Author Archives: Gray Rinehart

Estimating Our Coronavirus Risk

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I am not an epidemiologist, nor am I a medical person. I am, however, experienced with risk assessment and analyzing risks from my days as the Deputy Director of Safety and Health, and the Systems Safety Program Manager, at the Air Force Astronautics (nee Rocket Propulsion) Laboratory at Edwards AFB, California.

In the field of rocketry, dealing with toxic propellants of various kinds as well as massive amounts of flammable and explosive materials, risk assessment is serious business. We strove to understand the risks associated with our operations and to mitigate them as much as possible.

In the years since I left the Rocket Lab — I will always think of it as the Rocket Lab, “the Rock,” no matter how many times they change the name — I’ve had ample opportunities to analyze risk in other contexts. Today, let’s consider the SARS-CoV-2 virus, frequently called the “coronavirus” even though it’s really one of many such viruses.

Risk, in general, may be thought of as a combination of the potential for a bad thing happening and how bad the results are expected to be. In rocketry, we characterized it as probability times severity. For instance, an event that would damage an expensive piece of equipment would generally be considered less severe than an event that would injure a person, but the overall risk to the project might be similar if the first, damaging event was much more likely to happen compared to the second, injurious event. In each case, we analyzed the risks in order to figure out where we might apply physical and procedural measures to reduce it.

The risk presented by the SARS-CoV-2 virus is a little different because the severity of the COVID-19 disease is a given. Still, it seems to me we can conceptualize the risk in useful ways by assessing the probability of developing the disease and even that of catching the virus.

First, using reports that mortality associated with COVID-19 seems to be related to patients’ ages and whether they suffered from ill health, I took a stab at a matrix showing the risk of dying from COVID-19. Assuming one has actually been infected with the SARS-CoV-2 virus, it seems reasonable to say the risk of dying from COVID-19 rises with age and the number of complicating factors, as shown:


(Estimated risk of dying from COVID-19, having contracted the SARS-CoV-2 virus.)

Thus, as the doctors and epidemiologists have said, the older we are and the more health problems we have, the higher our risk and the more diligent we should be in protecting ourselves. Makes sense to me.

But what’s the risk of actually contracting the SARS-CoV-2 virus?

That’s a more complicated issue. Certainly one must be exposed to the virus, but every exposure does not result in infection. And every exposure is not the same.

For instance, the emphasis on Proximity Avoidance (my preferred term for “social distancing”) neglects how long we are in close proximity to one another. I have seen people step off the sidewalk into a thoroughfare in order to avoid spending a second or two within the recommended six-foot distance, because they apparently believe that the briefest encounter will result in infection. I’ve also read complaints about the practice of holding doors open, for the same reason.

Realistically, however, the risk is not just a function of distance but also of time. Spending a few seconds passing someone on the sidewalk is not as risky as standing shoulder-to-shoulder with them for several minutes. So if we assume someone near us is carrying SARS-CoV-2 and neither of us is wearing a mask, the risk of contracting the virus from them based on both distance and time probably looks something like this:


(Estimated risk of contracting the SARS-CoV-2 virus from encountering a single carrier.)

Other factors could come into play, of course. Passing in a tight hallway is likely a bit more risky than passing on a greenway. And if at least one of us is wearing a decent (i.e., fluid resistant) mask, most of those blocks marked “high” probably fall to “moderate” risk levels.

As we move away from one-on-one encounters to the possibility of encountering groups of people, the risk picture becomes more complicated and harder to illustrate in a simple matrix format. Both time and distance remain factors in how risky it is to be around people, and if we add to them the numbers of people and whether they are masked, we need to simplify things a bit in order to account for so many factors. The assumptions remain:

  • The closer we are to a carrier, the higher the probability of transmission
  • The longer we spend in the vicinity of a carrier, the higher the probability of transmission
  • The more people nearby, the higher the probability that one is a carrier
  • Masks that catch droplets reduce the risk but do not eliminate it

We can combine time and distance by dividing the duration by the amount of separation. Thus, the longer we spend in close proximity with someone, the higher the value. As shown in the matrix above, spending a full minute six feet away from someone is probably about the same risk as spending ten seconds only one foot away from them.

We can also combine the group size and masks (or “barriers”) factors. In this case, we can divide the number of carriers (or presumed carriers) we encounter by how many are wearing masks — and whether we are wearing one. So if we are masked and encounter a single person wearing a mask, the “carrier/barrier” factor would be one presumed carrier divided by two barriers: 1/2, or 0.5. Likewise, if we encounter four presumed carriers at once and only one of them (plus us) are masked, the factor would be 4/2, or 2.0. The higher the value, the higher the probability of exposure.

Putting those factors together gives a risk estimation that looks something like this:


(Expanded estimation of risk of contracting the SARS-CoV-2 virus.)

Folks may quibble about the values I chose for each axis, or whether a particular intersection should be rated differently (e.g., as “moderate” instead of “low”), but the real question after all of this is, how much risk are you willing to accept?

And the question after that is, should you force anyone else to accept a higher or lower risk than they are willing to accept?

In my last blog post, “Home of the Scared,” I noted that the fears associated with the SARS-CoV-2 virus are not new. “Fear was already rampant in our risk-averse society, albeit at something of a maintenance level, in terms of how tentative many people have become in their day-to-day lives. But people with vested interests applied the scary virus as if it were gasoline to more general fears that have smoldered for years.” It’s been all too easy to inflame those fears, because neither the media nor the recognized experts have presented this in risk management terms. Rather, many commentators and observers have emphasized the dangers of COVID-19 — i.e., its severity — rather than the probability of contracting it, to the point that “… a moderate danger like SARS-CoV-2 has brought some people to the point of near panic.”

Now, even though it’s been shown that moderate risk-taking results in greater satisfaction with life, neither fearlessness nor recklessness are especial virtues. Fear in itself is not a bad thing, nor is it a negative trait: It’s a natural reaction to extant threats. But while the inability to sense a threat is a deficit, and refusing to acknowledge a threat is foolish, it’s better to consider threats realistically and to take reasonable steps to reduce their risk — all the while accepting the simple fact that life without risk is impossible.

___
P.S. Don’t forget to order your Proximity Avoidance T-Shirt….

(Proximity Avoidance logo, designed by Christopher Rinehart.)

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Home of the Scared

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If I had a magic wand, I would make you less afraid. Not foolhardy, just less apprehensive of the world and the people around you.

I grew up learning that fear was a thing to be conquered, not a thing to which we should capitulate. FDR, for all his faults, famously said, “The only thing we have to fear, is fear itself.” Frank Herbert gave us the “Litany Against Fear” in his novel, Dune: “Fear is the mind-killer…. I will face my fear.” Yet, somehow, instead of learning courage in the face of fear, many people today seem to have become paralyzed by fear.

Some claim to be tolerant of others but demonstrate fear of opposing ideas when they shout down anyone who disagrees with them. Some claim to “speak truth to power,” but cower in “safe spaces.” And now, many not only hide away in fear of the SARS-CoV-2 virus but they demand that others sequester themselves as well. Fear has led some of us to become subjects of the state moreso than citizens of it: subject to the state, happy to trade our freedom for a little security … or the illusion of security.

Leaving off for the moment the unfortunate fact that some people regard the entire song as problematic, have we reached the point where these United States need to replace the last line of “The Star-Spangled Banner”?

In some respects, we reached that point a long time ago.

fear
(Image: “fear,” by Sean MacEntee, on Flickr under Creative Commons.)

This diatribe against fear, for instance, has been percolating in my brain for over a decade as I observed us, as a society, growing more and more fearful.

A dozen years ago, I read a book review entitled “Mill is a dead white male with something to say” in which Tessa Mayes interviewed Richard Reeves, a biographer of philosopher John Stuart Mill. The review began,

‘Harm’ is a political buzzword of our age. The spectre of harm is used to justify smoking bans in public places (to protect people from the harm of smoke), ‘anti-stalking’ measures against people who get involved in shouting matches with their partner or a workmate (in the name of protecting individuals from ‘emotional harm’), censorship (offensive words are said to ‘harm’ our self-esteem) and opposition to consumerism (apparently it ‘harms’ the environment).

All sorts of activities, from boozing to gambling to sexual relationships, are now said to involve harm – either to the person carrying them out or to people caught up in these whirlwinds of harmful behaviour. And thus, it is argued, government intervention into these intimate areas of our lives is not only justifiable, it is necessary.

To that list, we may now add such things as trading in non-state-approved items, traveling to non-state-approved places, congregating with non-state-approved people, and so forth.

The review pointed out that Mill

had a view of men as capable and energetic, who, when given the chance, could progress to become serious and even ‘heroic’ individuals. Thus, he had a quite narrow view of harm: in his view, it would take quite a lot to harm individuals who were possessed of free will and very often grit, and therefore he argued that only clear cases of harm could justify restrictions.

Today, by contrast, individuals are viewed as weak and vulnerable. The term ‘the vulnerable’ is used to refer to whole swathes of society. We are considered to be easily damaged and fragile creatures who must be mollycoddled by political leaders, social workers and health practitioners in order to keep our self-esteem intact. So almost everything is seen as ‘harmful’ to us today.

And how much more so when faced with something like SARS-CoV-2 that is demonstrably harmful? Something that mathematics predicted would harm millions, most especially “the vulnerable”?

It was not deemed sufficient to erect barriers to protect the “easily damaged and fragile” among us — the elderly, the infirm — when it seemed that medical facilities would be overrun with patients. Instead, political leaders and especially the media turned to a suasion tool that has proven far too useful: fear. Not that the fears associated with the SARS-CoV-2 virus were especially new. Fear was already rampant in our risk-averse society, albeit at something of a maintenance level, in terms of how tentative many people have become in their day-to-day lives. But people with vested interests applied the scary virus as if it were gasoline to more general fears that have smoldered for years. Carefully constructed and almost constantly negative reporting about the virus magnified those fears into quiet terror.

And people who are frequently (if not constantly) afraid are not likely to object to limitations on their liberties.

The difference between Mill’s view of harm and the popular view of harm today is the difference between a view of mankind as generally good and capable of freedom, and a view of mankind as weak and degraded. So where Mill emphasised the necessity of liberty, today many officials and commentators talk about the ‘dangers of unadulterated liberty’.

For Mill, any half-decent conception of the state had to be considered in line with individual liberty and social progress. As he writes in On Liberty: ‘A State which dwarfs its men, in order that they may be more docile instruments in its hands even for beneficial purposes, will find that with small men no great thing can really be accomplished.’

But why are we so afraid?

I submit that many of us are afraid because we abandoned faith. By abandoning faith, we abandoned hope in an afterlife, and by abandoning hope in an afterlife, we have come to fear death itself as the ultimate evil. Not to have a healthy respect for death, not to disdain it and to seek to postpone it because life itself is grand and glorious, but to fear it above all things.**

In his book The War of Art, Steven Pressfield noted that the Spartan King, Leonidas, said the highest virtue of a warrior was “contempt for death.” To count death as nothing, as unworthy of notice even though it is inevitable. Why is that important? Because if you don’t fear death, you won’t fear much of anything; in contrast, if you fear death too much, you will fear practically everything.

You may not admit it. But every fear stems from the fear of death. Believing in an afterlife is the surest way to overcome that fear, and such belief was the root of the fearlessness of mankind throughout history. But when more and more people began to disbelieve in an afterlife, once they came to fear death and to dread the very idea of it, they naturally began to shy away from anything too risky.

And those who deeply fear death do not understand those with contempt for it.

Not everyone can muster true contempt for death, can master that ultimate fear, but that ability in the face of predatory threats made relationships and status and roles much clearer in the past. We lack that kind of tangible threat these days. The SARS-CoV-2 virus, as dangerous as it is, does not pose such a threat — if for no other reason than that we cannot sense it directly.

When predators lurked outside, when their eyes shone in the dark beyond the firelight, when the dawn revealed the blood and mutilated corpses of the unwary, the weak and fearful naturally appreciated the strong and brave. We have been so long without a real existential threat that the weak have become less fearful, and the strong seem to have become less necessary. Some of the strong and good still protect the tribe, and we ought to be thankful for them. But we seem to have reached the point that the weak have grown comfortable enough that they feel justified in mocking the strong. That, I suppose, they may consider enlightenment.

Many years ago a popular brand of clothing featured the words “No fear.” That sentiment is lacking these days. Not only does almost everyone seem to be afraid, but many of us express our fears quite openly and surround ourselves (virtually) with those who share or at least bolster our fears. In some respects we appear to be a generation steeped in fear — and whereas our society used to wrestle with tangible fears like those of nuclear annihilation, we have given free rein to so many ephemeral fears that now a moderate danger like SARS-CoV-2 has brought some people to the point of near panic.***

Previous generations cultivated what the British called the “stiff upper lip,” but today we might well be a culture of quivering lips. Perhaps rather than the age of information, what we live in is the age of angst. Enemies need not bother terrorizing us anymore. We are already afraid. Not all of us, necessarily, but enough of us.

And, as I said at the start, if I had a magic wand to wave, I would use it to decrease our collective fear so we might once again lay claim to being the “land of the free, and the home of the brave.”

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*It is probably prudent to note that some people have been laying claim to rights without any emphasis on assuming the responsibilities that go with those rights. But, that’s a topic for another post.
**I recognize some degree of irony in my talking so blithely about death and having contempt for it, while still subject to deep and sometimes soul-wrenching grief.
***In a future post, I hope to look at the SARS-CoV-2 virus through the lens of risk management, in hopes of showing that there is less need for panic than some people think.

___
P.S. While on the subject of the virus, don’t forget to order your Proximity Avoidance T-Shirt….

(Proximity Avoidance logo, designed by Christopher Rinehart.)

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It’s Not Social Distancing, it’s Proximity Avoidance!

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Odds are that if you can read this blog post — and you obviously can! — you’ve been able to stay social to some degree even while physically separated from those you know and love. Whether it’s been through “Zoom” meetings or “FaceTime” sessions or (as I’ve done) talking on the phone while watching the same show on Netflix or YouTube, you’ve found some ways to stay connected — because it’s not really “social distancing” when it’s possible to be social from a distance!

What it is, and how you protect yourself and others from the SARS-CoV-2 virus, is Proximity Avoidance.

Now you can show your support for everyone keeping their distance, or remind others to avoid your proximity, with one of these 100% cotton, preshrunk T-shirts with a nifty graphic designed by my son, Christopher Rinehart. Not only that, but 10% of the purchase price goes to COVID-19 relief efforts!


(Proximity Avoidance T-shirts, available from CSS Embroidery & Print of Charleston, SC.)

Here’s a closeup of the logo:


(Proximity Avoidance logo, designed by Christopher Rinehart.)

Order yours today!

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Unprepared for Regret, Part V: Six Months Gone

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As the title suggests, six months ago today my wife of thirty-four-plus years, Jill Rinehart, died. Last month I wrote about the day she died, but for this semi-anniversary my thoughts have been more … general.

Thinking back, at first after Jill died so suddenly and unexpectedly, I didn’t imagine that I would be able to last six days. That week was a whirlwind of making arrangements for her memorial service and such, and sometimes I thought the grief would destroy me. Sometimes, I wanted it to.

Every night that week, as I remember, I thought perhaps that I would not wake up the next morning. For more than a month, there were many nights that I didn’t want to wake up. Once while walking the dog I even rewrote the old nursery rhyme, which Jill would have hated (because she hated the original version):

Now I lay me down to sleep,
I pray thee, Lord, to hear me weep
And let me die before I wake,
And my unworthy soul to take.

What amazes me right now, though, after first being uncertain of making it six days and then of making it six weeks, is that at this six-month point I don’t wish for my own demise anymore. (At least, I haven’t in the past few days.)

It’s fair to say that I was unprepared to wish so fervently for my own death during this season of grief. I suppose many people who have experienced a soul-rending loss can relate to the deep desire to fall asleep and never wake up, since waking up means having to go through another day without the person who was most important in your life.

Thankfully, friend after friend who had gone through the same kind of loss reached out to me, and offered me comfort and guidance but also a quantity of hope. In those early days I listened without fully understanding, and I’m still not quite sure I do understand, but I definitely appreciate what they said. I’m incredibly grateful to them and to God that I have now a fair amount of hope.

There are times when that measure of hope is incredibly small: a mustard seed of hope, like the mustard seed of faith that Jesus talked about. The mustard seed of faith is supposed to be enough for us to command mountains to move (not, I should note, for us to move mountains ourselves). Likewise, the mustard seed of hope seems to be enough for us — or has been enough for me — to make it from one day (and sometimes one moment) to the next, and the next, and the next.


(Jill Rinehart at Brookgreen Gardens, SC. Taken on this date in 2015.)

That’s how I made it to today: half a year gone by without seeing my beautiful bride’s smile except in pictures, without hearing her voice except in videos, without feeling her close except in my fading memory. Our lives were so intertwined that I believe she carried a bit of my spirit with her when she left. That wound has only begun to heal. But I think I carry a bit of her spirit with me, too, if I’ll just take the time to pay attention to it.

It’s fair to say that Jill, my beloved Jillian, is nearly ever present in my mind. I think of her most every time I see a flower or the sky, talk to our children or brush her puppy, drive her car or walk by the open door to the bedroom that was her art studio. I think of her so often that I sometimes hold my tongue when speaking with people, so as not to deluge them with my memories and thoughts of her. I avoid certain television shows because I watched them with her, and I watch others because she enjoyed them. Many’s the time I’ve sat alone on our couch, wishing that I could reach out and hold her hand, or have her recline while I rubbed lotion on her feet. When I stand at the top of the stairs, I hope to see her if I look over the railing. In the kitchen, I hope to find her getting a cup of coffee or fixing herself a snack, and I wish I could interrupt her routine just to give her a hug. I walk the dog — her dog, the puppy she insisted on getting only two months before she died — and along the way I ask Jill questions and point out things to her, or ask the puppy to help me remember to tell her when I get home. But she isn’t home anymore.

And yet it seems to be getting easier to maneuver my way through the hours and days.

I realized it was getting easier when the Moon was very full the other night. Full Moons were special to us, because we had so often enjoyed walking on the beach together under them. And every full Moon since Jill died I had cried thinking of her, because my memories battled my regret over not taking her to walk under the last full Moon we saw. I had counted on there being more time, on there being more nights of full Moons. But I counted wrong, because her time came to an end before we thought it would — and before it should have.

Yet this past full Moon was the first that did not dislodge an avalanche of regrets, and the feeling (or the lack of feeling) scared me a little. Under that Moon, I found I could begin to be thankful for all the ones we enjoyed together rather than regretful for the last one we missed. The notion hit me so suddenly, as I looked at the Moon without weeping, that it felt both good and wrong at the same time — but as I thought more about it, I began to accept that it was okay to feel good. That was a small breakthrough for me.

In a similar way, I’ve begun to be less regretful and more thankful. I’m still quite critical of myself and all too aware of my many, many failures, but I am not dwelling on them as much as I used to. I think I realize, or perhaps I admit (but have not wanted to accept) that each of those failures unfortunately represented the best I could do at the time. I suppose I will always believe that Jill deserved better.

That seems very much in keeping with the “unprepared for regret” theme of this series, as do these two observations:

  • I was unprepared for how much it would hurt to change things (e.g., in the house). I shifted some things around in the living room, but the result was that I could better see some pictures of her, so that was fine. But I can’t bring myself to change many other things: to move her purse, or her shoes from in front of the door, and so forth. I didn’t imagine it would be so hard.
  • I was also unprepared for how nonlinear the grief journey is. I had expected my grief to spike early on and then fall along a somewhat smooth curve, but it hasn’t done so. I’ve had a number of spikes, some nearly as high as the first, and been trapped on a couple of plateaus, but at the moment the grief is more of a persistent ache than an acute pain. It’s always there, but it doesn’t seem to be flaring up as often.

On my best days, the burden of grief is easy enough to bear. It feels lighter than it used to, and I feel happier. On my worst days, though, it’s a crushing load, and I’m nearly consumed with feeling lost, broken, and empty — but even on my worst days I hold on to one vital thing: love.

God, how I adored Jill. I was utterly in love with her, deeply happy with her nearly all the time — and even those infrequent, short-lived times I let myself get aggravated or exasperated with her had little effect on how much I loved her. I loved being associated with her, encouraging her, and pampering her. I could always count on her for several good, strong hugs every day we were together; we frequently held hands on afternoon or evening walks; and we usually snuggled together a little every night (even if it was just for a few moments before we went to sleep). I valued her more highly than anything. And what I regret most is not telling her or showing her more often — and more effectively — just how much love I had for her.

I think, in the end, what I would most like to be said about me is that I loved well. I’m not sure how best to characterize it — if I figure it out, maybe I’ll wrap the idea into a song — but I remember the story of Jesus weeping at the grave of Lazarus and how someone commented about how much he must have loved his friend. Likewise, if I accomplish nothing else in my life, I would wish people to say of me, Look how much he loved her.

So where do I go from here?

Forward. Onward. I don’t know quite how, and sometimes I don’t want to, but as difficult and devastating and heartbreaking as this is and has been, I have to find a path to follow, a direction to go. And while I hate stepping out — hate diverging from the path Jill and I were on together — for every step I take on this continuing journey, I’m very thankful for those who are willing to travel alongside me.

___

Previously in the series:
– Unprepared for Regret
– Unprepared for Regret, Part II: Valentine’s Day
– Unprepared for Regret, Part III: Jill’s Last Day
– Unprepared for Regret, Part IV: The Day Jill Died

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Unprepared for Regret, Part IV: The Day Jill Died

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According to author Christina Rasmussen, “Healing only lives in celebrating the lives of the ones we have lost, not how they died.” That may be true, but this recollection is no celebration….

Five months ago today, my wife of thirty-four years, Jill Rinehart, died. A month ago, I wrote about her last day, which ended this way:

I climbed in bed after I brushed my teeth, and — as I did every night — snuggled up with her a little bit while she fast-forwarded through a [television] commercial. She told me that the medicine she’d gotten, which she’d applied around her nostrils as instructed, made her breath feel “hot.” It bothered her, but it was supposed to be important so she was enduring it.

When the show was over, she said she was a little bit hungry and wanted a snack. But the puppy was asleep on the floor on her side of the bed, so instead of getting out that way she rolled over top of me. She lay on top of me for a second, and we smiled at each other, gave each other a hug and a kiss, and said goodnight. She got out on my side and turned off the light as she left.

That was the last time I saw her alive.

The medicine Jill had applied to her nose was some sort of antibacterial treatment that she was supposed to use until her surgery (coming up in five days). As I understood, it was supposed to reduce the risk of her getting sick prior to the surgery and to reduce the risk of infection. Why it made her breath feel hot, I don’t know.

It was not unusual for me to fall asleep before her. It was unusual for her to still be up before I went to sleep. It turned out that in addition to getting a snack, she also cleaned up the sculpture project she was going to teach the next day, and put the examples she had made in her studio with her art bag, ready to go. Then she came back to bed, but I was already hooked up to my CPAP machine and sleeping soundly.

I woke up to her sniffling and snorting — or so it seemed; I remember only one big snort — as if she had bad postnasal drip. The clock showed that it was midnight. She settled back down, and I thought about the medicine and guessed that it had caused her nose to run.

But almost immediately the puppy came around to my side and started trying to jump up on the bed. I told him everything would be okay and to go back to his bed. He did.

I was perhaps half-awake at that point, and expected Jill to get up (or at least sit up) to blow her nose. When she didn’t, I lay there for a moment wondering if she was okay. I actually wondered briefly if she had just died: I hate to admit that, because in that instant I didn’t immediately reach out to check on her. Why? Because she hated to be awakened in the middle of the night. (She always had trouble getting back to sleep.) So I lay there for another moment — I don’t really know how long, it might have been five seconds or ten or twenty, I have no idea — trying to discern if she was okay.

Finally, I reached out and touched her shoulder. And she did not move.


(One of my favorite pictures of Jill, taken in 1982 at North Litchfield Beach, SC, when she was oh-so-alive.)

The next few minutes blur together in my memory. I shook her, I called out her name, she still didn’t move and she didn’t respond. I knew from CPR training years ago that the most important thing to do was to activate the emergency medical system, so I picked up the phone and turned on the light — but that handset had no power so I had to run into my office and grab another one. I called 911 and put the speaker on. Then, because I know you can’t do CPR on a soft surface, I pulled her onto the floor as expeditiously as I could without hurting her. But the way our bedroom is situated, there is hardly any space between the bed and the wall, so I had to pull her farther into the room. Finally I started CPR, hardly able to speak to the operator or to see what I was doing through my own tears.

A few minutes later (again, I don’t know how long), the dispatcher told me that the responders were approaching the house and asked if the front door was unlocked. It wasn’t, of course, so I had to run downstairs to unlock it. At that point I took notice of the puppy. He must have been pacing around in the room while I was moving Jill and starting CPR, but he had never gotten in the way. Now, he ran downstairs with me and I put him in his crate. I unlocked and opened the front door and ran back upstairs to keep doing CPR.

But it didn’t work.

The next thing I remember, EMTs were in the room, shoving the end of the bed out of the way and pulling me back so they could start trying to help her. I think one of them escorted me out and led me down the stairs and asked if there was anyone I needed to call. At least, I know I ended up downstairs, sitting on the floor in my underwear by the dog’s crate, with my cell phone.

Both of our children live near us, so I called them and they came to the house as quickly as they could. By the time they got there, between the EMTs and police there were probably six or eight or more people in the house. The police were very polite and professional, as were the medical technicians. Stephanie and Christopher helped me answer questions, and at one point I had to go upstairs to show the detective the medications that Jill had on hand. Several EMTs were surrounding her at the time, and I could not see — perhaps because I didn’t want to — what they were doing to her. The young-uns and I answered questions about her upcoming surgery, and probably other things that I don’t remember.

I spent most of my time sitting on the living room floor, petting the pup through the bars of the crate. I occasionally heard the whine of the defibrillator the EMTs had brought in. I couldn’t make out what they said to one another upstairs, and maybe I wouldn’t have wanted to. I guess it was around 1:30 in the morning when they gave up because they weren’t able to get Jill’s heart to restart and keep a steady beat. Since she was scheduled for heart surgery in a few days, they made the assumption that she had died of a heart attack. The police said there was probably no need to do an autopsy, and the children and I agreed.

Next thing, we were being asked what funeral home we wanted to use — a question I never envisioned being asked. We picked the only funeral home I had ever been to in Cary, where members of our church had been taken care of, and I think the police detective actually called them. I don’t remember. But some time later, though still in the early morning, two fellows from the funeral home showed up. After a little consultation, they took her away. Because of the difficult arrangement of the stairs in our house, it was not easy for them to bring her downstairs and get her ready to go. The children moved into the kitchen, so they wouldn’t have to see, and I can’t blame them. The only saving grace is that the same faulty memory that keeps me from being able to recall really good things in vivid detail, keeps me from being able to remember much of the details of watching them take her out.

The rest of the day passed in almost as much of a blur as the early morning hours. We called family and friends, church people came over to offer what help they could, Christopher and I went to the funeral home to make the initial arrangements, and my sister drove in from Southport to stay with me. Things were complicated a little bit by the fact that the furnace stopped working that night, and I had to call to have it fixed (which the company was only able to do temporarily).

Since this post is supposed to be about the day she died, and is already quite long, I won’t go into detail about all the activities that went on before Jill’s memorial service a week later. Again, they all blend together in my mind: asking friends to play music or to read Scripture, setting up the memorial fund at the South Carolina Botanical Garden, and so forth. But I need to record one key event from that week, because it was quite possibly the hardest thing I’ve ever done.

In the middle of the week — I don’t remember now which day it was — I had to identify Jill before she was cremated.

I had to go see her in the funeral home.

I went alone, so the children would not have to remember her that way.

The hardest thing I’d ever done was to walk into that room, knowing that she was in there. I don’t remember how long I stayed — an hour, I’d guess — talking to her, holding her far-too-cold hand, kissing her beautiful face and her lovely hands. But, as it turned out, in the end walking into that room was only the second hardest thing for me. Because even though I knew that it wasn’t really her; that she was gone; that her spirit, her soul, was far away; by far the hardest thing I’ve ever done was to walk out of that room again, to leave her alone there. It still breaks my heart to think of it.

___

In terms of being unprepared for regret, my biggest regret is my hesitation: my failure to act quickly enough to be able to help her. My doctor and friends in the medical field have told me that it probably wouldn’t have made a difference, but I carry a significant amount of guilt and in a very real way I hate myself for every second that I hesitated. My greatest fear is that she might have wondered, for even a fraction of an instant, why I wasn’t helping her.

Another thing I regret is that I did not remember that Jill was an organ donor, so the technicians could take that into account. I also didn’t remember that both she and I have living wills and she didn’t wish to be resuscitated, but in that moment I could do nothing but try — even though I was too late.

I also regret now not having an autopsy performed, because according to Jill’s cardiologist she could not have had a heart attack. She had gone through an echocardiogram and had a complete workup in order to verify that she was a good candidate for the mitral valve repair surgery, and the surgeon told me that she had no coronary artery disease. Aside from the one problematic valve, her heart was completely healthy. As a result, we believe she had a seizure, brought on by the stress she was under of the upcoming surgery and recovery. (She had had a seizure four years prior when she was under some stress, so it’s at least possible.) I understand that an autopsy would not have conclusively proven a seizure, and may not have told us what happened. Some things, perhaps, we can never know.

One final note: After her first seizure — which was almost four years to the day before she died — Jill told me that as she lost consciousness she thought she was about to die. She said she thought something like, “If this is my time, and this is how I’m supposed to go, I’m okay with that.” As difficult as it was to lose her the way we did, I know that falling asleep in our bed and not waking up was a far better way to go than many other ways she might have died. I can only hope — and, oh God, how fervently I hope, I hope, I hope — that her last thought, in her last moment, was peaceful and that she was okay.

___

Previously in the series:
– Unprepared for Regret
– Unprepared for Regret, Part II: Valentine’s Day
– Unprepared for Regret, Part III: Jill’s Last Day

P.S. If you’re interested, you can read Jill’s obituary here.

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Unprepared for Regret, Part III: Jill’s Last Day

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Neither my wife nor I knew, four months ago today, that it would be the last day she would live.

By way of background, Jill was in decent physical shape — she was not ill or disabled or under long-term care for any protracted sickness — except for the effects of a leaky mitral valve in her heart. She had been diagnosed with mitral valve prolapse when she was twenty, and had been under the care of various cardiologists as we moved around as part of the Air Force. They had occasionally recommended having the valve replaced, but she had opted to monitor her condition in hopes that surgical techniques would improve over time. In fact, the latest surgical procedure would repair her valve rather than replacing it, and her cardiologist and the cardiac surgeon both agreed she was a good candidate. In the last few weeks before she died, Jill had had an echocardiogram and other tests to make sure that her heart was healthy enough to endure the surgery and recover from it. All indications were good.

On her last day — Friday, 18 October 2019 — Jill had her pre-surgery appointment. Her surgery was supposed to be on the following Wednesday (the 23rd), having been pushed back one day because of a higher priority case. Her pre-surgery workup had always been scheduled for the eighteenth.

I had gone with her to some of her prior appointments, like the echocardiogram, but she thought this one would be routine so instead I took care of our new puppy, Twix. She called me mid-morning, later sent me a text while she was waiting for her x-ray, and shortly thereafter sent, “I think I need to relax a little so I’m gonna take just a few minutes to walk at the art museum before heading home. I won’t be too long.”


(Jill’s last selfie, taken at the NC Art Museum on 18 October 2019.)

“If Anything Happens”

Jill got home about thirty minutes before we expected visitors from the church we were slated to join. She told me that she wished I had gone with her to the appointment because some of the things they said had frightened her — she might have said that they freaked her out, but I don’t remember her exact words.

Our visitors were two gentlemen who came as more or less a formality before the Elders voted to accept us officially as members. Most of the interview went unremarkably, as we explained how each of us had come to faith and the degrees to which we’d been involved in previous churches — until Jill said something that arrested my attention.

She was sitting to my right on the couch, looking at one of the visitors to her right, so I couldn’t see her face as she said, “The reason I want to do this now is so that if anything happens my obituary will say I was a member of the church. Because right now it wouldn’t say that, and that’s not me.”

I had never heard her say anything like that before. I was too stupefied to question it.

Our Last Meal Together

The visit ended, and she and I decided to go out for an early supper — not only because neither of us felt like cooking but to see how well the puppy would do in the crate for an hour or so. We ended up at an “Asian fusion” restaurant that we had frequented for years, partly because it was close to the pharmacy where she would pick up the prescription she’d been given.

During dinner, she told me a little more about her appointment: the instructions she’d gotten, the briefings she had had about what it would be like to come out of anesthesia and wake up in ICU, etc. She was very nervous about the prospect of waking up with a breathing tube in her throat, and being hooked up to so many machines, and said that all she could picture in her mind was her mom a couple of years ago when she came out of surgery.

As we talked, Jill thanked me for not questioning her about her obituary comment while the church men were in the house. She said the thought had just come to her that day. Her mood shifted from time to time, from serious when talking about the procedure or the recovery to playful when she asked me if I was eyeballing her dumplings that she was going to take home as leftovers.

After supper, we walked over to the pharmacy and picked up her prescription and a couple of other things. At one point, as we walked around one of the endcaps, she reached out and tapped a deck of cards, looked behind her at me, and said with a grin, “We’ll have to remember to take some cards to the hospital, so we can play something.”

I agreed that we would certainly do that.

Our Last Walk in the Park

We went home, got the dog out of the crate and put him in the car, and drove over to Bond Park — one of our favorite places in the Town of Cary. We discussed briefly whether we would take the pup with us to breakfast the next day (we almost always went out for breakfast together on Saturdays) or try leaving him in the crate again.

Once we got to the park, we walked a path through the woods from the Boathouse, up past one of the shelters and around to the Community Center. We passed a few pieces of exercise equipment, and at one point came upon a balancing platform: a round disk held up by a sturdy spring. I held her hand as she stepped up on it, and she balanced there for a brief moment and then hopped off, laughing. Then, just to show off, I stepped up without reaching out for her. She chided me for that, but we laughed together as I struggled to step up and then step off without hurting myself.

From the Community Center, we walked parallel to the big field by the levee and then down toward the baseball fields. We stopped at one and watched part of an inning of a youth league game, and Jill wondered when our friend’s son’s next game would be, for us to go to it.

As we walked on, twilight was fading and we entered a more woodsy area. Jill asked me to shine the flashlight from my phone on the path in front of us. I made some remark about being able to see fine and she scolded me again, with something like, “Okay, if you want to step on a snake, go ahead.” We laughed, but I did turn on the flashlight until the woods thinned out again.

The path took us to the base of the levee, and we walked up the steps until we could look at the lake. At the top, she asked if we could pause for a moment and slow down, because the steps always made her out of breath. I said of course we could, and we did — and I made some remark about how nice it would be once she had her surgery and wouldn’t get out of breath when she was walking.

We eventually made our way down the length of the levee, back to the Boathouse, and home.

Our Last Evening

There wasn’t much on television that Friday night, and Jill had an art class to teach the next day, so she went upstairs to her studio to work on example sculptures to show the children. When she was done, she took her bath and started getting ready for bed.

After I shut off everything downstairs, I went up to my office to check my email and found one from the assistant pastor saying the Elders had met and we were officially accepted as members. We would go through the formality of joining the church in the Sunday service. By then, Jill was finished with her bath and, as she did most every night, was watching a recorded episode of House Hunters International. I told her about the message, and we agreed that we would have to figure out how we were going to handle the pup Sunday morning.

I climbed in bed after I brushed my teeth, and — as I did every night — snuggled up with her a little bit while she fast-forwarded through a commercial. She told me that the medicine she’d gotten, which she’d applied around her nostrils as instructed, made her breath feel “hot.” It bothered her, but it was supposed to be important so she was enduring it.

When the show was over, she said she was a little bit hungry and wanted a snack. But the puppy was asleep on the floor on her side of the bed, so instead of getting out that way she rolled over top of me. She lay on top of me for a second, and we smiled at each other, gave each other a hug and a kiss, and said goodnight. She got out on my side and turned off the light as she left.

That was the last time I saw her alive.

___

What regrets was I unprepared for about that day? First and foremost, that I didn’t go to Jill’s pre-surgery appointment with her. Yes, it would have required us to put the pup in “doggie daycare,” but I wish I could have been there to hold her hand, to comfort her, as she listened to the doctors and nurses explaining what was in store.

Beyond that, I regret not having the presence of mind to suggest that we postpone the surgery, since she was so scared. Even if she refused the suggestion — and she probably would have, because she had been dealing with the effects of her condition for so long — I wish I had thought to make it.

But more than anything else, I regret not holding her closer and kissing her longer. We had no way of knowing, of course, that those would be our last hugs and kisses. We thought we would see each other in the morning, that we would go to breakfast, that she would teach her class, and that we would have more opportunities to talk and laugh and show each other that we cared. But we were wrong. We had probably said “I love you” two or three times that day — it was, thankfully, a common refrain in our lives — but I wish I had said it ten times as much, and hugged her tight every time.

___

P.S. If you’re interested, you can read Jill’s obituary here.

Previously in the Series:
– Unprepared for Regret
– Unprepared for Regret, Part II: Valentine’s Day

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Unprepared for Regret, Part II: Valentine’s Day

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(To read the first entry in this occasional series, see Unprepared for Regret.)

Valentine’s Day is special for many couples, but for my wife Jill and me it was particularly noteworthy because it marked the beginning of our serious relationship.

We had met in the Fall of 1979, when I was a sophomore and she was a freshman at Winyah High School in Georgetown, SC. She and her friend Evelyn were equipment managers for the football team, and I first met them when I stood at the counter to get my shoulder pads and helmet. It was the closest I’ve come to “love at first sight,” but she didn’t have quite the same reaction.

In the Spring of 1980, we ran track together. I first held her hand on one of the bus rides home from a meet, and I used to stand on the infield and “catch” her when she finished her races. I came to like her very much — truth to tell, I fell in love with her very quickly — and she liked me, too … but not too much later she told me she only wanted to be friends.


With Jill on the front steps of Winyah High School in the Spring of 1980 — before she told me she just wanted to be friends.

By the Fall of 1981, we were still friends. We had both had other relationships that hadn’t worked out, and I had seen her once over the summer and jokingly told her that if five years went by and neither of us married anyone then we should just marry each other. I think she laughed at the idea … but I don’t have much memory for the details of events in my life, so I can’t be sure. Anyway, that Fall Jill agreed to let me sponsor her for Homecoming, and to take her to a Halloween party and a football awards banquet, but we were not “dating” in any serious sense.

And then came Valentine’s Day of 1982.

We both went separately to the dance in the high school gymnasium, and late in the evening I asked her to dance a slow dance with me. I was never a very good dancer, but Jill was — I was always intimidated when dancing with her, and might not have had the courage to ask her if I hadn’t been just a little bit drunk (and, yes, I admit that I was a few months shy of the then-legal age of 18).

During that slow dance, possibly fueled by that same liquid courage, I said something along the lines of, “I know you don’t want to hear this, but I think I will always love you.”

And, to my surprise and delight, Jill said she loved me, too.

I feel certain that we kissed, and I wish I could remember it. A short time later, she had to catch a ride with her friends back to her house, and I recall being a bit unsure that she had really said she loved me. I had wanted to hear her say it for so long, I couldn’t quite believe it was real. But it was.

Ten weeks later we went to my Senior Prom together.


With Jill at my Senior Prom in May 1982.

We were married three years after that. We had some ups and downs, before and during, but our marriage lasted 34 years and change — and every Valentine’s Day was special because they marked the first time we both admitted (or, agreed) that we loved one another.

___

Postscript:

About two months after Jill died, I went home to Georgetown and walked our puppy around some of our old haunts. At one point I stood in front of the old, run-down, tawdry gym and thought about that Valentine’s dance. I wished for a clearer memory of that night — of the song we danced to, of what she wore, of the smell of her perfume, of her face in the low light — but my brain is built to remember what happened more than how it happened.

That defect in my memory — that it is “declarative” rather than “episodic” — is something I deeply regret, something I was unprepared to deal with in terms of grief, and something I dearly wish I could overcome — because I want to remember Jill more clearly, and to recall more vividly the good times we had. But I can’t … and as a result my life without her is sadder and more empty than it might otherwise be.

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Updated Grief Condition Model

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Yesterday I laid out a five-point “Grief Condition” model, but with the caveat that it could stand to be adjusted somewhat. It didn’t take long to come up with a more flexible version that allows for a wider range of emotional responses.

The first version only allowed for tears, but grief comes with more than just sadness. This version doesn’t specify any single response, so it allows for other emotions such as anger, guilt, loneliness, etc., as follows:

  • GRIEFCON 5: “Normal” life, with grief (rare emotional reactions, prompted by especially poignant reminders or memories)
  • GRIEFCON 4: “Normal” grief, with life (occasional emotional reactions, at ordinarily benign reminders)
  • GRIEFCON 3: Significant grief (unexpected emotional reactions, at even happy reminders)
  • GRIEFCON 2: Overwhelming grief (frequent emotional reactions, approaching outbursts, with little prompting)
  • GRIEFCON 1: Maximum grief (nearly constant, strong emotional outbursts, brought on by next to nothing)

And as before, beyond GRIEFCON 1 would be nuclear grief: total war with myself, deep despair, characterized by constant, crushing floods of emotion.

It’s still not a perfect model, but it may be useful. And, for the record, today I think I’m still in GRIEFCON 3.

___

Related posts:
– Grief Condition Three (GRIEFCON 3)
– Unprepared for Regret

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Grief Condition Three (GRIEFCON 3)

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The U.S. military uses the “Defense Condition” graduated scale to describe our readiness to fight a nuclear war. The DEFCON scale became an integral part of my everyday life when I was an Emergency Actions officer at U.S. Strategic Command, as part of the 55th Mobile Command and Control Squadron at Offutt AFB, Nebraska.

Yesterday, I wondered whether a “Grief Condition” — GRIEFCON — graduated scale might serve to describe the state of my grief on a day-to-day basis.

The DEFCON scale is a five-point scale as follows (from Wikipedia):

  • DEFCON 5: Normal readiness (lowest state)
  • DEFCON 4: Above normal readiness (increased intelligence & security)
  • DEFCON 3: Air Force ready to mobilize in 15 minutes (increased force readiness)
  • DEFCON 2: Armed forces ready to deploy & engage in < 6 hours (next step to nuclear war)
  • DEFCON 1: Maximum readiness (nuclear war is imminent) or immediate response (nuclear war has already started)


Our family posing with the kind of truck I drove as part of the 55 MCCS, where the DEFCON scale was a critical part of my work. (Offutt AFB, 1994)

My GRIEFCON scale would run in a similar fashion. Here’s my first cut:

  • GRIEFCON 5: “Normal” life, with grief (rare tears, prompted by especially poignant reminders or memories)
  • GRIEFCON 4: “Normal” grief, with life (unexpected tears, at ordinarily benign reminders)
  • GRIEFCON 3: Significant grief (occasional tears, at even happy reminders)
  • GRIEFCON 2: Overwhelming grief (frequent tears, with little prompting)
  • GRIEFCON 1: Maximum grief (nearly constant tears, brought on by nothing)

And at the last, beyond GRIEFCON 1, would be nuclear grief: total war with myself, characterized by constant tears with crushing sadness.

It’s not a perfect model, of course, and it could bear some adjustment — but it’s a starting point.

And, as the title says, today I’m in GRIEFCON 3. And I’m just taking it day-by-day.

___
Related post: “Unprepared for Regret”

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Unprepared for Regret

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Three months ago today, my wife, my high school sweetheart, Jill Rinehart, died suddenly and unexpectedly next to me in the bed. I tried to revive her, but neither I nor the EMS responders who came when I called 911 were able to bring her back.

We had been married thirty-four years, four months, and eighteen days. We had been together “officially” as a couple for over thirty-seven years, and had actually known each other for over 40 years.

I was not prepared to lose her on that day or in that way.

She had been concerned about surgery she was scheduled to have a few days later, and she gave me some indication that she thought something might happen during the surgery or when she was in the hospital. But she didn’t seem too concerned that Friday night. We talked about our plans to get up the next morning and go to breakfast together (as we did every Saturday), and she made all the preparations for the art class she was scheduled to teach. We even discussed the plan for church that Sunday.

Then, against all our expectations, she was gone. I was unprepared, mentally or emotionally, for her loss.

I don’t mind admitting that I was unprepared emotionally. There’s an element of surprise and shock built into all of this, because even though we vow to love and honor and cherish “’til death do us part” we don’t often think much about death parting us. Or, at least in our case, when we talked about it our reasonable assumption was that I would go first. But, even so (or maybe because of that assumption), Jill and I didn’t discuss it in enough detail to say that either one of us was prepared for it. It was always something that we assumed would be “yet to come,” something in the future, something that we had time to prepare for and plan for and deal with.

But in the midst of my unpreparedness, I was surprised by an avalanche of guilt and regret that buried me, and that I’m still digging my way out from under. I did not expect it, and it has choked me and frozen me in my grief.

For instance, I was unprepared for the guilt I would feel: guilt that I was unable to help her adequately the night she died. I may go into more detail about that in a future blog post, but for now suffice it to say that I hate myself, and probably always will, for every second that I hesitated after waking up to what I now know was her last breath.

But in addition to that guilt, that doubt, that self-recrimination — which my doctor and some emergency medical technician friends insist I need not carry — I have encountered powerful regrets for which I was equally unprepared. Unexpected and intractable regrets …

  • for times that I grew so comfortable in our marriage and our home life and our relationship that I took her for granted, and didn’t tell her or show her how deeply I loved her and how much she meant to me
  • for things I said or did that bothered her, or hurt her
  • for things I failed to do or things I didn’t say that could have made her life — or just one day or just one hour of her life — more comfortable or more bearable or happier
  • for every opportunity I missed to spend an extra hour with her, whether sitting on the couch or the front porch talking, or walking in the woods or on the beach under the moonlight
  • for things I’ve learned about that I didn’t know, that at times during our marriage she was unhappy or dissatisfied or depressed: specifically, for not having clearer vision and more wisdom to see what was wrong and know how to help; for being self-absorbed and ignorant … not uncaring or unconcerned, really, but stupidly blind to her needs


(Jill at Duke Gardens.)

 

So, yes, I was unprepared for regret in Jill’s passing. Some people have told me that confronting regrets like this is a normal part of grief, and maybe it is — the “unfinished business” of life, as one dear friend put it — but that doesn’t negate the fact that I had never considered it and was not ready to handle it.

I’m not sure I’m ready to handle it even now. But I don’t seem to have much choice in the matter.

If at this point I can offer any caution to you as you navigate in and through your own relationships, it’s this: do what you can, while you can, to let your beloved know how very much they mean to you. Let them know how sorry you are for those things you might have done (or that you meant to do but didn’t), for any ways in which you may have hurt them or neglected them. And let them know how ready you are to forgive them for anything they may have done, even unknowingly, that hurt you.

Keep the slate of your relationship as clean as possible for as long as possible. Erase any negativity from it as often as you can. And, so far as it is in your power to do so, only write on that slate affirmations and encouragement and praise and expressions of love. So that when — not if, but when, and hopefully many years in the future — death parts you, you are not burdened with so many regrets as I have been.

___
P.S. If you’re interested, you can read Jill’s obituary here.

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