A New Port Richey man undergoes brain surgery as his wife wonders: Will he remember her when it is over?
Nurses wheel Jim Rinker down the hall to the operating room. There, doctors will scrape away the tumor that has gnawed at Jim's brain for more than a year.
The fight with the HMO is over. Jim will have the surgery he and his wife, Audrey, have waited for since March.
Jim and Audrey know that when Jim wakes up from surgery _ if he wakes up from surgery _ he could be a different person. He could lose his memory. He could lose his speech.
The nurses pause just before pushing Jim through the double doors where the surgical team waits. Audrey leans over and brushes his cheek with her lips. She whispers to him how much she loves him. He's always upbeat, but Jim's resolve now cracks.
His last words to his wife before his surgery are hoarse, clogged with emotion: "I hope I don't forget how much I love you."
Audrey remembers the day she first met Jim _ almost 20 years ago in a small Louisiana town.
"He was such a gentleman. He was like my knight who rode up in shining armor," Audrey recalled last week after the surgery.
One of Jim's co-workers had urged him to get a haircut from the local hairdresser, who doubled as the local matchmaker. Audrey, recently divorced, had been getting her hair cut there for years. The hairdresser assured Jim she knew just the woman for him.
Both were skeptical.
Audrey said she and Jim waited about a month before they went on their first date. A year and a half later, Jim moved to Florida.
The morning before his surgery, Jim recalled their time apart: "Separations will either make or break you."
This one made them. Jim went back to Louisiana roughly a year later, where he wed Audrey in the side yard of her father's house. He took her with him back to Pasco County.
In the weeks before his surgery, Jim, 55, described his love for his wife: "She's still my sweetheart after all these years. . . . I think her voice is the prettiest thing I've ever heard."
Audrey, 52, says the couple's friends often remark on how close and devoted the two are: "I think some of them are envious." When walking together, they hold hands. When seated together to talk, they often touch.
"He overwhelms me with his kindness and affection," Audrey said.
Both had been married before _ Audrey once and Jim twice. Jim's first marriage, at age 24, lasted several years. His second marriage, at age 33, lasted several months.
By the time Jim married Audrey he was nearing 40, and Audrey said they both knew this time was for real. They set up shop in Pasco, with Jim, an engineer, building up the business they owned: Pasco Blueprint & Supply Co. Eventually Audrey joined in, bringing the skills she'd picked up as a bank manager. The Rinkers recently sold the business to focus on Jim's health.
Audrey said she knew Jim was her knight the day he rescued her off the roof of their business, where she'd climbed to watch him patch a leak. Once up on roof, Audrey suddenly remembered why she'd never been up there before: She was terrified of heights.
"I couldn't even get to the ladder," Audrey said. Jim gently led her to the ladder and stood on the top rung. Encircling her in his arms, Jim guided Audrey down, one step at a time.
Since his tumor was diagnosed in March, it is Audrey who has guided Jim: She's kept his thoughts away from the doubts and fears that vied for his attention. She has steered him away from people who wanted to focus on the darker possibilities that could face Jim after surgery, after doctors removed nearly half his brain.
Doctors discovered Jim's tumor three years after a 1996 car accident that apparently triggered a series of seizures. Doctors originally thought Jim's head injury caused the seizures, but now they think the tumor had been there all along and that the accident merely hastened the onset of the seizures that would have shown up eventually.
Jim and Audrey said they began having problems with their HMO, SunStar Health Plan, after doctors discovered the tumor. The diagnostic tests Jim needed _ the ones that showed the tumor most likely is malignant _ are offered at only a couple of hospitals in the state. None of those were part of the SunStar network, and SunStar refused to pay for the tests Jim needed, he has said.
SunStar has since been sued by the state Department of Insurance for not having enough money to pay claims.
Ultimately, the couple had to call on state Rep. Mike Fasano, R-New Port Richey, and the Agency for Health Care Administration for help. SunStar officials have said they never intended to delay Jim's treatment. They added that the seven months between when Jim discovered the tumor and when the state ordered SunStar to pay for his treatment were fraught with misunderstandings and miscommunications on both sides.
But that answer didn't satisfy Fasano, who wondered last month whether something sinister was at play.
"The question that comes to mind is whether the insurer is delaying on purpose with the ultimate, sick goal of allowing the individual to die."
The nurses have just taken Jim into the operating room at the H. Lee Moffitt Cancer Center & Research Institute. Outside those double doors, with Jim out of sight, Audrey breaks down. For Jim's sake, she has stayed upbeat. Now, she falls into her daughter's arms and sobs.
A few minutes later, Audrey dries her tears. She links her arm into her daughter's and together they slowly walk to the second floor lobby, where they will wait out Jim's surgery. It's just past 1 p.m.
Audrey tries to read a book about angels but is distracted by the phones and commotion. She pulls out a journal and scribbles a few words. She shows a reporter the memory book she has made for Jim in case he can't recall his family: It's a small photo album filled with pictures of her, her daughters, grandchildren, nieces and nephews and friends that were taken at Christmas.
Although Audrey and Jim have allowed a reporter and photographer from the Times to follow them throughout Jim's ordeal, she asks for a moment alone and slips into the fifth-floor chapel. Audrey emerges a few minutes later, her eyes once again wet with tears. She heads back to the waiting room.
At 4 p.m. a hospital representative tells Audrey it will be about another 45 minutes _ which means the surgery is progressing much faster than expected.
An hour later, Dr. Fernando Vale emerges, traces of powder from the surgical mask still dusting his face.
"We're done. Everything went as planned," Vale tells Audrey.
"He shouldn't have any speech problems. I'm more concerned with the memory than the speech," Vale said.
Audrey is ecstatic. "I feel so much better. I can't wait to see him."
Two hours pass. At last, Audrey is in the intensive care unit with Jim. His face is ashen, almost gray. The pain is unbearable; he reaches out his arm to touch his temple. Audrey kisses his forearm. She tells him she's there and that she loves him.
Then she hears him say the four words he has said to her every day since they married:
"I love you, babe."
A week after the surgery, Jim and Audrey still are waiting for the lab results that will tell them without a doubt whether the tumor is malignant. If it is, Jim will have to undergo radiation therapy or possibly chemotherapy. Several fingers of the tumor still remain in his head; removing that portion of Jim's brain would affect his motor skills. But the Rinkers say they are thrilled that the surgery has exceeded their doctors' predictions.
"For some strange reason I never thought it would be as bad as the doctors thought it would be," Jim said.
Answered Audrey: "I think God just answered the millions of prayers he'd been receiving."