The Wedding

Andrew turned 39 without a convincing prospect of getting married. He was busy establishing his tax practice and confined his dating opportunities to the J-date app. His future bride, Marissa, was also using J-date to find a suitable spouse. She was seeking a suitable life partner, but was frustrated in her search. No one fit her justifiably high standards. She had even hired a traditional Jewish matchmaker, a shadchan in Hebrew, to help with her search. Days after placing her deposit to the shadchan, she met Andrew on J-date and they fell madly in love. They had each found their soul mate. It all happened so fast that the first my wife Susie and I heard about it was after they announced the date of their wedding, October 7th of that year. The wedding was to be in Idyllwild, California. Idyllwild, true to its name, is an idyllic small town in the San Jacinto wilderness and is a beautiful venue for a wedding. Andrew had previously attended a music camp there and was familiar with its rustic charm.

But according to the State of California, Andrew and Marissa did not get married on October 7th. In fact, they got married about six months earlier in what they affectionately called an antelopement, with brother Eric performing the ceremony. They did not cancel the October 7th date and began to make arrangements that would include family and friends, and have a clergyman officiate the ceremony.

When we finally met Marissa, Susie and I quickly agreed that Andrew and Marissa were perfect partners. They share traits of kindness, commitment, and warmth, along with a keen sense of poetry. After meeting Marissa’s family, we were further reassured that this marriage was divine. Marissa’s parents had divorced many years before and each had remarried. Marissa had two lovely sisters in addition to the extended parentage. And each was a lovely, caring person.

Susie and I were looking forward to the wedding rehearsal on the evening of October 6th, and the wedding, which would take place the next day at the Harvey House in Idyllwild. Susan’s ninety seven year old mother, who was living with us at the time, was the only living grandparent and her presence was a vital part of the wedding ceremony.

The three of us set out around 2 PM with plenty of time to reach Harvey House for the rehearsal dinner. The typical time to reach Idyllwild from our house is about three hours, but this would be during the rush hour of a Friday afternoon and so we calculated that we would arrive no later than 6 PM, leaving us with plenty of time to unpack before the rehearsal. After lunch, the three of us set out and entered the destination of Harvey House in Susie’s Google Maps app. The app predicted an arrival time of 5:30, which seemed about right. As usual, Susie drove and I navigated.

As we started to drive I noticed that the app was directing us north instead of east, but I explained that to myself as Google’s way of directing us around the anticipated congestion of downtown traffic.

We passed Palmdale and continued east as per the app’s instruction. The road was free of congestion and we went through desert marked with many medium height mountains, common in the south Sierra range. Aside from the lack of road traffic, this would look just like a trip to Idyllwild should look using an alternate route. Nonetheless, I began to get very nervous as the clock inched closer to Google App’s predicted time of arrival. We weren’t climbing into the 10,000 foot mountains as we would if we were approaching Idyllwild. Finally, the app said we were at Harvey House. I looked around and instantly knew that something was seriously amiss. There was a small sign that pointed to Harvey House off nearby, but this couldn’t be the wedding destination because we were in the desert with no massive mountains in sight. I kept entering Harvey House in Susie’s cell phone, but it kept saying we had arrived. I told Susie she had to pull over so I could make some calls, but she insisted that pulling over on the shoulder of the road is illegal. I insisted she was wrong and that without pulling over we would never figure out why we weren’t at the rehearsal Harvey House. Actually, Susie was correct about the illegality of just parking on the shoulder, but I did persuade her to pull over anyway and I called Andrew. Everyone was anticipating our arrival, but he had no explanation for our botched trip.

Finally, I entered Harvey House in my cellphone’s Google Maps app, and immediately realized why we hadn’t arrived at the wedding location.

The explanation starts with the difficulty Susie has reading small print. She long ago had increased the font size of printed text on her phone. Normally, when you enter a location into Google Maps, the app gives you three possible destinations. For instance, if you enter Costco as a destination, the app will list the three closest Costcos and you can then make your final choice. Susie’s phone gave only one destination for Harvey House—if there were a second Harvey House, her phone wouldn’t show it, and therein lay the explanation for our errancy. The app had, indeed, directed us to a Harvey House, but not to the Harvey House that was hosting the rehearsal dinner. There was a second Harvey House in Southern California that was about three hours distant from our house. What is even more bizarre is that the Harvey House where we were now parked is roughly a three hour drive from our intended destination. In other words, our home and the two Harvey Houses lie at the vertices of an equilateral triangle. The chances of that happening are infinitely small! But despite the remarkable coincidence, off we went to the Harvey House in Idyllwild. Complicating matters, Susie’s mom, whom I adore as much as I adore Susie, has a problem with urinary frequency. She needed a rest stop about every hour and, late on a Friday in the desert, rest rooms are sparse. Fortunately, we found an open gas station and a market on the way. At the market, I noted that the only newspaper for sale was the Echo Times, a sure sign that we were deep into MAGA country.

We finally reached the base of the mountain where Idyllwild’s Harvey House is located, arriving from the east instead of the west. We chugged up the mountain just as the sun set. The drive up was longer than I had expected and we finally arrived at Harvey House well after sunset.We walked into the rehearsal room, exhausted, apologetic, and very hungry. Everybody welcomed us, and commiserated with our long odyssey.

After the three of us picked over what remained of the buffet, I asked where the groom was, and was directed to an adjacent room. Andrew was standing with his brother Eric and his wife, Jenn. I did a double take of Andrew, because he was now sporting a handsome mustache, which I hadn’t seen him wear in years. I was also surprised he grew this mustache just before his wedding and I emphatically warned him that the mustache would be in all his wedding pictures, such that if he decided to shave it off later, he might regret growing one just before the wedding.

I was quite familiar with this belated remorse because I, too, had a mustache during my courting and marriage to Susie, and after shaving it off a few months later, was later constantly reminded of my folly, notably by my kids. At the time, Californian males were more hirsute than other Americans, simply because we were in a more “hip” part of the country. Hippies flocked to California for its louche morals and its counterculture vibe. When I returned to my postgraduate medical studies, I decided to shed the “in” look and get rid of the mustache in the interest of looking more professional.

The three others burst into laughter and only then did I realize that I had been had. Andrew had grown the mustache for the express purpose of needling me, since he had often heard my misgivings about the mustache. I had totally fallen for it. He then said he was planning to shave it off before the wedding. I howled along with the other three. I was laughing so hard it was painful.

The next morning, the wedding party ate breakfast at the hotel and we had a chance to shmooze with our machatunim (the Yiddish word for in-laws). We then went back to our room to prepare for the wedding late in the afternoon. The women had made appointments with hair and makeup stylists. About two hours before the wedding ceremony, we would all get together again for pictures. There would be every possible combination of family imaginable—the bride, the groom, the brothers, the sisters, the groom with the bride, the brothers with the groom, the sisters with the bride, all of them together, sometimes with the parents, sometimes without. And, of course, all pictures on our side of the family were taken with and without grandma. The picture taking was an exercise in advanced combinatorics, the branch of mathematics that deals with the seemingly endless combinations and arrangements of various objects.

Guests were now arriving. Most drove in from the city and planned to return home late at night. Marissa—drawing on her expertise solving New York Times crossword puzzles— created a challenging word game and a crossword for the guests’ entertainment.

We settled in for the wedding ceremony. The setting was ethereal—a perfect autumn late afternoon in the woods—and the cantor performed this second wedding with humor and optimism. And then came the highlight of the evening. Andrew and Marissa each gave a speech honoring their partner. The speeches were profound and sincere expressions of their love for each other. We watched and listened in awe as the words swirled around the newlyweds. We were all enchanted. After the ceremony ended, we broke to join the food lines. After that came the six father-of -the-groom, father-of-the-bride, and sibling speeches.

Eric and I (and Andrew, to be sure) are experienced speakers. Although Eric takes after his mom and Andrew more resembles me, we three men all share a healthy sense of humor (if I may humbly be permitted to say), and it gives me great pride and comfort that at least some of my genetic material dribbled into my sons’ DNA. I have also reproduced my speech in the addendum to this chapter. Andrew lent me one of my favorite pictures of him, an arty picture taken by a friend in high school, showing him bare-chested with an owl on his shoulder. His arms are folded in a look of defiance. I enlarged the photo so I could show it to the assembled two hundred guests and thought of ways to incorporate the image into my speech. I suggested to the audience that perhaps the owl sitting on Andrew’s shoulder might resemble a parrot sitting on a pirate’s shoulder, or even that the owl was like Athena, the Greek god of wisdom, but I finally decided that that the owl was more like a Hindu atman that harbors the soul of its future self to come alive as reincarnation. That way, the owl could be Marissa waiting to be reincarnated as the real thing. I started to talk about the atman, but stopped suddenly and asked the audience if there was anyone who knew what an atman is, and only one hand shot up. Although the band, Marissa and Andrew, and I were in spotlights, the guests were seated in the night darkness and no one could identify the individual at that point. I asked, “Sir or madam, could you come up here and tell everyone what an atman is?” and moments later, a young boy started dancing up to the microphone. “Why it’s Dash, my seven year old grandson!” Need I say this was prearranged, and Dash, who even at age seven had a fearless stage presence, gave the correct answer. Everyone cheered. Dash also surmised correctly that the atman represented Marissa, Andrew’s intended, about twenty five years before he actually met her. Everyone cheered again as Dash danced back to his seat.

But Eric and I weren’t the only speechifiers who gave talks with humor. Marissa’s side of the family had a couple of ringers as well. Laughter filled the forest.

We started the dancing with the traditional Jewish dance, the hora. Through all this, I had been seated with a VIP guest from New York, one of Andrew’s clients. He had come to honor Andrew, and he sat there, incredulous that the speeches weren’t the product of a single hired comedian. He kept saying, “I’ve never seen anything like this wedding before, and I’ve been to lots of Irish weddings”. On behalf of the other speakers, along with Marissa and Andrew, I took that as a sincere compliment.

I then joined the dancing in the knowledge that both my sons were now happily married, and I would soon have another grandchild. I danced and hopped and hopped and danced. When the music stopped we all went our separate ways and returned to our rooms or cars knowing we had been part of the perfect wedding, except…

Thousands of miles away, a small army of Hamas terrorists and jihadist had just invaded Israel from Gaza, slaughtering twelve hundred Israelis and taking over two hundred hostages in an outrageously barbaric act of war. These terrorists certainly should have anticipated that Israel would inflict harsh retaliatory measures. No one, though, could guess that their actions would cause so much suffering to all Palestinians and to the families of the slain Israelis and hostages.

All this was unknown to the guests and members of the wedding party because the news came shortly after the wedding had begun. No one was glued to their cellphone as this tragedy unfolded, and most of us first learned of it when we later returned to our rooms and turned on the TV.

I for one was very tired. I had danced until I could no longer stand, and Susie and I had been up since early morning. She hit the pillow, but I stayed up to read. But the words weren’t making sense to me. I had to read and reread sentences and still I couldn’t keep even a phrase in my head. I finally gave up and went to sleep, thinking it was simply a result of fatigue and excitement.

I awakened the following morning with more deficits. I could barely speak a coherent sentence without stuttering and inability to complete a thought. I immediately suspected I had experienced a stroke, and that the neurological deficits would be permanent. I imagined what life would be like if that were true. I also tried to hide my symptoms from Susie. At first I was successful, but at breakfast she realized that something was seriously wrong. We quietly checked out of the hotel and drove home. Susie’s mom suspected nothing.

The next morning I awakened convinced that my symptoms were not as bad as the previous evening. And as part of my symptom complex I also convinced myself that my powers of reasoning had become more acute. If true, I reasoned that my stroke was not permanent and that, given enough time, my symptoms would disappear without a trace.

That thinking was nonsense given the severe disability I was experiencing, yet I chose not to call my internist to let him know of my condition. Over the next couple days, I documented my progress in great detail, thinking that my symptom complex was so unusual I could write a paper about myself.

Later I realized I had fallen into a trap first describes by William Osler, who said, “A physician who treats himself has a fool for a patient.” That was certainly true of me at the time, and the thought that I could write a paper was a variation of Osler’s saying. My symptoms were simply not getting better. That night, my adrenaline was pumping, and I couldn’t get to sleep. I still couldn’t read, but I knew exactly what I could and should accomplish in the wee hours of the night. My closet was full of clothes I would never wear again because I had lost thirty five pounds some time in the past. I often could not get to the clothes that fit me. I had wanted to clear out my closet long before that night, but I now decided at 1 AM to bestow upon Goodwill Industries all my size large, now unneeded wardrobe. I proceeded to drain my closets and drawers of long unworn suits, pants and shirts and pile them all on the chairs and stools in our bedroom. I worked through the entire night. Susie slept soundly through all this.

The next morning she was horrified when she awakened and wasted no time in calling everyone she knew to report that I had gone majorly berserk. I, in turn, was proud of my achievement. The closets were now far less crowded and I could actually see the remaining hanging clothes. Susie surreptitiously returned some of my discarded clothes back to the closet, but for the most part, she went along with my decisions and the excessive clothing eventually went to charity.

That day, I finally called my internist, Hector Rodriguez and he firmly told me to get my ass into the emergency room, and stop off to see a vascular surgeon on the way. He thought Ryan Haqq would be an excellent choice. I didn’t know Ryan because he started at Cedars after I retired, and, fortunately, Ryan squeezed me into his schedule. He agreed I needed an MRI of my brain, including visualization of my arteries, and sent me off to the emergency room. I observed my symptoms were as bad as ever, and I was convinced that life as I knew it was over, no matter what Dr. Haqq did or did not do.

I am sure that in the long course of medical history, many physicians experience symptoms that they encounter in their speciaty. I predicted a possible need for an operation (carotid endarterectomy) that I personally had done hundreds of times in the past. I knew that the operation posed several significant risks, including worsening of my symptoms and even paralysis of one side of my body. Even so, my symptoms were not those that a carotid narrowing would typically cause. My symptoms resembled the kind of stroke that occurs secondary either to a clot that breaks off from the carotid artery and floats deep into the brain’s circulation thus choking off the circulation of a part of the brain (an embolus), or an artery within the brain that spontaneously closes due to disease in its wall (a thrombosis).

I was whisked off for my MRI. I was told the next day that as I returned to my ER room, I experienced a grand mal seizure, which is a loss of consciousness, typically for half a minute or so accompanied by violent contraction of many muscles. I have no recollection of this event. It scared the hell out of Susie, but I was curiously indifferent to her anxiety.

The MRI showed that my right carotid artery was severely calcified and almost completely shut. This came as a surprise to me, since I had been having regular carotid ultrasound tests for several years, and I often did my own carotid ultrasound test. This series of tests, the most recent of which was only one year prior, showed that the artery was narrowing slowly, but had remained stable shy of 50% for a few years. That extent of narrowing is not an indication of severe disease, much less a need for surgical intervention. There was negligible calcification and narrowing in the left carotid artery.

How could my artery go from less than 50% narrowing to almost complete occlusion in a year’s time. The only explanation could be that there was a sudden hemorrhage between the slow buildup of plaque in my artery and the artery wall itself. This is common in the spectrum of artery narrowings. Such an event, in which an artery is partially diseased and suddenly closes off completely, is common in disease of the coronary arteries, and when it occurs, can lead to sudden death. I could practically pinpoint the moment my symptoms began—the night of the wedding after I had been dancing so vigorously. I conjectured that the jumping up and down had induced a carotid plaque to disrupt and practically close my carotid artery shut.

At this point I should say these finding were not a complete surprise to me. In fact, I had seen this movie unfold many years before. Allow me to explain.

My mother, Sally Gordon, had been a pack a day smoker for many years. She stopped only a few months before she was diagnosed with lung cancer. I insisted she come to California for the surgery she needed, not only because I knew an excellent lung surgeon, but also because she could recuperate at our home. The surgery was uneventful, but my mother was a difficult house-guest and my wife swore she would never take care of her in our home again, on threat of, well—divorce. Those were strong words, but I totally understood, since my mother was always demanding of our time and her needs. That was her usual demeanor, but now grossly exaggerated. Her recovery from major surgery was otherwise unremarkable.

A few years later, I received a call from her that a routine ultrasound test of her carotid arteries showed 80% blockages on both carotid arteries, almost surely a consequence of many years of smoking. She wasn’t experiencing symptoms, as I was, but the belief at the time was that cleaning these arteries would prevent a future stroke. We now are less sure about that, and today, many physicians would treat narrowed but asymptomatic carotid artery disease with blood thinners and more frequent testing. I assured my mother that the operation was relatively simple, taking only about an hour, and that she would return to full activities in short order. She responded, “If the operation is so simple, I’ll find a doctor here in Chicago to do it.” I really couldn’t object, because I actually agreed with that decision. I called Jimmy Yao, a colleague I knew at Northwestern University and asked if he could see my mother. Jimmy was an internationally renowned, experienced hands-on vascular surgeon and I knew she would get the best care possible.

I flew in for the operation and had return tickets for two days later. On the day of surgery, I kissed my mom and said I would be seeing her soon. Away she rolled on the gurney and I went to wait in the waiting room. At Northwestern, after each surgery was completed, the routine was to call the family into a private room to discuss the conduct of the operation and the results. I waited patiently for my turn. One, two, three hours later I still wasn’t called and I began to panic. Finally, it was my turn. Dr. Yao did not have the smiling grin I was hoping to see. “Your mom did not make it easy for me”, said Jimmy. “She’s fine now, but just before she entered the operating room, she turned to me and said in an insistent voice that I had to give her a cosmetic incision.” I immediately knew that my mom had, in essence, unwittingly directed Dr. Yao to make a transverse (side-to-side) incision instead of a vertical (up-and-down) incision to expose the carotid artery. Transverse incisions heal with less scarring than vertical incision.

A vertical incision is the customary way to do this procedure, if only because it follows the course of the artery from the chest, into the neck, and then on toward the brain. If the surgeon needs more operating room to access the carotid artery higher or lower, he can then easily extend the incision up or down as needed. To make a transverse incision is to assume that the pathology you need to correct is in the middle of the neck, as it is almost 100% of the time. Unfortunately, my mom was an outlier—a big time outlier. The takeoff of her internal carotid artery at its bifurcation, along with the pathology, was located very low in her neck, just above the collarbone.

Poor Dr. Yao, had to struggle to gain routine control of the arteries above and below where he needed to work. He reassured me that the operation was otherwise uneventful and that she was awake in the recovery room. I told Dr. Yao that her insistence on a cosmetic incision was almost predictable, and knowing my mom’s domineering personality, I readily forgave Dr. Yao for giving in to her.

But as luck would have it, that evening in the intensive care unit, my mother’s blood pressure became difficult to control, and she started to bleed into her neck. This resulted in a large hematoma (a collection of blood outside a blood vessel). Although she was awake without any signs of a stroke, I knew she might need another operation if the bleeding wasn’t controlled. The treatment for this complication is to give an intravenous medication to control the hypertension. The chief resident started an infusion of nitroglycerine, which works better for veins than arteries. Nitroglycerine is often given under the tongue to control chest pain due to narrowing the heart arteries, but is not the best medication to lower blood pressure for the purpose of stopping acute bleeding from arteries (which I assumed this was).

I was in a difficult position. I realized I was not “on my turf”, meaning that I felt I had no authority to countermand the chief resident.
I equivocated whether I should call Dr. Yao directly, but in the end, I felt that would be unprofessional and could sour my relationship with him. Although I knew I should advocate for my mom, I essentially froze. Fortunately, the bleeding seemed to be slowing and the blood pressure was high but not life-threatening.

When she was discharged from the hospital, she had a huge hematoma on the right side of her neck, and I was obliged to care for her for the next two and a half weeks. Mom made a full recovery, and repeatedly touted her wise decision to demand an invisible neck scar, despite the anxiety others had for her survival in the immediate postoperative period.

Fast forward to me about thirty years later. In the course of the many carotid ultrasounds that I underwent, I discovered that I had the same anomaly (abnormality) as my mom. My right carotid artery also branched very low near my collarbone. I could only speculate how that information was passed on to me in the DNA I inherited from her. I had long ago envisioned I might eventually need an operation on that side, and I constantly played that operation over and over in my mind. I was determined to enlighten any surgeon who ventured to put steel on my neck.

In the movie remake, I was now the lead actor and Dr. Haqq was the lead supporting actor. I proudly told Dr. Haqq that the bifurcation was low in my neck and I thought he would be grateful for that information. He responded by saying that he always does an ultrasound of the arteries before he starts surgery and he would have discovered that anyway.

I couldn’t resist telling Dr. Haqq how to do the rest of the operation, and he essentially responded with “F**k off, I’ll do it my own way.” I had all kinds of suggestions, but in the end, he indeed did it his way, with the exception of a neat trick I suggested about how to place a tourniquet around the artery when it’s deep down in the neck. He did a beautiful job, and he graciously acknowledged my trick. We both went away happy.

When I awakened, my family and I were pleasantly surprised that I was completely normal. Still irascible, to be sure, but with no neurological symptoms whatsoever. I was completely baffled as to why. The only one who predicted this course of events with great assurance was my internist, Hector Rodriguez. Neither Dr. Haqq nor my neurologist could be certain to what extent I would improve after surgery, if any at all.

Throughout this strange, unexpected journey, Marissa and Andrew were blissfully honeymooning in Japan. Everyone agreed that there was no point in spoiling their vacation while events unfolded on this side of the Pacific. When they returned home, they were grateful I was up and running again as if nothing had happened.

¹ Fred Harvey built eighty four Harvey houses across American to provide superior accommodations for train travelers. Most have come down, but there are two lodgings, both at the south rim of the Grand Canyon, that that were once active Harvey Houses— the El Tovar Lodge and Bright Angel Lodgings. The Harvey House near Barstow California, where we were now parked, had been converted to a Route 66 museum and was often used for social events, like weddings. The Harvey House in Idyllwild was named for a different Harvey, and from its start served only as a hotel and venue for weddings and such.

² I owe the reader a bit of explanation. The carotid artery really refers to three arteries. On each side of the neck, the common carotid artery brings blood straight up from near the heart to the middle of the neck. Roughly halfway from the collar bone to the bottom of the skull, the common carotid artery divides into two branches. The larger internal carotid delivers most of the blood the to brain and the smaller external artery supplies the muscles and tissues in the face and skull itself. The point where the artery divides is important because almost all of the narrowing in the carotid arteries occurs where the common carotid artery divides into two branches. When vascular surgeons make an up and down cut in the neck, they are confident they will find that dividing point smack in the middle of the neck, give or take a half inch or so, and so it is—most of the time.