Always Forever His Woman

“My bounty is as boundless as the sea, My love as deep; the more I give to thee, The more I have, for both are infinite.”

William Shakespeare in Romeo and Juliet

I met them long ago, back in the days when I practiced general medicine in the tiny office on New Halls Ferry Road.  I forgot who came first: I do remember that one spouse quickly followed the other.  She had rheumatic heart disease, a rare finding these days of effective antibiotics and excellent public health.   She had developed mitral stenosis, a narrowing of the valve on the left side of the heart.  At 32 she developed heart failure, so the decision to proceed with a valve replacement, although stressful, was easy to make.  She would not have lasted a year without an artificial valve.

Things did not go well.  In those days, the success rate was good, but nowhere close to the near perfection that we can achieve now.  She suffered a severe stroke during surgery.  It left her paralyzed on her left side.  The new valve required a lifetime of taking blood thinners.  After months of rehab, she was still confined to a wheelchair.  She could feed and cleanse herself, and her speech and swallowing were unaffected.  Still: she was 32 and had a lifetime of disability to look forward to. 

I met her shortly after she left the rehab unit.  She weighed 98 pounds.  Her hair was unkempt.  Her eyes were matted.  Although she was capable of maintaining a conversation, she did not make any effort to establish eye contact with me.  Her husband, a stocky and attentive gentleman, wheeled her in and gave me most of the history. Other than the paralysis and the sounds an artificial heart valve makes, her exam showed nothing to be concerned about. 

I took stock of the situation.  I concluded that her future seemed empty and hopeless to her.  Her husband tried to be upbeat. It was clear that he came close to doing total care on her (besides doing all the cooking and housecleaning, plus working 40 hours a week).  Yet I could see that this routine was going to be too much for him, and that he was not good, and was never going to be good, at helping a woman to groom herself.

We had a long talk.  He became a bit defensive when I mentioned getting help with her hygiene and makeup.  I placed it in a context that girls know much better what to do about these things; this way I did not threaten to take control away from him, and I reinforced the masculine, I-can-do-anything stereotype that he had been culturally conditioned to adopt.

He agreed to a female daytime helper.  I made some calls and was able to get his insurance to pay for this expense (I doubt that I could achieve this result today.  In fact, ten years after they agreed to pay, they tried to stop this benefit.  Things ended up in court, and my patients won after I testified for them).  They hired a bright, cheerful, very compassionate woman who dove into her work.

By the next visit Jenny (we will call her Jenny) looked like a different person.  Her face was clean.  Her hair had been shampooed, and was neatly done.  At home she had made some attempts at pouring herself some milk and coffee.  And she looked at me straight in the eye. 

Her husband looked ten years younger.  He was now able to accept overtime when the opportunity came his way.  He began to make plans for a family vacation.  His health seemed to be excellent.  They lived in a small house and were very frugal, so her uncovered hospital and surgical expenses were quickly paid off.

Four months later she had gained twenty pounds.  She was back at her usual weight.  Over the years they were able to save enough money to take the whole family, including her caregiver, on vacations.  Our visits, although necessary because all sorts of monitoring needed to be done, were mostly spent socializing and discussing their two children.  Despite the huge burden that her condition imposed on them, they were the typical blue-collar suburban couple.

The children grew.  Both became sources of disappointment for these very nice people.  Much trouble in school; some trouble with the law.  Their medical insurance increased the amounts for deductibles, copays, and medicines. Their finances tightened up.  There were very few outings and no more vacations.  They had no money to consider any remodeling on their tiny house.

Jenny’s husband bore it all with admirable poise and patience.  Even after they hired the caregiver, he was the one to drive her to my office.  Even when she could have done more for herself, he catered to her.  From my point of view, she seemed to take his efforts for granted.

After one of their visits I remember thinking to myself about how unfair life had been to this couple, and this man in particular.  I wondered when their luck would change. Soon afterward it did.  Jenny liked to gamble.  In those days St. Louis had no casinos, and they did not have enough money to be able to fly to Las Vegas.  But this is something that Jenny really wanted, so her husband found the money somewhere.  All three of them packed their bags and headed for a Vegas weekend.

Hours after they arrived Jenny asked her husband to park her wheelchair in front of a slot machine.  He complied with her wish.  Because he was not a gambler, he wandered off, trying to think of something to do for the next hour.  As he left the casino, he casually inserted a quarter into the slot machine nearest to the exit.  This is when all hell broke loose.

A loud bell rung.  Lights began to flash.  Many lights.  Then a siren went off.

Jenny’s husband figured that he had broken something.  He had no money to pay for any repairs.  He began to run away.  A security guard ran to track him down.  He stopped running, put his arms up in the air, and said: “OK; I’ll pay for it.”

Pay for what, he was told.  He had just won a jackpot.  A big one.  When the sirens stopped blaring the machine focused on the amount.  It exceeded $130,000. Jenny and her husband showed me the check when they came back to St. Louis.  I was overjoyed.  Something nice had happened to this couple after all. 

I asked if they had plans for the money.  A bigger house.  New furniture.  The husband’s job seemed secure, and they were both in reasonable health.

Not a chance, he said.  The house and its decorations would not change.  He arranged for a lawyer to set up a trust fund for Jenny, just in case that some day he may not be there for her.  I insisted: they should spend a little bit on something that they did not need.

“She’s always forever my woman, doc,” he said.  “I need to make sure that I provide for her.”  There was a curious mixture of love, pride, and duty in the way that he said this.  I told him that I understood.

At her next visit Jenny was brought in by the caregiver.  She was beaming.  When my nurse left the exam room after taking her vital signs she was also beaming.  “She has something to show you,” she said.  I walked in the room.

What’s new?

She said nothing.  She used her right arm and hand to lift her left wrist.  Her caregiver pointed to the limp ring finger.  A huge diamond ring was decorating it.  My jaw dropped.

Wow!

“My husband said you convinced him.  He told me that I was always forever his woman.”  A few tears and a huge smile followed.

Things.  So devoid of useful purpose.  It’s just a rock, or a piece of metal, or poured concrete.  Yet so meaningful.  Hundreds of millions of lives that can be positively influenced by a ring, or a painting, or a new car.  The bulk of humanity’s history shaped by our pursuit of basic food and shelter, and things.

A diamond helped her to focus on what she probably knew all along.

Always forever his woman.