SAYING GOODBYE

         

Ann passed from my life on a Friday, in the early morning hours of Christmas Eve, 1999.  Being Jewish, the significance of that date is important only in that it required the rented hospital bed and oxygen supplies to remain in her bedroom over the holiday weekend, making it impossible for me even to go past the door without crying.  It has been four days now and my heart hurts like a tooth broken off at the gums.

          We had been together for nearly 30 years.  Every day of my life in that period of time has been an extension and an interlocking piece of hers.  Even in bad times, and there were some, she was my safe haven and refuge from the world.  I’m not a very social animal; in fact, I don’t really like people all that much.  Ann was social enough for both of us and I liked it that way.

          The cancer was diagnosed in late summer.  She had been complaining of chest pain and had a nagging little cough.  Non-small cell lung cancer they said, attached to the mediastinum.  I didn’t even know what a mediastinum was.  Early indications were that the disease was confined to that one area.

Ann was hospitalized in early September.  First treatments involved chemo- therapy combined with radiation, an aggressive approach designed to reduce growth and swelling of the grapefruit-sized tumor in her chest.  The radiation caused her to have grating, burning pain in her throat when she tried to swallow, so her appetite for solid food nearly disappeared and her weight fell off precipitously.  This course of treatment lasted a month.  It was okay though, she said, if it would help beat the cancer.  Typically upbeat, she assured me she would be alright.

Her short-term goal was to be well enough to make the trip from Little Rock to Jacksonville, Florida for Thanksgiving.  The family gathered there every year at that time and it was a pleasure she didn’t want to give up.  Midway through the month of September however, she unexpectedly went crazy.  By crazy I mean she began to have trouble communicating verbally and would be disoriented as to places and times.  We were later told that this was a rare side-effect of the chemo.  At the time though, we didn’t know what it was.  Maybe the disease had infected her brain.  Maybe it was Alzheimer’s.  We just didn’t know.  More tests were ordered:  EEG’s, EKG’s, MRI’s, bone-scans, other scary-sounding things.  By the end of the month it was determined that she could continue treatment on an out-patient basis, and I took her home.

For the first three weeks of October we had to make a daily trip to the hospital for radiation treatments, but she could sleep in her own bed.  The craziness had subsided, but eating solid food was still an excruciating ordeal for Ann.  Cold milk and occasionally a little Jell-O pudding; that was about it.

On November 8, the day after my birthday, we went back to the hospital for a CAT scan and then to the doctor’s office.  There appeared to be three small tumors in Ann’s brain.  More radiation treatments.  The radiation wasn’t really painful she said, but it required her to assume very uncomfortable positions for long periods of time and that was murder to her back, which had already been a source of pain for years.  Radiation aimed directly at the head had caused her thinning hair to begin to fall out all the more rapidly.  But it was okay if we could make it to Jax.

As luck or fate or sheer iron will would have it, as Thanksgiving got closer, she began to improve.  We came to know that she could see her family in Florida.

We arrived in Jax on Monday of Thanksgiving week and spent the night at the home of her brother, Sam.  The next day we made the short drive to Fernandina Beach, where the relatives had rented several condo units for the holiday get-together.  The first few days of the week were great.  While easily tired, Ann was having a wonderful time playing with the grandkids and visiting with the rest of the family.

Friday she began to have pain in her left hip and complained of headaches.  We made the flight back to Little Rock on Sunday with her in a lot of discomfort.  The hip began to hurt so much that we called the doctor on Monday and went into the hospital again the next day.  Tests revealed that the disease had metastasized, migrating to other parts of her body.  There was now evidence of cancer in the bones of the hip.  The doctor gave us the sobering news that there would not be a cure.  The cancer was doing whatever it wanted and would soon win.  A couple of weeks to a couple of months was the prognosis.

Intravenous feeding was begun immediately, along with more chemo.  Ann again became mentally disoriented.  Verbal communication became a frustrating and often useless guessing game.  She couldn’t articulate her wants and needs very clearly, starting sentences only to stop in the middle of a thought.  The feeling for me was one of utter impotence.  Every waking moment for her was now a moment of pain, so she was heavily medicated, waking at the end of each two or three hour period of stupor only to be given another shot of something to make her sleep again.  It became a tortuous and interminable cycle of misery.

On Friday of the second week in the hospital the doctor gave orders to remove the I.V. feeding and made the ominous notation “DNR” in her chart.  It was recommended that I bring Ann home and have hospice nurses come in to assist with her care, but Ann didn’t want to leave the hospital.  We finally figured out that she was afraid she couldn’t get the pain medication she needed at home.  When those fears were allayed she was ready to make the move.  Having not had any sustenance at all except a few sips of milk and water since Friday, she came home on Tuesday.  And then the real nightmare began.

We had been told that the hospice would take care of Ann’s pain; keep her medicated to whatever degree was necessary to alleviate what was now incessant and all-encompassing pain.  There was to be four-hour shifts of nurses and/or aides to allow time for me to get a little rest and take care of the household matters that required attention.  But it just didn’t work out that way.

I had pre-arranged to have the rented hospital equipment delivered and was home when Ann was delivered by ambulance.  I had been afraid that she would be scared and I wanted to ride with her in the ambulance, but it was the only way I could make the schedule fit.  My fears were groundless however, because she arrived sitting up on the gurney and said, “Hi, honey.”

Along with the automatic pump that delivered her pain meds, Ann was to be given a periodic oral dose of Valium, a foul-tasting elixir that was mostly wasted down the front of her gown, leaving spots of purple stain from the grape juice used to wash it down.  She slept fitfully Tuesday night, waking every two or three hours, when I would try to give her some Valium.  Every time she woke it took 30 minutes or so for her to relax enough to drop off to a pseudo-sleep that was clearly troubled and uneasy.  Her breathing was noisy and labored, and each time she woke she coughed.  I slept six feet away from her bed.  Whenever she woke, I woke.  Somehow we made it through the night.

Wednesday morning we were visited by a hospice nurse who arranged to have the Valium administered with the I.V. pump, and called an aide to come to the house and help give Ann a bath.  The nurse stayed about 45 minutes and left.  The aide’s name was Rosie.  Rosie bathed Ann and then she left.  We were alone again.  Wednesday night was the worst night of my life.

Years before, Ann and I had promised each other, as most couples probably do, that we would do our best to see to it that a long and painful dying was not to happen for either of us.  Now, here I sat, and it was happening.  Sometimes when she would awake, she would whisper, “Help me.”  I tried to talk to her about what she wanted or needed, but no meaningful exchange was possible.  I couldn’t help but feel that somehow I was failing her. 

Rather than making things easier, the I.V. Valium had complicated matters.  It seemed to put Ann in an agitated, wired-up state; the exact opposite of the desired result.  Rosie came by Thursday for a four-hour stint and again gave Ann a bath and changed her gown, but I couldn’t take advantage of the opportunity to get a little rest. 

After Rosie left Ann continued to be wakeful, which meant that she was in pain, confused and disoriented.  By this time there wasn’t enough narcotic in the world to give her relief.  The only coherent and connected thought she could utter was, “Oh, my honey.”

When Thursday evening arrived, I was beginning to become frayed at the edges, irritable and impatient when I couldn’t understand her needs.  I stopped giving Ann the I.V. Valium and went back to the oral dose.  She dropped off to sleep about 9 P.M. and I lay down next to her for a few minutes, finally crawling into the adjacent bed about 9:45.

Ann woke around 11:30 and I gave her another sip of the nasty-tasting Valium.  I sat in a chair beside her bed and held her hand until I felt the wasted muscles of her arm relax.  After several tries, she dozed off.

When she woke again at about 3 in the morning, I was a basket case.  I cursed God aloud at one point and, strangely enough, that was the only thing she completely understood and responded to in the last three days of her life.  When I screamed into the night, “I hate God”, she cried and begged, “Please don’t say that”, tears streaming down her face.  I wept with her and apologized, trying to reassure her that I really didn’t mean it.  Once more, she calmed down and went to sleep.

Shortly after 6 A.M. I woke to sound of her noisy, raspy breathing.  I got up and sat in the chair beside her bed, my hand on her shoulder.  Her breaths were coming more quickly and more shallowly than they ever had before.  I think I sensed that something wasn’t quite right but, selfishly, I didn’t want to face the ordeal if she woke.  I let her sleep.  While I sat there, resting my head on the bed rail, she took a couple of short, ragged gasps and then just…..stopped.  The beautiful person I had shared life and love with was gone.

The kernel of whatever immortal substance or spirit that made her mortal disappeared.  What was it?  Where was it? Where did it go?  Why did it decide to leave?  These forever unanswerable questions are all that remain.  I miss her so much.

POSTSCRIPT

On Saturday, December 25, 1999 I went to the funeral home to make arrangements for the cremation of Ann’s body, as this was her wish.  After completion of the paperwork I asked to see my wife for the final time.  The representative cautioned that there might be some unnatural discoloration, but I insisted.  I was asked to wait alone while her body was brought into an adjacent room.

 When I went in I found her body lying on a gurney, covered with a clean white sheet.  Her facial features appeared to be more relaxed than I could remember.  I then realized how much the pain had touched and marred even this small facet of her being.  

I sat there for a little while, crying some, and eventually said my last goodbye.  Before leaving, I pulled the sheet up gently to her chin, covering the little purple stains on the flowered gown.

A couple of weeks later I transported the ashes for interment in Evergreen Cemetery in Jacksonville, Florida.