It’s Been Almost a Year Since Dad Died…

I don’t think a day has gone by that I haven’t remembered that horrible last day, and yet the month leading up to that was kind of a trial run for what  Dad would deal with if he ended up in a nursing home… I’d never wish that on him.  There are a lot of nice nursing homes (I’ve worked in a few), and I have nothing against the nice ones at all… and can be a huge positive move when someone is mentally ready to make the decision.  But Dad had always been SO active.  Just six weeks before he died, he drove home from Florida in two days, ‘outrunning’ an ice storm.  He did all of the driving, though he had a friend with him for company . The second day, he drove from S. Georgia to home (near the IL/WI border) all in that second day. He never drove that far in one day when I was a kid, going to FL for Christmas vacations, when he felt OK.   He’d call me when he stopped for gas that second day, and ask me to look at the radar to see where the ‘ice line’ was… and he made it home by about 9 p.m.  He had been feeling bad, and wanted to get home to see his doctors (regular guy for the current stuff,  and oncologist  for routine follow ups after successful thyroid cancer treatment).   He felt bad.   He’d been in the hospital near Palm Beach for a couple of days, and it scared him.

The week before he died (when that wasn’t even on the radar), and after every other visitor had left, he asked me “what are you going to do with me?”   He’d been in rehab for about a week, after 3 weeks in the hospital.  I asked “What do you mean, what am I going to DO with you?”.   He asked about options if he couldn’t come home.   I had been making a lot of phone calls to various facilities that I knew were nice places with good reputations,  in the event dad couldn’t transfer with one assist (which he couldn’t at that time).  The one-person assist transfer was what would determine any real options.  I’d been getting quotes about hourly rates for Certified Nursing Assistants for 12-hour days; I would have stayed  during p.m. (and overnight hours)  after the CNA got him more or less tucked in for the night, and his friend would have taken the morning/day ‘shift’ so Dad was never alone with a stranger. We figured out how long we could swing that financially (it wasn’t that much extra to keep him in his own house vs. a private room in a nursing home, estimating the costs for medications, doctor visits, etc– but nursing homes are EXPENSIVE.  The daily rate only includes room and board- no meds, therapies, doctor visits, etc).  But it all depended on him being able to transfer with one assist.   At that time, he didn’t even know if he was actually standing up straight during therapy, and was totally unable to transfer without two people AND equipment (for safety).   It wasn’t looking good for going home, but I was willing to arrange things  if he got well enough to really have choices.  He totally understood the one-person transfer requirement,.  He knew  that was the only reason he was able to care for mom at home, as well as travel with her in those later dementia years, was because she was an easy transfer.  He understood.

Dad wasn’t a guy who would do well being subjected to other people’s schedules, the noise of call lights, having to wait to get something he asked for, confused patients wandering into his room, etc.    He would have been miserable in an institutional setting.  He would have missed his friends, church, and estate sales (though I’m sure his friends would have visited- still a huge emotional hurdle for someone who had been SO independent for so long).  This was a man who was always on the go.   Being stuck in a wheelchair, dependent for basic mobility/personal needs, and the noise would have been intolerable to him.  He was already having trouble hanging in there with the hospital “routine”.   He didn’t understand the process of what happens when a doctor writes an order for a new pain med (or anything else).  He hurt and didn’t see why it took so long for the doc to write the order, the unit clerk to send the order to the pharmacy, the pharmacy tech to fill it, the pharmacist to check it and call the doc if there were any issues – which meant the doc had to return the call, sending it back to the floor Dad was on, the nurse checking the medication, and then dealing with the thing that was like a medication vending machine, requiring scanning Dad’s arm band,  scanning the medication, and then marking that it had been given ( and being only one of 5-6 patients his nurse was keeping up with).  On a good day, that could take over an hour… standard hospital operations.  In a nursing home, a new prescription would likely arrive late at night with the routine pharmacy deliveries, though nursing homes are required per state regulations to keep initial doses of some of the more common meds to hold someone over until the deliveries came.   There are reasons things take so long, but that is of little help  to someone who just wants to feel better.

There was also the issue of  a private room – something Dad would panic about because of his uber sensitive hearing- misophonia- where ‘routine noises’ like snoring roommates, gum chewing, chattering visitors for the roommate, chatting in the room with his friends,  etc were actually way more than annoying to him .   They almost caused a panic reaction, and more than once his blood pressure went very high just because someone was chewing/snapping gum close enough that he could hear it.  He couldn’t help it.   He didn’t have any control over the reactions, which could be rather angry and cause physical symptoms.  So a private room in the hospital or any facility was “mandatory” to him.   He’d literally beg me to “promise I get a private room”  when he was in the ER, and I told him I’d do what I could, and then I’d beg the admitting doc to write the order for a private room, explaining the situation.   They were always accommodating, but hospitals and nursing homes MUST  save some private rooms open for infectious patients – or  like  in my case with the leukemia, minimizing exposure to ‘outside’ people  who may have had  a minor cold, or a sick kid at home.   Fortunately, he got private rooms- and I had to explain many times, to whoever I was talking to that it wasn’t a ‘snob’ thing, or that he was the sort to isolate… it was actually a painful situation to hear certain noises.

I think dad knew that he wasn’t ever  going to  come home.  In those quiet early evenings alone with him in the hospital or rehab hospital, he’d give me lists of some of his possessions that he wanted specific people to have.  We had  always had a very open relationship about ‘end of life’  decisions, other health topics, or whatever,  so I didn’t think it was that odd.  And  fear can be expressed in ‘final wishes’, even if someone is expected to recover.  It didn’t strike me as odd.   I just kept making notes.   I’m so glad I did.

Backtracking a bit, that first night in the hospital (March 3, 2016), he was terrified.  He asked me to look at his feet, and I said I’d be happy to, but wondered what I was looking for.  He asked if his feet looked like my mom’s did during her final 30 hours.  Hers had been mottled with the coloring I’d seen many, many times in people who were very close to death.   I told him that his feet looked fine, and were warm,  had good general color, had good capillary refill (how fast it takes for the color to return to normal, after  enough gentle pressure  to make the skin turn very pale), etc.  He was so terrified.  I made a promise to him that night that no matter what,  I’d be honest with him about what was going on, and if my nursing experience wasn’t enough to know the answer, I’d find out and tell him.    He told me that I helped ‘calm him’.  I wasn’t able to be up at the hospital as much as I wanted to (mobility issues, heat intolerance, needing the wheelchair, increasing pain the more consecutive days I went up there, etc), though we talked daily.  I talked to his nurses (which he wasn’t that thrilled about if they were in the room, as the “racket” of discussing his care/condition annoyed him- or, my favorite- “don’t bother them”… he never quite got comfortable with the idea of telling them he needed or wanted something, unless it was for pain- and Dad didn’t even own Tylenol… he had little frame of reference with pain,and generally waited too long to ask for something). I had phone calls from the social worker working on discharge planning, and other behind the scenes stuff- getting rid of the ancient food in his fridge (and replacing it as promised), getting stuff he wanted from home, and checking in to things as he requested.

One late afternoon, he told me he needed the urinal, so I got it for him and told him I’d be in the hall by the door so he could let me know when he was done.  He told me that all dignity he had was shot, and didn’t care if I stayed… but he was my DAD ❤  I wasn’t going to not give him privacy.  He had the sheet covering him, but still…  His only complaint was that I hadn’t let the leg part of the bed down… “Can you fix this so I’m not peeing uphill?”…. Yep, Dad,  I can do that.  🙂  He hated having   to  ask for any sort of assistance for basic daily needs.  I could tell that it was wearing down.    He felt helpless, and that just wasn’t  Dad.

ALL of these things help in a way for my grief process (I don’t mean that to sound selfish)… Dad would have been miserable in a nursing home IF he’d been able to survive any type of surgery.  He likely would have ended up with a colostomy, and whatever was going on with his spine wouldn’t have gotten better.  We never did know what the lesions pressing on his spinal cord were…. he’d had biopsies of all sorts of things, MRIs (that’s a whole other story), bloodwork,  ultrasounds, and whatnot.   It wasn’t for lack of trying that the cause of those spine lesions wasn’t found.   As much as I miss Dad, I know that being in “the home” would have broken his heart.  He would have put up a socially acceptable front, at least for a while.  He was such a great social person.

I knew something was changing the summer before when he was offered the chance to be on a private 160 foot yacht, going around Sicily, with his friend and her family (son-in-law was way up there in the top %1).  He loved to travel, but didn’t want to go.  First he said he thought he might get seasick.  He had been in the NAVY… not for long (knee issue), but seriously?  He’d also co-owned a sailboat, and loved sailing with his cousin in Milwaukee when he and his wife lived there.  Seasickness wasn’t going to fly with me.  I pressed him, and he said he was just too tired- he didn’t want to be a dud guest with keeping up with conversation (something dad had always been really good at).  That made more sense.  I got his OK to talk to his oncologist (same one I’d had for a while) so that on his next visit they could do any additional lab work at the same time they did the routine stuff.  Turned out that his thyroid meds needed tweeking.   But for him to turn down a trip?  That scared me.   In some ways, the early twinges of grief had already started when he was still very much alive and active.  His health was becoming an issue- which was very new.

On that last horrible day, it also helped that the ER docs were so amazing in how they tried everything they could to make sure that nothing was overlooked when he was admitted that last time.   They called four  specialists (urology, infections disease, surgeon, and gastroenterologist).  They pulled me out of the room, and were SO kind in helping me make the decision that was really already made by the disease process.  They made sure I knew what was going on, though when I saw the lab work and  heard that the infection from the ruptured diverticula  had gotten to his blood, and many other places... I knew.  I let them know I was an RN since 1985 (disabled, but keep my license active).  I understood the ‘head’ stuff.  My ‘heart’ was a mess… but Dad and I had talked about what he wanted, and I promised him I’d do whatever that was.  I did.  Signing the Do Not Resuscitate form was excruciating… but I’d promised him.

His docs during the hospital stay prior to rehab were also amazing, from his regular oncologist to the rotating hospitalists and specialists.  He got good care in the hospital .  One of the nurses went above and beyond when he found out Dad liked Heath bars… he’d seen some of the mini ones in a bowl at the nurses station, and snagged some for dad.
I’ve mentioned this before, but it’s something that goes through my head a lot (along with the initial delirium, when the mentally intact man I’d talked to less than 10 hours earlier was incapable of making decisions).  I was pulled out of the ER room so the docs could tell me what the CT showed.   Dad was resting quietly at the time (after a wild time getting the IV in so they could give him pain meds), but I went back in and told him that the docs knew what was going on but they couldn’t fix him.  HIs eyes were closed, but he nodded when I asked if we were still on board to get through this with as much comfort as possible.  He nodded when I asked if he was ready to see Mom.  And I promised I wouldn’t leave him.

Those last few hours  were (and still are)  so precious.  A couple of Dad’s very close friends, and his cousin had been up to see him.   I just watched, talked  to him a little, held his hand, kept his lips moistened, and whatnot.  Some say that being there when someone dies is’t really for the dying person;  it’s for who is left behind.   I’m not sure i agree with that completely, but it is true that I would have been devastated if I hadn’t been there for him, if he had died alone.    Whether or not he heard me didn’t matter nearly as much as  it did for me to know that he wasn’t alone.   He was showing some signs of abnormal brain activity (snout reflex when I used the swabs to clean his mouth).   The toxins were taking him.

I miss him so much, and yet I’m thankful that he didn’t end up in a nursing home.  He would have felt  so defeated.   He wanted a quick death (who doesn’t ?).  While the back pain had been around for months, the infection that killed him didn’t get to the point of  him being really sick until those last couple of  days.   He had time to give me more instructions, and spend time with close friends and family.   He didn’t “linger” which is what he wanted.   The Palliative Care team at Swede’s was fantastic.   They included me in nearly every decision.  That helped me feel like I was an active part of   dad’s final  wishes.   So yeah, I guess that being close is more for those left behind- but at the same time, you never know how much hearing remains, or what senses are ‘enough’ for the patient to know that they’re not alone.   And I had to keep my promise.

*** please pardon any typos… my eyes are ‘swimming’ as I’m ready for bed.  I’ll fix them tomorrow 😉

I Just Need To Write…

It’s been a weird few weeks in a lot of ways, and I’ve been exhausted.  Today when I woke up, I got the message from one of my cousins that her dad (my late mother’s brother) had passed away.  He’d been sick for a relatively short period of time (well, that we know of- he hadn’t been to a doctor in almost 60 years), and was diagnosed with end stage esophageal cancer.  He was getting it treated, and long story short, they found him very early this morning just before his heart stopped.

I have so many emotions going through my mind.  First, I feel for my cousins, their spouses, and assorted grandkids and great-grandkids.  Their dad had never been easy to deal with, but he was the only dad/in-law/grandfather on that side that they’d known.  It’s a loss, regardless of how close they’d been, or what he’d been like to them over the years.  There is no chance for  additional healing at this point, with him directly.  They can only fish through their own memories and pain, and figure out how to remember him over the long run.  It might be easier to deal with anger now, but there will still be some degree of the type of pain that comes from a little kid who lost their daddy- even if it comes out sideways. The only dad they knew is gone.

I feel sad for my uncle, that he created his world in the way that he did.  He and my mom were siblings.  My mom also had multiple sites of cancer, and while she beat it, the radiation to her brain left her demented for the last 10 years of her life.  She wasn’t mean or unkind (most of the time), but before her cancer, when I was a kid, she  was hard to ‘read’ – and that was very hard as a kid to figure out. I didn’t know if she liked me, and sometimes she was unkind (though I don’t think she always meant it to be that way), and it took until my 30s to figure out that it had nothing to do with me… she was wounded in some ways that I knew about, and undoubtedly in ways I had no clue about.  Their mom was orphaned at age 6, and she had her issues with attachment (that she talked to me about- not just me speculating), which didn’t help with being a mom to her four kids- though her issues were more with ‘omission’ than ‘commission’…she was afraid to lose more people, and didn’t want to get too close.  She turned 100 years old two days ago… and today she will find out that she’s outlived a second ‘child’.

It’s sad that my uncle  pushed people away by bullying them (that was when he was being kind).  And at other times, he was very generous in hosting family reunions that were no easy or inexpensive tasks.  There were a lot of us roaming, eating, and talking through a full weekend.  Sure, some of it was to show off his home (which is very nice), but he didn’t have to do it.   I ended contact with him when he lied about a conversation that was deeply hurtful, and he called me ‘human debris’, and said he was ashamed to be my uncle.  Fine.  No more relationship.  End of story; I won’t stay through that sort of thing  (and that was a drop in the bucket compared to being raised by him),  though I did e-mail him when I found out about his illness to let him know I’d be praying for him, and if he had any questions I could help with as an RN, I was available.  I’m not sure if he answered back, or someone else did, but I got a reply.   I know I can feel OK in that I reached out.  But I’m still really sad that he died.  Mostly because he left so much unfinished business with his kids and surviving siblings.  I feel so badly for them.  None of them ever did anything to warrant the way he treated them.

In general, to folks who have pushed people away by being abusive jerks, fix it before your time is up (which could be anytime, we are never guaranteed a tomorrow).  Understand that your interactions mean something, and leave lasting impressions and scars.  The world isn’t all about you, but how you either add to it, or make things worse for others.  For those who are afraid to lose someone, so you keep people at an arm’s distance, know that you also have an impact on those around you, especially if you have kids.

For those who have been hurt by someone close, especially as a kid, know that it wasn’t about you.  It was the one who caused pain who had the problem.  You may have gotten the brunt of their character defects, but it  shows that they are damaged- it would have been anyone there at the same time if it wasn’t you.  Yeah, it hurts, is maddening, and feels very personal… but for someone who is incapable of functional, healthy relationships, it’s all they can pull off in life, and that is pathetic.  I’m not saying to not feel what you feel… I’m saying it’s not about you.   I had to figure that out before I moved back to my home town to help take care of my mom.  IF I hadn’t figured that out, I’d still be living 1250 miles away (where I’d been for 17 years).  In the years I’ve been an RN (since 1985, though disabled in the last several years), I’ve seen a lot of families’ pain that really stemmed from the hurtful one not being able to give what the others needed.  There were some who were outright sociopaths, but most were situations where the damaged ones didn’t know any other ways to interact.  It was the best they could do, and/or had no clue on how they were hurting people.  Absolutely no insight about their impact on others. It was their normal.

My uncle is dead.  My cousins are having to deal with whatever ways they grieve.  My grandmother lost another child.  My surviving aunt and uncle lost a brother- another sibling.  But, I think saddest of all, the chance for reconciliation and building good memories is gone for all of them.  I’m still reeling from three very significant deaths this year in my family (on the other side), and while my relationship with this uncle was purposely estranged to not get any more of his crap, I still feel badly.  I remember him  when I was a kid, when we got together (and I’m guessing he was on his best behavior), and it was good.   His wife/my aunt (who passed away several years ago) was  a bright part of my life.  It’s hard to explain, but it’s kind of like him dying takes away more of her.

I’m rambling… just be decent to each other, and don’t let relationships erode because of ego or general apathy about how interactions can be so deeply scaring.  Reach out, and try to make things right.  Don’t be someone who others want to stay away from.  Know that at the end of the day, you didn’t do anything to hurt another person.  Especially family.  Truly be able to rest in peace whenever your time is up.

If my uncle were here, I’d say “I wish we’d had a better relationship during these last several years, but I’d never wish anything bad on you.  Nobody deserves to have a painful death, or to have to deal with cancer.  I just wish I knew what made you OK with treating people how you did.  I have a feeling I’d be more sympathetic than angry, since you and my mom came from the same family.  Regardless of anything else, you were still my uncle.” 

To my cousins, aunt, and uncle (grandma isn’t online)…. I’m SO sorry.  I’m sure his death hurts in a lot of ways.

When There’s a Death In The Family

On March 2, 2014, my fifty-five year old cousin died. She would have turned fifty-six in May.  She was only five and half years older than I am, and my closest cousin on that side of the family since we reconnected as adults.  While she lived about 80 miles away, we stayed in contact by e-mail, phone calls, and the yearly family Swedish Christmas Eve party.  I’m still sort of numb, though her death didn’t come out of the blue.  She had a particularly evil form of cancer.  But it’s hard to really accept that she’s gone. She’s the first in our generation of cousins to die, who lived past infancy or early childhood; there were some tragic deaths of infants and children in the family, including my cousin’s older brother at age seven, when she was eleven months old .   If anybody could have beaten this, it would have been her.  For a while, she seemed to be handling chemo relatively well (it’s NEVER easy).  The complications  from the cancer and chemo were another story.  My brain isn’t working that well in writing this, so I apologize ahead of time if it’s scattered.  It’s disjointed, and it’s really, really long…  (for my cousin, the textbook editor… always succinct and grammatically proper… oy).

Our grandmothers were sisters who came to the US via Ellis Island from Nordmaling, Sweden (WAY up on the northeast coastal area, Lapland, reindeer, midnight sun) in the 1920s. They came over on the ship called the ‘Drottningholm’, leaving from Göteborg, Sweden when they were in their late teens and early 20s.  There were 13 siblings in all, and most of them came here, settling in the same general area in the Midwest, in and around Chicago. Nobody spoke English before they got here. They left everything they knew to start a new life .  Eventually, many moved all over the country as their families grew, and jobs took them away from the Chicago area.  Our parents are first cousins (at 81 and 89 years old)- both still very much alive and running around.

When we were kids, that five and a half year difference in age was huge, and I was in the ‘little kids’ group of cousins when we got together for family parties.  The big  yearly family  party was the Swedish Christmas Eve  shindig , and it was THE family party to look forward to  (crazy, crazy fun party !!). There is still a smaller version, that is equally anticipated and keeps that Swedish heritage alive, which is such a treasure.  Whenever possible, family came from all over to attend that party.  I’ve blogged about that elsewhere 🙂   I adored my cousin. She was ‘cool’, and always nice to us younger kids.  I was also the recipient of some of her outgrown toys when I was a little kid, which I still remember (really nice doll buggy, and a whole set of ‘Little Kiddles’ – little 3″ tall child dolls who had their own house that doubled as a carrying case !!).  We lived in the same city for many years, which not all of the cousins did, so I’d see her more often than many of the others of that generation. It was still only a few times a year, yet it was often enough to really like her and enjoy the times I did see her ( there were two of the boy cousins closer to my age that I saw regularly throughout the time I lived at home, before moving to Texas after nursing school in late 1985).  This cousin was someone I looked up to as a kid, and was so glad to reconnect with her when I moved back to my childhood hometown in late 2002.  I moved back a few weeks before Christmas Eve, so we saw each other  for the first time in many years at the now smaller Swedish family party.  We quickly became as much friends as  we are cousins.

When this all started last June 2013 (thereabouts), she called me a few times about some troubling symptoms, and her intense feeling of being discounted by the first gastroenterologist she saw (I later suggested she send her first full colostomy bag to his office).   I’ve been an RN since 1985, and she had some questions, and wanted to know what I thought about this guy saying  she was fine except for a minor problem (for which she was given some topical medication), and did that sounded ‘right’. Though disabled, I still keep my license, and need the 29 years of knowledge and experience to deal with my own medical issues- and am always more than willing to be a sounding board or ‘medical translator’ for family and friends.  This is a cousin who called me in the past for some of her family and  own questions when medical issues came up, and I knew that she knew her own ‘normal’ very well; she needed to listen to her ‘gut, in my opinion.  She’d been in France a few  weeks earlier, and had some vague symptoms there, and they were getting worse.   I told her that if she felt that something wasn’t being addressed, she might contact her primary doctor for a referral to another specialist.  And she did.  She was able to take a scheduled ‘fun’ trip to California after the initial specialist appointment, before seeing the new specialist.  While I was glad she was able to travel at the time, I’m even more thankful now that she was able to have two great vacations before her 9 months of hell began. 

She had an appointment for additional testing, but before she got there had a severe episode of rectal bleeding while at work, and was immediately driven to the ER at a nearby hospital.  She got the preliminary diagnosis (from a tactless ER doc) that she had a rectal mass.  She had known something wasn’t right.  She was admitted for more tests, and long story short, she was diagnosed with a neuroendocrine colon cancer after surgery and the full biopsy, which surrounded her rectum about %75 the way around it (basically like a fist around the end of her colon), and needed a permanent colostomy.  Surgery  took a little over week to actually get done, and in the meantime, she was in intense, constant pain.  She had a moderately ‘normal’ recovery from the surgery, and had to get used to the colostomy, and some decent pain management.  From there, she spent some time in a rehab facility to regain her strength before going home. I remember there was more going on (I still have some brain fog post-chemo), but she was looking forward to getting on with treatment. At that time, the plan was to treat it, and her plan was to do what was needed to  recover, and keep the part of the tumor that couldn’t’ be removed in check.

Now, I get mixed up as to what happened when, but over the next 9 months (give or take a week or two), she had non-stop hospitalizations and  complications with chemo and the cancer.   They were unable to completely remove the tumor because of how it was positioned and the nearby blood vessels, so lymph nodes in that area and additional tumors (spread from the main one) in her liver began to be an issue, growing and causing pressure.  She was given  various types of chemo (including a clinical trial ‘cocktail’ of already approved meds used for a different type of cancer, that was being looked at for neuroendocrine tumors), and I really felt that if anybody would be in the ‘survivor’ percentages, it would be her.  She was in otherwise  good health, and she was young, especially for this type of cancer.  But, neuroendocrine tumors are absolute bastards in the tumor world.  When I was looking up information when she was first diagnosed, I was horrified at the statistics… but I still thought that she had a chance.  It’s never over until it’s over. (Valerie Harper was diagnosed with a brain tumor and given three months to live; that was fifteen months ago, and she has said “Don’t go to your funeral until you’re dead”, and did ‘Dancing With The Stars’.  I love that. 🙂  )  And those statistics never differentiate between ages, other health issues, or actual cause of death. If someone dies crossing the street on the way to their appointment, they are included in the deaths from whatever disease is being studied and reported.  SO, someone who is 85 years old, with multiple chronic diseases, who is hit by a bus going to the store is still included in the cancer death rate because they died during some particular study.  So statistics are iffy- they are a reference point worth considering, but not the be-all, end-all ‘rules’ of survival/death.  I was looking at the possibility that a 55 year old female in otherwise good health could be in the small percentage of survivors- why NOT her?.  I couldn’t see it any other way… but I knew it would be a hard battle.

In the months she was being actively treated, she had a kidney stent (she called me about some nagging and increasing flank pain- and she was right; something was wrong– there was pressure on her ureter from the mass of lymph nodes, cutting off the flow to the bladder from the kidney- so her kidney couldn’t empty out, causing a lot of pressure and pain), low potassium and magnesium, constant vomiting (which can be a cause AND symptom of low potassium- ‘nice’ vicious cycle there),  an infection that I’m foggy about,  multiple fractures in her sacrum, blood clots in her legs, fluid around her lungs, a LOT of pain, multiple adjustments in her medications, a port placed (for giving chemo and drawing blood to avoid multiple IV sticks), medications to deal with medications, a new kidney stent, a lump in her neck from lymph nodes-which caused arm pain from the lump pressing on nerves, and on and on. And during it all, she was mentally going on as if she was sure she would be fine in the end.

I have over 700 e-mails between the two of us from the time just before she was diagnosed until January 2014, when I noticed things were changing because of the change in communication.  She wasn’t answering e-mails or posting as much on the support site for friends and family.  That was different. Something wasn’t right.  I didn’t call her much.  I knew she needed rest (and she had friends who were visiting her, which was SO wonderful), and if she didn’t answer e-mails, she wasn’t online, or up to ‘talking’/communicating. I understood that, and we had  an  arrangement that if she wanted to call, she could- and if she were at a facility, I’d call her back on the room phone so she didn’t have to use her cellphone minutes.  If she was home, she called from her landline.  I waited to hear what was going on from the site set up for family and friends as well.

I saw her at Christmas, and she was in ‘new’ pain (I was SO glad to finally SEE her after all of the  e-mails and phone calls !).  That would turn out to be the fractures in her sacrum, which she had to have glued back together.  She had her bones glued. Back. Together.    She never got a break during the entire 9 months.  There was always something else she had to deal with and/or get treated.    I cried a lot, as I knew that each time she called with something ‘not right’, it meant that the cancer was not giving up to the chemo.  In February, it became official.  The clinical trial meds weren’t working (and those aren’t given when there are ‘known’ medications that work) so that was already a sign that things weren’t going well at all… but someone has to make it, right?  There was nothing left to do. It was a matter of time, and not that much of it.

She called me in mid-February after being discharged from another rehab facility to help her get stronger after the hospitalization for blood clots, fluid around her lungs, neck nodes,  and getting her bones glued.  She  told me the doctors had no more  options for additional treatment. I’d already been told that her prognosis wasn’t good (from dad, via uncle, then e-mailing her mom, who called me back) , but I asked her if she’d been given any time frame and she said she didn’t want to think about time limits. She also said she didn’t feel like she was dying.  I’d learned a long time ago that patients do have some feeling of when their body is not going to recover.  My answer was  “then don’t” !  (Real clinical and technical, I know…).  I didn’t say anything about the time prognosis I’d talked about with her mom.  She didn’t need me to have some sort of mental countdown going on… so I blew that off as best I could.   She said she wanted to check out some alternative healing options and knew of a Chinese medicine doctor  nearby, and I told her she had nothing to lose, and who knows?  Something might help her at least feel better.  So much of Western medicine comes from natural sources (plants, animals, etc).  Why not?  I encouraged her to do whatever she felt was right for her.  She didn’t have anything to lose, and only something to gain.   She wasn’t ever able to find alternatives… she ended up on Hospice shortly after that phone call.

That was the last conversation we had about getting well.  She called me  a few more times, and each time she sounded weaker and more tired, sometimes a little foggy.  She wanted to know about how hospice decides when to do things, and when not to, and if palliative care was better (she wanted to be at home, so that pretty much answered that).  The last time we talked was within a few days of her death, and by then she sounded almost deflated and she told me she was tired of ‘all of it’. She was still denying any feeling of  ‘actively dying’, yet also sort of saying she was ready for it to be done.  She also asked me why I was able to get well (from the leukemia I had diagnosed in late March 2010, and had 19 months of daily chemo to treat, including 50 infusions of arsenic trioxide).  It wasn’t in an angry way, or in any way ‘upset’ with me  for surviving… it was almost a childlike tone, just wanting to understand the incomprehensible. I really didn’t have an answer, except that she got a meaner cancer than I did.    I told her I had just gotten extremely lucky to have been diagnosed while there was time to treat it.  Many people with what I had are diagnosed at autopsy; I know of two people, one a child, who were gone within two days of diagnosis.  I also told her to do this next phase of her life (the last days) however she needed to do them.  I guess it was how we said good-bye.  I didn’t know how soon ‘it’ would be, until I got word from the support site posts that she was sleeping most of the time, and rarely woke up…then I read she had a brief period of awareness and drank some juice.  That is common very close to ‘the end’, and I knew any calls I got from family would be to tell me she had died.   And that’s what happened.

Cancer is a mean, nasty disease, and there are various forms of cruelty that it can throw out to torment people.  She got one of the worst I’ve ever seen in the 20+ years I was working in various areas of nursing, and with other friends and family (my mom had breast cancer, second breast with suspicious cells, lung cancer, and brain cancer and all of the treatments and surgeries with those… and then dementia from the brain radiation, and lived for another 17 years cancer free).  My cousin never got a moment’s reprieve from agonizing pain, or if the pain was doing better something else would go wrong.  It was SO unfair.  It’s never ‘fair’, but she went through more in nine months than most people go through in a lifetime.  It’s not really fair to compare people’s diseases , since whoever is going through something like cancer is feeling pretty scared, and having their own journey with their disease, but from an objective standpoint with nurse eyes, she had it really, really bad.

One thing that she was so consistent with (even before the cancer)… she always knew when something wasn’t right.  She knew when there was something brewing or just outright wrong .  She knew her body- even with all of the ‘new normals’ she had to get used to- and she got things taken care of when she knew things weren’t right.  Everyone needs to do that.  She’d call me and ask what something might mean… and if she should call her doctor then, go to the ER, or wait until office hours (depending on what was going on).  Sometimes she needed an explanation about something, and sometimes I encouraged her to call one of her doctors (we’d figure out which one to start with since she ended up with several).  Other times, I encouraged her to get checked out as soon as she could.

I will miss her so much.  I already do.  And yet I’m glad she isn’t being tormented by that nasty tumor and it’s offshoots and chaos any longer.  She went through all of this with such grace and dignity, and never gave up the idea that she was going to be OK, until the very end.  And then, she went peacefully in her sleep with her mother and housemate at her side.   I’m not going to be able to go to her Life Celebration because of my own medical issues (and the logistics of getting there with various equipment).  I’m upset that I can’t be there.  I know she’d understand, since she knew I couldn’t attend but a couple of hours of the Christmas parties, after dinner was over.  I’m just really sad.  I wish I could hear more about her from the people who are going to be there.   I’d like to be there for her mom, and her  brothers (who have had to say goodbye to two children/siblings now) and their families.  So instead, I write to clear my own head, and in some very small way, pay tribute to my cousin.  There are a lot of things I’ve thought about during this past nine months, and how my cousin made my life better just by being herself.  As adults, we had a great relationship, and I found her to be   a kind, compassionate woman, with a great sense of humor and an amazing work ethic.  She was never judgmental.  She looked for the good in everything we ever discussed.  She was loyal, and able to help me out with her own perspective on a difficult situation. She knew how to have a conversation without injecting drama.  She let me be there for her, when I often feel like I’m not useful for a whole lot anymore.  I just wish it had been for something that left her here (I’ve never had a ‘nurse call’  be for anything good 😦  ).  It’s always hard to say goodbye to someone, and someone in my generation in the family is just plain scary.   Especially someone I really cared about, not just because we’re related, but because she was a person who added so much good simply by being.

I will love you always, K.P.A.