giving, artificial breath that keeps my father alive? That, and a laundry list of medications that he must take several times a day: Albuterol, Atrovent, Serevent, Flovent, potassium chloride, Fosimax, Prednisone. Primary medications to treat his immediate health concerns, secondary medications to thwart the side effects of the primary medications, tertiary medications to supplement the gaps that the other medications don’t treat, stand-by medications that come into the picture as needed, supporting actors in a long running drama. Why do I care now? Why didn’t I years ago?
~~~~
My father rides shotgun with my oldest brother and his family to our house for Thanksgiving dinner last November, an hour and a half drive away. When he walks in the door, I am alarmed at his whitish-gray skin tone and swollen face. The skin around his eyes seems looser, sagging even more than I remember; his chin bulges out of the top of his t-shirt like a bullfrog’s throat. He makes his way to the head of the dining room table, pulls the chair out and turns it around, straddling it backwards, his large belly pressing against the spindles of the chair back, as he always has, for the past thirteen years. It takes pressure off his legs and supports his breathing, he’s always told us. He sits at the table for several minutes, his large belly rising, then dropping sharply as he quietly focuses on catching his breath.
When dinner is served, he loads up his Chinet plate with a glob of mashed potatoes, turkey, dressing, baked corn, cranberries, a heap of sweet potatoes. He drowns the entire heap with thick brown gravy, and tops it off with a dinner roll. The stiff paper plate bows under the weight of his meal. This is the way this man has eaten his entire life, sick or not, as though every meal were his last. I scowl at him, tell him to go easy on the food. Why must you pile on the food like that, I snap, as I do at any meal I bear witness to his eating habits. You know what your doctor said. He looks at me over the rim of his glasses and says nothing as he puts the dinner roll back. I feel like an ass. I‘lll shut up. Just take the roll, I say repentantly.
Several hours later, after dinner, card games and visiting has worn everyone out, after the last of the pots and pans are wiped dry, everyone is saying goodbyes, in various states of leaving. My father lumbers out to my brother’s van in the sharp, bitter November wind. He makes it to the open van door, where Mike already has the van running and warmed up. My father clutches the inside of the door handle and stands, gasping for air. I am standing outside, without a jacket, at my father’s side. He is looking straight ahead, eyes glossy, gasping. I urge him to get into the van where it is warm. We’ll help you dad – just a quick jump up – it’s better than standing out in this cold – the cold is what’s making it hard for you to breathe— my brother and I count to three and heave him into the front passenger seat. I stretch the seatbelt across his stomach. He automatically grabs the belt and pulls it toward the clasp, but doesn’t buckle it. I don’t think he can buckle it across his swollen belly. Call me when you get home, okay, Dad? Make sure you call me before you go to bed tonight . . .
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It was this last visit that made me quit my “social smoking” habit for good. I am still very healthy and active, but I’ve suddenly developed an ability to fast forward my life ten, twenty years from now. Will my own smoking history eventually show up like it has my dad’s, like the Devil himself, and rob me of all the things I currently take for granted? I can’t continue to make excuses. The evidence is right in front of me. My husband does not know the man who played slow pitch softball, who helped me and my siblings move countless times while in college, who worked as a heavy laborer for decades, who could fix anything. He only knows a decrepit older-than-his-years man who seems to always prematurely end a family gathering by a frantic health crisis. The other man, also my father, is a stranger to my husband.
No doubt, I miss it. I enjoyed smoking. The ritualistic elegance of the act of lighting a cigarette. The coupling of weekend cocktails and a smoke. The calming, soothing nicotine weaving through my bloodstream. Smokers are always the fun ones in the crowd. Take a look at any party or gathering – they’re the ones laughing the loudest, telling the raunchiest jokes, staying the longest, while the non-smokers huddle in their pocket of pure air, snidely commenting about the smokers contaminating their lungs, that all restaurants and bars should be smoke-free, about their right to breathe clean air.
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As time goes by, the effects of even my part-time habit are starting to appear. I notice that even just one beer and a smoke or two has the same effect as an all-night bender. I wake up short of breath, dehydrated, foggy-headed. Tiny lines around my lips match exactly the act of pursing my lips around the filter. Squinty-wrinkles radiate from the corner of my eyes, that may have been deepened as a result of peering through a cloud of smoke.
My obsession with the act of breathing has found me observing smokers at various ages. People in their teens and twenties are cool and casual with a cigarette at their lips. Young women are elegant and carefree, men more dangerous and wild. But something seems to happen to people who smoke as they reach their 30’s. I think it’s the coloring of the skin that gives it away, a subtle ashen quality to the skin tone of smokers. Faces are either gaunt or puffy, but definitely showing more wrinkles and depressions than non-smokers, definitely lack the healthy glow and elasticity of a non-smoker. Many of my friends who are in their 30’s and still smoke seem to have a constant catch in their throat, as though they need to clear something from it, but the something never clears.
As smokers reach their forties, the consequences are even more evident. The ashen tone is more pronounced, skin appears parched, puffing and exhaling of smoke etches deeper lines and wrinkles across the face. Coughing and hacking is constant, shortness of breath is clearly detected even in such benign activities as carrying on conversations. By fifties, smokers can be painful to look at. Often inconsistently overweight, especially thick through the middle, spindly limbs, wheezing and labored breathing while reaching for another smoke. Many women who smoke into their 50’s appear so frail – painfully thin, no muscle tone, with skin that has lost all elasticity, hanging like delicate fabric draped over bones. I’ve decided that smoking in one’s twentiess is indeed, cool, sophisticated, wild. But unfortunately, by the time it becomes a habit, the “cool” morphs into deterioration that becomes more apparent with each decade.
Vanity, more than quality of life, became the main motivator for me to quit smoking for good.
February, 2006
My father has just been dismissed from a two-week stink in Immanuel St. Joseph’s Hospital in Mankato because his potassium levels are out of whack, his oxygen levels drop dangerously low at night when he sleeps, the causes are unknown, his doctor says.
I have elected to join my father at his follow-up medical appointment, to hear first-hand what the doctor knows about my father. According to my father’s primary physician, it appears that his condition is getting progressively worse (as though the past twelve years haven’t been bad enough). At four feet, eleven inches tall – my father has always been very short, but he’s shrunk at least an inch or more over the years – he is also morbidly obese, weighing well over two hundred pounds.
I stare at him, shaking my head. “Are you kidding me? Look at my dad. Look at his health history. How can you even say that—of course you know what’s causing this.” I’ve gone round and round with this doctor before, when I’ve accompanied my dad to other appointments. I’ve been reading up on COPD and what can be done to manage the symptoms. I’m convinced that with dietary guidance, if he can lose some weight, it will help with his quality of life—breathing, sleeping, his bad knee, he’d have more energy to be more physically active. His doctor isn’t convinced.
“Your dad needs to exercise to lose weight—he’s got to burn more calories than he consumes—but he can’t because of all his health issues,” the bespectacled, disinterested doctor says.
“That’s ridiculous—you could at least try to be proactive, instead of just pumping him full of medications while you wait for the worst to happen. Addressing his diet would make a significant difference—my dad doesn’t know how to eat well. He needs help.” We’re talking as though my father isn’t siting right next to me. My father sits silent.
During his hospital stay, a test reveals an abdominal aortic aneurysm. Because of my father’s precarious health, he is not a candidate for surgery. However, we’re told the Mayo Clinic in Rochester performs a non-invasive procedure for abdominal aneurysms and my dad might be a candidate. We set up an entire day’s worth of appointments, to meet with doctors, specialists, anyone who might have some say as to whether or not my dad could benefit from the procedure. Our trip to the Mayo Clinic verified the aneurysm measures six and a half centimeters in diameter (surgery is recommended for aneurysms five centimeters or larger), located very close to the renal arteries. However, though the aneurysm is at a size that needs immediate attention, because of my father’s precarious health, he isn’t a candidate for any type of surgery, no matter how minor.
I am overcome with emotion at this news. I vacillate between deep sorrow for him, when I see the look that settles on my father’s face after the team of specialists tell him that, regrettably, there’s nothing they—world-renowned miracle workers—can do for him, and acute fury at him, for allowing his health to deteriorate so severely, for dragging us along through his self-induced hell all these years.
On our drive home from the Mayo Clinic appointment, I can’t hold back – he is my prisoner for the next hour as we drive back to Mankato. I hear my husband’s words in my own, as I tell him that it’s hard to feel sorry for him because 100% of what is wrong with him is his own fault and that he’s had all the chances in the world but has done nothing to make his situation better in the twelve years that he’s lived with this disease. I call him a hypocrite because he made his children suffer for years on end from second hand smoke and now he’s writing letters and complaining to the apartment manager about the smokers below his window. I ask him why I should care so much whether he lives or dies, because he doesn’t seem to care much himself. I tell him that when he decided to be a father, he should have known that every action he does to himself directly affects five other lives, not just his own. Let’s not even talk about what you’ve done to your own mother, sisters, friends, over the years I spit words at the windshield. The agony of every single ER visit and ICU stint and hospital stay seethes from my body, hanging in the air like a smog. It’s like all these years, you never once gave one shit about us, I heave the words into what little space is left between us.
He sits quietly as I rage on. My mouth is thick with saliva, my eyes pool with the tears that I’ve been fighting to hold back, blurring the road in front of me as I speed down Highway 14, toward Mankato. A throbbing at the base of my head builds with intensity, my eyes burn hot and wet. After miles of unmemorable miles, my ranting begins to lose steam and finally, I’m reduced to sobbing, as I speed along the two-lane highwaay. After more miles of telephone poles and farms and empty fields, my father reaches over and places his hand on my shoulder. I’m gonna be okay, baby. This time, I’ll work harder to get better. Don’t worry about me. I can’t look at him because I know what will come out of my mouth if I do, and I can’t do that to him, even in my justified rage: You don’t get it, do you? You will never get better. You are going to die soon.
My husband is a tertiary victim in my father’s health saga. I slip into bed after the long day spent in Rochester, wheeling my father through the arteries of hallways that lead us from one doctor to another, each one performing a specific test on my father as they try to piece together the puzzle of his health situation. At the end of the day, at home, I lie in bed, my body exhausted, my eyes still puffy and sore, my mind spinning wildly, unable to slow down. I try breathing exercises. I try visualizing my body calming down. I try to focus on the rhythmic breathing coming from my husband next to me in bed. I fidget in bed. I finally get up and go out to the sofa, so he can get some sleep.
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I am becoming adept in the medical world of abbreviations, sounding important and informed as any seasoned social worker or medical professional as the acronyms fly off my tongue. COPD, CO2 and O2 levels, MA, Medicare part A and B, SSI, Bi-PAP, DNR, MRI, C-PAP, EKG, ENT, ICU pepper the alphabet soup that has taken over my language. I visualize my conversations in capital letters and find myself retrace my dialogue, filling in words that have been reduced to letters. I am an armchair social worker, can spew out the basic qualifications of someone on disability who is applying for Medical Assistance. I am learning what Medicare will cover and what it won’t. It is becoming apparent to me that Medicare is a reactive program, not proactive. It will not pay for many preventive services my father could benefit from, yet it has no problem paying the thousands upon thousands of dollars of emergency room visits, week-long stays in ICU, when his health state plummets to critical stages. I am beginning to see that our health care system is a system so screwed up, highly reactive rather than proactive, I don’t know if there’s even a way to change it in this lifetime.
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Lately, I’ve become acutely aware as to how I breathe, the quality of my breath and how I breathe under various circumstances. My breathing is barely perceptible when I’m deeply engrossed in something, such as reading the newspaper or working on my laptop. If I eat too much, my lungs don’t have room to fill completely, and I feel the discomfort of obstructed breath. When restless at night, I quiet my mind by taking slow, deep breaths that stretch my lungs followed by long, cleansing exhalations that slowly release my lungs. When I run with my dogs, my lungs expand and contract deeply and fully, they are pliable and elastic. I wonder about my lung capacity and the quality of the air sacs buried deep within my lung tissue, at the tips of the bronchi that spread like tributaries of a river across a continent. What do mine look like, I wonder.
I think about the quality of the air that I breathe. As a hairdresser, I am in constant contact with volatile chemicals: ammonia and its countless deviations, peroxide, acetone, formaldehyde, sodium hydroxide. Hairdressers are blissfully ignorant to many health-hazards of the industry. We tell each other and clients confidently, “If our industry was so bad, every other person in this business would be sick.” But, what are the statistics, really? I know many stylist who have severe seasonal allergies; my favorite sales rep (who, incidentally, had to quit doing hair due to severe product-related dermatitis) was recently re-diagnosed with breast cancer. Have my ten years’ exposure to these chemicals begun to eat away at my air passages? Am I inhaling tiny bits of cut hair into my lungs as I cut and clipper my clients? I have a mental image of my lungs during an autopsy, that they look like porcupines, spikes of hair embedded into chemical-atrophied tissue. Ah, yes, the forensic scientists will say. She was a hairdresser.
I wonder about my own years of smoking. No, I wasn’t a “never without a cigarette” smoker as my father was, but the severity and susceptibility of COPD and related illnesses affect people differently. I think about people who are diagnosed with lung disease, or lung cancer, who never smoked a day in their lives. I think of people who are diagnosed with the disease who lived with smokers, the victims of second-hand smoke. I think of people who smoke their entire lives and live to the ripe old age of 99. I think of my dad, who, at 64 years old, would have a far different life right now, if he had quit smoking, or better yet, had never started. I wonder what my dad thinks of at night now, when he’s alone with only his thoughts. Is he filled with immense grief for the pink lungs of his younger days? How do you go to sleep with such a death sentence hanging on you.
I think of the man I encountered while walking my dog last spring. He was getting his mail from the road-side mailbox as we walked by. I couldn’t tell if he was 50 or 80 – he had weathered, leathery skin, white razor stubble sprinkled across his chin, and was hunched over and shuffled as he walked. But beyond the leather skin were young eyes, handsome, even. Beautiful dog, he said to me in a tired, gravely voice. I stopped to let him pet my 110-pound Alaskan malamute. I had a dog, till just last year. He speaks to my dog more than to me, gazing at Gaia as he scratches her ears. A Golden Retriever. Died of lung cancer. He turned his intense gaze toward me for just a moment. I killed her. Smoking. I sucked in my breath sharply as he turned and shuffled back toward his house.
Realigning Red 