I was admitted through the ED to a step-down unit shortly before midnight on a rainy late July Thursday. My wife, Gwen, had driven me there because of increasing gut pain, but upon intake it was noted that I also had significantly low heart rate and blood pressure. Initial tests provided no immediate explanation for any of the conditions, but because the pain became sufficiently intense that they had to administer a low dose of morphine, and since I’d spent time there several years earlier due to pain associated with what turned out to be nerve issues in my neck, they decided the admission was warranted. I’d just turned sixty-six, so after I’d kissed Gwen goodbye and was being transported to the fifth floor, the sobering stare of my own mortality felt a bit harsher than usual.

Once settled in my room, IV meds were started, then a restless and mostly sleepless night ensued during which any sort of repositioning in bed became impossible because of the pain it initiated. That became a bit more bearable the following morning when I got sitting up in a chair as long as I remained completely still.

My cell phone had gone dead, so I sought distraction by scanning through channels of bad television until mid-morning when a short, somewhat disheveled man of Asian descent shuffled into the room in a white lab coat. He harrumphed, dipped his inside shoulder my way, and said, “Mr. Sanders?”

“That’s right.”

“I’m Dr. Yang, the attending.” He frowned with what appeared to be something close to displeasure. “Your test and lab results are normal, so I don’t have any idea what’s going on with you. How’s your pain?”

I cocked my head, considering. “Maybe an eight when I move. Not bad if I don’t.”

He nodded. “Well, we’re consulting with Cardiology and GI, so we’ll see what they want to do. I’m a medical doctor, a hospitalist.” He shrugged. “So, I’m just not sure.”

I watched him almost grimace at something undetermined beyond me, then turn on his heel and hurry out as my young nurse, Trent, replaced him pulling an apparatus on wheels.  He held up a blood pressure cup attached to the machine and said, “Just need to take your vitals.”

Trent strapped on the cuff and clipped a sat monitor to one of my index fingers. From the start of shift, I’d been impressed by his easy yet proficient manner. As he was readying the thermometer to take my temperature, I said, “So that was Dr. Yang.”

 “The good Dr. Yang, yes, indeed.” His small smile held just a hint of smirk as he extended the thermometer towards my mouth and said, “Open up.”

I had to return to bed around noon and remain prone on my side in a particularly uncomfortable position for a lengthy echocardiogram. Gwen came to visit afterwards, carrying a satchel that held my travel toothbrush, toothpaste, razor, and shaving cream, as well as charging cords, clean underwear, the book that had been at my bedside, and our iPad. After I’d thanked her and gotten my phone charging while I gave her a quick summary of events since she’d left, we sat together on the room’s couch and watched episodes of a Netflix limited series on the iPad that we’d just begun at home. Rain continued to fall silently outside, dimming the room’s natural light.

Around three, a tall, fortyish, prematurely salt-and-pepper haired doctor came into the room in an identical lab coat and presented us with a pleasant smile while we shut down the iPad.

“Dr. Sax,” he said extending a hand we both shook. “I’m with Cardiology.”

“Jack Sanders,” I said, stiffening. “And this is my wife, Gwen.”

“Nice to meet you.” He hesitated briefly. “So, I’ll get right down to it. The results from the echo indicate that you have severe leakage from your heart valve that joins the two chambers on the left side. In a nutshell, instead of pushing all blood up from that ventricle into your right atrium like it should, it’s sending some back up into its own upper chamber, and I’m afraid the consequences of that can be quite serious.”

Gwen and I exchanged glances before turning back to him with furrowed brows. “I know that’s probably a shock, but the good news is that the likelihood of us successfully treating it is quite high. We need to send you down to Intervention Radiology for several other tests to get a closer look at exactly what’s going on, and after those results are reviewed, either I or my cardio-thoracic surgeon colleague, Dr. Linnet, will be in touch to explain next steps.”

Gwen and I exchanged another troubled glance before she muttered, “But he’ll be all right again. I mean, eventually.”

“Can’t promise anything, but there’s an extremely good chance of that, yes. At least heart wise.”

The rain fell silently outside the large window behind us and the sounds from the hallway became a low collective din while I tried to absorb what he’d just told us. Both of my parents and one brother had survived heart surgeries. Finally, I nodded and said, “Okay, thanks. Let’s get it done.”

He gave a reassuring smile, shook our hands again, and left. Afterwards, I looked into Gwen’s deep brown eyes, the ones I’d first fallen in love with when we met as student teachers at the same elementary school all those years before, until she took my hand, pressed her lips together, then said, “We’ll find our way through this.”

“Sure.” I nodded and squeezed her hand, recalling her own uncommon determination during breast cancer treatments. “You bet.”

I wasn’t taken down to Intervention Radiology until almost four. We were told the procedures they had planned could take up to three hours with recovery time afterwards, and visiting hours would likely end before I got back to my room, so I convinced Gwen to go on home. They said someone would call her to let her know when it was over and I was in recovery.

While they were prepping me for transport, Gwen said, “I’ve been in touch with Katie. She’s very concerned, of course, and says she can arrange to fly home, if needed.” Our daughter, Katie, had remained in Uganda to continue the water purification work she’d begun during a Peace Corps stint there more than a decade before. “With all your pain, I told her not to try texting or calling you for now until we had a better idea where things stood, but she sends her love.”

“Right back at her,” I said. “To you both.”

Gwen had time to give my forehead a quick peck before two transport guys released the brakes on my bed’s wheels and took me away. As we clacked across the seams in the linoleum, I thought about the trip Gwen and I finally had planned to visit Katie in Africa that fall. The two of us had just retired from our teaching positions in June and had only been able to see her on intermittent visits home every few years since she first left. I was proud of her; she and Gwen were so alike it made me ache. I closed my eyes and hoped it would be a trip we’d still be able to make.

During the night, my gut pain became so debilitating that after moaning at nearly every breath, I was given a strong narcotic against it. That knocked me out enough that I was able to doze on-and-off until morning. Getting upright and out of bed was a five-minute ordeal, but sitting in the chair helped again. At seven, I managed to eat a little breakfast while I gave a phone update to Gwen, returned a few good-wishes texts afterwards, then tried to ignore the pain and read until she arrived just before ten.

Dr. Yang followed her into the room. If possible, he appeared even more unkempt than the previous day, his thinning hair looking like it hadn’t been shampooed for a while. He assumed his same leaning posture, and without introducing himself to Gwen said, “Your white blood cell count has become elevated.  They’re going to do another CT scan of your gut. The one from the ED showed nothing, but this one will involve contrast imaging.” His eyes finally travelled briefly between ours with distracted consternation. “So, then...yeah. That’s the plan.”

And without another word, he turned and left.

Gwen raised her eyebrows after him and said, “Unique bedside manner.”

I nodded.

“But at least, they may finally find an answer to your pain.”

“Hope so.”

I watched her settle onto the couch, take yarn and needles from her satchel, and continue on a knit cap she was making for Katie who’d recently begun a project in the mountains just across the border into Kenya. Before resuming my book, I googled Dr. Yang on my phone where I found his professional and personal profile on the hospital’s website. He had an impressive academic background and had been practicing for more than fifteen years; in his spare time, he enjoyed riding bikes with his wife and two young sons, as well as trying out new restaurants. So far, I hadn’t seen anything remotely resembling the smile he wore in the accompanying photo.

A little later, Gwen took my vibrating phone off the lap table, looked from it to me and said, “You’re getting a FaceTime call.”

I labored over next to her while she pressed the icon in reply. A middle-aged man popped onto the screen wearing a surgical cap and scrubs. He told us he was Dr. Linnet, the cardiac-thoracic surgeon who worked with Dr. Sax, and apologized for not visiting with us bedside as he normally would, but that he was about to perform lengthy back-to-back surgeries, and wanted to give us his review of the previous evening’s procedure results beforehand. He confirmed the significance of my heart problem but explained it could be addressed by his doing minimally invasive Mitra Valve Repair surgery on me. If completed in a timely manner, he said the odds of a complete recovery were extremely high, but that in my case, having it done sooner than later was advisable. He concluded by telling us that someone from his office would be contacting me soon for scheduling.

When he signed off and the screen went blank, Gwen and I looked at each other in what had quickly become a customarily dazed manner.

Eventually, she huffed a sigh and said, “Busy morning. A bit much to take in.”

“It is, yeah.”

“But we’re getting somewhere,” she said. “We’re getting some clarity, at least.”

I nodded. The rain had ended overnight, and dust floated in shafts of bright sunlight streaming through the window, bathing the side of Gwen’s face in a lovely amber glow.

Perhaps an hour and a half after I was back in my room following the CT Scan, a doctor entered in scrubs with a stethoscope looped around his neck. He was about Dr. Yang’s age, reed thin and black-haired, with rimless glasses.

“I’m Dr. Weinstein,” he told us taking turns to shake our hands. “From General Surgery-GI.” His demeanor mirrored Dr. Sax’s. “So, we’ve already had the chance to go over your scan results, and I’m afraid you have an acutely infected gall bladder, which has clearly been the cause of your pain. We’ll get you going on a couple of antibiotics to fight that, but it’s so inflamed that we also need to immediately insert a drain to prevent rupturing, which we can safely do now within the limitations of your heart condition. The gall bladder will eventually need to be removed surgically, but the timing on that is something we’ll have to decide on with Cardiology’s input.”

I heard Gwen say, “My...it’s that bad?”

He nodded. “Frankly, I can’t believe it hasn’t perforated already.”

She asked, “What does the drain empty into?”

“Just a little bile collection bag on his side. Can be clipped onto clothing and easy enough to manage. Some patients have them quite a long time or even, on rare occasions, permanently.” After Gwen and I had exchanged another brief glance and both given nods, he continued, “You should feel gradual relief from the pain afterwards, although perhaps not much right away because of the incision, which might even cause a temporary increase.” He paused, his eyes commiserate. “The procedure will be done in Intervention Radiology like your heart stuff yesterday. They’re coming for you now. They should have it completed and have you back in your room in about an hour.” After another pause and friendly smile, he asked, “Any questions?”

“Not that I can think of right now,” I said.

Gwen asked, “A person doesn’t need a gall bladder?”

“Technically, no. You can function fine without one.”

“And this will take care of his pain?”

“It should, gradually.”

The next glance Gwen and I exchanged seemed almost comically ritualized. I turned back to Dr. Weinstein and said, “All right. We appreciate your input.”

After he left, I mumbled, “Don’t get old.”

“Too late for that,” Gwen replied, mustering a smile of her own. “But it sure beats the alternative.”

True to Dr. Weinstein’s word, I was back in my room fifty minutes later, a little groggy from the local antiesthetic they’d given me prior to the procedure and with my gut still numb from the Lidocaine used during the incision and placement. Both wore off pretty quickly, and then Gwen held my hand while I winced and whined shamelessly over intensifying pain that was both internal and topical. Per standing order, Trent didn’t take long to administer a larger dose of the narcotic they’d given me that first night which he explained would probably knock me out again and that I could continue to receive, as warranted, every six hours. By then, it was already mid-afternoon, so I nagged at Gwen to go home until she reluctantly agreed.

Before she left, she showed me a sweet text from Katie that concluded with a series of “love” emojis. I took Gwen’s phone from her and replied: “Pops here. Thanks so much. Miss and love you to Saturn’s rings and back.” That final phrase was one we’d exchanged fondly with each other since she’d been a toddler. Then I added several “gratitude and heart” emojis of my own, handed the phone back, and was asleep again before I knew it.

They kept me well medicated, and the overnight went a little better than the previous two. In the morning, the trip between bed, bathroom, and chair was slightly more tolerable. I hadn’t even finished my breakfast before I received the first medical visit of the day by dark-complexioned, thick-chested younger man who introduced himself as Dr. Kumar, on-call Cardiology resident. His deep-set eyes held something akin to muted merriness.

He asked, “How are you feeling? Any improvement with your pain?”

“I think so, yes.”

“Good, that’s good.” He clapped his hands together once. “Well, I’ve been going over your chart, your heart and GI issues and so forth, and it’s my strong belief that you should go ahead and have your gall bladder removed here while you’re currently inpatient. I feel your heart is in adequate condition for that. When a gall bladder drain is placed, the patient typically goes home for four to six weeks before further procedures are initiated. But following that timeline, a couple of more weeks would usually then go by before the gall bladder is removed, and around the same amount time would need to pass before your Mitra Valve Repair could take place. In combination, that would put you two or three months out before that procedure’s completion, which, in my opinion, is too long, too big a risk.”

“Okay,” I heard myself say. “I mean, it is my heart we’re talking about here, so I’d like things to move along as quickly as possible, too.  I trust your judgment.”

“All right, then.” He made another singular clap of his hands. “I’ll put a note to that effect in your chart. But I caution you that I’m low person on the totem pole here, and it’s the weekend, so communications can become delayed, complicated.”

“I understand,” I told him. “Appreciate anything you can do.”

He gave a final handclap, then exited the room.  I didn’t have long to digest what he’d said because he was replaced shortly by a sandy-haired woman who said she was a nurse practitioner with the GI team. After another initial exchange about how I was feeling, she told me that my white blood count had decreased overnight and all my other indicators were normal, so that if the pain became manageable over the course of the day, I could be trained on the collection bag maintenance, and a discharge by later today was their recommendation.”

When I responded with a summary of what Dr. Kumar had just said, her brow knitted and her expression turned contemplative. “Well, with all the factors involved, especially your heart situation, that timeline does seem preferable. We always like to do surgeries while a person is inpatient, if possible, to avoid inevitable outpatient delays and hurdles with insurance approvals and such. And if Cardiology gives their blessing...” I watched her nod, more to herself than to me. “Let me contact a few people, and then someone will get back to you.”

I felt a bit askew after she left, not dissimilar to the sensation I’d had after being twirled about on an old-fashioned playground merry-go-around in my youth. There were so many players and shifting elements that it was dizzying. I was startled from my reverie by an incoming text from Gwen asking how I was doing.

“New developments,” I replied. “I’ll explain when you get here.”

Gwen arrived a couple hours later after taking our lab, Gus, for his weekly visit to the dog park; he wouldn’t stop complaining until she did. Trent was taking my vitals and emptying my collection bag while I summarized things to them both.

“Wow.” Gwen’s eyes had grown wide. “Wow, wow, wow.”

I looked over at Trent where he stood charting at the computer stand and asked him what he thought. “Well,” he said, clacking at the keys. “A lot of moving parts, that’s for sure.” He paused, squinting at the screen. “No new notes yet from Cardio or GI, but that’s not unusual, especially on the weekend. Many of those folks finish their rounding first and then do a bunch all at once, or they enter a quick note on the spot but don’t sign it until later when they find time.”

“When do you think we’ll have a decision?”

“Not sure. Of course, things will have to involve Dr. Yang.”

“He still the attending?”

“Yep.” Trent’s nod was slight. “He is.”

For some reason, I found that response wearying, so after receiving a bed bath, I spent the rest of the morning napping until lunch while Gwen knitted on the couch. My next transition over next to her was easier than the others. My mind wandered as we tried to fill time with more Netflix episodes. I thought about our sunset wedding on the dock of her family’s lake cabin. About the day Katie was born and our many family backpacking trips as she grew up. About the little school in enlisted military housing where Gwen and I had spent our teaching careers, how silently and selflessly admirable those families had been. I thought of our retirement plans, in addition to Africa, to make a tour of several famous National Parks. I’d hoped to rekindle a woodworking hobby I’d started with my grandfather. We both had long-awaited books we were anxious to read now that we had the time.

Trent came in several times to take vitals, administer meds, empty my collection bag, or chart. I asked him to check for new doctors’ notes each time, but he always responded with a shake of his head when he did.

As the afternoon wore on, I got back in bed propped up as comfortably as possible and napped some more. The light in the room had already begun to fall when I was startled awake by Dr. Yang jostling my leg at my bedside. Trent stood at a right angle next to him charting on the computer.

“Mr. Sanders,” Dr. Yang said, resuming his familiar posture. “I’m pleased to say you’re getting out of here. I’m approving your discharge, which should take place soon.  Of course, you will need to be followed outpatient by Cardiology and GI.”

I felt my pulse quicken but didn’t speak right away, trying to compose myself. I sensed Gwen’s and Trent’s eyes on me when I finally said, “I think there’s been some confusion, some missed messages maybe. Both of those folks rounded with me earlier and appeared to agree pretty strongly that I should remain inpatient for the gall bladder surgery right away.”

Dr. Yang recoiled with an audible grunt. “I’ve heard no such thing. Four to six weeks recovery from drain placement is standard. Then you can deal with those other departments on the order of things.”

“Can you please recheck the chart?”

“I did before speaking to you.”

I glanced over at Trent who was scrolling through entries on his screen. He gave me a quick shake of the head, then said, “Dr. Yang, I’m not sure it’s completely up to date yet.”

Dr. Yang pivoted and barked, “Don’t tell me how to read a damn chart...I’ve been doing this since you were in diapers!”

“Listen, Dr. Yang,” I said, “why in God’s name can’t you just contact them directly to clarify things?”

“You’re not my only patient, Mr. Sanders. You’re one of twenty-five on this revolving door of a unit. All in need of my care, all in need of my attention, all in need of my direction. You’re not special.”

Gwen gave a short gasp, to which Dr. Yang fixed us both with a simmering glare before striding out of the room. I sat staring straight ahead, blinking at the patient info whiteboard on the wall, only vaguely aware of the goal that had been scrawled there about resolving gut pain and heart issues. Gwen blew a long breath out into the silence.

Finally, Trent cleared his throat and said, “Don’t take it personally.” His voice was hushed, restrained. “This is really above my pay grade, but I’ll see what I can do to move needed communications along.”

He gave my shoulder a pat before leaving the room. I looked over at Gwen who sat with her knitting in her lap, trying to fashion a sympathetic expression in return.

“What just happened?” I asked her. “Was I too abrupt with him?”

She shook her head. “You were frustrated. Justifiably so.” Her cell phone pinged on the couch beside her. She glanced at the screen, then stood and reached it over to me. It held a text from Katie that said: “Any updates?”

I hesitated, then tapped a reply: “Nothing yet.”

A little later, Gwen went down to the cafeteria and brought us back some dinner, which we ate on the couch while I watched the clock tick towards shift change at seven. Just before then, Trent appeared in the doorway, regarded us for a moment, then said, “Well, you’re all set. Your gall bladder removal surgery has been scheduled for tomorrow morning at nine-thirty. They’ll start prepping you about a half hour before that.”

I slowly lowered the cup I was holding and heard myself say, “Thank you.”

Gwen folded her hands into steeples which she tapped to her chest, mouthing the same sentiment to him several times.

“You bet,” the young man said. “Listen, I’m off the next three days, and I hope you’re not still here when I get back. Truly. Trust everything goes smoothly from here on out.” He glanced behind him. “Gotta debrief with your night nurse. Hang in there.”

Like many of the military parents of former students after conversations, he gave a little mock salute. I wondered if he’d been a military brat himself; he carried himself that way. The doorway stood empty, backlit against the room’s gloaming. A sort of flush had spread over me, which only warmed when Gwen reached over and took my hand.

They were able to do the surgery with no problems via laparoscope, which normally would have resulted in going home the same day, but because of my other complicating factors, they decided to keep me admitted to be on the safe side for another night. The next morning, I felt considerably better overall, the pain really just tender soreness, and my mobility had also improved. I was shaving in the bathroom with its curtain drawn when I heard the door to my room open, footsteps approach, then Dr. Yang say, “Mr. Sanders?”

“In here.” My razor remained suspended in midair beside my half-foamed face.

“Don’t hurry out.” His voice had gone flat. “Just wanted you to know I’ve ordered your discharge.”

I watched my reflection in the mirror reflect gratitude as I said, “Listen, I’m sor...”

But my room’s door’s room clicked shut before I could finish. I slowly shook my head at my reflection afterwards.

Eight days after I got home, I had a follow up with GI and was cleared for the heart surgery, which took place without incident two weeks later. Dr. Linnet and Dr. Cox were both pleased with the results and at my subsequent checkups encouraged me to gradually increase my exercise; by late August, I was walking nearly my former daily goal of three miles around our neighborhood.

I was given health clearance for our end-of-September trip to Africa, and Gwen was close to giddy in the days leading up to our departure. Our bags were mostly packed and waiting open-faced on the bed in Katie’s bedroom several days beforehand.

When I dug it out of storage, I discovered my old backpacking poncho almost in tatters, so drove over to a sporting goods store and treated myself to a new Gortex shell. Upon returning with it to my pickup in the parking lot, I found a man bent over the open hood of his car in the spot directly in front of me.

I put my bag inside the cab and asked, “Engine problems?”

The man straightened, turned in exasperation, and then it only took a handful of seconds for Dr. Yang and me to recognize each other. It was a sweltering day, but I felt a chill bloom up my back and across my shoulder blades.

“Mr. Sanders,” Dr. Yang said.

I nodded.

He shifted uneasily before saying, “You look well.”

“Good as new,” I told him and gestured towards his car with my chin. “But looks like you could be doing better.”

His shoulders slumped as he glanced from his open hood back to me. “Yeah, dead battery, and I let my damn AAA card expire. Plus I’m already late as hell.” He exhaled loudly and his countenance seemed to collapse a bit on itself. I watched him squeeze his eyes shut and rub the heels of his hands into them. When he reopened them, they were red-rimmed and moist. “Truth is I’ve let a lot of things go recently. Been struggling, frankly.” Our gazes held, and I did my best to keep mine steady and without judgment. “My wife left me a few months back, took our kids. Truth is, I’ve been sort of a mess.”

And now you’re vulnerable, I thought; vulnerable with dignity cracked, a place we’ve all been. I said, “I have cables. Go ahead and get inside with the key ready. I’ll hook you up and tell you when to try turning it over.”

He nodded. After I’d started my truck and attached the cables, I stepped to the side where I could see his slight figure in cargo shorts and a T-shirt behind the steering wheel, and gave him a thumbs up. He turned the key and his engine immediately roared to life. We exchanged grins, and he left his car idling while he stepped outside next to me and watched me disconnect the cables and drop both our hoods closed.

Dr. Yang squinted up into the sun at me and said, “Really appreciate that.”

“Sure, not a problem.” We continued to look at each other in the hot, white light until I said, “Hope things turn out all right with your wife. Your family.”

He shrugged, looked off beyond me briefly like he had during our first encounter in my hospital room, then said, “Well, she agreed to counseling, so that’s a start.” Like I had, he used his chin to indicate the sporting goods store. “And I’m taking my boys camping overnight for the first time. Just bought us new gear. Hope I can figure out how to raise the tent.”

“You’re a darn doctor,” I said and smiled. “Pretty sure you can figure it out.”

He snorted a little chuckle, then paused and seemed to gather himself before saying, “I apologize for how I acted with you in the hospital. Not an excuse, but I’m afraid I wasn’t at my best just then.”

“No worries,” I told him. “Me either.”

I extended my free hand, he shook it, and I said, “You take care.”

“You, too, Mr. Sanders. Be well.”

Like Trent had, I gave him a little mock salute, tossed the cables onto the floor of my passenger seat, and reversed out of my parking spot. I didn’t look back at him as I drove away into the midday’s glare. I wanted to leave him with as much of that dignity as he had left. Perhaps a little hope, too, which at that moment, I had plenty of for him.