Harvesting a Loss in Eulogy

Harvesting a Loss in Eulogy


Storied:
My baby brother passed away this past Thursday in Grapevine Texas at 8:36 in the AM. David was 59. Ive begun writing this today exactly to the day and minute in the weeks time lapse of his passing. Hepatocellular carcinoma (liver cancer) took him although it should never had advanced to stage IV as David once had hepatitis C. Through interferon treatment he was cured, but Hep C survivors should have three month checkups then go to six month checkups if all is going well after a year’s time. The reason being is that hepatitis C survivors run a good risk of developing liver cancer. David’s doctor, Dr. Theodore Nophsker, his supposed health care provider never ordered an annual liver checkup much less a three month evaluation. Liver cancers are slow growth tumors and this one had three and a half years to reach its deadly zenith in being inoperable.  

Brother Dave and I

Although in only wanting to remember the times in his life, I was there through it all in his last remaining days because he so wished it. The last twelve hours were grueling, but the last six minutes were pure torture. To helplessly sit and stand there by the bedside as...the one you grew up with, shared deep thoughts with...his life ebbs away is closing in on the specifics of catastrophic. It is so final, an ending witnessed to all that was once before. The hearing of his voice and laughter, that tranquil feeling in being in his company no more...gone...

This episode all started when my brother Dave was visiting me up here in N.W. Pennsylvania. The night before he was to go back to Texas, he had the initial painful chest attack that became the beginning of the end while we were watching my daughter Claire’s gym practice. He had previously had a heart attack and this is what it initially appeared to be. Rushing him to the hospital and once stabilized, the medical personnel ran a CAT scan. The results were puzzling as they informed us whatever was causing the blockage must have exited fairly quickly as no real damage could be detected in the vicinity where he was complaining of the pain.

After further evaluation of the chest scan, they noticed the large mass in his liver. They theorized the mass began applying pressure to his diaphragm. This caused the heart to convulse. The stints put in from his former heart attack are rigid and when the heart convulsed, the stints rubbed up to and irritated the softer heart tissue.

It first appeared that this was a blessing in disguise, no real heart attack and a chance to reveal the cancer and commence treatment. But due to the tumor’s massive size and its metastasizing to his lungs and throat beside his larynx, as it turns out, it was only a harbinger of a few weeks left. That is another thing David’s doctor ignored or overlooked.

When he was visiting me and the family last spring, he had a peculiar cough. I asked him what it is and how long he’d been doing this. He felt it was a cold that he’s had for a couple of months. I told him colds don’t last two months, why don’t you go see my doctor up here. He preferred to go back to his and check it out. Once he left for Texas, he did make an appointment. Doctor Nophsker told him to open his mouth where he stuck a tongue depressor inside, gave a quick look then wrote up an antibiotic prescription.

David said during phone conversations that the antibiotic kind of walloped him, but didn’t do anything for the cough. No wonder, he had a condition, not an infection. If the good doctor had really observed his throat he would have seen there was no bacterial infective redness, but a small lump in his throat. If that was detected back then, the disease could have undergone earlier treatment by almost a year’s time and perhaps have saved David’s life.

In getting back, once David was stable enough to leave Pennsylvania, we rebooked him for a flight back to Texas where he was to begin treatment. Back in Texas he forced an open appointment with his doctor as his office had not reserved one, even though we had been in contact with them while he was still up here to get an immediate appointment for him once he arrived in Texas. Supposedly that was arranged on their end and verified by my phoning them.

While there, the good doctor reviewed the records and CD scan taken in Pennsylvania, then pronounced to David, you have three-six months and I hope you don’t have Obamacare because it won’t be accepted down here in Texas. This upset David and rightly so; what business is it of his what insurance David had, but to throw that into the mix after just telling David his end is near, in my opinion is asinine.

Further after David inquired, the good doctor told my brother that health care is a privilege and not a right. If that is your opinion, fair enough no matter how crass it may be, but if that is your opinion, in my opinion you have no business being in the health care profession.

With the quick appointment wrapped up, Doctor Nophsker walks him to the receptionist desk to fill out the paperwork and as he’s leaving to go back to the patient receiving rooms, he turns around telling his office girl to, “Oh yeah, why don’t you write down an appointment for David in six months this June;” this, after he had just issued a three-six month death sentence. One day, I will visit the good doctor’s office and will find out if he was giving David some hope or was merely being sarcastic.

It took a week before David could see an oncologist then another two and half weeks before treatment could commence. Meanwhile, his health is deteriorating daily. On a Wednesday his treatment was supposed to start, but that Monday before, he became jaundiced indicating liver failure. His daughter, Jennifer was there as his caretaker, flying in from California. She phoned me in asking what to do, so I stated, get him to the hospital since his oncologist was on vacation.

From there, I arrive in Texas early that Wednesday morning. Immediately speaking with the doctors, it appeared that they weren’t doing ‘this’ because an ‘aforementioned’ came up first and couldn’t do ‘that’ until ‘these’ go away. Meanwhile, David’s kidneys are at two-thirds failure as overloaded in attempting to perform what they can’t and what the liver has failed to do.

To me, in my interpretation, it was as if they were justifying a chain reaction of events to not treat. It was specifically explained as nobly as I could that we are not simply going to roll over and allow David to die without first putting up a good fight. We are going to do our darnedest in reversing the chain reaction, so told them to give me options and elaborate on them.

The attending gastro-intestinal (GI) doctor stated that the main bile duct that empties into his small intestine is totally obstructed and blocked by the tumor. They cannot blindly try to unblock it by stinting it. I inquire about the minor bile ducts within the liver and the doctors say yes they are visible and dilated, but they felt these tributary ducts would not aid the liver if they were stinted.

I replied, “Look, I understand an endpoint, but not until we’ve exhausted all avenues, this is a shot no matter what low percentage you give it in being successful.” Finally, with my brother Mike seeing my side and aiding me in the discussion, the GI concluded he would talk to the surgeon to set up a surgery for tomorrow morning.

That morning as Jennifer and I accompanied David into the surgery room, the surgeon said, “This most likely won’t work, but I’ll do my best.” I quickly replied, “Good! Your best is the best and I thank you for it.”

The surgeon performed the surgery and attached a drain bag to collect the bile from the liver. The next day, David’s kidney count had dropped from 2.72 to 1.04 nearly there to normal functioning within the range from 0.01-1.00. His liver bilirubin count had dropped from near 20 to 9.98. Another GI doctor came in and stated that if it continues, it should reach 5.0 or less in four-six days, then we can start treatment. It was fantastic news, but wasn’t to last.

David had an episode that Saturday night hallucinating on the morphine. With his open palm he hit Jennifer on her right temple then literally tore his IV line in half and ran into the hallway trying to leave the hospital by entering other occupied rooms. Jennifer phoned me and by the time I got there, he had already been secured and calmed with sedatives. That morning his bilirubin count instead of going down went up to 12 something. However, his kidney count had still dropped further to 0.94 which is now in normal functioning range.

I said, before we do anything let’s see if the bilirubin count was a fluke. Perhaps with the adrenalin his body had also pumped more bilirubin into his bloodstream. Before David’s hallucinating episode, his bile bag had to be drained once every six hours. Now it was filling up every hour. I was hoping it had opened up another stagnant area and was draining more efficiently, but that was not the case. The next count had climbed to over 15 then over 17.

David’s wish was to stop treatment and allow the disease to take its course. I was wrong and the physicians were right, but even in realizing the endpoint had been reached, I surely knew we had done the right thing in fighting. It wasn’t that I was pushy; I was simply aiding his body which was doing all the pushing and fighting.

His body had fought hard and won in battling hepatitis C and interferon treatment that has its own side effects on the liver. His body fought hard and came back strong from a previous stroke and a ‘widow maker’ heart attack. It wasn’t giving up any inch either on this cancer.

David has always had a low tolerance to pain. It didn’t matter if it was a pinch on the arm, stumped toe or a tumor in his liver, he dramatized the pain. Bless him though, for out of us four siblings, he was always the prime target prone to injuries. For sure he was in pain with this affliction, but he did dramatize. He would say, “Oh Lord take me,” then I would interject his pain level scenario and he would change from a forlorn defeated face and whispering voice to chewing me out. I adored that, for it signaled to me he still had fight in him.

Once after accepting there was nothing else that could be done I had to tell our mother. She had intentionally not been going to the hospital, because for her as out of sight everything would turn out OK. I understood this well, for no matter how old a child is, a mother does not want to see her child die. Going back home and telling mom was very, very difficult in explaining that David’s status was now changed from healthcare to imminent care; in other words taking him off any life support, only now to simply make him comfortable for the ultimate end. Explaining this to mom, it finally hit her and hit her hard. She agreed to go up and see him.

Arriving in his room, I led her to sit next to him where he was already unconscious due to sedation. As we were all there, she put her arm up around him then gently hugged his head saying, David, David, my son. The scene was surreal and emotionally draining, but also uplifting in seeing mom display her love and affection for her son. It was also good for her in an accepting value. She released her emotions for her baby son instead of having them remain pent up.

I am forever glad though she did not witness the end. In his last minutes after his kidney’s had failed, then his liver and then his lungs, his heart resisted making his shoulders lunge upwards and his lungs gasp. Then slowly within the next five minutes his heart beat no more.

Holding, watching your loved one pass is ever so hard. Feeling his warmth turn to cold, feeling his body go from flexible to rigid was an enduring saga. Then to see his daughter Jennifer, who had to witness her mother passing almost ten years to the date of liver failure as almost the same fate as her fathers was wrenching. She hugged him sobbing uncontrollably repeating, my daddy, my daddy, oh daddeeey.

At that moment David was here no more...

Epilogue:
I have protected my brothers from bullies all their lives. If anyone was going to pick on them it was only going to be me. But this bully I could not touch and much worse could only watch as it did its bullying damage. My only conciliation is that while my brother is in final peace somewhere else that tumor is now dead and nowhere.  

My Brother Dave advancing his politics

I have learned from this that the hardest two breaths we take in life is the first one when we are born that gives us life and the last one taken when we die that takes away life.

Death is as much a part of life as birth is, but in comprehending that, it still doesn’t alleviate any pain from its finality. Grievance has no time frame.

There is nothing no one can say that can ease the current pain. The only true deed a friend can offer is in simply letting you know they are there whenever you call them to be.

From some relatives, some of the medical staff and even David, I was told to let him have his wish to die and eliminate the suffering. I was even told I made him suffer an extra few days due to the surgery decision. But I am proud of my decision, for I was not going to let my brother go down without throwing a few fighting punches back. We all experience the same emotional pain during a death, but we express it in our own individual terms. I expressed mine, they expressed theirs, but we all did so in sympathy for my brother’s passing.

At one moment when I was alone with David and his comfort level was at a higher point, he mustered some strength, then sat square up in his bed and told me he wanted to live ending with a little smile. No matter what he was saying in his painful hours, I did my best to honor that moment of what he told me.

Many times a chaplain would come into the room and along with him, family members would pray and say he is going to a better place in heaven. I am the heathen of the family and would think that’s fine, but I don’t want him to be stuck in heaven; I’m greedy, for I want him to check out of heaven and come visit me every once in a while.

Without any measure of doubt, David, out of the four siblings gave my parents the most trouble. But it was him that was most impacted from our father’s death. David possessed a very kindhearted soul. Thrifty in all aspects when it came to spending on himself, he’d give his last dime to anyone he felt so in need of it.

I terribly miss my brother Dave. He not only was my brother he was the only true ally I had in battling life’s punches.

I hear his voice and deep laugh as plain as day, but only from within and never again from outwards. I love you David...

The Four Seasons:
I place David upon a higher pedestal rather than mixing him up with manmade gods that are no older than six thousand years. Of time immemorial, I place him with that very element that causes an atom to vibrate and issue warmth. I put him squarely within this universe intermingled with the exploding nova, galaxy formation and the force that keeps the universe forever expanding. I place him as fixtured permanence to this universe’s energy and relish in the memories I have of him when this universal energy transformed a minute part of itself into David’s life force.

No one can say where he is now, for no one has truly come back from the dead to express what it is after an earthly death. Some might quip, but oh yes they have, but no they haven’t. For if you are truly dead, you are not coming back. Experiencing a few moments’ worth of a coma state is not being dead once you regain consciousness no matter where the brain’s misfiring neurons took you. My brother could just be nonexistent as one whole to being in a state far grander to any one god’s mythic heavenliness.

David wanted to come visit me during the four seasons we have up here in Pennsylvania. Of this last trip, he completed that wish in making it here this winter.

Sun setting moment

Just before he became unconscious and although he couldn’t really talk, I hurriedly wrote down a quick note and held it for him to read. I titled it ‘The Four Seasons/Brother to Brother’ It was short and addressed in large lettering. He read it, tearing in between then stating “I miss them, I miss them” in reference to my two daughters, Claire and Paige. They had an especially fond bond for one another based all on having fun in life. He wanted so much to see them one more time.

Debating on whether to publish it here, I decided the note to remain as shared by only the two brothers. Therefore, it stays with me and of course with David.


Paige, Claire and Uncle David 
David, as a son, brother, father, uncle, nephew, cousin and esteemed friend, you left us in sorrow, but more so forever richer in being attached to us all impacting our lives immensely for the better.

Memories all the way back from day one continually flood into constant thoughts of you.

What I would give just to share one more day...

During the biopsy

In Deep Remorse,
BJA
03/31/2016