Case Study

Her father is back in the ER. His second time this month. The first was a short stay. After an overnight in emergency and two days in the ward, he was discharged. The doctors told her (and she translated) that her father’s abdominal pains were caused by an acute GI infection, possibly from an earlier viral infection, a diet change, or age. The second time is for the same problem, but much worse. The pain and infection returned tenfold. The emergency doctor is perplexed. So her father is transferred to the surgical ward, where he is monitored by a new team of doctors.

Her mother is there as well. In the corner of the room in a chair. On video calls, the daughter can’t quite make out her mother’s face, because of shadows and the position of the camera. She suspects her mother has been crying but can’t prove this. The daughter has never seen her parents cry. Around 5 p.m., her mother drives home. She has trouble driving in the dark.

The patient in the next bed talks to himself and has no visitors.

A bell chimes over the intercom when a baby is born. Twice for twins.

“My eye is bleeding,” her father says, and pulls up his eyelid to show her, over video, the veiny red ball. “It’s the medicine,” he says. “What medicine?” she asks. He has trouble pronouncing its name. The doctor wrote it down on a piece of paper that her father has misplaced.

Her mother puts the daughter on FaceTime whenever someone in scrubs enters the room.

“Are you the doctor?” the daughter asks, when she sees a woman. “No,” this woman says. She’s the phlebotomist, here to draw the father’s blood.

“Are you the doctor?” she asks, when she sees a man. “No,” he says. He’s the nurse for the next bed over.

“Are you the doctor?” she asks, when she sees another man. The man hears the question but ignores it. Ignores, too, the phone-sized face sitting on her mother’s palm. So, yes, he is the doctor, and talks in that clear, loud voice of import. “Surgery is not imminent but cannot be entirely ruled out,” he says, while pressing on her father’s abdomen and asking if that hurts. She can’t hear what her father says. She can only hear the doctor: “Yes, Mr. Wang, I acknowledge.”

“That was a doctor,” her mother says later. “But not your father’s main doctor.” The vascular surgeon, who does his rounds only at 11:45 p.m. Her mother was told this by the hospitalist, also a doctor, but not the main doctor, not the one who makes the decisions. Big doctor. Little doctor. That’s how her mother starts to differentiate.

“You could have been a big doctor,” her mother says, when she remembers the daughter had once considered it. “All these men,” she says, a lifetime homemaker. “You were smart enough. You could have helped.”

Which is exactly what the daughter is trying to do, by dropping everything and anything she is doing whenever her mother calls. Afterward, she spends hours on the internet learning the medical jargon so she can translate it for them. The vascular surgeon who calls at 11:45 p.m. says, after reading her father’s most recent CT angiogram, that the diffuse colitis was likely caused by mesenteric ischemia, which was caused by a thrombosis of the false lumen of a SMA dissection. She asks the surgeon to go slower, so she can write the terms down. The surgeon then goes very slow and speaks to her as if she were an idiot. Dissection, not as in frog dissection, but as in a tear in the inner layer of a major blood vessel, like an artery. SMA for the superior mesenteric artery. Duh.

The doctors stress that her father’s case is unique. In years of practice, they have seen only one. Etiology unknown and likely spontaneous. Her father doesn’t smoke, drink, have hypertension, or lift 200-pound weights. So the only risk factor the team can think of is that he is an older man of Asian descent. The daughter doesn’t know how to take this information, so she doesn’t translate it. Is being a unique medical case meant to be reassuring? Can your identity really be a meaningful cause?

The heparin turns her father’s eyes red. A blood “thinner” to reduce the thrombosis, which is the formation of a blood clot, as opposed to the thrombus, which is the clot itself, as opposed to the embolus or a free-floating blood clot, broken off from a thrombus, that floats through your arteries to damage another part of the body, like your brain.

Whenever her father has an abdominal episode, they need to give him a shot of Dilaudid. Dilaudid is an opioid, and as she is explaining this to her father, his eyes widen, stretching his already thin skin. Opioids. Opium. The Opium Wars, when the West came and used that drug to control the East. “I don’t want to be here,” her father says. “I want to go home.”

Home for her parents is Arizona, where, for many years, they ran a motel outside Phoenix. After selling the motel, they retired and bought land on which they now farm. Her mother grew 100 winter melons last year and went door-to-door in their suburb, giving them out to everyone. But most people had no idea what a winter melon was or how to cook one, so they were left outside like decorative gourds until they rotted.

A friend tells her to request a translator. “It’s every patient’s right,” says the friend mightily. “And the least a hospital can do.” The daughter knows her parents will not trust a translator. Her friend means well but doesn’t have immigrant parents.

The daughter lives in Boston, where she went to college and grad school. She feels more at home there than in Arizona. As for how things are going in the daughter’s life, her dad is in the hospital, yes, but she is also currently unemployed and has recently separated from her husband. Not through any singular, catastrophic event such as infidelity, but because, over nine and a half years, they grew apart. This past month, her husband took up a studio two T stops away, so that if she really needs him, he’ll be close, but under normal circumstances, they won’t cross paths. She hasn’t told her parents about the separation or unemployment. She feels that it will only make the thrombosis worse. Her parents have often asked, “Why, compared with everybody else, are you so far behind?” “No husband” (when the husband was the boyfriend). “No kids” (still true). “Working 12 hours a day at a start-up” (now false). “What kind of life is that?”

From the hospital bed, her father reports how many babies were born that day. After another chime goes off, he says, “If you have a child by next year, I will give you 200 winter melons. I will go to USPS myself.”

She looks at her calendar and considers flying to Arizona. But then she remembers that whenever she is physically in the same room with her parents, they talk over one another and try to tell one another what to do. Moreover, if she flies there, she will be setting a precedent: that she will fly back whenever something like this happens. She isn’t ready to commit to that just yet. She also has a wedding this weekend. The bride is the last of her close friends to be married, whereas she is the first to move in the other direction. The growing-apart could be seen in her husband’s disengagement with her friends. After nine and a half years, you would think there would be no “her friends” or “his friends.” But whenever they were out with his friends, he was jovial. Whenever they were out with her friends, he scrolled through his phone.

“I’ll just skip the wedding,” she tells her father, who is told daily by different doctors that surgery, though not imminent, cannot be entirely ruled out. She decides, precedent or not, that if the non-imminent surgery becomes imminent, she should be there to help. Her father orders her to go to the wedding. “I’m fine,” he says, though he has lost 18 pounds. “I’m back to the weight I was in my 20s,” he says. “My 20s were a happy time.”

In his 20s, her father was still in the homeland. He met her mother, and they married, and lived together in a small apartment with no heat or functional plumbing. To flush, they would pour a basin of water down the toilet. To keep warm, they would burn coal and wear all of their clothes. “We were poor but very happy,” he says. The daughter feels ice in her heart when her father says this. She can’t help but wonder, Happy because you hadn’t left yet? Happy because I wasn’t around?

In her 20s, she was under the delusion that she was happy, but in retrospect, she was lost. Back then, she and her parents were estranged. They went months without contact, and even when the motel caught fire or her father was robbed at gunpoint, she chose not to go home. In her mind, they owed her something. That’s what her silly 23-year-old self believed. They had not approved of her lifestyle, her dating, her drinking, and her staying in the Northeast. So she complained about them to anyone and everyone. Her stereotypical Asian immigrant parents. “I really can’t stand them,” she would say, while drinking, smoking on occasion to overcompensate. “We would be better off without each other, doing our own thing.” What was her thing, then? Sitting in a dingy bar with other lost people, wishing her parents away?

Her parents used to walk laps in their suburb. Sunrise and sunset, lap after lap, at least three miles a day. The most her father can do now is go past the privacy curtain to the doorway, then, at the doorway, make a slow U-turn back to the bed. His gait is shaky, and he’s hunched. He pushes his own IV pole but holds on to her mother.

When her father’s diet advances to soft liquids, a bowl of cream-of-mushroom soup sets off a prolonged episode. It’s the cream he’s not used to. Butter, fat, lactose. After the Dilaudid shot, he is back on only ice chips, which he can’t tolerate, because they are too cold. The daughter tells her mother to ask the little doctor if her father can at least have sips of the hot water that her mother brings dutifully each day in a thermos. Her mother reports back that the little doctor asked the big doctor and that the question was acknowledged but went unanswered. So the daughter finds the number of the nursing bay and calls that. The nurse on the line is not her father’s, so is not clear on the situation. The daughter hears her own panic: “He can’t handle cold food. He microwaves bananas. Even lukewarm water would be fine.” The gentle nurse says, “I understand.” Some hours later, sips of lukewarm water are approved.

The new patient in the neighboring bed drinks a can of Diet Coke with every meal. Breakfast, lunch, dinner. He takes his pills with Coke. Her father is horrified and amazed. Amazed, too, that when his diet advances again, they give him chocolate pudding and green Jell-O. When the Jell-O comes, he sends the daughter a picture. Fluorescent green. Radioactive green. Slime. “How can this be considered health food?” Her father reminisces about the homeland, where hospital patients are given soup cooked from a whole fish. The only problem with whole fish is the bones. Should one get caught in your throat, you must be wheeled to the special department dedicated to plucking out fish bones from throats. “During New Year, that department always has a long line,” her father says. “You were once in that line. You were just a toddler.”

Besides the daily FaceTimes with her parents, the daughter is roped into long group texts about the wedding. Guests who know one another band together to discuss the logistics of getting to the vineyard venue, which is just far enough from Boston to require a car. Rather than carpool with anyone, she decides to ask her husband for their car, which he took because he used it more for work. Their car. His car. She texts, “Hey can I borrow the car?” He agrees and, later that day, even drives it over. They chat for a bit about the wedding, which he will no longer be attending. They agree on a fabricated story to explain his absence. She considers updating him on her father, technically still his father-in-law. Her husband would have smart things to say about the situation: “What your father is receiving is equal but not equitable treatment.” “Jell-O is meant to create a sense of nostalgia for the average American.” He, too, would have suggested a translator.

The growing-apart could also be seen in her disengagement. A few years ago, they began splitting the holidays. Come December, she’d fly alone to Phoenix, while he’d stay at his family home, in Newton. Her husband comes from a large family. Yet even when the long table was full of people, she noticed that, after saying grace together, they took turns to speak. Her husband was the one to point out that she and her parents had a habit of talking over one another. She wasted a lot of mental energy trying to disprove this fact.

In the end, he gives her the car keys, and she doesn’t update him. She asks him how he’s getting home now. “Bus,” he says, hands by his side, no ring. He wishes her a good time at the wedding.

On the drive to the vineyard, she has to pull over. Two surgeons have come into her father’s room to explain what they’ve learned from radiology. The tone is ominous, and the daughter is sitting on the side of a highway, rocked by the gusts of fast cars. “This is serious stuff, Mr. Wang,” the younger surgeon starts. “Dissections never truly heal, and conditions like these have been known to exacerbate.” He lists fatal aneurysmal rupture as an example. At this point, the older surgeon steps in: “Dissections can heal over time; good news is, blood flow has been restored to your intestines. You will require close monitoring but no surgery, though the chance of future surgeries cannot be entirely negated.”

Having listened to dozens of doctors of late, she has noticed a pattern: The younger ones think everyone is going to die. She asks when her father will be discharged. The surgeons say they don’t make these decisions. They’re just here to assess the need for surgery. Had her husband been beside her, he would have inserted himself and said, “But you haven’t really done a good job of that, have you? You’ve kept my father-in-law on a terribly restrictive diet. You’ve told us no surgery today or tomorrow, but you never eliminate the possibility. Given your level of training and education, how can you not know?” She would have been the bigger person and thanked the surgeons. Then, despite being equally frustrated, equally helpless, and more or less on the same side, she and her husband would have argued.

Back on the road, she puts her parents on speaker and listens to her father complain about the pudding, the Jell-O, the bucket of ice chips they dump out and refill. He is nothing but pleasant with medical staff but demands to know from his daughter why, if no surgery, he can’t be discharged, and why, if no surgery, no one knows when he will be discharged. He’s already been in the ward for 10 days. Four different patients have been in the bed next to his. Two hundred and sixty-nine babies have been born. He worries about the bill.

“The medical team decides when you leave,” repeats the daughter. “They have to decide as a team. You are still not well.” Her father insists that he’s well enough. He raises his arm that’s hooked to four IVs, two for medication, two for nutrients. He hasn’t been allowed to shower because of these IVs. He laments getting old. He worries about the bill.

“Seventy-thousand dollars,” he says. The total amount a hospital had once charged someone he knows.

“But you don’t pay all of that.”

“For every five-minute visit, the doctor charged $150.”

“That’s just how it is.”

“Sounds like a scam.”

While her father talks, her mother says she also doesn’t like the American health-care system. “Why can’t they just send one doctor and one nurse? Why an army of people that changes every day? And why is each doctor only responsible for one thing? The human body is not a car.”

In fact, the human body is a car, the daughter thinks. How else does a sane person prepare themselves to cut into another person?

“It’s not about like or dislike,” says the daughter. “It’s what we have.” Her mother reminisces about the homeland.

At the wedding, the daughter wears a black dress with a black shawl. She hadn’t meant to wear all black, but she’d packed with little to no reflection, thus forgetting all of her toiletries for the night. She inspects herself in the mirror. The words fatal aneurysmal rupture come to mind. She’s known the bride since college and, at the pre-ceremony hour, dodges as many mutual friends as she can. But one finally corners her and asks immediately where her husband is. This curious person is joined by another, and soon she is surrounded by cheerful, eager people in pairs. The fabricated missing-husband story is told again and again. She also has a work story that is truthful. Had anyone asked, she could have carried on an entirely valid conversation about the risks and rewards of start-ups and what her next steps will be in finding a new role.

The ceremony forces her to remember her own. Outdoors. Springtime. Initially, her father had been hesitant to walk her down the aisle—no tradition of his—and only after much insistence from her and her mother had he changed his mind. Which reminds her that after the ceremony, she has to call him again, to remind him to stand up and walk around the room. Standing helps circulation. Standing saves lives.

Before the reception, she makes the call from a dim hallway by the banquet room. When her father doesn’t answer, she calls her mother. When her mother doesn’t answer, she calls her father. Back and forth she pings. Mother. Father. Mother. Father. She feels her entire chest coated in sweat. She feels completely alone. Then, as she is about to leave the reception to drive back to Boston and get on the first flight to Arizona, her mother calls her back, annoyed: “What? All the ringing and buzzing. What? What?” Her parents have just come from the bathroom, where her mother had wiped down her father’s body with a damp towel. “He smelled,” her mother says. Even the other patient had complained. “Everything is fine,” her mother says, and pans to her father, who waves and has a clean, white towel draped over his neck.

The banquet room is filled with circular tables, and she is at the college table, with the same pairs of cheerful people. The seat to her right is empty. She takes her husband’s name card and folds it repeatedly until it is just a tiny, insignificant square. She imagines her parents will press her for a cause. Something must have driven you two apart. Etiology is never spontaneous. But even when she tries, she can’t cobble together an answer—there’d been no gleaming moment of clarity in which they both knew, just many dull moments of discontent. It must have been their identities, then, an incompatibility that took nine and a half years to figure out. She considers never telling her parents. What would happen if she never did? It’s not like her husband and her parents were close, though that was less his fault than hers. She had intentionally picked a man her parents would never understand. So, all along, she has been the problem. The bad daughter, bad at both embracing her given family and creating her own.

During dinner, she and the person seated to her left attempt conversation but lose momentum. After a while, he turns the other direction and looks relieved. During the toasts, she drinks wine and runs a napkin across her teeth and mouth. The bride’s family members stand up one by one, offer their well wishes, and say something they remember about the bride. What she remembers is that in college, they had crazy late-night escapades. They stayed out until the morning. No curfew or irate parents waited at home to punish them. So, like this, the image of her father in the doorway comes back to her. A younger, heavier man with no IV pole, just hands gripping the doorframe, face darkened, ready to scream. When he used to scream, she used to cower. Only anger she saw then, not I’m angry because I’m scared to lose you; I’m scared to lose you because you’re all I have.