Friday, December 30, 2005

A death in the family

I wrote on Tuesday that this is turning into a memorable Christmas, but not for good reasons. I was intentionally vague, mainly because I didn't yet know how things would turn out and I wasn't quite ready to write about it.

Now I know. I'm not sure if I'm actually ready yet, but here goes anyway.

I was informed yesterday that my uncle had died the night before. It was not unexpected. In actuality, what was unexpected (to me, at least) was that he had held on so many days. That doesn't make it any less hard to take, although in a way it was a bit of a relief when the news finally came.

It was early in the morning the Friday before Christmas when I got a phone call. I was at my in-laws' house in Ohio, and my cell phone rang. The ring tone told me it was my parents. As I tried to rouse myself to some semblance of consciousness, I wondered what it was about. I knew from experience that phone calls before 7 AM are almost never good news. This one was no exception. My mom was calling to tell me that my uncle had suffered a massive heart attack and was in the ICU on a ventilator.

I had been worried that the end was near for my uncle for several months, but this was actually unexpected. You see, my uncle had been battling non-Hodgkin's lymphoma for three and a half years. I remember well the evening when, while I was at our year-end departmental banquet, the ring of my cell phone startled me (not that many people call my cell). It was my cousin, calling to tell me about the new diagnosis and ask me for advice. Since his initial presentation, he had done well for quite a while, but recently had learned the tumor had relapsed. Having been in a lot of pain for the last couple of months, he was depressed and was not looking forward to the last-ditch attempt at high dose chemotherapy and stem cell transplantation, which would have involved at minimum a month of extreme unpleasantness in the hospital--and that's if everything went smoothly. Consequently, although I had expected that the end might be near, I didn't really expect it for a few months at least and was surprised at the form it appeared to be taking.

My wife and I headed from Ohio to southeast Michigan as planned later on Friday. On Christmas Eve, my father and I headed to the hospital. I hadn't seen my uncle in several months; surprisingly, other than some edema he didn't look all that different from how I remembered him.

Here's one thing that sucks about being a doctor. Having a critically ill family member in the ICU like this brings up a load of conflicted feelings and thoughts. Prior to this, I had only had to deal with them twice before, once 16 years ago when I was just an intern and then a couple of years ago. Standing there in that room, it was hard to shut off the physician-analytical part of my brain. I looked at the ventilator settings. I looked at the drips. (He's on high doses of dobutamine, dopamine, and Levophed, I thought. Not good. Not good at all.) I approvingly looked at the Diprivan drip used to keep him sedated. At the same time, I hated myself for thinking like a doctor in this situation. That wasn't just any patient lying there! It didn't help, either, that my uncle bore a strong resemblance to his brother, my father. In fact, other than his being considerably taller than my father, my uncle could almost pass for him.

Perhaps that was why I had always found my uncle a bit intimidating when I was a child, and it could never really be said that we were particularly close. Nonetheless, later on, I came to realize that he was a pretty cool guy. He had joined the Marines right out of high school, and during recent holidays he had enthralled us with some of his tales of Marine life and some misadventures he had had with his buddies in basic training. He had a strong love of jazz and the blues, and loved to check out the blues clubs in Chicago whenever he went there to visit relatives. In fact, if you want to know how teenagers annoyed their parents before the advent of rock 'n' roll, he had shown me one way: blasting jazz at loud volumes until my grandmother told him to turn it down. After his stint in the Marines was over, he married, went to work for GM in a personnel office at one of their Detroit area plants (where he ultimately retired around 10 years ago), and started a family. Over the last three years, I had come to admire his stoicism in the face of such a serious illness. He rarely complained. He even kept up a part-time job at Starbucks to keep busy. (For some reason, he really loved Starbucks, and would go there nearly every day for coffee, sometimes more than once a day.) My cousin related to me that he would sometimes tell her that it wouldn't be the cancer that got him in the end.

It turns out that he was right.

As I alluded to, there's definitely a downside to being a physician in situations like this. Normal reactions are infused with our physician's training. The hope that nonphysicians hang onto, no matter how small, we know to be unrealistic. Our training tells us as much. His daughter and wife were at the bedside. I feared for his wife, because she always depended upon him for so much. I knew the odds of his pulling out of this were very slim. (So did pretty much everyone else, but I also knew that, even if he did pull out of it, he wouldn't have long to live because the cancer would get him, especially since the heart attack would eliminated even the small hope that the high dose chemotherapy and stem cell transplant offered. I wondered if she knew, really knew. In the background on TV, of all things, Lethal Weapon was playing. (Yes, I know it's strange, given how I've been ragging on Mel Gibson lately.) Complaining about having had Mel Gibson's crazy cop (Riggs) assigned as his partner, Danny Glover's character muttered a comment that God hates him. Mel's character responded: "Hate Him back. It works for me."

At a moment like that, I understood that sentiment a bit more than I would like to have admitted. We turned the TV off.

Later, our usual Christmas Eve celebration was a bit eerie, because none of us could keep my uncle's predicament out of our minds. The kids seemed pretty much oblivious, thankfully, and the unwrapping of the presents proceeded in its usual chaotic and noisy fashion, but none of the adults seemed to be as into it as usual. How could we be? The disconnect between the joyous shouts of the kids as they unwrapped their toys and my own thoughts weighed heavily on me. It didn't help when later on that night, I found myself in the emergency room with a different family member for two or three hours. Fortunately, it turned out to be nothing serious, but the whole experience simply added to the feeling of unreality that night.

Christmas Day we traveled back to Ohio to see my wife's side of the family. It was a typical Christmas, and I managed to have a good time in spite of myself, although I definitely drank more than I should have. It was stupid of me.

On Monday, I was informed that my uncle had been taken off the ventilator and off all drips other than sedation and morphine. Stubbornly, he held on, even in the face of a pneumonia, high fever, and the progressive shutting down of his kidneys. On Tuesday evening we returned to my parents' house.

Sometime early Wednesday morning, my uncle finally succumbed.

Now I'm reminded once again why I detest living so far away from the bulk of my family. Because of the holidays and a couple of other reasons, the funeral couldn't be arranged until the middle of next week. Because of work obligations, staying in Michigan until then is not practical, and I'm not sure if I'll be able to come back for the funeral. Some may find living far away from their family to be a good thing. I'm not one of those people. All we could do for the moment was to visit my cousins and aunt and pay our respects last night, tell tales of my uncle, and peruse his old basic training yearbook. I was amazed to discover that, in the 1950's at least, the Marine Corps produced what looked very much like a high school yearbook for each group that came through basic training, in my uncle's case the Fourth Battalion, 234th Platoon. There, quite incongruous after the pictures portraying classes on map reading, rifle assembly, and hygiene and photos of young recruits learning how to throw grenades, skewer the enemy with their bayonets, fry them with flamethrowers, and fire rifles, were rows upon rows of pictures of smiling recruits, looking so young--just like the high school seniors most of them were a few months before. And there, among the rows of recruits, was a picture of my uncle, looking every bit the 17 year old that he was. Odd that I had never seen his Marine photo before until now, after his death.

That's not a bad way to remember him. Not a bad way at all.

Rest in peace.

30 example(s) of insolence returned:


At 12/30/2005 8:43 AM, Anonymous Gary said...

Sincere condolences for your loss. The holiday season is probably the worst time for these situations. It reminds us even more to hold those who are still with us closer and tell them how important they are to us.

Godspeed.

 

At 12/30/2005 9:04 AM, Blogger Bronze Dog said...

Sorry for your loss, Orac.

 

At 12/30/2005 9:27 AM, Blogger Kev said...

My condolences, your Uncle sounds like many of his generation in that he had an innate stubborness to do things on his own terms and in his own way. My Grandad was exactly the same.

I'm not religious at all so can't say anything on that front but it sounds like your Uncle lived and loved his life. What better epitaph could anyone hope for?

 

At 12/30/2005 9:34 AM, Blogger The Probe said...

My deep felt condolences to you are your family for your loss. I had suspected that there was a very negative event which you were alluding to.

The loss of a family member at any time of the year is bad enough. A loss during a holiday time is quantumly worse. We had a miscarriage at Passover in 1985, and the joy of that holiday is gone.

My younger son's friend died of an anuerysm a week before this Christmas and his loss weighs heavily on my son. His friend was very special, a teammate. You can read of him here:

http://www.newsday.com/news/local/longisland/ny-liscot264566433dec27,0,4298998.story

Again, my deepest condolences to the Orac family.

 

At 12/30/2005 9:48 AM, Blogger Fat Doctor said...

This is a beautifully written tribute to your uncle as well as your physician-nephew conflict. Peace to you, brother.

 

At 12/30/2005 9:54 AM, Anonymous Dave Harmon said...

My condolences and sympathies.

A few days ago was the seventh anniversary of my father's death. He died suddenly, while getting dressed for his 60th birthday party. I was on the subway to his house for the party. Given most of his relatives and friends were already on their way, the birthday party became a rather stunned memorial gathering. (He had also been battling cancer, but died of a sudden lung hemorrhage.)

 

At 12/30/2005 10:04 AM, Anonymous Anonymous said...

You and your family are in my prayers. Distance is difficult. When my mother was dying, I regretted the many miles between us. The phone is a wonderful invention, but not a substitute for being able to hold hands.

And the knowledge does hurt, I knew talking to my dad on the phone and to the ICU nurses that my mother was dying and still my father said, you don't need to come yet.

Peace and grace.

 

At 12/30/2005 10:52 AM, Blogger Abel PharmBoy said...

Hey brother,

I feared it was something like this. I'm only a Ph.D. but Dr PharmGirl is a medical oncologist, so I've seen the struggle of being a doc when things like this happen in the family.

Sounds like we're about the same age, so someday I'll share with you the loss of my Dad, also a Marine, while I was two time zones away. It sucks royally that the academic medical career does indeed take you away from the family.

You did a beautiful job of honoring your uncle and relating the struggles in reconciling your training and experience with the grief over losing him. The suspended reality of his ultimate demise from an MI rather than the NHL, and then the ER trip with the other family member - sheesh, my heart goes out to you and your family.

The long highway drives probably gave you a lot of time to compose this before you sat back at the computer. The timing was just right and the sentiment was right on.

Thank you for sharing this with your readers. Be well.

 

At 12/30/2005 11:11 AM, Anonymous Burt Humburg said...

My sincerest condolences for your loss. Best wishes,

BCH

 

At 12/30/2005 12:07 PM, Blogger Bill Hooker said...

I am very sorry for your loss, and I wish you a quick trip through the necessary grief to the lasting happy memories.

 

At 12/30/2005 3:05 PM, Blogger nolo said...

My heartfelt condolences, and thanks for sharing your memories of your uncle. May the coming year bring hope and healing, both spiritual and mundane, to you and your family.

 

At 12/30/2005 3:13 PM, Blogger Ali said...

My condolences. I understand that feeling of relief. While struggling with a particularly bad case of Parkinson's, my grandmother died rather unexpectedly last year. After the initial shock wore off, mingled with feelings of sadness and loss was one of relief. I knew that she wouldn't have to suffer any longer, and it softened the tragedy somehow.

Your uncle sounds like a heck of a guy, and I'm glad you found such a wonderful way to remember him.

 

At 12/30/2005 5:43 PM, Anonymous DawnCNM said...

Orac--please accept my sincerest sympathies for you and your wife in this sad time. I know how hard it is to be this far from family. You are in my thoughts and my prayers. Hugs.

 

At 12/30/2005 7:57 PM, Blogger Acad Ronin said...

My condolences to you and your family. Thanks for blogging on this (it brought back some memories) and throughout the year. May next year be better.

 

At 12/31/2005 12:47 AM, Anonymous HCN said...

My sincerest condolences.

It does not matter how old you are, or how old the loved one is, or how long they have been ill... it is always a shock when they die, and the real personal way grief effects us.

I was very saddened when my grandmother died. This was even though she was well over 80 years old. I missed her, and her sense of humor. It fit that she literally died laughing (she had a stroke during a "Casino Night").

I hope you have a much better new year.

 

At 12/31/2005 1:25 AM, Blogger JM O'Donnell said...

Very sorry to hear about this Orac. I know how hard it was for our family when my Grandfather died and I know it's never good to have such things happen around this time of year.

 

At 12/31/2005 4:59 AM, Blogger Kristjan Wager said...

I'm very sorry for your lost.

 

At 12/31/2005 3:51 PM, Blogger Parkin said...

I am sorry for your loss. Wishing for a happier New Year for you and your family,
Love
Kath

 

At 12/31/2005 4:22 PM, Blogger GrrlScientist said...

I am so sorry to hear of your loss, Orac! Please take good care of yourself and those you love as you mourn.

GrrlScientist

 

At 12/31/2005 6:27 PM, Blogger Nana said...

So very sorry for your family's loss.

 

At 12/31/2005 9:44 PM, Blogger Wade Rankin said...

My condolences, Orac. Your uncle sounds like the kind of guy I would have enjoyed meeting.

 

At 1/01/2006 7:09 AM, Blogger MichaelBains said...

My condolences Doc. May new life and new joys fill the New Year for you and yours.

 

At 1/01/2006 2:40 PM, Blogger Kathleen Seidel said...

Orac, you have my sympathy, both for the loss of your uncle, and for the pain of living at a great distance from other family members. I've got 3,000 miles between me and my folks, and sometimes it's especially hard.

 

At 1/02/2006 1:58 AM, Blogger Babbler said...

Is too late to send my condolences?

 

At 1/02/2006 2:28 PM, Anonymous Camille Clark said...

Orac,

I'm sorry. I didn't check your blog until today. Death is a shocky thing. It seems like it hits a person at some very unexpected and unexplainable level when it happens to someone you know. I agree with the previous comment about taking care of yourself, I think emotional drain this is hard on the health.

I appreciate your writing about the conflict of being a doctor and a member of the patient's family. Hugs to your family.

 

At 1/02/2006 9:47 PM, Blogger Miranda said...

I am so sorry to hear of the loss of you uncle. It's never easy, even when you know the end is near.

FWIW, I have one of those yearbook thingies from my Army basic training in '92.

 

At 1/02/2006 11:34 PM, Anonymous CardioNP said...

My condolences on the loss of your uncle and the loss of your planned festive break from work.

You mention not having previously seen the "yearbook" from your uncle's Marine days.

My mother died at 66 yo, 5 years ago from an aggressive T cell NHL - nearly one year to the day after finding adenopathy. After her death we found photos that we (me + my 5 siblings) had never seen. Her sisters could identify a few pictures, but not most.
May I suggest that during future family gatherings you get your own family albums/photos/boxes of pictures etc down from wherever they are and go thru them while your parents/siblings are healthy with intact memories and can identify their friends or other family members and label the photos and document events. Otherwise you may find yourself like my family trying to guess who or what event is in the photo.

 

At 1/03/2006 4:33 PM, Anonymous Anonymous said...

Sorry to hear of your loss. My father has also been diagnosed with non-Hodgkin's lymphoma, although when first diagnosed we were told he was unlikely to die of the cancer. It gave us hope at the time but I wonder now what was behind that comment. He has battled hard for 18 months and doctors keep talking optimistically.

He puts on a brave face for us so we don't really know what is going on...

 

At 1/05/2006 6:46 PM, Anonymous Anonymous said...

He is in God's hands now and resting. Bless you and your family. I too have all your same thougths being an ACNP. I understand fully after the loss of my father.
God's Hand's

 

At 1/09/2006 1:30 PM, Blogger Kim said...

I am so sorry to hear about your uncle. Words never seem to be enough at this time. I'll pray for you, his wife and the rest of your family.

My husband has his "yearbook" from Marine Corp boot camp, too.

Semper Fi!

For Your Uncle....

 

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