Posts Tagged ‘death and dying’

Moving into the Mystery

December 28, 2011

“Pittsburg,” is the only part of what he says that I can make out. He sits up, trying to muster the strength to do what I know he cannot: move from the bed to the commode next to it. He has asked a question that I cannot decipher, except for the word “Pittsburg.” I can think of no connection to Pittsburg, no conversation we’ve had about the city—nothing. Either I, in my weariness, am just not putting together something obvious or he has drifted farther away cognitively. I consider the possibility of the former but suspect it’s the latter.

I have given him his morphine and I eventually get him to lie back down, but he sits up again almost immediately. I tell myself that if I could get a bit of Adavan in him, he might be less restless, but he won’t take the Adavan. I call Antonio, thinking that he may be more successful at it than me, but before Antonio can get to the house (a thirty-five minute drive), Howard is down and has taken it. I call Antonio’s cell to tell him that he needn’t come, but he insists on coming anyway.

While Antonio is at the house, Kristen, the hospice angel of a nurse who had helped get him back into bed the previous night (Christmas night), calls. She had promised to follow up and is fulfilling that promise. She manages to convince me that we can get a hospital bed into the room without removing the queen-sized bed and her description of how we’ll manage it makes sense to me. Howard needs the restraint of the sidebars and I need the ability to move the bed up and down.

It is a stroke of luck that Antonio is with me. Kristen has ordered the bed and it arrives in less than an hour and a half. Kristen continues to behave as if she has angel wings. She comes to the house and the three of us manage to move Howard from the guest room bed to the hospital bed—no small thing because even though he has lost a great deal of weight over the past month, he is still somewhere around two hundred pounds . . . of dead weight.

Howard is semi-comatose and cannot help at all in this process. That’s the downside. The upside is that he also cannot fight against it. He has refused a hospital bed up to this point because it represents death to him. But it can no longer be avoided and he is, indeed, close to death.

In a moment of overwhelm, I call my sister Maureen, who has offered to drive out from Illinois to help with Howard’s care, and tell her, “I give up. Come on out.” But after we have Howard settled, I think, I can do this. Nevertheless, I’m glad she will be on her way. I’m not sure she will actually make it before he dies, but I will be relieved to have her there with me.

And now the waiting begins. The next couple of days are a blur. I consider what should be done before Howard dies and call his sister Ann and his three sons, not simply to alert them to the fact that he is close to death, but to give them a chance to say whatever they want to say to him. He is beyond words now, so he won’t be able to talk to them, but I can hold the telephone up to his ear and they can talk to him.

They all want to do this.

With each, I hold the telephone to Howard’s ear and tell him that he need do nothing, just listen. I’m fairly certain that he can still hear, even if he cannot talk, and I want to give him permission to just listen and not struggle to even try to get words out. But he does try to get words out with each of them. He’s unsuccessful at this except with his oldest son, Jim.

Jim makes his peace with his father and it brings me to tears as I hear what he says over the extension. Then, quite miraculously, really, Howard gathers the strength to say what Jim and I later agree is, “Okay.”

Once his closest family have had a chance to speak to him, there is really nothing more for me to do but try to administer his medication and wait. He hasn’t lost the ability to swallow yet, so I am able to give him his liquid medication. I do my best to make him comfortable and wait. I’m restless.

I talk to Antonio on the 28th and he tells me he’s coming over to do ceremony. He and his wife, Helena, come. I welcome their calm strength. Even though I’m a strong woman myself, I can stand outside myself just long enough to realize that the one leg I always have in the other realms, as the shaman I am, has actually pulled more of me into those realms than the part of me that is on this side. I’m unbalanced, too much in an altered state and too little grounded. Ceremony is actually the best thing for me, whether or not it is something Howard would want if he were lucid enough to state his preferences.

The death ceremony we do is so magical and so what is needed that I’m less restless afterwards, more at peace. [The details of this ceremony can be found in my March 28, 2011 post, titled “Death Ceremony.”]

No more than a couple of hours after they leave, my sister arrives. I make dinner for us and, not long after we sit down to eat, I hear something coming from Howard that I’ve never heard before—a gurgling, gasping frustration. I tear into his room with Maureen on my heels. We get there just in time for me to hold his body up as black ooze issues from his mouth. One eye stares at me and the other has rolled back. He has entered a coma.

Maureen and I clean him up, which takes no small effort. The sheets must be changed, all of his clothes must be swapped out, and his adult diaper must be changed. Mo (the diminutive I’ve long used instead of my sister’s full first name, Maureen) has just arrived to be swept into the most difficult kind of help to provide. I had told her, before she came, that she would have to be tough to manage this. She hasn’t even had dinner before she’s put to the test.

We have to cut off some of his clothes because the combined strength of the two of us is not enough to effectively move him. And I’m not about to call hospice. This is sacred duty; I need to perform it and Mo is willing to join me in it. His clothing is insignificant at this point because he won’t be wearing it again and getting him clean and comfortable is what is needed.

Mo and I struggle so much to get the job done. We take sides on either side of the hospital bed and try to manhandle the sheets and clothes without doing harm to my poor dying husband. Eventually, I look up at her, start to laugh, and tell her we’re like the Keystone Cops. We’re clumsy and incompetent, moving about with too little purpose and using too much effort, but we manage.

When we’ve finished and return to the table, Gretchen Minney calls. She’s just returned from spending time with family out of town and I can hear in her voice that she is jet lagged and weary. She wants to know how Howard is doing and when I tell her, she insists on coming over, even though she’s barely put doen her luggage.

Dinner shifts, becoming almost a celebration. It’s an odd celebration, but it does seem like one. I’ve opened a bottle of champagne. I’ve made a good meal. Gretchen, Mo, and I seem aligned in knowing that Howard is about to break the bonds of human form, step out of his body, and step into the mystery. And that is a very good thing.

Finally, Gretchen leaves and I settle Mo in my bed. The only other option is the bed in the guest room and I’m the only person who should be in that room on death watch. She retires, as do I. I lie awake for a time, listening to Howard’s death rattle. The hospice nurse had prescribed drops that sometime eliminate the sound, which she has told me can be quite disconcerting. The drops have worked until now. And I now understand what she means. I’m too weary and too relieved that the end is near for a mere death rattle to rattle me much. I fall to sleep and sleep like the dead until I awake with a start at around 1:35 a.m.

I look at the clock and realize I’ve missed giving Howard his morphine and Adavan on schedule. Then I realize that the death rattle is gone. I leap from bed, go over to him, and can hear that he is still breathing—softly, gently. I give him a small dose of morphine, thinking that it is probably unnecessary, and I pull up a chair and sit next to him, rooting under his covers to take his hand. It won’t be long now. His breaths are so infrequent that I think he is gone more than once, only to hear him take another breath. His sleep apnea over the preceding several years has, thankfully, prepared me well, and I am not jarred by the sporadic breathing.

I have a headache and after some minutes, I get up to take something for it. The combination of stress and champagne have left me with a head that doesn’t quite feel like my own and it is distracting. I want to be clearly focused.

When I return to the room and wait for the next breath, there isn’t one. He’s gone. I look at the clock and see that it is ten minutes of two and I’m startled by the knowing that he’d awakened me so I wouldn’t miss this moment. He knew I wanted to be there and he woke me up so I could be. What a blessing! I thank him, even though I know he’s not actually there any longer. In fact, he has mostly been gone for days. And the death ceremony had helped the rest of him go.

I think about something he’d said, sometime over the last month. “I don’t think we told each other we love each other enough.”

He was probably right, but we had told one another often enough and we’d shown one another in many ways. And he’d given me this last gift of love—waking me so I wouldn’t miss his death. What is enough when it comes to love? There is never enough when it comes to feeling the love, murmuring the words, acting in love. But I’d come to the knowing, years earlier, that any instant of love is not lost, but reverberates on in the universe—onward, outward, past the farthest reaches.

And I feel it, right then.

And I continue to feel it.

Copyright 2011 by Melanie Mulhall

Christmas

December 26, 2011

I was walking on eggshells. I’d been sworn at enough the previous night to make me more than a little careful around my husband. He was dying—days from it at most, as far as I could tell—and he wasn’t himself. But I was weary of being the bad guy. While he had been the quintessential noncompliant patient for some time, I had been the annoying person trying to persuade him to comply, arguing against his attempts at doing things he could no longer do—things that would require me to call for help. I was the annoying person who knew how close to death he was and wouldn’t pretend it wasn’t so. I was the annoying person who was seeing him at his most vulnerable on a daily basis.

My tactic of the day was to walk on eggshells with him. Unfortunately, he was still lucid enough to know that something was off between us. He wanted to know what was wrong. I demurred. He conjectured that I was upset because he wasn’t dead yet.

That was downright cruel. I knew he was close to death and I wanted the release of death for him, but I didn’t feel impatient about it. There had been times over the nearly four years since he’d been fighting the metastasized cancer that I had certainly wondered when it would be over and fantasized it being over. But as his death drew near, I’d felt the sacred quality of it and felt honored to be witness to it. I wanted the release for him, but felt in no hurry for me.

I didn’t feel honored to be on the receiving end of swearing and cruelty, though.

In tears, I told him I couldn’t comply with his wishes to leave the door to his room closed, now that the commode was in it. He looked at me as if completely confused and said, “I don’t understand you at all.” And in that moment, he meant it. In that same moment, I considered the possibility that this statement might be true of the entire relationship between us.

He said he wasn’t hungry, but changed his mind and decided he wanted scrambled eggs. I made the eggs. He pulled himself up in the bed by grabbing onto the covers and ate a bite or two. Then he sat there for a long time, as if he’d forgotten he had a plate of eggs in his lap.

I said, “Your eggs are getting cold, Dear.”

He replied, “Shut the !&%$ up.”

I left the room in tears.

The hospice nurse had asked what we usually did on Christmas and suggested that I follow our traditions, to the extent possible. Not much of what we usually did was actually possible, but it was Christmas Eve and I decided to make a grocery run to buy some of the things we usually had on Christmas morning as we opened gifts: shrimp, caviar, smoked salmon. Against all reason, I also bought a standing rib roast, which I found in the reduced section. We’d often had standing rib roast for Christmas dinner and even though I knew he would not want it—any more than he would want the shrimp, caviar, or smoked salmon—I decided to buy it. At least he would be able to see that I was treating Christmas as I usually did and wasn’t exactly on death watch.

He was quiet that evening. I climbed into bed with him for a bit and lay there, allowing my mind to wander to our life together. Here we were at the end of it. And it was, for the moment, peaceful. I kissed him and told him I loved him when I left the room. And he said, “I love you, Dearie.” That erased any hurt I had sitting in my gut from earlier in the day.

The next morning I came into his room and said (with all the Christmas cheer I could muster), “You made it to Christmas.”

“When was the last time I did that,” he replied.

I could have taken it as just another bit of wry humor from him, but he had said it wistfully and a few days earlier, he had commented that he felt as if he’d been through all of this—this process of dying, in this body—before. I had suggested that he was describing déjà vu and he allowed that it might just be that. I’d told him I had a couple of theories about déjà vu and asked if he wanted to hear them. Surprisingly, he did.

I suggested that he might have planned all of this before he came into this body and that he was experiencing what he had planned out. An alternative theory was that he was leaving his body some of the time and coming back in (something I knew, in fact, was happening), so he was sometimes watching himself from outside his body.

I might have proposed other theories—I had them—but left it at that. He had little to say but seemed to be considering what I’d said.

I brought out our usual Christmas fare, though he had little interest in eating any of it. He seemed to like the smoked salmon more than anything else, but that only meant he had three bites of it to the one nibble of shrimp and no nibbles of the caviar. Nothing had tasted right to him for months, and over the past week he had eaten and drunk so little, I knew he was edging closer and closer to death.

I brought the few gifts to be unwrapped—all for me because everyone finally understood that he wouldn’t be around to use anything they would give—and opened them on the bed, commenting on each. He could barely stay awake for it, but he made an attempt and managed it, just barely.

He slept most of the rest of the day, though his sleeping was interrupted at least once by an attempt on his part to leave the bed to make his way down the hall to the bathroom. I could not let him even try at this point. I told him that if he needed to go to the bathroom, he had to use the commode. He objected. I pressed. He objected. I finally told him that if he made an attempt to get to the hallway bathroom, I would pick up the phone and call hospice or go next door to ask for help because I knew he would not be able to make it there and back and I was smart enough to know that I could not restrain him. I knew he was royally pissed about this and told him that I couldn’t let him hurt himself, that I was not his enemy. He insisted that I was his enemy and I told him that he would rethink this position at some point. What I didn’t say was that he might rethink it once he was on the other side and had some perspective.

His body was fading and his mind was fading with it. One moment he was sweet and peaceful; another he was irrational, agitated, and angry. He seemed to be losing sight and hearing, too, and I was unable to tell how much of his behavior had to do with what must be the alarming fading of these senses and how much had to do with the malfunctioning of his mind. But I did know that his mind was abandoning him rapidly.

Christmas night he struggled to the commode and was on it for an hour, then two hours more a little later. He now had no energy to lift himself from it and slide back onto the bed. I attempted to help him, against his wishes, and failed. I knew I couldn’t leave him there all night. I had not option but to call hospice. He sat on the commode babbling, “Blueberries, blueberries, blueberries.” I wondered if his mind had left him completely or if he was trying to avoid swearing. It was frightening to see this brilliant, virile man in this condition—even though I’d been present during the entire downward slide.

Kristen, the hospice angel of a nurse on call on Christmas night, came from the other end of the metro area. Together, we managed to get him settled.

He was not only on morphine at this point, he was on Adavan, a drug meant to reduce anxiety and/or depression, often prescribed to people who are at the end stages of dying. I had come to understand, both from my online research and from my conversations with his hospice nurse, that patients who are dying are often restless and disoriented. Adavan helped with that.

But what I was experiencing with my husband had been confusing over the past week or so. According to what I’d read, there was a pre-active phase of dying and an active phase of dying. The former could last a couple of weeks, while the latter tended to last three days or so. These were, of course, averages. I’d seen his lower legs and feet swollen (pre-active phase) and blue (active phase) one day, then fine the next. It was crazy making. He had the restlessness and confusion of the pre-active phase, along with prolonged periods of sleep, overall withdrawal, coolness of skin, decreased intake of food and liquids, and comments that suggested to me he was trying to resolve anything unresolved between us. But he had been lucid most of the time and had not shown other signs of being in the active dying phase . . . for the most part. He was becoming incoherent, was losing his physical senses, and was—the shaman in me saw—mostly gone.

Sometime earlier, I’d intuited that he would be gone by Christmas. It hadn’t occurred to me that his essential nature would be mostly gone by then, but his body would still be with me.

Yet, I knew time was very short.

Copyright 2011 by Melanie Mulhall

Drama Everywhere

December 25, 2011

“I wonder why I’m sleeping so much,” he said, as if he truly didn’t understand it.

I reply, “Your body is shutting down. So you sleep. Your metabolism has changed.”

Of course, the fact that he was on a low dose of morphine administered more than once a day had something to do with it, too, but I didn’t point that out. I had said, “Your body is shutting down,” and not, “You’re dying.” We both knew he was dying. I’d been more willing to say it than him, but I didn’t need to say it again.

His hospice nurse thought that this comment was meant to prepare me for his death. I almost snorted at that. I’d been prepared for his death for some time; he hadn’t been. He understood he was dying at this point, but he didn’t seem to understand that he might not just go from being lucid and vital to dying in an instant, that, instead, his body might shut down slowly.

On December 23rd, he asked what day it was and I said, “It’s Mom’s—my Mom’s—birthday, December 23rd. My mother had been gone since 1995, but I always remembered her birthday.

I was taken aback when he replied, “Do you want me to die on your mother’s birthday?”

“Well, that’s up to you,” I said. “And I think of death as more like graduation.”

And it was time for him to graduate. He was fading. He was now attempting to use the commode instead of fighting his way to the bathroom, but whatever in him still held on to some sense of personal dignity inhibited him. He was having trouble managing the pull-ups and I’d had to change the sheets in between hospice visits. He couldn’t bathe himself but wouldn’t let anyone else bathe him, either. The previous day, I had managed to get his bed in order and had given him some clean clothes, but after undressing and struggling with the pull-ups, he’d accidentally put the dirty clothes back on. He had spent his limited supply of energy and had just gone back to sleep in his dirty clothes.

Later, he awoke and said, “I think I’ll take a shower today.”

I’d thought that we were past that. There was no way he could make the short trip from the guest bedroom, down the hall, into the master bedroom, and into the shower. He barely had enough strength to sit up. Yet he believed he could do it with my help. My help? When he went down—and he would surely go down—he would go down like an ancient tree and would take me with him.

I reminded him of the debacle some days earlier. He’d insisted on taking a shower and was going to struggle his way to it. I’d at least convinced him to wait for the hospice nurse to help him. I’d actually thought she would talk him out of it, but he was determined and she was willing to stick with him until he demonstrated to himself that he couldn’t manage it. His oxygen tank in tow, he’d managed to make his way to the master bath. It had probably taken forty-five minutes to an hour to get that far. But he couldn’t actually get into the shower. He sat, defeated, on the toilet and allowed the nurse to at least wash his torso and legs. Then it was a very long struggle back to the bed.

But when I mentioned that event, his reply was, “I did shower.” I reminded him of what had transpired and his faulty cognitive function kicked into high gear and brought back enough of the affair for him to recall that he hadn’t actually gotten into the shower that day. “She kept saying, ‘You don’t have to do this,’” he said, “so I eventually let her do it.”

Let her wash him, he meant—something he could scarce imagine.

He slept most of the day on the 23rd. I had a hair appointment I badly needed to keep, but I thought I would have to cancel it because I could not leave Howard alone at all at this point. But Cindy Morris made keeping my appointment possible. She agreed to come and keep an eye on Howard. I asked her to just sit in the dining room, facing the closed door to the guest room, and stop Howard if he tried to leave the room. He couldn’t make it the bathroom any longer but frequently forgot that fact and would attempt to get up to make the trip. He needed to be protected from himself and she had the grit to agree to be his protector, even if for only an hour and a half or so. It was hugely courageous and an equally huge gift to me.

When I got back home, I heated up some homemade soup for the two of us. She’d brought some vegetables and a small dessert to go with it. We were eating and chatting when I realized, with a start, that I hadn’t given Howard his morphine on schedule. I left the table and went into his room. Unfortunately, he had made his way from the bed to the commode and barked at me when I opened the door. He might be dying, but he still wanted complete privacy when it came to the commode. I backed up and went back to the table.

We had the monitor on the table with us and could hear him straining and in discomfort. Was he trying to get back to bed? Was he struggling with the pull-ups? I couldn’t quite decipher what he was doing from the sound. After a time, I went back to the room. He was still on the commode. This time he didn’t just bark, he swore at me. In fact, we could hear the “God damn you, Melanie,” over the monitor as he continued to swear at me after I left him alone and was back at the table. More time elapsed. I was worried about him. This time I knocked. More swearing.

Cindy was a trooper. She just took it in stride. I was concerned about Howard, and I made every attempt not to take his swearing at me personally. He was dying. He was losing cognitive functioning and what cognitive ability he had left was very annoyed by his failing body and the fact that he couldn’t hide the fact that his body was failing.

Once dinner was over and we’d chatted for a time—our talk punctuated by Howard’s swearing, as heard over the monitor—she’d had enough and was ready to leave. But just as she was getting ready to go, an ambulance came down the street in front of my house, lights flashing. It swung off E. 3rd and onto Bellaire, the cul-de-sac my house sat next to. More emergency vehicles followed. They all pulled up to a house in the middle of the street. While we didn’t know the couple living in the house, we’d seen the man who lived there many times, attending to his yard and sitting in a chair, just inside his garage, watching the neighborhood.

Cindy stayed. We looked out the back door and talked about what we’d done as children when emergency trucks pulled into the neighborhood. She’d grown up in the Bronx; I’d grown up in small towns in the Midwest. But it seems that the response was universal, at least when we were growing up. We would stop whatever we were doing and either peek out our windows or go outdoors for a good view of the activity. Life drama, right in front of us, had been more compelling that eating, sleeping, television, work, or anything else. Everyone we knew when we were growing up came to a stop when emergency vehicles were anywhere nearby. The girl from the Bronx and the girl from the Midwest still did.

Someone was brought out on a stretcher, but it was difficult to tell for sure if it was a man or a woman. Someone was ill or injured bad enough for an ambulance to have been called. Could someone be dying across the street? What were the chances of two people on the same block dying—or close to it—at the same time? Everything in my life had become a bit surrealistic, but this sent my mind sliding off the edge.

And then I had a moment of complete clarity. I had been so focused on my little patch of earth at 1093 E. 3rd Ave. and the drama in my own home for so long, I’d lost perspective, lost the understanding that drama was happening elsewhere—often nearby—all the time. It hit me in the gut, moved up to my brain, then settled in my heart: At any given time, there are people within a block of me enduring one drama or another. Someone might be dying. Another might be grieving a death. A third might be suffering a serious illness or suffering through a divorce. Someone else might be in the deep well of chronic depression. One of these people might share their suffering with me but most wouldn’t. I didn’t even know most of the people who lived nearby. But I understood, in one flash that moved through my system like an electrical charge and settled in my heart, that there was now and always would be suffering around me.

I was changed by it. There was something utterly tragic about it and, at the same time, there was something comforting about the fact that others were sharing this aspect of the human condition. I was appalled by the fact that any part of the knowing gave me comfort and was stricken with sadness by the thought that there would always be others nearby suffering. My heart constricted in pain. And then it opened a little wider than it had been before—to take it all in and make a home for it.

Copyright 2011 by Melanie Mulhall

Best Friend

December 18, 2011

There was one person Howard hadn’t seen in some time and wanted to see before he died: Pete. For many years, Howard had considered Pete his best friend. They were both former Marines, they’d been cops together during the early Lakewood days, they’d been to Kosovo and Iraq at the same time—but the friendship wasn’t just about those shared “tough guy” experiences.

Long before I knew Howard, he and Pete had gone to the Santa Fe Opera together. They’d donned tuxedos and were, no doubt, on the prowl . . . and I’m sure they made quite an impression on the ladies. Howard had stood up for Pete when he married the second time around and Pete was Howard’s confidant to the extent that Howard allowed himself to have one (apart from me) at all. Pete could hold his own in almost any conversation with Howard and they were both dedicated to a code of integrity and service. In other words, they were close. And Pete was one of the first people Howard introduced me to when we slid down that slope from friends to lovers. My acceptance of Pete and his acceptance of me were that important to Howard.

Howard and I had spent some lovely times with Pete and his wife Kim, but for the most part, the men got together without their wives—usually for a beer and a chat. But that changed somewhat when Pete began working outside the metro area, up in Chaffee County. It changed even more when Pete switched political party affiliations and decided to run for sheriff. The political shift was inexplicable to Howard, a committed Republican (juxtaposed against my own committed position as an Independent). The decision to run for sheriff was, in his mind, ill advised. He saw his friend as too innocent to last in politics and too upright and honest to be able to stomach it for long. He couldn’t support his friend’s political ambitions and his friend was immersed in them.

As with everyone else, Howard had done his best to hide his declining health from Pete. The two hadn’t seen one another for months. Howard was hurt to the core, but too stubborn to do anything about it. I suspected Pete was the same. I doubted Pete understood just how close Howard was to death and I knew, in my own core, that if they didn’t see one another before he died, Howard would die unsettled about it and Pete would regret it.

After an aborted attempt to reach him Thanksgiving weekend, I let the matter sit for a while, hoping that word would get to Pete about Howard’s condition and he would come by. When we didn’t hear from him, I took matters into my own hands and called Kim at work. I might have begun the conversation calmly, but if so, it lasted for no longer than a few seconds. I was desperate to get them together and had to choke back sobs just to talk. I explained how little time Howard had and how much I knew he wanted to see Pete. I admitted that I knew Howard was hurt by Pete’s lack of contact and said that I suspected Pete was hurt by Howard’s lack of support. And, as usual, unable to do anything but tell the truth as I saw it, I suggested that they both had more pride than brains. Kim agreed.

Pete called sometime thereafter and made plans to come for a visit. I made him promise not to tell Howard that I had instigated it. Pete came, pulled up a chair next to the bed, and the men chatted as if only days—not months—had gone by since they’d seen one another.

Something lifted in my heart with that visit. I knew that Howard would die easier, thanks to that visit.

Before he left, Pete asked Howard if he could come by again. Howard encouraged him to do so, and as I walked Pete out to his car, I encouraged him to do so, too. But I doubted there was time for another visit before Howard died.

Before the visit, Howard had wondered aloud why Pete had decided to come. He asked if I had a sense of it. I lied as convincingly as I could, knowing that the truth would be known to Howard soon enough, once he’d died and had the broader view from the other side. I believed it would be important to Howard for Pete to come of his own accord, as opposed to coming because I—the wife of the soon-to-be-deceased—had implored him. He needed to know that Pete really did give a damn. So I offered a conjecture or two, but kept the truth to myself.

After the visit, Howard’s musings turned to the reasons for Pete’s asking if he could visit again. “All these years . . . neither of us ever asked a question like that. We knew we didn’t have to ask,” he said. He was perplexed. Why would Pete ask?

Of course, the two hadn’t really addressed the rift between them during the visit. They hadn’t gotten any cards on the table. So Howard was left wondering. Did Pete think Howard was still annoyed with him? Did Pete think Howard would fear he, Pete, was still annoyed? In Howard’s mind, the chat itself should have answered any such concern and should have answered Pete’s question without his ever having to ask it. They were buddies; no need to ask if he could come by again.

He might have been perplexed by Pete’s question, but he was pleased that Pete had come to see him. And maybe I was imagining it, but it seemed to me that something lifted in Howard’s heart, too, because of that visit. There were few things he seemed to need to have resolved before he left, but this was an important one. It was as resolved as it was going to be and he was more at peace. That was enough for me.

Copyright 2011 by Melanie Mulhall

Sacred Space

December 7, 2011

I wasn’t exactly sure when it happened, but sometime in December of 2010, I realized that my home had become a church.

I had always taken care of myself and my appearance, but now I found myself taking special care to dress well and attend to my grooming. I traded in shoes that clicked on my wood floors for those that were as quiet as . . . well . . . a church mouse. I became more attentive than usual to the cleanliness and neatness of the house and I wanted only soft music playing. I felt calmer, more congruent, and more at peace with myself than usual and I found myself speaking in hushed tones. I carried myself with a kind of dignity I had never before noticed. And then one day I realized that I had made sacred space of my entire surroundings. It was clear to me that Howard was nearing death and the very air seemed charged with all that was holy.

It wasn’t that my husband was a particularly “holy” man. He was a man, with all the idiosyncrasies, charms, failings, peculiarities, gifts, talents, and personality eccentricities of a man. But that was actually the point. He was human and he was dying and I seemed intuitively bound to treat this moment in time as the significant and ephemeral instant of magic and mystery that it was. He was my husband and, therefore, important to me. But he also seemed to stand for humankind itself and the essential goodness of humankind.

So my house had become a church without my consciously making it so. And the space seemed poised, waiting for something important to happen.

This is not to say that there was little activity. In fact, there was so much activity, it was sometimes dizzying. Hospice is a blessing and an army of help, but that help rings your doorbell on a fairly regular basis and has to be let in, communicated with, attended to, and put in interactive mode with the dying party. That dying party was Howard and he remained intent on being entertaining—that is, when he was not being a curmudgeon. He carried both with no apparent paradox.

Apart from hospice, friends began to appear at the door. The word had gotten out—through the phone lines, Internet, and thin air—that Howard didn’t have long. He had refused to allow people to see him in bed, but one day, Joe Schalmoser stopped by without notice and Howard allowed him into his sanctuary, where Joe found him propped up in bed. A month earlier, Howard had been downright rude to Cindy Morris—a friend of mine who had become his friend, too—when she followed me upstairs as I announced her arrival. He’d refused to be seen at all. He simply had not been willing to allow anyone to see him in any kind of compromised condition (as with an open bag of Depends nearby). And now he was welcoming Joe into his bedroom, treating his bed like a throne.

Then Pat and Mary Ahlstrom—old friends from the early Lakewood PD days—came by. He had softened to the idea of people seeing him in bed and with their visit, he softened further. He now wanted to see people more than he wanted to appear to be something other than he was—a dying man. Diana Wilson came on a regular basis. She had been a dispatcher at the Broomfield Police Department when Howard was chief. Years later, they connected again because of art. They were buddies and my sense was that she understood, very clearly, that the chances to see Howard were running thin.

Tom Deland, Broomfield’s chief of police since Howard left the post, came and brought his two deputy chiefs with him. It was an act of respect.

A woman who had been his paramour years before I was in the picture came to see him. She had been important to him and there was still an easy intimacy there. She’d also had cancer and knew what she was seeing in him.

She was one of the few who did. It was excruciating and frustrating to me that many of his friends and some of his family still did not seem to understand that he was dying—and going quickly. Those out of town just couldn’t see what I was seeing and Howard did his best imitation of a robust man when he talked with them on the phone.

When I wasn’t tending to the revolving door and Howard’s needs, I found myself doing things I did not want to do at all, but knew needed to be done. Like calling All-States Cremation to see what they needed from me before Howard’s death. I talked with them and faxed them information surreptitiously, which was not difficult since Howard slept when he had no visitors. And he hadn’t been downstairs to my office since the day I brought him back from his last transfusion.

I also called the assistant to my Raymond James broker to get some money because I knew my attention would not be on work for some time and any monies coming to Howard via direct deposit would stop, abruptly, with his death. Early in December, I finished an editing project and energetically shut off the flow of work so I would not be distracted by potential clients I knew I would be unable to serve until sometime after his death.

I had no time for clients anyway. Everything—and I mean everything—took more time than I would have thought. The incoming telephone calls, the visits, tending to Howard, the updates on his condition for family and friends, keeping the house and yard tended to—everything took more time. When I was in my office, I would sprint up the stairs to his room, two floors above, every twenty minutes, just to check on him. Even after my friend Helena Mariposa sent me a baby monitor so I could keep tabs on Howard more easily (one of the best gifts anyone can give to the caretaker of a dying person), I continued to wear a path up and down those stairs, just not quite as often.

Just making sure that I was there if Howard fell or otherwise found himself in a fix took time. If he had to go to the bathroom, he slowly and painfully pulled himself up in bed, swung his feet over the edge, sat for a long time to rally his strength, hefted himself up, and slowly, over many minutes, inched his way to the hallway bathroom, which was just steps outside the guest room door. Then it was half an hour before he made the slow and treacherous trip back to his bed.

Everything took on an enhanced level of difficulty and we were both behaving like Olympic gymnists, taking on the difficult moves and intent on mastering them.

But I was also on the receiving end of some remarkable acts of kindness. Out raking leaves in early December—thanks to cottonwoods that held on to their leaves like Scrooge clutched his money purse—I felt overwhelmed. I’d already raked and bagged at least twenty-five bags of leaves earlier that fall. The prospect of more sucked the life right out of me, but head down and shoulder to the project, I started in.

Then neighbors from across the street called over to me. “You look like a lady in distress,” Glenn teased. It must have been that obvious. He and his wife Kathy came over, rakes in hand, and the task was accomplished quickly. They hadn’t known that Howard was dying until I told them that day, barely able to hold back the tears.

Heather McBroome, who had been doing shamanic work with me for several years, stopped by one day, wanting to help. When you are in the thick of crisis, you can’t even readily see what someone else might be able to do for you. I told her the only things that really needed attending to were things no one else would want to take on, things like taking Howard’s truck in for an oil change.

I have no idea why it seemed urgent that this task be done. He certainly wasn’t going to be driving that truck again. Perhaps I knew I would and that it would be a long time before I’d have the presence of mind to get the oil changed. Heather didn’t blink. She took the truck in for an oil change.

Some of my friends—most notably Antonio Arguello, his wife Helena Mariposa, Cindy Morris, and Gretchen Minney—understood what was happening perfectly and were rock solid support. There was support, too, from Boulder Media Women colleagues, clients, old friends, and new friends.

But Howard’s sister Ann was right there at the center. She and Howard were very close. I knew that what was happening to him was felt by her five hundred miles away in Ogden, Utah. Through the ether. Through the blood. Through a lifetime of energetic connection. I called her regularly to keep her abreast of what was going on. She’d been a nurse for many years, so we could talk in a kind of shorthand. Then regular calls became daily calls. I didn’t want her to be blindsided when he slipped away. But in truth, I also needed her. I needed to talk to someone else who loved him, I needed a witness to what was happening who had a deep heart connection with him. That would be Ann.

I’d always loved Ann and, over the years, I’d come to feel that she was my sister, too. But that sisterhood took on a new depth. I didn’t want to burden her with the details, but there was something important in sharing them with her. The details allowed her to be there with us. And she could not be there physically. She’d had polio as a child and that had developed into post-polio syndrome, decades later. She could get around, but she couldn’t get around easily, and there was no way she could handle the stairs in our house. I knew that it pained her to know that her big brother was dying and she couldn’t be there with him.

And I needed her, even if only by phone. I didn’t have to explain my exhaustion to her, didn’t have to explain my tears. She understood the term “incompliant patient,” which was the precise term that described him, and she understood it not simply because she had been a nurse, but because she knew her brother. I felt that Ann and I were bonding in the most intimate and painful of ways—through the dying process of someone we both loved.

That was sacred space of a kind, too. The space between me and Ann, me and Howard, me and my friends and family—it was all becoming sacred space. I knew it was a little like holding one’s breath—it couldn’t last forever. But much of my daily experience, it seemed, was becoming one ongoing experience of holy communion. I was hyper-focused on Howard and his process, under the kind of stress that one is mostly unaware of while experiencing it. I was sometimes exhausted, sometimes manic with energy, and sometimes cranky. And yet, everything took on a quality of sacredness and every interaction had become one of holy communion.

Copyright 2011 by Melanie Mulhall

Specters and Human Angels

November 27, 2011

Sometimes when Howard slept, I could sense that much of his essential nature—his soul, if you will—slipped out of him and stayed out until he awoke again. One evening, the sense of it was so powerful, I felt he was already gone, already dead, even as he lay sleeping in the next room.

Late in November, I awoke in the middle of the night and sensed that the entire upper level of the house, the bedroom level, was filled with spirits. I could identify some: my council of guides, my mother, what I sensed were his guides and some of his ancestors. Others I could not identify. These specters returned, again and again, over the coming weeks. When I first sensed my father, I was surprised. While my mother had adored Howard (and he her), my father had died long before Howard and I met. They hadn’t known one another. Then I realized the sense to it. Like Howard, my father had been in the military. Like Howard, he had been an intellectual and a writer. Like Howard, he’d enjoyed chess. Of course he was there. They were going to be great friends on the other side. I was eventually able to discern what I thought were Howard’s parents and his cousin Jack among the ghostly visitors. It was comforting, and it was also telling. I knew that they were all there to help him with the process of leaving his body.

I was happy to take comfort in whatever form it came. After years of bucking up, I cried every day, multiple times a day. I mostly kept it from Howard, but not always. He didn’t question it. He knew his time was short. Some nights, I crept into bed with him, put my arms around him, and just lay with him. Sometimes we talked; other times we just soaked up one another’s presence. And sometimes we wept together. Those were sweet times, those nights. There was a deeper level of intimacy than we’d had in years—maybe a deeper level of intimacy than we’d ever had. It wasn’t about words and it wasn’t even really about physical proximity. It was about the partnership, the unstated contract between us to be partners during this pilgrimage to his death. The unstated understanding that we were what we had been saying for years: best friends. And best friends sometimes just witnessed one another’s lives. I was his witness.

He slept most of the day every day. He could no longer get up and down the few stairs from the bedroom level to the living level without a struggle. He only struggled to do so once or twice a day, mostly to get to the kitchen. I was happy to bring food to him, but he needed to demonstrate to himself that he could still make the stairs. He made one effort to sit in the living room, then asked for a chair in the bedroom. Antonio helped me move a comfortable one from the journey room (the room in which I did shamanic work with people) in the lowest level of the house up to his room. He used it only a few times, but just having it there made him happy.

Everything was beginning to make me nostalgic. I turned on the television to find an episode of Globe Trekker on Fiji. We had been married in Fiji. Another day, the movie When Harry Met Sally was on. I smiled and cried because it was one of many movies he liked a good deal. And while Howard often referred to the house as my house—an accusation more than anything else that I’d arranged it according to my own tastes and needs—everywhere I looked in it, I was reminded of Howard and our life together. It was as if he were already gone. And in some ways, he was. He was slipping further away from me every day.

Yet, a few days after Thanksgiving, he asked if we were going to see the new Harry Potter movie. He had almost died days earlier and he was completely unable to get down the series of stairs that led outside. Still, he seemed to have told himself that he could do this. When I finally got ready to return the borrowed oxygen tank to the cancer center, he said, “I’d like to go with you.” Again, it was a physical impossibility for him. Did he sense that he would never again see the nurses and doctors who had been so kind to him? Perhaps, though it did not occur to me at the time. What did occur to me was that he was becoming farther and farther removed, mentally, from his physical reality. Getting to the bathroom was a major undertaking. Leaving the house? No chance.

Finally, in the last days of November, he agreed to hospice. But even here, he insisted on doing it his way. He slept until he had just enough time to get himself up and together before they came to the house to meet with us. He dragged himself to the shower, dressed, and struggled his way downstairs to the dining room because he did not want them to see him as an invalid. He did not want hospice to see him as an invalid.

The meeting was a negotiation. The hospice staff quickly determined what he was made of and that he would need more than their respect, he would need their agreement to participate in the hallucination that he was not the dying man they saw before them. They stepped up. They’d done this before. He had feared that bringing in hospice meant he would no longer have access to blood transfusions. I knew that he’d already had the last one he would need in this life, but it was an important consideration in his mind. They assured him that it was not beyond the realm of possibilities and that it could, in fact, be done at home.

At one point, during the discussion with hospice, he said, “Maybe I’ll just disappear . . . leave the house, drive away, and not come back.” It was a threat. He wanted them to know that he was still in charge. He wanted them to know he’d already had enough of his body betraying him, before signing on with them, and he didn’t want nonsense from them (or me).

Of course, he would have needed me and a couple of strong men to get him downstairs, outside, and into his truck by this point. Still, I had no doubt he could still drive if he could be helped to his truck. Where would he drive to? No question about that. He would be off on another adventure. Maybe the trip to Alaska he’d been sorry to have never made. No Thelma and Louise action from him. Never.

Unbeknownst to him, hospice and the nightly cadre of spirits were preparing him for his next adventure. No escaping to have an adventure on his own. Not this time.

Copyright 2011 by Melanie Mulhall

Cheating Death One More Time

November 18, 2011

If Howard wanted to be the inconspicuous recipient of a blood transfusion, collapsing at the hospital entrance was not the way to do it. The medical staff crowded around him like a pack of vampires on a warm body. I could do little to help. He was already annoyed with himself and with them. I did not want to say or do anything to make matters worse. I stood back while they attended to him, wondering what the split in their attention was between fulfilling the Hippocratic Oath versus mitigating hospital liability.

He was taken to the emergency room, as opposed to the ambulatory care unit where he was to receive his transfusion. We were in for a long day. There is irony in coupling the word “emergency” with that particular unit in a hospital because there seems to be little urgency to the treatment received there. But on this day, the emergency room was bustling. On our way to the hospital, we had passed a serious looking accident, not half a mile from the medical center. If you’re going to have an accident, being close to a hospital is genius. By the time Howard was ensconced in a treatment room, the human wreckage had arrived at the hospital.

Still, they were living up to my expectations, at least as far as my husband was concerned. He was not a priority and we were mostly left alone for long periods of time. Ultimately, the medical staff wanted to admit him and keep him tucked away in a room at least overnight, thereby providing me with an opportunity to demonstrate that I could be trusted on the “no ambulances, no hospitals” pledge. He and I were a united front: no admission.

Hours—and endless frustration—later, he was placed in a private room in the ambulatory care unit and they were beginning preparations for his transfusion. Even as an outpatient, he was going to be there all night. The transfusion would take that long, not only because they were going to give him four units of blood, but because he had to be given saline infusions after each unit of blood. This would, of course, put a demand on his already overworked urinary track. Fortunately, there was a bathroom right outside his room. Unfortunately, he was hooked up to a monitor because of the earlier incident. In theory, that meant he would need to buzz an attendant every time he needed to go to the bathroom. In practice, I knew he would simply rip the sensors off, thereby setting off alarms, and struggle unassisted to the bathroom.

It didn’t take him long to prove me right. It was not only going to be a long night for Howard, but also for the ambulatory care unit staff. After helping him order some food, I made my escape. My presence all night would be of no help, and I was not keen to be an observer to the paces he was going to put the staff through. It had been morning when we made our way to the cancer clinic and it was now past sundown.

In a moment of stress induced practicality, it occurred to me that I should make a stop at Gretchen Minney’s house on the way home. She had some of my canning jars and I needed to collect them. I called to see if she was home. She was. I told her I would swing by to get the jars on my way home from the hospital. Hospital—the magic word. That was all I needed to say. By the time I reached her house, she had a plate of hors d’oeuvres and a bottle of champagne waiting for me, along with an open heart and a willing ear.

Every once in a while, a friend not only proves herself, but demonstrates her keen understanding of your precise needs. Even the best of friends do not often manage that, but this was one of those moments. It had taken me ten minutes or so to get from the hospital to her house, yet all was waiting for me when I arrived.

Awards are given for all manner of heroic acts, but never for an act like this. How would it be submitted? How could it be described? I couldn’t say that she had saved my life. Technically, she did not save my life that night. But I would argue that a glass of champagne, some nibbles, and the simple act of bearing witness to a story of crisis are highly underrated as life saving measures.

I was gravely worried and with good reason. When I brought my husband home the next morning, he went to bed immediately and slept most of the day. The following day, which happened to be the day before Thanksgiving, he was no better. In the past, transfusions had perked him up and brought color back to him. This transfusion had done neither.

That night, he was uncomfortable to the point of admitting it. His entire body was rebelling and in pain. Breathing was especially painful. He had been prescribed Ambien to help him sleep and oxycodone for pain, but had taken little of either. Now he asked me to bring him both. My husband, the stoic, was moaning and I found it unsettling. I couldn’t imagine how bad it had to be for him to be moaning. This was the man whose pain measurement was based on the level of pain provided by a gunshot wound. I gave him the requested medications, climbed into bed with him, and held him. After an hour, he felt no better and he looked scared.

I knew I needed to act and I knew whatever actions I took would be further demonstration—or the lack of it—that I could be trusted to follow his wishes. I asked if he wanted an ambulance. He was adamant that he did not. I had to honor that, but I also had to do something. I told him I was going to call Antonio. He fought against it, wanting no one to come, but it was either an ambulance or Antonio.

Antonio, the shaman to whom I had been apprenticed, was not only a shaman, but a nurse. He had urged me, over the last few months, to call him—night or day—if I needed his help with Howard. It was after 11:00 p.m. and I was ready to take him up on his offer. I called to find that he was still awake. I explained the situation and I think he must have been getting his clothes on, preparing to leave, before he hung up. I knew, from years of driving between my house and his, that it was a thirty-five minute drive. He arrived a good ten minutes earlier than it should have taken him. He had clearly ignored the posted speed limits all along the way.

I crept into Howard’s room to tell him that Antonio was with me. Howard was delirious and nearly incoherent. He muttered, “No, no. I’m asleep. I’m asleep,” thinking, in his confusion, that I had called an ambulance. I explained that it was Antonio, no one else, and that he had come to see if he could help.

I had never witnessed Antonio’s work as a nurse and was stunned by his ability to gain Howard’s compliance and trust with little more than a few well chosen, calm words. Well . . . that and summoning up the kind of energetic power few but those of us who practice shamanism can muster. He took Howard’s vitals. Blood pressure: 60/40. Pulse: forty beets per minute. Respirations: almost undetectable.

Antonio met me outside the room and told me it was unlikely Howard would make it through the night. In fact, he thought Howard would pass very soon. We sat, side by side, on the cedar chest at the foot of my bed in the master bedroom. And we waited. I had some Jameson’s I’d bought to make hot toddies with and I got each of us a slug of it. He might not have needed it, but I did. Years of treatment and months of declining health had skidded, abruptly, to a stop early Thanksgiving morning.

But after an hour, Howard was still among the living. Weak vitals, but still alive. Antonio went home, expecting that the next call from me would be the call to say that Howard had passed. He had no sooner left than the moaning began again. I called his cell and asked what to do. He suggested I give Howard another small bit of medication.

Sunrise found me exhausted and anxious . . . and my husband still alive. Thanksgiving Day. It was not clear to me if I should be grateful that Howard was still alive—my immediate instinct—or sorry he hadn’t passed during the night. And there was no way to know if he would make it through Thanksgiving Day.

What I did was so predictably Melanie-in-survival-mode that I saw it for what it was, even then. While Howard remained semi-conscious, at most, I made stuffing, baked the twenty-two pound turkey, and otherwise carried on as if there would be someone other than me to eat Thanksgiving dinner. And I gave thanks for everything good and true in the world.

Copyright 2011 by Melanie Mulhall

The Beginning of the End

November 1, 2011

There are pivotal points in life. Life is often compared to an hourglass, our days like the sand dropping one grain at a time until all the sand runs out. Maybe, but the sand does not trickle at a constant rate. Certain events speed things up. Like the pebbles in a rain stick, there is a point where the trickle that sounds like raindrops becomes a flow that sounds like a downpour.

The radiation treatments were coupled with a regimen of steroids. The steroids made Howard a little cranky. Then they made him easily annoyed. Then they gave him the kind of short fuse he’d had twenty years earlier and which he’d gotten over as age and life softened him. At first, I didn’t like the transformation. Then it scared me. He accused me of trying to control him when both of us knew that neither of us could actually control the other. That had been worked out years earlier. When he became instantly angry over something trivial and actually raised his arm, as if to strike, he frightened both of us. He didn’t know what was happening to him. Neither of us was sure it was the steroids, but I suspected as much. He called his doctor and quickly went off them. Within a couple of days, he returned to the kind of equanimity we were both more comfortable with.

In only a couple of weeks, the radiation treatment was complete. In a matter of speaking, Howard was fully cooked and he was weakening before my eyes. I had become proficient at determining when he needed a blood transfusion and I was sure he needed one. For a couple of weeks, I nudged. He wasn’t ready. Then I pushed. He still wasn’t ready. Finally, I asked him what was going on, why he seemed reluctant to call for an appointment to have his blood tested. He’d had blood transfusions when he needed them for months. Why was he dragging his feet now?

Something in my tone, combined with his weakening state, broke through the defenses. He admitted that he was putting off having his blood tested because his radiation doc had told him that if there was a reoccurrence of his symptoms, he should have his wife drive him to the hospital. I was certain that his doctor was referring to the symptoms related to the cancer having spread to the dura—the numbness in his face, for instance—and not the weakness associated with needing a blood transfusion. But it was the word “hospital” that had brought him up short. He feared that all of the doctors were giving up on him and he would now be consigned to hospitalization. And that was the last thing he wanted.

It took him a good minute or two, after dropping this bit of information, to add that he did not want to complicate his life—meaning the hospitals and everything that went with it. He was near tears. I bust out laughing.

“Complicate your life? Do you realize how ridiculous that sounds? Complicate your life? Could it get more complicated than it already is?”

And then I invoked the Gretchen Principle. Gretchen, meaning Gretchen Minney. The Gretchen Principle was a reference to something she had done when her husband, Bill, was dying of a brain tumor and found himself in the hospital. He wanted out. Gretchen understood the implications of doing so, but broke him out anyway. She commandeered a wheelchair and they escaped.

I told Howard that I would not allow anyone to keep him in the hospital against his wishes. I added that I was in agreement with him to stay out of hospitals if at all possible. I promised to break him out, as Gretchen had done for Bill, if necessary. He was relieved and seemed to relax a bit.

It was a good agreement. We would need it soon.

The morning he finally decided he needed that blood test, he slowly made his way from the upper level of the house to the lowest level and took a seat in my office, where I was busy editing.

“I need you to drive me,” he said.

I turned to face him, raised my eyebrows, and told him I would drop what I was doing and take him. “I need you to drive me” was code for a lot of things.

I had been concerned about his driving. His doctor had not forbidden him to drive because he hadn’t had a seizure, but driving seemed risky at best. He’d fallen more than once coming to or going from the truck when he felt particularly weak. He’d made it into Newsland on one occasion, only to fall once inside. An ambulance was called. He was mortified and talked his way out anything but a quick check. That he’d actually told me when he returned home was a surprise because he had been embarrassed and it was exactly the kind of thing he might have kept to himself. Apparently, he had come to the conclusion that he needed a confidant about such things and I had proven myself trustworthy. Not an easy decision for a former Marine and Chief of Police.

When I’d expressed my concerns about his continuing to drive, he had promised me that should the day ever come when he felt he could not drive himself somewhere, he would ask me to drive him. I hadn’t believed him, but he was doing just that—right in front of me. I was not so much surprised by the fact that he was too weak to drive as I was him admitting it.

He was so weak that I’d told him, wryly, that he’d be dead soon if he didn’t go for a transfusion. It was that critical. I had seen him in need of a blood transfusion before but I had never seen him this weak.

Slowly and with care, we got into my car and made our way to the cancer clinic. It was only my second time there. He had insisted on going alone for all the time he’d been treated there. I’d gone with him when we discussed the matter of radiation treatments, less than month earlier. When we arrived, the nurses immediately saw what I had seen. They took a blood sample and assured him that even without seeing the results, they could tell he needed a transfusion. I offered to place a bet with them on the number of units, knowing it would be at least three. That told them pretty much all they needed to know about the wife. They could see that I was neither naïve nor weak spirited. They could also see that I was not going to be placated or assured. I was calm, I wanted answers, and I wanted to know what we needed to do for my husband—right then, right there.

Three was an underestimate. He needed four units. The nurses were very concerned. He was used to having the blood work done one day and the transfusion the next. There wasn’t going to be a delay this time. He was going to get that transfusion as soon as we could get him to the outpatient unit at the hospital and he was going with an oxygen tank in tow. His blood oxygen level was 82-85%. No compromises, no leaving without the tank.

He objected. They persisted. He growled. They were adamant. He did not want to be seen as an invalid. Didn’t matter. They rigged him up with a tank while they made arrangements for the transfusion. Arrangements made, we left the clinic with an oxygen tank trailing us. I got him settled and the tank settled. Just as I was about to drive off, heading for home to grab a few things before continuing on to the hospital, he said, “Be careful,”—meaning that I should take care with my driving.

I left the car in “park,” turned to look at him, and said, “Are you kidding? Be careful? We can’t get into an accident. We have an oxygen tank in the care. If we’re hit, we’ll blow up.”

The absurdity of it was so funny that it was verging on Monty Pythonesque. It wasn’t quite . . . but we would be all the way there shortly.

At the hospital, I swung around to drop him off at the door. He was not going to let me help him in and he was not going to let me get him a wheelchair. The best I could do was drop him off, snag the closest parking spot I could, and sprint back to him. I found a spot very close and was away from him for less than sixty seconds. Too long. As I approached the hospital doors, I could see that he had never made it inside. He was on the ground with a flock of people around him. To make matters worse, the automatic doors kept opening and closing on a woman who was also on the ground. I soon found out that she was a nurse assistant who had been in the wrong place at the wrong time. She was coming in as he was and when he began to go down, she tried to catch him. She was a small woman. Even ill, he was a large man. The doors thwamped and thwamped on her until someone finally stopped the beast.

Howard was on the ground, conscious and annoyed. Doctors and nurses were gathered around him. That part was good. Someone called for a neck brace and a board. That part was also good. But numerous people kept asking him the same questions, over and over. “Are you conscious? How long were you out? Did you lose consciousness? Can you move?” And on and on. One time would have done it as far as Howard was concerned. He wanted to answer the questions and get the heck out of there. He was embarrassed, unhappy at being prone, and becoming increasingly annoyed by the mantra being murmured by the medical staff in the form of questions.

If there was any chance that Howard might get a glimmer of understanding that he had waited just a tad too long to go in for a blood transfusion, it would happen right there as he lay on the cement in front of the hospital doors. It was alarming, but it was so . . . so . . . Howard. There was something just a bit funny about it. The thwamping doors. The fact that I knew some version of “Just shoot me” was being muttered just enough under his breath as to be imperceptible to anyone but me. The surreal quality of it all.

Not funny at all was my internal radar. It was on alert and sirens were going off inside. I knew that this was the beginning of the end.

Copyright 2011 by Melanie Mulhall

Coming to Terms with It

October 24, 2011

For some years, I had been erratically hypersensitive to endings and beginnings. I cannot recall quite when it began, but it was after my husband left for Kosovo in 2000 and before he left for Iraq in December of 2004. I say that it was erratic because I could not predict the people or circumstances that would trigger it. For instance, our friend Andy Wilkinson would come for a visit of two or three days and the sense of a very real ending would wash over me when he left, for no apparent reason. But some other day, weeks later, I might wake up entranced by the way the sun filtered through the trees and feel a sense of beginnings. Again, for no apparent reason.

This happened again and again, often enough that the phenomenon did not escape my attention. But then, it couldn’t have because the endings were tug-at-the-heart endings and the beginnings were first-day-of-the-world beginnings. Objective reality was irrelevant. This was highly subjective and very real to me. Sometimes I felt that I was apprenticed to some archangel of endings and beginnings; at other times I felt that the accumulated endings and beginnings over many lifetimes were pressing down on me in this lifetime.

When Howard’s cancer metastasized to the dura, with tendrils threatening the brain itself, I had that sense of both an ending and a beginning, all in the same event. Earlier that year, I had begun to suspect that my hypersensitivity to life’s alphas and omegas had been a kind of training for what was to come with Howard. By late October and early November, I saw the wisdom of it. This was a time for him to lessen his grip on denial: an ending to the smoke and mirrors. It was also a time for accepting that death was closer than he would have it: the beginning of the end, followed by the ultimate ending, followed by a beginning into some state and condition that was a mystery to him—and is a mystery to us all if we are honest about it. And because I was his companion on the pilgrimage, these endings and beginnings were felt by me too.

I knew I would have my own endings and beginnings with his death, but life had placed me in the most elegant of positions for the time being and that position was both feet on the ground, right in the present moment. It was not an option. It was not some lovely payoff for years of meditating. Nothing so grand as that. It was simply the increased focus and amplified sensory acuity one has when they are with someone who is dying. I was witnessing and experiencing endings and beginnings on a daily basis.

Howard began to release his denial about the encroachment of death. He had a sense of urgency about seeing some people and one of them was Pat Wilcox. Howard had probably known Pat for somewhere between thirty and forty years. They had met when Pat was a journalist for a local paper and Howard was a cop with the Lakewood Police Department. They shared a love of writing and Howard was, no doubt, taken by her intelligence, keenness of mind, and riveting personality—the same things that drew him to certain women, in general. But Pat was special. It wasn’t a romantic thing; it had never been that kind of relationship. But there was a bond built from shared confidences, conversations both cerebral and earthy, teasing, and collegiality. He loved her and hadn’t seen her for a number of years. He wasn’t sure she still lived in Colorado and, in fact, wasn’t sure she was counted among the living at all.

But a chance comment at an event put him hot on her trail and he tracked her down at a retirement complex for veterans . . . on the other side of the metro area. He insisted on going to see her, despite the fact that his doctor wanted him to curtail his driving—both in regards to distance and frequency—and despite the fact that his old red truck was having difficulty getting into gear. He needed to see her and he did. I worried but mostly kept my mouth shut.

I recognized it as one of the signs that he was coming to terms with the fact that he didn’t have much longer to live. While he didn’t say it, I suspected he saw the radiation treatments not only as a way to mitigate some potentially nasty problems, but also as a way to buy him just a little time to come to some kind of closure within himself and between him and important people in his life.

This did not mean that he had developed a newfound willingness to talk about his condition. He was still vague about it with his friends. He did not even tell Pat Wilcox details—despite the fact that on at least one occasion, he went straight from a radiation treatment to her abode.

Before one of his friends came to town from out of state, I attempted to fill him in on just how risky it was for Howard to be driving around the metro area and asked him to meet Howard for lunch somewhere much closer to our home than they usually did. It wasn’t until they had that lunch—at the place they’d been lunching together at for years, a place many miles from our house—that his friend began to get an inkling that this might be the last time they would see one another. It wasn’t that Howard told him explicitly that he was dying. Howard had not told anyone that he was dying in those exact terms. But he had a way of leaving things unsaid, of leaving gaps in the telling, that allowed the observant conversation mate to at least have suspicions. That and the fact that he appeared to be a more fragile version of himself than anyone was used to seeing.

Those occasional meetings with friends left him spent. He would return home and head straight to bed. The radiation treatments were also draining him. And I was finding it increasingly difficult to interest him in eating, despite my complete about-face on what qualified as food. Howard had a sweet tooth and a tolerance for junk food. Left to his own devices, he would have happily chosen donuts over eggs for breakfast and apple pie over just about anything else for dinner—on a regular basis. Fortunately, I was a cook and he loved my cooking. Fortunately, too, I limited the junk food in the house. But now I was happy to present him with donuts, apple pie, or anything else that he was willing to eat.

One day Howard told me that he’d once heard of a man on his deathbed who, when asked what he regretted in his life, had answered, “Not enough apple pie. Not enough beer.” That became a private joke between us. Fortunately, we could still laugh.

Copyright 2011 by Melanie Mulhall

Worst Fears

September 26, 2011

What we fear most sometimes ambushes us when we are otherwise preoccupied with challenges we believe are, in themselves, about as much as we can take. My husband had a brilliant (if sometimes perplexing) mind. He was a wordsmith and the keeper, in our household, of obscure words and interesting etymology. He was a deep thinker, though he occasionally proclaimed that if personal depth could be compared to the depth of a pond, his would be revealed as being only ankle deep. I felt it would be measured in fathoms, not inches.

The decline he experienced the summer and early fall of 2010 was mostly a physical decline, not a mental one. He could handle the physical decline, even if he did not like it. His worst fear—and mine for him—wasn’t physical decline, but losing his mind during the downward spiral.

The threat of that ambushed us in mid-October. One of his closest friends, Andy Wilkinson, was visiting from Texas. I had urged Andy to visit because I feared that Howard might die before they had a chance to see one another again and something in my sense of urgency had gotten through to him.

Neither Howard nor I thought much about the MRI scheduled during Andy’s visit. There had been so many scans and tests over the previous three years that I no longer gave them much mental or emotional air time because they almost never revealed anything important or even useful. But the MRI had been scheduled because Howard had reported some rather puzzling symptoms during a checkup. He’d been having a certain numbness on one side of his face that seemed to be present when he was prone and went away once he was out of bed and moving around a bit. He hadn’t been quick to tell me about it and when he had, he hadn’t seemed overly concerned. The fact that he had actually informed me of the symptom should have told me more than his seeming lack of concern about it. But my antennae must have been slightly misaligned that day.

I’d chalked it up to his overall lack of mobility. The blood just wasn’t having a chance to circulate like it should. I had little fear of stroke because it didn’t fit the kind of numbness connected with stroke. He and I had both noticed that words were occasionally failing him, too, but that didn’t alarm me, either. It wasn’t severe and I thought it to be symptomatic of his overall decline.

The MRI was just a minor interruption to an otherwise lovely visit by Andy. In fact, Andy went with him to the appointment.

His doctor called the house before they returned. The cancer had metastasized to the dura—the covering of the brain. There were also a half dozen nodules between the dura and brain, one of them large enough to be putting some pressure on the brain. That was probably what was causing his symptoms.

This was the first time in fifteen years his oncologist had seen this kind of metastasis in one of his prostate cancer patients. The online research I did later suggested that cancer metastasizes to the brain in 1-2% of prostate cancer patients and that this percentage might actually be inaccurately low based on the autopsy results of some men who had died of prostate cancer. It would seem that the cancer might be finding its way to the brains of these men more often than assumed, but when it did, they often died before it was discovered.

As his doctor talked, it seemed to me that the fear I’d never allowed handhold, foothold, or any purchase at all in my mind was standing in front of me and making faces, instead of just climbing around in my head. If the cancer continued to spread in this area, any number of alarming and deadly things could happen, depending on the part of the brain impacted. He could have seizures. His ability to swallow, breathe, see—in other words, his ability to perform one or more bodily functions necessary to live—might be impaired. He could lose his ability to speak . . . or even think. The possibilities were ugly.

I was in tears when he and Andy got home. One look at me, before I said a word, told Howard that something was very wrong. I don’t think he immediately connected it to the MRI because, like me, he hadn’t expected the MRI to tell us much. Andy was an innocent caught in a drama he hadn’t auditioned for. Fortunately, Andy was as good a friend and as strong a man as I had always believed him to be. But he’d come to our home without having seen, first hand, Howard’s decline over the past few months and was now finding himself in something of a B-grade horror movie.

I think Howard’s doctor had been in shock, too. He didn’t hold out much hope for doing anything about this newest development during my initial conversation with him. But by the time we saw him, less than two days later, he had a plan. We could do nothing about this newest development. Or . . . Howard could undergo a round of radiation treatments, not to effect any “cure,” but to mitigate some of the potential consequences of the metastasis. In other words, if we were lucky, Howard might continue his pilgrimage toward death and ultimately die without losing his senses or his mind.

Neither of us was keen to have him undergo radiation treatments, but we were both relieved by the sliver of hope that having them might allow him to maintain some of that keen mental prowess so important to him.

I found myself supporting the idea. Howard had chosen an allopathic, conventional approach to the treatment of his cancer. It was not an approach I liked. It was an approach I doubted I would take if I were diagnosed with cancer. Yet, here I was—the woman who mostly disdained the entire approach to medical “care” in the Western world—not only supporting radiation treatment, but feeling grateful that it was an option.

As for Howard, he never wavered from his stance that Death was going to have to do more than show up and invite him to depart, it was going to have to wrestle him—like the angel who wrestled Jacob through the long night. The poet Rainer Maria Rilke once wrote that it is not winning that tempts the man who would wrestle with such an angel. On the contrary, the man who would undertake a match like this would have the wisdom to know that being defeated by such a powerful being would make him more than he had been before the match.

Perhaps, but Howard wasn’t quite yet ready to surrender in this way. He wanted to hold on to any shred of his physical presence that he could . . . and as much of his mind as could be bargained for in the delicate negotiations between Death, allopathy, and his own considerable will.

Copyright 2011 by Melanie Mulhall