FINAL EXIT
Carlos slide his body deeper into the filled bathtub of lukewarm water. With his back resting against the slope of the end of the bathtub, small traces of soapy tried to cling to the stubble of whiskers on his chin. His butt no longer stuck to the scratched rough-glazed white enamel on the base of the bathtub and at times, it was difficult to keep from sliding and finding his head under the surface of the soapy water.
He arms were out of the tub hanging like galleon oars on each side of the chipped and scratched four-legged monster. It was as if he were ready to paddle the tub through the humid stale bathroom air. He wiped his hands on the dry soiled washcloth so that he could extract a cigarette from the pack that rested near his feet at the end of the tub.
Once lit by his trusty Zippo lighter, he inhaled a deep breath of the burning More cigarette, re-adjusted the flow of water into the tub and rested once more on the slope of the tub. He felt as if he were in a reclining chair.
“God, I need this cigarette,” Carlos muttered to himself as he raised both bare feet up out of the water. His toes stood like marching soldiers above the water. The overflow drain behind his bobbing feet now cascaded the excess water displaced by his body weight down the waiting gaping hole into the drain below.
He took two more rapid puffs and balanced the half-smoked brown paper More cigarette on the flat edge of the tub rim near a half-used bar of soap. A dribble of ash fell into the water and dissipated after a slight movement of his feet. His sudden action seemed as if he was in fear of being burnt.
This was the first cigarette Carlos had had in over 9 years. It was nine years and seven months, to be exact, since that horrible day-after Thanksgiving heart attack.
No one, that he could remember, had ever suffered a heart attack in his family.
It had to be all the rich food, he reasoned, all that butter in the mashed potatoes and the sugary glazed carrots must have been the cause of it.
The heart attack was only the beginning for this 72-year-old man. A more serious illness was waiting patiently in the wings to make its star-studded appearance on the stage of life for Carlos Mendez.
Carlos ran more hot water into the area around his feet in the tub. His ankles were both red and swollen, not from the infusion of extra hot water, but edema that increased the size of each ankle along with impaired blood recirculation valves. The redness was from millions of tiny ruptured and tortured blood vessels now demanding more and more space within each ankle.
The heart attack had also brought a new fearful condition into Carlos’ life – blood clots. At the time of the heart attack, the surgeon inserted two metal stints into the major artery leading into Carlos’ heart and successfully restored the vital passageway for blood, but now the fear was of possible blood clots in other parts of his body.
Carlos would be on warfarin, the blood thinner, for the rest of his life, following three discoveries of blood clots in his left leg. Now subject to extreme bruising and bleeding when falling or cutting himself, Carlos would be subjected to weekly blood test to determine the dosage of the notorious “rat killer” medicine.
For a brief second, Carlos allowed all of his medical problems to melt away in the hot tub. The water felt good even though it burned his skin.
Carlos remembered that at a time in his life as a forty-year old man, he began having double vision of the left eye accompanied by severe headaches. His doctor ruled out a brain tumor and since the pain was located in his left temporal area, he was referred to a neurologist, who ran extensive chemical and diagnostic imaging tests, as well as visual tests certifying that the condition was not caused optically, but was a result thereof.
The disturbing condition lasted for over a year with countless tests of all sorts imaginable along with heavy dosages of the glucocorticoid drug, Prednisone. The neurologist ruled the condition as temporal arteritis, but the condition did not abate or go away with the medication.
A second consultation discovered a small lesion or tumor on the temporal optic nerve from the left eye. Simple same-day surgery and the removal of the offending mass substantiated that it was not cancerous. The double vision/pain situation ended along with the daily heavy dosage of Prednisone.
Carlos had lived his life in a dream world not knowing what the Prednisone had done to his body, especially the bones within his body.
Three years after the heart attack, Carlos complained of left hip pain and his orthopedic doctor x-rayed and ruled his condition as “the beginning of chronic avascular necrosis.”
“It is a serious condition, Carlos. The bones in your hips are beginning a cellular death, necrosis, of its component parts due to the interruption of a constant rich blood supply. Without this critical supply of nourishing blood, the bone tissue of your hip joints is dying and eventually, your hip joints will collapse. The articular surfaces of your hip joints are being destroyed by the avascular necrosis and the pain will only increase in intensity.
“Your left hip is in the worse condition, but at this time it is not necessarily demanding a total hip replacement. We must monitor the rate of necrosis of the ball on the femur bone as well as the receptacle socket in your hip joint.”
It was a monitoring period of only one year.
Terrified, Carlos underwent total replacement of his left hip. After three days in the hospital, he began an eighteen-day intensive physical rehabilitation program. When sitting on the edge of his hospital bed, a kindly attendant suggested to Carlos that his right leg appeared to be longer than the now surgically corrected left leg.
“Not to worry, Carlos. I will correct the slight difference in the leg lengths when I do your total right hip replacement next year. I will be able to even up the differences in length and you will never notice it.”
All that was five years ago. Carlos was now forced to wear elevated heel orthopedic shoes to compensate for the 3.18 centimeter or inch and a quarter difference in leg lengths. He was also forced to sleep flat on his back and endure the torturous awakenings each night from a deep sleep and find that he was resting on either his right or left side. The excruciating pain awakened him constantly throughout the night.
Unfortunately, both hip replacements were performed knowingly using metal on metal prosthesis and now cobalt and chromium was bleaching from the metal into Carlos’ body.
Lidocaine patches, cortisone injections, injected pain-killer drugs, needle aspirations, biopsies, and an unlimited assortment of pain-killer drugs continued to rule Carlos’ every moment of his life. The bursa sacs that once contained the viscous lubricating fluid for his natural hip joints were now compromised.
There was nothing that anyone could do for Carlos to ease his pain and give him a meaningful life without constant pain. Some suggested that he undergo replacement of the two metal on metal prosthesis with improved metal, plastic, and ceramic structuring, thereby ending the cobalt/chromium poisoning of his body.
Extensive blood testing of the cobalt/chromium issue indicated that if the replacement surgery was not performed, his hematologist suggested monthly dialysis, a many hour procedure, to remove at least part of the contaminates from his blood.
There was no guarantee that replacement surgery would alleviate the pain or not increase the present levels to a point of not being able to walk at all.
That last “good news” Carlos was to receive in his lifetime was why the total loss of coordination in his right knee, while walking, was causing him to fall sometimes violently and with great damage to his body, even while using a walker.
An imaging technic known as computer tomography revealed osteoporosis of the knee joint and the need for total joint replacement or at least a “hit or miss” surgery using arthroscopy to remove the offending meniscus.
Carlos’ family was well informed and opinionated as to what he should do. Now at 82 years of age, he was seeking answers to how to best enjoy the remainder of his now trouble medical life.
Still settled into the comfort of his bathtub, Carlos lit yet another More cigarette.
Above the hot and cold-water taps of the tub, a red box cutter knife lay waiting along with a half-empty bottle of pills and an open bottle of vodka. Carlos had decided to end it all. He was going to kill himself.
In his mind he would first have a good soak in the tub, a few comforting cigarettes while sipping his premium vodka – something he had never bought before – take all of the pills, and then cut his wrists.
It was very simple in his mind.
By a previous count during one of his remorseful times of planning his death, Carlos had confirmed a total of 22 oxycodone pain killer pills were waiting to be consumed along with generous swigs of his good vodka.
He hated the pills, but was often forced to take the “two pills every six hours – as needed for pain” due to days of more constant hip pain.
“If I’m woozy the next day after just taking two oxycodone, I wonder what I would feel if I took the whole bottle at one time. Enough not to not feel the pain of cutting my wrist I hope.”
