Jane and I were not obsessed with death. If anything, we were too busy living to spend much time on the subject. But once every year we took a portion of a day to talk about life-threatening medical issues and what we wanted done if we were incapacitated for some reason in a way that left us unable to make end-of-life decisions for ourselves.
Have the conversation.
That discussion became considerably more intense in the days leading up to the surgery to replace the valves in her heart the NET cancer had destroyed. At the best of times, those conversations had been difficult. But we saw them as necessary long before we heard the word carcinoid–and they became even more necessary as her disease progressed.
We all live with death
Neither of us feared death. Nor did we see it as an immediate threat when we first began having those conversations in the months before we got married. Death, for us, was a piece of life–but a piece of life in the distant future. That didn’t mean we did not prepare for it as best we could. Neither of us wanted the other to have any questions about where the lines were, though, if it came on sooner than expected.
Jane and I were not obsessed with death.
As I wrote recently, death is one of the elephants in the room for NET cancer patients. But it is an elephant in the room for most Americans. It is a thing very few of us are comfortable discussing. It is as though we think that by not talking about it, we can avoid it.
Knowledge matters
After Jane’s surgery, she spent four weeks in a cardiac intensive care unit. On three separate occasions, I had to make decisions about her care because she was not in a position to make those decisions. Someone who is comatose can’t answer questions about her care. I was very glad we had discussed, as precisely as inexperienced people can, what it was she wanted done under those circumstances.
Neither of us feared death.
I discovered that the land at the edge of death is far more murky than either of us could have imagined. We had seen it as a place with clear black and white boundaries. We could not have conceived the number of shades of gray that inhabit that place until we had seen them. If intubation will buy the time it takes to solve the riddle of potentially life-ending falling blood pressure and respiration, is it really an “heroic measure?” And when the only thing keeping the body alive is a pacemaker, is there a point to letting it continue to circulate the blood?
Decision-making about care
Despite all the conversations we had about what to do, none of the decisions I confronted in those final 28 days was easy to make. But I cannot imagine having to make them without those conversations we had about where Jane saw lines–about how and when she wanted her life to end. I tried to honor what she wanted–which was not necessarily what I wanted.
…the land at the edge of death is far more murky…
Yet I also know that the vast majority of the patients on that floor had never had a conversation with anyone about what they wanted the end of their lives to look like. Nurses and doctors told us over and over how lucky we were to have discussed those issues–that two-thirds to three-quarters of the patients in that cardiac unit had never had a conversation with anyone about what they wanted if they were in a coma with no hope of recovery.
Knowing where the lines are
And I saw the results of those failures to communicate on this vital subject. The husbands’, wives’, sons’ and daughters’ plaintive tears and cries are etched on my brain forever. They didn’t know what to do–and there was no one who could legally–or morally–tell them.
I tried to honor what she wanted…
Jane and I drew our lines in different places than others might–than, likely, you who are reading this will. That doesn’t matter so long as you–as caregiver or medical proxy–know where the lines are for your loved one–and you are willing to carry out their wishes. The only way to know those things is to have that awkward and difficult conversation about end-of-life issues–and I’m not talking about funerals and burial plots.
The conversation matters
If you have advanced NET cancer you owe it to the people you love to have a frank discussion about when it is time to let you go. If you are the caregiver for a patient, there are things about what that person wants that you need to know before they are unconscious and unable to communicate their desires. You can only get that information by talking with them about those realities–no matter how uncomfortable that discussion makes you both.
I’m not talking about funerals and burial plots.
When Jane was in her first coma, someone told me she would awaken from it–but that at some point I would have to make a decision about letting her go based on the quality of life she would have if we continued. When Jane descended into her last coma, one of her doctors reminded me of what we had both said to all of them over the preceding weeks–that when a fighting chance became no chance, that it was time to make her comfortable and let her go.
The value of knowledge
So I did. And I let her go with a clear conscience, knowing she was going to Death on her own terms.
You can only get that information by talking…
The days since have not been easy. I miss her every day. But I know things would have been far more difficult if I had not known what she wanted.
I went to visit Jane’s grave today. To get there, I had to climb over a three-foot high drift the plow left behind when it cleared the narrow road through the cemetery. Then I trudged through the 10-12 inches of powder yesterday’s storm dropped, tramping it down so that others can get to the headstones of their loved ones more easily. I should have brought a shovel.
…that feels like moving forward.
The snow has reached Jane’s name on her family’s stone. The snow is actually deeper than that but the wind has hollowed out a space around each grave in that section of the cemetery. It looks strange. The cemetery is at the top of a hill and the wind blows through there at a pretty good clip in the winter. I put some Valentine’s Day decorations on her grave but I didn’t stay too long. It’s been colder there on other days, but on the best of winter days my body won’t stay there long. I can hear both Jane and her mother chiding me for standing out in the cold.
Changing spaces
As these monthly anniversaries go, today was not bad. Last month, I had trouble getting out of bed; every minute of the day was a struggle. I spent yesterday shampooing the rug in the dining room and hall. This morning, I moved the plants and furniture back in place and decided I still don’t have the living room set up in a way that works.
I should have brought a shovel.
Truth be told, the way Jane and I had it set up originally was just about perfect. Unfortunately, I discovered very early on that I couldn’t live with it set up that way after Jane died. In fact, I’ve redone every room in the house in terms of how the furniture is arranged–and in some cases have changed the purpose of the room as well. What was our study is now my bedroom. The room Jane used for her crafts is now a combination library and home office. The bedroom has become a TV room that doubles as a guest room and a place to keep Walking with Jane items we use for various events.
Mixing pasts, presents and futures
And I’ve been gradually repainting all the rooms in the house, changing the colors from the careful neutrals Jane and I chose when we built the house to warmer, darker tones. It’s not that I am trying to expunge her presence–I have photographs of Jane scattered throughout the house, as well as her cross-stitch and other craft projects.
…I’ve redone every room in the house…
The houseplants we both loved still dominate the living room and dining room as they always have, though I have rearranged them as they’ve grown. And though I’ve replaced the mattress in the bedroom, all the furniture we bought when we first married is still part of my bedroom–and I still sleep in our bed every night, though never on her side of the bed.
Different people, different responses
I know people whose houses have not changed in any way since their spouse died. I know others who sleep on a couch or in a chair at night because they cannot face sleeping in the bed they once shared with their husband or wife. I know others who gave away every stick of furniture they had purchased together because living with those constant reminders was more than they could handle.
…I still sleep in our bed every night…
I know people who sold their house for much the same reason–and others who were forced to sell because with a single income they could not afford to live there no matter how much they wanted to hold onto those memories. There is no magic formula to dealing with grief–no right answer. There is only the answer that works for you—-and that answer is different for every person who grieves.
Moving thoughts
There are times I think about moving. This house and its yard are too big for me to handle by myself sometimes. And it has too many stairs for me to deal with when I get old. But we spread the soil on this land, planted the grass and the shrubs and the trees. We installed the suspended ceiling in the basement and hung the sheet rock on its walls. We spent hours looking at chandeliers and light fixtures and deciding on countertops and cabinets. I am not ready to abandon those memories–and I am not sure I ever will be.
…that answer is different for every person who grieves.
But I can’t live in some kind of unchanging shrine either–a place where everything is precisely as Jane left it. I want my memories but I don’t want to be overwhelmed by them every day. For fifty months now I’ve tried to reestablish a sense of balance in all areas of my life. Part of me thinks I haven’t been very successful at that. But then I realize that Jane and I spent 23 years together, growing closer and closer every day until, at the end, we truly were Aristotle’s single soul in two bodies.
Questions of balance
And then she was gone–and everything was different. Fifty months is no time at all compared to the years we spent together as a singular entity. We made every decision together, did every chore together–lived our lives as together as two people can be. When Jane died, I suddenly did not know who I was anymore. I’m still trying to figure that out.
I am not ready to abandon those memories…
But change is the nature of life. The carpet and linoleum are beginning to show their age. I replaced the faucets in the bathroom and the kitchen over the last year. I’ve expanded the vegetable garden and enlarged a flower bed. I reworked the sitting area under our deck, digging out the sod and replacing it with stone. I’m thinking about setting up a bee hive, planting some fruit trees and creating a large bed of wild flowers.
Moving forward vs. moving on
People talk about moving on after someone dies. The truth is, often we don’t move on. The further I get from Jane’s death, the more I am convinced I will not “get over it” in the way that most people mean that phrase. But we can move forward–which is very different from “moving on” or “getting over it.” In fact, we have very little choice about moving forward. Life forces us to do that by its very nature.
Fifty months is no time at all…
Faucets do wear out. Lawns do have to be mowed. Driveways do have to be resealed. Our bodies do have to be fed and cared for. We have to cook and clean and do the routine little things that in the depth of grief we do not want to do–but that we do anyway.
Moving through the snows of grief
My muscles ache tonight. I’ve moved over four feet of snow in the last two weeks. I’ve moved every plant and piece of furniture in the living room and dining room at least twice in the last two days. I’ve run the rug machine until my arms hurt and my hands have blistered. There is more snow in the forecast for Thursday and again for Sunday.
The truth is, often we don’t move on.
But for now, the snow is shoveled and half the living room looks and feels right to me. For 50 months after Jane died, that feels like moving forward.
Jane and I loved house plants in the winter. They brightened things. Jane got into creating topiaries at one point and created a heart from an old coat hanger and an English ivy. When Jane was in the hospital, I rarely got home, but when I did I made sure everything got a good drink. When I came home after she died, we had lost just one of the plants–the topiary heart. The symbolism was not lost on me.
…I have learned, again…to let the dying go.
But in another pot there was a single tiny sprig of ivy that had survived. I took the heart frame and moved it into that pot. I have tended it carefully since then. Forty-nine months after Jane’s death that single strand has grown to cover 4/5s of that frame. It is not as dense as it was when Jane was alive–that will take a couple of circuits–but it has nearly filled the frame.
The real heart
I tell myself my heart will finally be healed, perhaps, when that frame is filled again with green life. A couple more sprigs have appeared in that pot. Eventually, they will grow long enough to join that first strand and strengthen that heart.
The symbolism was not lost on me.
Not long before Jane’s cancer came to light, I was reading a story about the Dragonriders of Pern. One of the Riders loses his dragon and the children ask why he is so sad. They are told that if a man or woman loses their dragon they lose half their heart. One of the children tasks how long it takes for the missing piece of heart to grow back. None of the adults have an answer.
The power of symbol
When Jane died, I suddenly knew what it was to have only half a heart–and I had no idea how long it would take for that piece of my heart to grow back–or if it would do so at all. That silly topiary tells me each day how to regrow my heart–and reminds me every day that it is possible. It takes patience and careful tending–but it can be done.
None of the adults have an answer.
I don’t expect ever to love again in the way that I loved Jane. But I know that, some day, my heart will be fully healed. It will not be the same as it was before. There will be scar tissue there that is never quite right. A part of me is dead and beyond recovery. But I will grow strong again and I will love again. Truth be told, I have never stopped loving–even in the worst hours of grief. I will love Jane until I die–and even then I will still love her.
Lessons of love and death
And I will love the world and every creature in it–because I always have. The pain of loss makes us forget our true nature at times–but forgetting does not mean that nature vanishes or ceases to be. When we are born, the agony of birth makes us forget where we came from. But that pain does not leave us empty of who we are, nor does it change where we came from or where we will go.
A part of me is dead and beyond recovery.
Jane’s death cost me a great deal. It has taxed me physically, mentally and emotionally to the limits of my strength–and sometimes it has seemed like beyond that. And it still hurts–hurts more than anyone who has not had a similar loss can know. But it has made me a better man than I was. It has made me more compassionate, more patient and more driven to be of help than I was before. I understand now things that I really only knew in theory before–as much as I truly believed I understood them.
The price of a new heart
We each have a road to walk and things to endure. We learn from every thing and every being we encounter–and from every experience. Jane paid a hideous price for the knowledge she gained from her illness–and I have paid a hideous price for what I learned from losing her and what I have faced every day since. I cannot dishonor her sacrifice or my own by turning my back on what I have learned–or by failing to share those things with those who need that knowledge.
Jane’s death cost me a great deal.
I have learned what it takes to love those around you when what you really want to do is hate them for the things they still have that you do not–and that you will never likely have again. I have learned what it takes to hold a broken soul in your hands and will it back to life and health. And I have learned, again, in Ursula K. Le Guin’s words, to let the dying go. Most importantly, I have learned what it is–and what it takes–to grow a new heart.
For those of you who don’t know, Stuart Scott of ESPN died this weekend of cancer. Some reports early in the day said he may have died of exactly the same form of NET cancer that Jane had. An article on Sportsgrid, which posted the earliest report of this, now says they, “have been contacted by the PMP Research Foundation, which noted that Stuart likely had appendiceal adenocarcinoma, another type of tumor that is more often treated with the kind of systemic chemotherapy Stuart underwent. This tumor often leads to pseudomyxoma peritonei, which is uniformly fatal without treatment.”
I blew it–and I am truly sorry.
If this is correct, then Scott’s cancer was even more rare than carcinoid/NETs. Most mainstream media continue only to say he had an unspecified intestinal cancer that was not colon cancer. Given their errors in the past, that may be a safer course.
An apology
I apologize for moving too quickly on that initial report. Unfortunately, I have seen the mainstream media foul up stories about high-profile NET cancer patients too many times. I too often wonder what might have been different had the true story of Walter Payton,Dave Thomas or Audrey Hepburn been told made it into the newspapers in the years before Jane’s diagnosis.
…Scott’s cancer was even more rare than carcinoid/NETs.
And much as I wish I could say the media did a better job on Steve Jobs. They didn’t. And many carcinoid/NETs patients are now suffering the consequences.
Carcinoid/NETs is fatal
None of this changes the reality for patients. Mainstream doctors and oncologists continue to tell carcinoid/NETs patients it is all in their heads. When they finally get it right–and many times they never do–they operate to remove the tumors they have found. They then declare the patient cancer free and ignore all signs to the contrary.
I apologize for moving too quickly on that initial report.
For the record: there is no cure for carcinoid/NETs unless it is caught when there is only one tumor. That only happens by accident because patients with just one tumor are rarely noticeably symptomatic. The disease is eventually fatal unless something else kills you first. People do die in fires and auto accidents. Your death from those things does not mean you didn’t have a fatal cancer–just that something else killed you first.
Complicating the quality of life issue
The quality of life for many carcinoid/NETs patients is bad enough physically. It can involve frequent abdominal pain, constant diarrhea, insomnia, painful gas and bloating, as well as flushing, and fainting caused by low blood pressure. To be called crazy or be told you are making things up by your doctor–and I’ve heard both things related by patients–is worse than unhelpful: it is often fatal.
…there is no cure for carcinoid/NETs…
Jane died of carcinoid/NETs. She died, in part, because one of her doctors told her that her disease was all in her head. She did not trust another doctor for years. She died, as one of her doctors told me, because she defeated her disease the only way anyone ever has beaten this disease: by dying and taking it with her.
NET cancer patients are not crazy
That is reality for NET cancer patients. They have a horrible form of cancer for which we have no cure and for which even our best palliative treatments are too often ineffective. At the end, it often strips away every last shred of dignity. They are not crazy. They are physically ill with a disease that is difficult to detect and that will kill them.
…quality of life for many carcinoid/NETs patients is bad enough…
I keep hoping the media will eventually call a high-profile death from this disease the death from NET cancer that it is. That is probably too much to hope for, however, in a world where most doctors can’t get it right in the first place. Lay people cannot be expected to get things right when doctors routinely don’t.
Into the future
I feel badly about getting the Stuart Scott story wrong this morning. In hindsight, I should have let things play out a bit further before I jumped into the fray. But it looked like I had everything right at the time and I just couldn’t let what happened with Steve Jobs happen again. I blew it–and I am truly sorry.
They are not crazy.
But let’s make this the year we finally put this disease in the minds of every doctor and every American. Educate yourself about the disease. Educate others about the disease. Only that can change the current deadly realities.
(Editor’s note: This is a revised version of an earlier story, updated with new information. The most common form of NETs often starts in the appendix. I will continue to update this story with regards to Scott as more information becomes available.)
Editor’s Note: I posted this a couple of places last week. I am seeing a number of people having real trouble tonight on New Year’s Eve. I won’t take the time to dress this up or paste in a lot of links. The one most people will need is for the online grief group I am part of.
Jane died 15 days before Christmas in 2010. We buried her a week before Christmas. That first Christmas was nightmarish. I spent it with my father outside Seattle. He’d lost my mother to Alzheimer’s 10 months before. It was our first Christmas for both of us without our other halves.
My father had a stroke in August. He was brain-dead before my plane took off and body dead before it landed.
This year was my fifth Christmas without Jane–and the first I spent in the house Jane and I built together. I went out to be with friends Christmas Eve and went to a Methodist church service. I knew those things were purely to get me out of the house for a few hours that night. Neither Jane nor I were particularly religious in any traditional sense.
The next day, I had my in-laws in for Christmas dinner. I surprised them with a couple of presents. They left about 3 p.m. Jane’s father was released from a rehab facility the day before. He has prostate cancer that has metastasized to his bones. He tires easily.
I watched “It’s a Wonderful Life” Christmas night and sat for a time in the glow of the Christmas tree. Jane made me promise I would always have a tree–even that first year. Gradually, I have dressed the house for Christmas more and more since then. It is hard to do, sometimes, but I do it anyway.
For many of you here, your losses are fresh. You are trying to adapt yourself to the most horrible losses imaginable–and there is no easy way to get there. Holidays can be the worst because they have so many memories and triggers built into them. But sometimes the “ordinary” days can be just as difficult.
I am not a grief counselor but I have been at this for a very long time. I’ve listened to a lot of folks who understand this state far better than I do. They have been certified as grief counselors as well as going through their own grief. And I remember well what they told me in the early days after Jane’s death.
First, it is OK to cry and feel miserable–and to feel that way for a very long time. People talk about the “Year of Firsts” as though once you’ve been through each of the events in a 12 month cycle you are magically OK–that you are back to who you were. For some folks, this is the case. But for most–especially if you had a good relationship with your loved one–it doesn’t work that way.
You are never going to be who you were before they got sick. You’ve lost a major part of the life you had and of the person you were together. “The deeper the love, the deeper the grief,” is the reality. When someone says to you that you should be over your grief by such-and-such a time, they are generally people who have not lost someone important to them in the way your spouse was important to you. They’ve read an article or a book or taken a course and think they understand. Most of the time, they really have no idea.
But while you are never going to be the same, that does not mean you will never be happy again. Right after Jane died I didn’t think I would ever smile again, let alone laugh. But the smiles did come back–as did the laughter. I am never as happy as I was when she was alive–but the grinding sorrow and depression have lifted to a great enough extent that I feel alive again. The holidays–Christmas, Halloween, her birthday and our anniversary in particular–remain especially difficult, but I no longer feel I am drowning most of the time.
You do get better at coping as the months and years pass.
You can speed that up in several ways. Not fighting with your feelings and trying to control them is the first step in that. Grief often comes in waves and all any of can really do is ride them out. Fighting your grief is like fighting the undertow: fighting it will just make things worse. Let yourself have that good cry when you need to. You will feel better afterward.
Crying, of course, is more dehydrating than people realize. It is important that you drink plenty of water–especially in the first months when the tears are falling like a torrential downpour. Avoid alcohol, however. It is a depressant and will only make you feel worse. I didn’t have so much as a beer in the first 14 months after Jane died. Even now, I drink alcohol sparingly.
Crying also burns huge amounts of energy. That means eating properly is important. Unfortunately most of us bury ourselves in comfort foods when we are stressed or–worse–eat nothing at all. You want to establish good eating habits as quickly as possible. Have a good breakfast, a good lunch, and a good dinner every day. Begin cooking for yourself as soon as possible–even if you are cooking only for yourself and hate every minute of it. It will give you better portion control and make you feel like you have regained control over at least one aspect of your life.
Gaining control over your life is an important thing. Grief makes us feel like everything is out of control. Start small in regaining control. When you get up in the morning, make the bed, pick up the bedroom, take a shower, shave and have breakfast. Little acts of control like this are the beginning of regaining control over your life. The sooner you begin to establish regular habits, the better it will be for your state of mind.
One of the toughest patterns to re-establish is regular sleep habits. I’m still wrestling with that four years out. You don’t want to go to bed because if you do, you have dreams. You don’t want to get out of bed, sometimes because of the dreams and sometimes because of the corrosive reality that awaits you. But I set the alarm every night and try to get up at the same time every morning. And I try to go to bed the same time every night. The former is easier than the latter–at least for me.
Get exercise regularly. It doesn’t need to be strenuous. I try to walk for an hour every day. In bad weather, I drive to a local mall and walk there. In good weather, I go out my front door and walk through the neighborhood. Exercise releases endorphins into your bloodstream that make you feel better. Even a half hour walk gets them cooking through your system. Do see your doctor before you undertake any kind of new exercise program.
Join a grief group. Your local newspaper will have listings for groups in your area–as will your local hospice organization. Many hospitals and cancer facilities sponsor groups. Just talking with other people who are going through what you are going through can be very helpful. There are a number of groups available online as well, though there is nothing like being in a physical group where you can receive and give hugs. Online groups, however, are especially good when a huge wave of grief hits you at 2 a.m.
For me, one of the toughest things was the social loss. Jane was not just my wife, she was also my best friend. We did everything together. I try to have at least one social event every week–even if it is just going out for coffee with someone. I do lots of volunteer work, in part, for the same reason. Much of my work is cancer-related, so it really does double-duty. I am avenging Jane’s death and getting some human contact at the same time. I didn’t think about the social aspect of that work when I started doing it, but the social aspect does help me get through the rough patches.
One of the problems we all face is that the grief really gets worse just about the time everyone around us has gone back to their daily routines. Their lives get back to normal just about the time the shock wears off for us and we enter the real heart of our loss. Finding something to do to help others can provide us with social outlets beyond our traditional circle of friends.
Another thing I find helpful is writing. Sometimes I write for no greater purpose than to move my grief from inside me onto the page. Keeping a journal can be a good way of doing that. You can write things there you don’t want others to hear or see. You can rage against the gods, the doctors, the insensitive person who asks three months in if you are going out with anyone yet….
That’s another thing you are going to encounter. Sometimes people can be so insensitive you can’t stand it. Most of the time that insensitivity comes from their ignorance. Most people see TV and film as reality. There, grief is over in an hour or two. It just doesn’t work that way for most of us.
There are others who try to compare this loss to a divorce. One of my brothers did that to me barely a month after Jane died. He’d had a divorce many years before. He did not see why I was not already out there dating. He didn’t understand that while he and his wife stopped loving each other, Jane and I hadn’t. That alone makes the situation different. But people don’t see that.
In fact, rushing into another relationship is frequently a bad thing. You are wounded and vulnerable and incapable of making a rational decision about financial matters, let alone emotional ones. I swore off making major financial decisions for a year after Jane died–a vow that has lasted until at least now as I write this, with the exceptions of getting my will written and committing as much as I can toward NET cancer research.
I’ll also admit to having had a number of crushes in the last two years. I have acted on none of these because I still feel emotionally too fragile to do so. After four years and 19 days, I’m still wearing the wedding ring Jane put on my finger 25 years, three months and 27 days ago.
I hope those of you who are relatively new to grief will find what I’ve written above useful. Grief is not a sprint. It is a marathon–or maybe an ultra-marathon. But there is no finish line and there are no prizes for those who finish first. And unlike a competitive race, we can help each other get through it.
I picked up my sister-in-law this morning just before 8 a.m. We drove to a local mall where we walked for about 90 minutes. We talked about a number of different things as we paced along–her father’s health, the weather, the economic climate locally–but there were two things we didn’t raise at all, though I am sure we both thought about them. She is going in tomorrow for a biopsy of a suspicious lump. I am going along to keep her company. That came up–but only briefly–when I dropped her off.
It was raining this morning. It was raw and miserable. She commented on that and I said the weather suited my mood. That was as close as we came to what happened four years ago today. But it was the first thing in my mind when I got up this morning.
Four years of traditions
I drove home, showered and shaved. I had soaked some raisins in cherry brandy overnight in preparation for putting together a pair of fruitcakes today. Jane and I made some every year from my old family recipe. I’d pried it loose from my parents a couple of years after I graduated from college. I may have the only copy of it that still exists. The world has stopped caring about fruitcake. And given how bad the store-bought ones were, I’m not surprised.
Making a homemade fruitcake is not for the faint of heart, however. The ingredients can be–some of them–hard to find. And most of them are not cheap. Worse, the ingredients have to be prepared in five different bowls before being combined–and the final mixing requires a strong arm. There is comparatively little flour in a good fruitcake–just enough to bind the fruits and nuts together.
Four years at a grave
The baking takes about two hours in a slow oven. While the heat transformed the sticky batter into something edible, I made my pilgrimage to the cemetery. I took a Christmas basket with me made up of fake Poinsettias and real pine cones and pine branches. It joined the wreath I had placed there after Thanksgiving. There was a soft rain falling and a light breeze. Other than me, the cemetery was empty. Not even the birds were interested in being out there today.
I didn’t care. I wasn’t there to talk with the living or listen to the birds. Four years after Jane’s death, I still hurt–I’m still angry–I’m still frustrated. Of all the cancers she could have had, why did it have to be this one–the one without a cure? The one with endless diarrhea? The one with endless gas and bloating? The one that destroys your heart? Part of me knows the answer to those questions, but the answer brings no real comfort.
Four years of growth
There is some lichen beginning to take root on the stone that marks the grave she and her mother share–that eventually her father and sister and I will share. Part of me thinks I should clean it off come spring. Part of me thinks it gives the granite more character. It is most visible on cold, wet days–like today. It is a pale green against the dark gray.
I left three kisses and four touches on that stone as I left–as I do on the tenth of every month, on every Saturday–and on every other one of the important days on our calendar. Right after she died, I tried to go there every day that I could. I took flowers and small stones and other decorations with me. Those visits tore my soul to pieces.
Four years of painful days
Sometimes the visits I make there still do. Her birthday this year–she would have been 60–and our anniversary–our 25th was September 2–were especially difficult. Today was easy by comparison, but still brutal.
I came home, took the fruitcakes out of the oven, then made bread. Jane taught me about single-rise yeast early in our marriage. It takes what was once a day-long chore and cuts it back to a couple of hours. I’ve been experimenting with a new bread recipe of my own devising. It makes a very fine-textured wheat bread that I like for toast and for sandwiches. I played with the recipe today, scalding the milk and putting just a touch more butter and honey in the mix. It seems to slice a bit better in its freshest state this way. But the weather could be playing a role as well.
Four years of creative tension
Jane is dead. She died four years ago today. Part of me died that day, as well. Sometimes I feel all my movement is just the dying inertia of our life together–that my body is still moving because it does not know it is dead yet. Other times, I know that is not true–that I move forward every day because I still have work to do in this world–that I still have things to discover and invent and experience.
There is this constant tension between those two things. There is constant tension between observing tradition and creating the new. There is constant tension between living and dying. There is fruitcake–and there is bread–and both have a place in this life I am living.
We were watching a “Frazier” rerun in Jane’s hospital room four years ago today. Jane had not slept much the night before but we had moved her out of bed earlier. Now she was having trouble keeping her eyes open. The nurse asked her if she wanted to get back in bed and take a nap—and she did.
…you’ll be making a difference in the lives of carcinoid/NETs patients…
Moving Jane from the chair to the bed meant getting her back into a sling that hung from a crane. I remember having to support her head as we moved her that morning—something I had not had to do before. Alarm bells should have gone off in my head at this new weakness, but we had been in the hospital for more than a month. I had helped change her bedclothes after multiple episodes of diarrhea, walked her through two comas, major heart surgery, and, just the week before, the installation of a pacemaker.
Everything looked promising
Neither of us had gotten much sleep the night before, but I was more optimistic every day that we were headed in the right direction in this long battle against her NET cancer. She had begun physical therapy again two days before and today was the third day in a row she’d been able to spend time out of her bed.
I had helped change her bedclothes after multiple episodes of diarrhea…
I held her hand as she fell asleep—and continued to do so as I read once she was napping.
Jane’s last carcinoid attack
Maybe 45 minutes later the nurse came in to take Jane’s blood pressure. While Jane was on a monitor, sometimes it would stop working because of her position and how thin her arms were. The nurse said she was checking it manually because of that ongoing problem.
…I was more optimistic every day…
But the monitor wasn’t the problem. Jane’s blood pressure was crashing as a new carcinoid attack went coursing through her body. This time there was nothing left we could do to stop it. Thirty-eight hours later, she would be dead.
What we learned from Jane’s case
In four months, from Jane’s single case, her doctors told me, we had essentially doubled our knowledge of carcinoid syndrome and NET cancer. It isn’t that we learned that much, it is that we knew so little. But Jane was a scientist—and she knew how important even the small amounts doctors and researchers could learn from her body as it dealt with the disease could be.
Thirty-eight hours later, she would be dead.
The world of NET cancer has changed a lot in the four years since Jane’s death. We’ve found some new techniques that can slow down its advance and discovered new methods that can help us detect it more reliably. And we know a lot more about the genetics that drive the disease. But we still have nothing that looks like a cure.
I’ll walk again on September 20, 2015 and serve as captain of the NETwalkers Alliance team—a new name for the Caring for Carcinoid/Walking with Jane, Hank and Anne team I’ve worked with the last four years. Every penny we raise will go to researching carcinoid/NETs and finding a cure for the disease that killed my wife.
You can help
You can help in one of two ways. First, you can join our Walk team. You can walk the full 26.2 miles of the historic Boston Marathon course from Hopkinson to Boston, or you can walk 13.1 miles along the same course, starting in Wellesley, or you can walk five miles from Cleveland Circle, or three miles from the Jimmy Fund Clinic. In each of those cases, you’ll need to raise $300. Or you can be a Virtual Walker, cover no distance, and raise whatever you can.
Either way, you’ll be making a difference in the lives of carcinoid/NETs patients–and hastening the day I can stand at my wife’s grave and tell her that her cancer will never kill another living soul.
Pax et lux,
Harry Proudfoot
NETwalkers Alliance
(Formerly Caring for Carcinoid/Walking with Jane, Hank, and Anne)
When we think about death, most of us think primarily about our own death. If we think about it in terms of its impact on others, we think about whether we have provided for our loved ones sufficiently through insurance or inheritance, whether anyone will miss us, whether we have done anything worth being remembered for in the larger world.
…what the Hell do I do now?
But we don’t spend much time thinking about how our deaths will really emotionally affect the people who love us. Part of it is most of us are pretty self-centered when we think about death—when we think about it at all. In the United States, we are almost pathological in our efforts to avoid death and avoid talking about it. More importantly, however, none of us wants to think about the psychic pain our deaths will inflict on those closest to us. Contemplating our own impending death is hard enough. Contemplating its true impact on others under those circumstances is beyond most of us.
The proper focus excludes us
Even if we know someone who is dying, our thoughts are rarely on those they are leaving behind. Instead, we focus on the dying person’s last days and hours. The soon-to-be-mourners wrestle with their coming loss in the sickroom, but largely try to put up a brave front for the soon-to-be-deceased in order to ease that person’s movement from life into death. We do what we can to ease that passage, telling them they will soon see the loved ones they have lost, that they are going home to the heaven they believe in, and we ply physicians and nurses with pleas to ease the dying person’s last hours with the latest concoctions of modern medicine.
…most of us are pretty self-centered when we think about death…
Then, the breathing stops, the heart shuts down, and the brainwaves vanish.
Every death is different
Sometimes the death is sudden. Sometimes it comes with agonizing slowness. Sometimes there is time to say good-bye—to say all the things you want to say to each other. Sometimes, there is only a phone call or a knock on the door, and all the things you wished you had time to say can never really be said.
We do what we can to ease that passage…
Whatever it was that animated the body is gone. The survivors make the necessary phone calls to the relatives and friends who could not be at the bedside. They write eulogies, finish the funeral arrangements, and prepare for the wake and the burial.
Ritual thinking, ritual words
Those rituals are supposed to give the survivors comfort. We go through the receiving line and offer our stock phrases: “I’m sorry for your loss;” “At least they are no longer suffering;” “I’m here if you need me;” “Anyone as good as they were has gone straight to Heaven;” “Call me if you need anything.” Some people bring food by the house in the immediate aftermath. Others send flowers or sympathy cards.
Sometimes it comes with agonizing slowness.
The night Jane died, I called her sister and father. I’d told them not to come to Boston on that last day because I wanted them to remember Jane as she was the last time they had seen her. In retrospect, that may not have been the right thing to do—but it seemed so at the time. I asked them to call Jane’s aunts, uncles and cousins.
And now you know
Then, I called my father. He had lost my mother just 10 months before after a long struggle with Alzheimer’s. “And now you know,” he said, “That there is nothing anyone can say to you that is going to make this feel any better.” That may sound cold and heartless, but it was the truest thing anyone said to me in the ensuing months—and somehow there was more comfort in that than in all the hugs and condolences that followed. My father was telling me the one thing I really needed to hear—that the bleak greyness that had crept around me for weeks and now shrouded everything, was not going to go away because of what people said to me, no matter how well-said or well-meant. Jane was gone—as my mother was gone for him—and nothing was going to bring her back to me this side of the grave. If I were going to live—really live—again, I would have to accept that reality and deal with it: there was nothing anyone could say. There were things they might be able to do that would help me get through what I was feeling, but the clichés of the receiving line—no matter how carefully crafted—would be of no use.
Those rituals are supposed to give the survivors comfort.
Strangely, I thought at the time, I felt pretty good in the immediate aftermath of Jane’s death—so much so that I apologized to her doctors and nurses for seeming so unaffected by it. But I had, finally, given her the dignified death she wanted—even if it had been delayed from the earliest moment it might have happened. I was proud of the way she had fought her cancer, proud of the way she had moved the hospital staff with her constant displays of love and courage, proud of the way we had held each other up. I was relieved that she was out of the agony and the soul-crushing embarrassments of the uncontrollable diarrhea she had endured. She was no longer in pain and had moved on to our garden home, where she would be cared for and loved and prepared for her next flight into this world.
Think about impact of different deaths
I have slowly come to realize that this is a normal reaction for those who lose a spouse or a parent to cancer or some other protracted death. We are relieved that their pain—and our own, born in having to watch their final struggle—has finally ended. They are at peace—and so are we.
I was proud of the way she had fought her cancer…
The death of someone we love brings a stunning shock with it that numbs our souls and our emotions for a time. It lets us function in the world long enough to get through the funeral planning and participation. It lets us stand at the head of the receiving line and talk with those who have come to say farewell. It let me serve as a pall-bearer to help carry Jane’s coffin to her grave, as I had once carried her across the threshold the day we were married. It let me convince everyone that I would be fine. I even had myself convinced.
I wasn’t fine
But I wasn’t fine—and I should have known I wasn’t fine. I should have known the moment I entered the empty house the night Jane died. The quality of the silence was different—different even from the silence of the times I had come home to water the plants and pay the bills while Jane was in the hospital. It was the silence of a house that no one lives in—a silence that can only be experienced and never really described.
I should have known by the way my body curled into a fetal ball in the extreme upper left corner of the bed—as far from where she should have been sleeping as possible.
I should have known from the way I aimlessly wandered the house the next morning—finding myself now in this room and now in that with no idea how I got there or why I was in that particular spot.
They are at peace—and so are we.
I should have known from the way I could not bring myself to open the bag of clothes we had taken to the hospital for her to wear during her physical therapy in the step-down unit—the bag of clothes that we had never opened.
I should have known from the way I could not open the plastic bag that contained the clothes she had worn the day she checked into the hospital for the surgery to replace the valves in the right side of her heart that her cancer had destroyed.
I should have known from the volume I played the music at to break the silence and fill my mind with something beyond the thought that she was dead and never coming home again.
There were a thousand other things that should have told me then—and in the days that followed–that I was not OK—and that I was never going to be OK in the way I had been ever again.
It is nothing…
I’ve lost both my parents. I know what it is to find myself an orphan at 62 years old. I know what it is to suddenly be the oldest person in my immediate family. I know what it is to stand over the body of my father’s corpse. It is nothing compared to losing Jane.
We lost Jane’s mother four years before Jane died. It was the most horrible death I have ever witnessed. She spent the last three days of her life suffocating from the effects of pulmonary fibrosis. It was like watching someone drown for three days and not being able to do anything about it. I know what it is to lose a mother-in-law who has adopted you as her own son. It is nothing compared to losing Jane.
I should have known…
I have lost students I cared about deeply—every teacher does. I have cried uncontrollably for those losses. But they were as nothing compared to losing Jane.
I have never lost a brother or a sister. I have never lost a child as a parent does. I don’t know what those things feel like. I may experience the first. I will likely never experience the second. Perhaps they are like losing Jane was for me. Perhaps they are worse.
What we say and what we do
But we don’t talk about any of these things until they happen to us. Even those who have been through them only talk with others who have had those experiences. And most only do so briefly. We are like soldiers who have experienced combat. We do not speak of it to the uninitiated.
It is nothing compared to losing Jane.
We have this bizarre belief that grief lasts a year, at most—that anyone who has grief that lasts beyond that needs professional help because that kind of grief is abnormal, at best—and unhealthy, at worst.
A different vision
I work with an online grief group that has a very different attitude toward grief. We say, “The deeper the love the longer the grief.” We talk about adjusting to the “new normal” that is never the same as the “old normal” even if we fall in love again and remarry. If we were given to laughing at ignorance, we would laugh at the idea that once around the calendar through all the firsts—the first Christmas, the first New Year’s, the first Valentine’s, the first birthday, etc.—cures grief and returns one to the person he or she was before their spouse’s death blew their world into smithereens that make the task of putting Humpty Dumpty together again look easy.
We have this bizarre belief that grief lasts a year…
Our experience is that often the second run through the calendar can be just as hard as the first. Perhaps it is because of the belief that after the first go-round everything is supposed to be normal, which raises our expectations too high to be met by the reality. I can’t say. I know only that I am facing my fifth Christmas without Jane—and that it still is not right, despite putting up a tree every year and decorating the house.
People think we’re fine
One of my neighbors lost her husband to a heart attack more than 15 years ago. She tells me she still has not healed from his death. My father died 54 months after my mother. He was still mourning her death when he died. My father-in-law, over eight years after his wife died, still has not recovered from her death—nor has he recovered from Jane’s. Neither has Jane’s sister.
I know only that I am facing my fifth Christmas without Jane…
Of course, we all look fine. We do the grocery shopping, keep our houses tidy, read the newspaper, watch television, go out with friends, work—some of us even date—though I haven’t yet. I even have two friends who have remarried.
But the world is different for all of us. We do not see the world in quite the same way. We do not experience things in quite the same way.
Experienced voices
When Jane was in the hospital, I ran into a younger couple whose experience was similar to ours in some respects. The husband had gone through serious heart surgery with a long recovery and poor prospects of success. He had survived—and more.
We do not see the world in quite the same way.
He spent 30 minutes telling me what Jane needed from me—and his perspective as a patient was invaluable. But when he went off to answer a phone call, his wife took me aside. Her role had been what mine was now.
Our point of view
“Everything he told you is true,” she said. “But he was a patient—not the caregiver—not the spouse. Our experience is different from his—and different from you wife’s. They don’t know the things that we know—they don’t know the things that we experience. They have no idea how hard it is to be positive every minute we are with them. They just expect it—and get angry with us if we fail even for a second. He threw me out one day—said I clearly didn’t love him enough if I couldn’t stay positive.”
Her role had been what mine was now.
Her husband had survived, she told me. But there were times the doctors had told her things he never heard. It was a miracle he survived—and a miracle the stress had not driven her crazy. She told me to get out and walk for a while every day—even if Jane wanted me there every second. She told me I needed to eat whenever I could—and that I needed to eat as healthy as I could.
Actions have consequences
“You’re going to lose weight,” she said. “You probably already have. You are putting huge stress on your body—and no matter how this turns out, you are going to get really sick yourself if you don’t take care of yourself. And after the hospital thing is over, no matter what, you have to keep taking care of yourself. You have to force yourself to laugh—no matter how miserable you feel. Go rent the funniest comedy you can find—and make yourself watch it. It will help you get through the aftermath.”
‘They don’t know the things that we know…’
She was right on every count. By the time Jane died, I had lost 20 pounds—over 10 percent of my body weight in less than six weeks. The night before Jane died, I realized I had stopped walking the way I had—I was using an old-man-shuffle to get around. I was 58 years old. And I couldn’t remember the last time I had really laughed.
Complications
Of course their situation was very different from Jane’s. He had faced one major, high risk, heart surgery. It had gone well. Jane’s heart had been much more badly damaged than expected. Her surgeon had to get creative to make it work—but he had succeeded. Jane’s heart was healing normally.
By the time Jane died, I had lost 20 pounds…
But her cancer complicated her recovery. Unlike most cancers, her tumors came with the power to create any of the 24,000 hormones and peptides the body manufactures. Her tumors had settled on serotonin, a hormone that controls digestion, blood pressure, and respiration among other things. Any operation or physical stress can kick the tumors into high gear, creating what doctors call a carcinoid attack that crashes blood pressure and respiration while causing dehydrating diarrhea.
God is an elephant
And Jane’s heart operation was the first of three procedures we would have to have done—including, potentially, one that had never been done on a patient with her cancer before.
Jane’s heart was healing normally.
I am not a traditionally religious person. I think most views of God(s) are like the three blind men sent by their busy king to find out about the elephant. The first describes it as a great snake that blows out hot air. The second calls the first an idiot and says it is a great dusty wall. The third calls down curses on the other two for their clear ignorance, for the elephant, he says, is like a rope that ascends to heaven—and when you pull on it all this smelly stuff comes down and hits you in the head.
What no one tells you
But if someone asks me for proof of an interested divinity, I point without hesitation to that chance encounter in the lobby outside the sixth floor cardiac ICU one day in early December, 2010. Between the two of them, I learned some things I desperately needed to know that I had no idea I needed to know.
I am not a traditionally religious person.
There are lots of articles and books for patients about the challenges they face as they deal with cancer or heart disease or a host of other diseases. When you visit a doctor or surgeon, they will patiently explain what the procedures are they will do and how they will affect your body. But no one explains what your role as spouse/caregiver needs to look like. No one explains to you the emotional rollercoaster you are about to embark on. No one tells you just how murky the lines are when it comes to making life and death decisions about your unconscious love’s treatment. No one tells you anything except that you need to take notes, keep the list of questions that need to be answered and ask those questions when your other half—caught up in the breathtaking moments of treatment and confusion—forgets to ask them.
Then it all changes
We and the doctors and nurses focus on the patient—as we should.
And just about the time you figure out all the things you really need to know and do that no one has told you that you need to know and do, you turn from caregiver and assistant to chief mourner and executor. And no one tells you about any of that in advance, either.
There are lots of articles and books for patients…
If you get lucky, a social worker comes to talk with you in your spouse’s last hours when all you want to do is hold her hand and whisper final words to her that will comfort her and guide her home. You are numb and torn by a range of emotions that includes anger, sorrow, guilt, and failure. There is no one there to take notes or ask the questions you should ask but don’t know you should ask—nor how to ask them even if you do. Maybe there are other family and friends there at that moment, but they are nearly as torn up as you are.
The question
And if you are like me, you look and sound competent and aware and healthy while every dream you had turns into insubstantial dust that gets picked up by the ventilation system and blown out over the city.
You are numb and torn by a range of emotions…
One thought kept coming back into my mind unbidden over and over again: I am too young to be a widower and too old to be a bachelor—what the Hell do I do now?
To everything there is a season, and a time to every purpose under heaven.
Jane-and-Harry died December 10, 2010 just before 8 p.m. EST in the Cardiac Intensive Care Unit at Brigham and Women’s Hospital in Boston, MA. Four years later, I still have not made peace with that fact nor been able to adjust to the reality of it in any but the most superficial of ways. Jane is buried next to her mother in a cemetery in Fall River, MA. The headstone that marks the grave still does not bear the date of Jane’s death.
I haven’t forgiven myself yet…
Jane was my wife for 21 years, three months and eight days. We knew each other for almost exactly four years before we married–and we knew the day we met that we were soul mates. But the knowledge terrified us both. We did not go on our first date together for two years after that first meeting. We were that afraid we would screw things up.
Saving each other from worse than death
I’d had six relationships before Jane, if you count kindergarten and one case of unrequited love in high school. I was the second person she’d ever been out on a date with, and her first boyfriend. I was 38 when we married. She was 35.
Jane-and-Harry died…
Jane told me several times that I had saved her life–but never more poignantly than the day before I took her to the hospital for her final battles against the cancer that eventually killed her. And I told her several times that she had saved my life–and my soul–over the course of our marriage–and never more poorly or awkwardly than on that day.
Joining two souls beyond Death
Our wedding vows consecrated our bodies as one flesh. Our souls were joined long before that event. We both believed we had lived many lifetimes together. We both believed–and I believe now–that we were destined to live many more in the future. And we both believed I would recover from losing her very quickly because of that belief. What, after all, is the passage of even 100 years in the lives of two souls who counted their existence in billions of years? In that scale of things, even lifetimes of separation amounted to no more than a business trip.
…I had saved her life…
We were totally wrong about that–at least from my perspective. Seven days from now, I will visit her grave on the fourth anniversary of her death. The pain is not less than it was the day she died. The quality of the silence in the house has not changed. The emptiness of the space in the bed next to me at night has not changed. The absence of her touch or the sound of her voice at any point during the day or night has not changed. The missing her has not changed.
Death and loss take no holidays
All that has changed is my ability to deal with those things. They are–on most days–less debilitating than they were. For the first year after Jane’s death, I don’t think I ever slept more than three hours a night. Going to bed is still difficult, but once there I sleep for 5-6 uninterrupted hours. When I do wake up, most nights, I can get back to sleep. I rarely dream of her last days in the hospital now. Instead, I dream about the better times or have conversations with her about what I am doing and what I’m thinking about doing next.
Our souls were joined long before…
But the tears still come with little or no warning. I was in the grocery store Monday, walking down an aisle. I was looking for candied fruit for the fruitcake we made every year. I reached to pick it up and maybe the colors struck me in just the right way, but my eyes were brimming up with tears. Later that night I was watching a scene from Gods & Generals in which Lawrence is talking to his wife–and there we were. The tears came down across my face.
What Death took
Jane and I were a couple in a way it is difficult to describe to someone who has not had that experience. It wasn’t that we finished each other’s sentences or dressed to match each other–we didn’t do either one. But even separated by the length of a school, we could be on the same page. I taught English and she taught AP Biology, chemistry and physics in the same building.
Going to bed is still difficult…
One summer, I grew a beard. I’d had one when I was younger, but Jane had never seen me with one except in pictures. She liked how it looked, but was not really in love with how it felt against her face in the end. Still, I kept it to begin the school year while we saw whether it would soften. My students were stunned by my appearance and wanted to know why I’d grown it.
A story without death
“Ms Dybowski and I had an interesting summer,” I dead-panned. “The CIA asked us to come back to work and go to Afghanistan to look for bin Laden. I grew the beard as part of my cover.” Now neither of us had ever been spies or undercover agents. Nor had we been to Afghanistan. Our knowledge of any of the languages there was non-existent.
High school students can be pretty gullible, but I really didn’t expect them to swallow that whopper whole. We maintained a certain air of mystery about our outside interests and our students knew we both had a dry sense of humor that could be missed if they were not paying attention. But this tale was way over the top.
One summer, I grew a beard.
Still, they weren’t sure whether to believe me or not. Instead, since several of them had chemistry with Jane the next block, they held their peace, certain they would get a straight answer from her. Jane knew nothing of what I had told them and could have laughed at their question. She didn’t.
“Were you and Mr. Proudfoot really in Afghanistan this summer,” they asked?
“Yes,” she replied with a straight face, “And let me tell you, those burkhas are itchy.”
I’d made the story up on the spot. I’d never discussed it with her. But her answer was psychically perfect.
It took us weeks to get our students to believe we’d been kidding–and some of them are still nor entirely convinced.
Couplehood
We knew each other that well because we never made major decisions about anything without talking to each other–and rarely made even minor decisions without discussion. It wasn’t that we didn’t trust each other or were incapable of making decision without the other’s input. Rather, we wanted to be sure we had considered all the angles on everything before making a commitment. We knew that we were smarter and more observant together than we were separately.
‘Were you and Mr. Proudfoot really in Afghanistan…’
For example, we looked at more than 400 possible houses before settling on the one I still live in. We had a checklist that included the dimensions of every room as well as the shape of the yard and the position of any trees on the lot. This house was a shell when we decided to buy it. We looked at light fixtures for days and discussed the pros and cons of each one in each room before making a decision. We did the same thing with the flooring, the cabinets, the exterior and interior colors. We studied grass seed and foundation plantings and landscaping–even lawn mowers and snow shovels.
Human work
There was no such thing as man’s work or woman’s work. We both cooked–though Jane was the better cook–we both cleaned, we both mowed the lawn and pruned the trees and shrubs. I did more weeding and vegetable gardening, perhaps, but only because I enjoyed doing it more than she did. She loved cross-stitch and other forms of needlecraft–which I have no facility with–and filled the house with examples of her work.
It wasn’t that we didn’t trust each other…
On a hot summer afternoon, we would sit under the trees and read or write or work on some craft we loved. The majority of the ornaments on our Christmas tree are things Jane had created. We would work together on finishing a piece of furniture or designing a new flower bed. If one of us wrote something, the other would play editor.
To Hell and back
Sometimes we argued with each other. Sometimes we got angry with each other. One day, Jane was so angry she told me, “Go to Hell–And come back.” Then we both laughed. “Well, at least I told you to come back,” she said by way of apology. We might go to bed angry with each other, but by morning the fit would have passed. Before Jane’s illness, we spent just one night in different beds–and that was because I was out of town for a conference. We both hated it so much neither of us ever went on an overnight again without the other.
…no such thing as man’s work or woman’s work.
Yet we had very different interests we pursued without a second thought. Jane loved playing tennis. In the summer, she would play for two hours every morning with her sister. Sometimes she would get an invitation in the afternoon to go play doubles with three male teachers we knew. While I like watching tennis, it was never a sport I had much interest in playing–and what ability I had was so far below hers that it would spoil the game for her were I on the court. I had interests, birdwatching, for example, she found equally dull and excused herself from.
Great expectations
While we were both politically quite liberal, I was more of an activist than she was. We never discussed whom we voted for after the fact, though we explored every candidate and issue in detail together beforehand. Most of the time, I think, we agreed in the voting booth, but I suspect there were sometimes real differences we simply ignored. But those differences were more a matter of the pace of change than where we wanted things to end up.
‘…at least I told you to come back…’
We both fully expected to grow old together, gradually losing our physical and mental strength over time at about the same rate. Then we would die–if not at the same moment, then close enough to it that the other would not have too long a time before joining the other. We both come from long-lived families that tend to stay sharp and healthy into their 80s and 90s. We believed we would have 30-40 years together after retirement
The argument
Two nights before she died, we had a horrible argument that left us both angry and frustrated. It started when she told me she wanted me to help her into the bathroom so she could use the toilet. She’d been on bedpans and catheters since the operation that replaced the valves in the right side of her heart three weeks before. I had to tell her that I couldn’t–and that the nurses couldn’t–that moving her that far would risk pulling out the needles that were keeping up a steady drip of medication, risk pulling out the monitors. Getting her out of bed meant putting her in a lift–and that lift would not fit through the bathroom door.
Then she told me she wanted to go home–and I had to tell her she couldn’t–that she wasn’t strong enough and that she needed to go through rehab first. “You’ll be out of here right before Christmas,” I told her–as they had told us both earlier in the day. “Rehab will take until the first of February–and then you’ll come home. We’ll go to New Hampshire for a week–like we planned.”
‘I want to go home,” she said. “I want to go home tonight…now. I want to sleep in my own bed.” Every sentence was a breathy rasp and a struggle–as every word had been since they had put in the breathing tube in her throat so they would not have to intubate her again. It was a combination of reading lips and trying to make out the words she had not yet entirely succeeded in learning how to form. The exercise frustrated us both at the best of times.
We both fully expected to grow old together…
I explained again why that couldn’t happen. She sank into a sullen silence, then returned to wanting to go to the bathroom. I went out to consult with the nurse about making that happen, knowing already that it simply was not possible. The nurse came in and explained it to her in much the same way I had already done. The explanation just made Jane angry at both of us–and even more angry with me.
The nurse left and I tried to distract Jane from her helplessness with a Celtics game. She liked watching basketball and previous games had taken her mind off her troubles before–but not tonight. She would not look at the screen. Instead she glared at me. I tried showing her a comedy, a drama, a sit-com. She glared at me. I tried a channel that was just music. I was angry now, myself. Still she glared.
I talked with her some more–explained why she couldn’t use the bathroom like she wanted, explained why she couldn’t go home yet. Her glare said, “You don’t love me; you never loved me. If you did, you’d get me out of this bed.”
Time out
Finally, I gave up. I walked out of the room for a few minutes to try to calm myself. It didn’t do much good. I wasn’t angry with her. I understood her frustration. I was frustrated, too. We’d been in the hospital for 26 days. I’d been sleeping on the fold-down couch in her room for 22 of those days. I wanted us both to go home, but knew that was still weeks away. I’d explained it all the best I could. The doctors and nurses had explained it the best they could.
‘You’ll be out of here right before Christmas…’
But we could get up when we wanted, use the toilet when we wanted. My world was limited, for the most part, to the corridors of the hospital. But her world was limited to what she could see from her bed and the chair next to it. She felt trapped and alone and there was nothing I could do to change any of that. I could be there every waking moment of every day, but just the fact I could get up and move without help was a painful reminder of what was denied her. It made me an alien to her at times–and it had to hurt.
That I couldn’t fix that made me angry–especially at myself. Not for the first time, I wondered if it would not have been better if I had let her go the first time she’d gone into a coma. Not for the first time I wondered if I made a mistake letting myself be convinced not to let her go when she had gone into the second coma. Logically, I had made the right call on both occasions. I know that now and I knew that then. Our mantra was, “So long as there is a fighting chance, keep fighting. When there is no longer a fighting chance, let go.”
Death’s doorstep
I took a deep breath and went back into the room. “We both need sleep,” I told her. “Do you want the TV off?”
She glared at me.
That I couldn’t fix that made me angry…
I turned away and lay down on the couch. I closed my eyes and tried to sleep. I opened them. She was glaring at me. “Go to sleep, love. You need to sleep.”
Every time I opened my eyes, she was glaring at me. Every time, I begged her to go to sleep.
Death’s truth
At 4 a.m., they came in to do the overnight x-ray. I left the room while they did it. When I came back in, I sat with her until the sun came up. Somewhere in there, she softened. She still wasn’t happy. But the edge of anger was gone. In retrospect, I think she knew she was dying–that the reason she wanted to go home was so she could die in her own bed.
By 10:30 a.m, she was in a coma again. At noon they told us there was nothing more they could do. That afternoon, we began planning to take her off the oxygen and the feeding tube and everything else so she could die the way she had always wanted to. But it would be in a hospital room and not at home.
‘Go to sleep, love. You need to sleep.’
I haven’t forgiven myself yet for that final argument, for not realizing what she was trying to tell me, for not sitting up that whole night with her holding her hand. I thought I was seeing one thing when something else entirely was happening.
Jane was 56 years and 23 days old when she died of a cancer her doctor had never heard of. Her death changed everything.
Today is the day I should have let Jane die four years ago. Death that day would have been, in retrospect, better for her. It might have been better for me. But it would not have been better for our knowledge of carcinoid/NETs. It would not have been better for those who took life-lessons from her struggle. It would, arguably, not have been better for patients.
…Death was in the room with us–and I knew it.
The weekend before had been difficult. Jane had suffered from massive diarrhea as the food she was finally able to eat passed through her almost as quickly as she could eat it. I helped change her gown and the filth laden sheets after nearly every episode–though twice I had gone down to the cafeteria for food for myself and found myself locked out while they cleaned her up.
Psychosis in the ICU
She also lost her mind for long stretches of that weekend. She asked me to eat my meals in the room because, she said, she thought the doctors and nurses were trying to kill her. She lied about her physical therapy and said her doctors had told her not to do it–that she didn’t have to. She was angry and terrified and, sometimes, a complete stranger to me. There were times I was not sure she knew who I was.
Today is the day I should have let Jane die…
One of her doctors told me she was suffering from what they called ICU psychosis–a thing that is not uncommon among patients who are trying to shake off the lingering effects of the sedatives used during extended surgeries and begin feeling trapped in a small bed. Certainly, that was possibly part of what was going on. I know I was terrified and working hard to keep it out of my face and out of my voice.
Death enters the room
I was up with her much of Sunday night into Monday morning and she seemed to be calming down. I held her hand and talked soothingly to her until the day nurse came on at 7 a.m. I went out in the hall to tell her what the weekend had been like. She said she thought the idea of ICU psychosis might be wrong–and that I should be prepared for the possibility Jane might not make it. She saw a marked deterioration in Jane since Friday.
There were times I was not sure she knew who I was.
That this might well be the end had been in my mind all weekend. I knew diarrhea like she was having could not be sustained for long. I knew her blood pressure and respiration were fluctuating wildly. I told the nurse I would not sit in on rounds that morning–that I would stay with Jane instead. It was my habit to listen to the reports on Jane each morning and to understand the plan for the day in the week since her surgery. I felt like I was more a part of the team that way.
Staving off Death
I went back into the room. Jane was sleeping. I took her hand. She opened her eyes and looked at me, then closed them again and focussed on her breathing. I breathed with her. “Breathe with me and stay with me,” I repeated over and over in time with her breathing. I was dimly aware of the doctors, nurses and medical students talking in the hallway.
…she seemed to be calming down.
“Breathe with me and stay with me,” I chanted. The medical group moved down the hall to the next patient. “Breathe with me and stay with me.” Then her breathing caught and stuttered. I should have just continued to hold her hand. I should have said nothing and done nothing and let her slip away just after 9 a.m that Monday morning.
Death’s exit
But I didn’t. In a calm, un-panicked voice I called into the hallway. “Something isn’t right here.”
Then her breathing caught and stuttered.
Then the room was filled with doctors and nurses and they were pushing me behind a curtain so I couldn’t see what was going on. I hated that–but then the hospitalist was there asking about intubating her again. He said that would buy them a little time to figure out what was going on–and if they couldn’t fix it, they could always take it out again.
Conversing with hope
“Give it a few hours,” he said.
“A fighting chance,” I asked?
…they could always take it out again.
“A fighting chance.”
‘The moment it isn’t, you’ll tell me and we’ll end this?”
“The moment it isn’t, I promise.”
The end of the first death
We pulled her back from the edge of death. She spent 33 hours in a coma before the steady drip of octreotide brought her back to consciousness at 6 p.m. Tuesday night.
‘The moment it isn’t…’
You think about a lot of things when the person you love most is unconscious and you don’t know if they will ever wake up again–or what they’ll be like if they do. I sat by her bed. I held her hand. I talked to her. I watched the news with her. I sang to her. Somewhere in there I slept a little, I think. I know they sent me off to eat a couple of times. The memories are fuzzy.
I should have let her go
I never stopped believing she was coming back. I never stopped believing she was going to heal. I never stopped believing she would beat her cancer and all the damage it was causing. But Death was in the room with us–and I knew it. And I should have let her go with him–no matter how much it changed the future.
The memories are fuzzy.
But I didn’t. I didn’t know what I didn’t know. And the world is a different place because of that.