Aloha — Sharing the Breath of God

George, a fifty-eight-year-old native Hawaiian pig farmer, suffered a devastating heart attack. He had been in the intensive care unit at the hospital now for three days. His condition was serious and not getting better. He lay in a strange, uncomfortable hospital bed from which he would never again rise — the so-called deathbed. George's life had changed so quickly and unexpectedly over three days from surprise to disbelief to denial and now fear. He wondered what would happen next in this nightmare.

I was part of the team of doctors, nurses, and technicians that had done everything that modern medicine could do to restore and prolong George's life. Unfortunately, it was not enough. George's heart muscle was severely damaged from the heart attack and was now terminally weak. George sat uncomfortably upright in his bed, severely short of breath. He was wearing a special oxygen mask to try to push extra oxygen down into his lungs and into his circulation. The heart attack had caused fluid to build up in his lungs and make breathing difficult. He felt like he was drowning. His agony was getting worse each day. He was exhausted and wanted to sleep but feared it would be his last sleep. His fear was appropriate. He had copious amounts on sweat on his forehead and strained wrinkles on his face. The primary diagnosis on the front page of his medical chart was acute myocardial infarction with severe congestive heart failure and shock.

We treated his congestive heart failure aggressively with multiple intravenous medications. These included medications to maintain his blood pressure and keep his heart rhythm regular, and diuretics to reduce the fluid in his lungs. However, this could only give him minimal temporary relief from his agony. The damage done to his heart from the heart attack was irreversible and severe. Certainly, his medical situation was complex but not dissimilar to many patients I had seen with these similar massive heart attacks, many of whom had died in front of me. Yet there is always hope, because still many patients do survive such devastating problems.

As George's heart became weaker, the blood flow to his internal organs became suboptimal. As the kidneys weakened from lack of oxygen, toxins accumulated in his blood. This clouded his thinking. Lack of blood flow also caused his liver to malfunction. This further increased the fluids in his lungs to the point where he could not lie flat because that made his breathing problem worse. As George sat up in the hospital bed, he used every muscle in his chest to struggle for each breath of air. He was very restless. His fatigue grew worse each day. His eyes were bloodshot from all his bodily stress. Because of his severe dyspnea (shortness of breath), his conversations with me became condensed to simple words and expressions of discomfort. Even with a special oxygen mask over his mouth and nose, he continued to struggle for each breath. Every cell in his body screamed for more oxygen. But the only way to get the oxygen into his body was through the lungs, and his lungs were saturated with fluid.

George grew more and more tired with each breath. Each single breath was so difficult yet so precious. Each breath separated his life from death. With his struggle to breathe, he realized how much he still wanted to live. He loved his life and wanted it to go on forever. This is a natural desire since we know nothing different or what the future holds. For George, like most of us, this was the most fearful moment of his life.

In a short, quiet moment between treatments, George remembered how easily he'd breathed a few days earlier before the heart attack and how he'd taken that for granted. He had had only mild breathing problems when he had to do some heavy work on his farm. That seemed like a lifetime ago after three days of stress and misery. His sole wish now was only to breathe with ease in the presence of those he loved.

George had been a regular patient of mine for many years. During those ten years, he also became a good friend. George was a large, muscular Hawaiian man with dark brown skin. He had short, curly dark hair with just a little bit of distinguishing gray. He had large, compassionate brown eyes. His hands seemed enormous to me, yet in spite of his hard work, they remained incredibly soft. He had a deep, resonant voice and a genuine, kind smile. He was truly a gentle giant.

George's wife's name was Rosie. She was half-Chinese and half-Filipino and half the size of George. She was physically much the opposite George. She was small and had delicate facial features. Although she was small, she had enormous strength of character. They complemented each other. This made George and Rosie a good couple.

George and Rosie had met each other as teenagers and had been married for thirty-eight loving years. They were very devoted to each other. With their combined talents, they worked very hard on their pig farm on the west side of Oahu. They made only minor profits. Each day was a financial struggle, but it did not matter to them because they had each other. They had spent every day of their married life together and happy. That was what was important to them.

George and Rosie were grateful to have a lovely daughter, Kai, short for Kailani. They had wanted children for many years but were told by the doctors that they could not. Fortunately, doctors are often wrong. After many childless years of marriage, much to their surprise, they were blessed with a baby girl. Her name, Kailani, means "gift from heaven" in Hawaiian.

I had known Kai since she was born. I was at Kai's first birthday party. In Hawaii, this is often a big celebration for the family and is called a baby luau. All the extended family and friends are invited. Everyone, whether family or not, becomes an unofficial auntie or uncle. Because Hawaiians often do not have too much money, the celebration is held outside around the garage. Everyone brings enormous amounts of food, and local musicians play Hawaiian music outside all day with their guitars. In Hawaii, the custom is to eat until you sleep. This was one of my first baby luaus. I did eat a lot delicious local fish, poi, rice, and coconut pudding, and I did sleep well that night with Hawaiian music still resonating in my head.

Kai was a beautiful young girl. She had long black hair, big brown eyes like her father, soft brown skin, and a big smile and delicate feminine features like her mother. She always looked like a princess. She frequently came to the hospital with her father when he had checkups with me. She liked talking to my nurses, who always entertained her while I was examining her father. She was a real chatterbox.

At the time of her father's heart attack, the little Kai was now eighteen years old. How quickly she had transitioned from playful child into a lovely young woman. Kai was now married and eight months pregnant. It seemed like just a second (or a breath) ago I was at her baby luau.

Both Rosie and Kai...