Saturday, June 7, 2014

An Octogenarian Incident

Bugatti roadster. 1926

What is the significance of this car?   I see it as a metaphor for my life. Both I and the car are 88 years old. Unfortunately, I do not know the owners of this car, so I can't investigate further. About fifteen years ago when we lived in rural Vermont, there was a congregation of Bugatti owners with their classic 1920’s and 1930’s cars. They were parked at the local tavern; I went to admire them. Later that day, the twenty or so French masterpieces of design and engineering paraded slowly down the country road on which we lived. They were as graceful as gazelles crossing an open field. For me,these Bugattis  represented quality and enduring value - standards to which I have aspired throughout my life.

On January 1, 2014, I celebrated my 88th birthday. I had been in very good health, had a lot of energy and felt good all the time. In terms of medical history, I spent two overnights in the hospital and that was it. When I reached 65, I decided that I needed to see a doctor and have a physical exam. Nothing seemed to have changed over the next 23 years. I was taking 3 prescribed  meds (cholesterol, heart, glaucoma) and a dozen  vitamin  supplements.

About two years ago, I had been advised to get a pacemaker, but was reluctant to do so. I consulted with four cardiologists at Cedars-Sinai Hospital.They said that I would need one eventually, but for the moment, it was my call. I assumed that there would be some symptoms or warnings. None appeared.

January 28, 2014

Our son Abe was in town. We had a picnic with  my wife Mary in Griffith Park. We left him at Sunset Junction and proceeded back to Hollenbeck Palms where both of us live. I am in independent living and Mary is in skilled nursing. Dropped Mary off at the usual spot. The nurses took her to her room. When I trIed to start the car, it was evident that the battery was dead. Called AAA;  a service truck arrived and the driver replaced the battery. I drove to the Flower District, got flowers and retuned to Hollenbeck. Parked and proceeded to Mary’s room. Arranged the flowers.

Everything went blank!

When I awakened, I saw myself on the floor of Mary’s room with LPN’s Anthony and Rolando hovering over me. Recall being lifted on to a gurney and into an ambulance; everything went blank again. Later I awoke in what must have been the OR recovery area of White Memorial Hospital with a team of doctors in attendance. Perhaps Abe was there? If not, he was ever present thereafter. The doctors introduced themselves: surgeon, medical doctor, cardiologist, neurologist and Pacemaker specialist. They explained that I had a stroke, that they had utilized APC, a stroke treatment medication developed at the USC Medical School Department of Neurology, and that they had inserted a Pacemaker. I was told that I was lucky that all of these disparate factors meshed within a short space of time.

From there I was moved to a private room in Cardiac Intensive Care. I was stunned, miserable and uncomfortable. I felt like I was having a nightmare. I was not paralyzed, but the left side of my body was numb. I could not walk. Had to use a wheelchair. I had become an invalid! Not a very comfortable feeling. 

This was probably the most transformational event of my life. I felt as though I was living in someone else’s body and still do. Absolutely nothing is the same. While I had boundless energy before, now I tire quickly. Fortunately, my brain was not damaged. Abe thinks I am sharper now than I was before because the pacemaker pumps more blood into my brain. Evidence of that, is that I purchased a new iMac on which I am writing at the moment. Although difficult, I have been able to deal with the issues associated with endlessly updated software.

From Cardiac Intensive Care I was transferred to Rehab, remaining there for three weeks. It was here that I began to overcome the stupor that had replaced my former demeanor. Moving any part of my body, created discomfort. Abe brought my iPad in my iPhone. Having both of them, made it possible for me to reconnect with the real world. When I went to bed, I would play music on the iPad. During the daytime, I would use the iPad to send e-mails. Although my body was hardly fully functional, it appears in my brain was. Thank God, for that!

Rehab had a routine of daily sessions with a physical therapist and an occupational therapist. They were influential in awakening my body from the stupor into which it had fallen. I got to be friendly with a Chinese-American male nurse. When I was lamenting my condition, he offered me his philosophical perspective. He said that his father had lived to the age of 78. He, the nurse, said that he considered anytime beyond the age of 70 to be bonus years. He said that I had little to complain about because I already had 18 bonus years.

At that point, I was using a wheelchair. After three weeks of what I would describe as sensitive care in Rehab, I was sent back to Hollenbeck. Still in a wheelchair. I was given a room in Hensel, the skilled nursing section where Mary is a patient. Weird as it may sound, I was placed in the same room that Mary had occupied on her arrival at Hensel. All of the personnel were familiar to me because of Mary’s being there. It was a very strange feeling to be a patient in the place that I had visited regularly to see Mary.

Fortunately, I had a private room. I had daily sessions of physical therapy and occupational therapy which benefitted me considerably. Rather than eat dinner in my room, I decided to have dinner in Mary’s room with her. Abe brought my iMac. We established a routine of locking it up during the day and taking it to Mary’s room in the evening. This gave me a chances to handle my emails because the room was already wired for wi-fi.

My major concern at that moment was knowing if I might be able to return to my apartment in Magnolia Court, an independent living complex that felt more like an apartment building than an old folks home. My greatest fear was to be placed in one of the other units where I would be submerged in a sea of bent over people with walkers and canes. My accumulated anguish was dissipated when Hollenbeck’s business manager and its physical therapy director came to my room to inform me that I demonstrated that I would be qualified to return to my apartment making it possible to have as much of a normal life as I could under the circumstances.

For moths, I had been so consumed with my own health that I have given little thought to Mary. At  the end of March, she had open sores on her legs and was wearing medicated stockings with her feet elevated. Her condition improved and she is back in a wheelchair.There is no question that her fall, fracture and hospitalization in November altered her life for the worse. Last summer, when our mutual pleasures seemed boundless, it felt like we were on a second honeymoon. The memories persist!

Now, Mary is a much diminished person, but she still has an active and at times, coherent mind. She makes observations and comments. She is aware of my presence, calling my name,  which is gratifying. I am not certain that she is aware of my health problems. Given my adjusted state, I can do less for Mary.

My cardiologist recommended that I see a neurologist. I discovered that the University of Southern California Medical School Department of Neurology had a stroke clinic. Mary was already a patient in that department and I knew that the staff was of high calibre. I was introduced to an occupational therapist and a physical therapist, both of whom I meet with regularly. They have helped me recover damaged parts of my body. At the stroke clinic I learned of the South Baylo University School of Acupuncture  where there is an inexpensive  clinic. I go there once a week and can feel the benefits. 

I am again able to prepare meals and take them to Mary’s room. This provides satisfaction for both of us. It was one fragment of our lives that I could restore; however, in her diminished state, Mary can no longer feed herself. I find it difficult to feed her; it usually takes over an hour.

Stroke recovery is an arduous task. I am doing my best and am aware of my progress. Last week,  four months from the event, I abandoned my cane. I have been given daily exercises by my Occupational Therapist and Physical Therapist.I need to do 150 minutes of aerobic exercise per week - riding a stationary bike and swimming at The Y. 

One can't live in LA without a car. As a consequence of the stroke, my driver's license was revoked. I need to take all of the tests to have it reinstated. In the interim, I have developed a number of transportation alternatives. 

It is apparent that Mary and I are entering one of the final phases of our lives together. We need to do everything possible to create as much shared  pleasure as possible. That has been my mantra for the last several years; however, the options continue to narrow.

Wednesday, June 4, 2014

Massimo Vignelli as Heroic Caregiver

Massimo Vignelli, the great, internationally recognized graphic designer, died in 
New York on May 27. There was a flood of articles praising his work. As a 
consequence of a letter writing campaign originated by his son Luca, there were thousands of messages acknowledging his preeminence and influence. 

Massimo and Lella, his wife, were what is known in New York parlance, "a power couple."
They were business partners and sometimes co-designers. Earlier this year, Massimo created an online book dedicated to Lella's work.

"This book is dedicated to Lella Vignelli, an inspiration to all women designers who forcefully stand on the power of their merits."
Massimo Vignelli 

Although it is generally not known, Lella Vignelli, was stricken with Alzheimer's several years ago. Because Massimo knew that my wife, Mary, had been similarly afflicted earlier, he saw me and my experiences with my wife as offering him some guidance. I shared every bit of information that I could offer him.

Taking care of a person with Azheimer's, is very demanding. It is not something that one can dismiss easily. There are two dramatically different choices. One is to have your loved one live at home, and the other is to have that person live in a skilled nursing facility. Knowing that I could not become  a full time caregiver, Mary and I made the decision to move to Los Angeles and live in a continuing-care community. At that point, Mary was in the early stages of the disease. For a short time, we shared an apartment in this complex. Now, Mary lives in what is called  a skilled nursing section while I reside in the independent living section. So, I could speak with authority regarding this option.

Massimo investigated nursing home possibilities in the New York City area.
However, no matter how difficult and demanding, he decided that his preference 
was to keep Lella at home in their spectacular apartment. This meant
that he would have enormous personal responsibility. He did what very 
few people will do, became a full-time caregiver. 

Having made that decision, changed his life radically. He once said to me, " That he felt closer to Lella, at this point in their lives than ever before." Daily, Lella would come to Massimo's office in their apartment in full attire, adorned with jewelry of her own design, and position herself at right angles to Massimo who sat at the head of his black stone table/desk. She would thumb through design magazines while he worked.

Massimo told me that he decided to learn how to cook. That meant not only cooking, but shopping as well. Fortunately,  they lived in a neighborhood with excellent food stores in proximity. In the course of assuming these new duties, he managed to remain active professionally.

Massimo and Lella were world travelers. They had covered the globe for work and pleasure. One of the most vexing decisions that he had to make involved going to Frankfurt, where their daughter lives, at Christmas last year. Massimo anguished about getting Lella off and on the plane, as well as dealing with her incontinence. I sensed that he knew that this would be the last trip that they would take together. Mary and I had made a similar decision several years ago. Knowing that this would be our last international trip, we went to Rome and then to Puglia in the southeastern corner of the Italian peninsula. Despite all of the problems that we encountered, which I had relayed to Massimo, I encouraged him to go with Lella. I never heard the details of the trip, but I am certain that there were many problems. However in the long run, I am equally certain that he would not have questioned the decision.

Shortly after their return, he spent nearly three weeks in the hospital and his decline became evident.