By Mark David Blum, Esq.
These past weeks, I have been spending more and more of my evenings at a local hospital on a death watch. A close family friend of nearly 16 years is dying of end stage lung and brain cancer and hasn’t been out of her hospital bed for seven weeks. Daily, her situation is deteriorating but she still has a lot of fight in her. Clearly and admittedly, she is tired of fighting death and pain but is not yet ready to give up. When conscious she is as big of a bitch as she was in full health; which is a good sign that she still has a distance to go. The doctors say “days” or maybe a week or two. All I can do is the mitzvah and sit there and be a friend and shoulder to her and her husband.
I am not going to name the hospital to protect the privacy of those concerned. The onocology unit there seem to be well stocked with the most patient and understanding staff. As in any large organization, the personalities run the gambit from giver to taker. Collectively however, they are doing a wonderful job at pain management and comfort.
It has been a long time since I have wandered the corridors of a hospital in the wee hours of the morning. Standing in the hallway of a cancer ward at 3:00 in the morning, you can hear the quiet gentle moaning of the dying. Every room has its own pain that tends to seep out into the general area between struggling breaths. I can only bear witness to the horror of having to lay helpless and alone in pain beyond relief knowing my body is slowly being consumed from within.
Obviously not every moment is an experience in grief. There is the cancer patient who also suffers from Alzheimers and loves to sing and talk loudly enough to flood the hallways. “Ed” (not his real name) sadly provides moments of levity when he comes out of his room in a military beret and salutes every passing person. Ed’s dying too but Ed probably doesn’t know it or care. Behind his eyes, you can see how oblivious he is to his situation. Some may say that is a blessing. I am not sure.
The unit also has amongst its patients a marathoner. For hours each evening, this patient emerges from his room draped in those worthless hospital gowns, and takes his IV and other machinery as he walks squeaky lap after squeaky lap around the floor. Perhaps he is trying to maintain his conditioning or at least get out of bed and have some exercise. He is lucky to be able to do so. His problem is nothing that WD-40 couldn’t fix.
I don’t know how many of you have ever sat and watched a person slowly deteriorate and die. Trust me when I tell you it is nothing like on television. Every day is a new crisis, a new drug cocktail, a new emergency, and a different appearance. One minute you are helping to wipe shit off her ass and the next you find yourself cleaning blood off her mouth and nose. Her left lung is completely gone now and her right lung cannot transfer enough oxygen to her bloodstream. They tried blood thinners to help the oxygen move around and that just resulted in heavier internal bleeding. So they stop the thinners and blood clots start to form.
At least her personal doctor comes from the enlightened school of medicine that sees modern technology as having an actual purpose. Some old school doctors feel that pain management and treatment should be to the level of tolerance. After all, we wouldn’t want a terminal patient to become addicted to morphine. Enlightened physicians realize the value of technology and use it to eradicate pain completely. Our friend is fortunate to be heavily medicated so as to no be in any real pain. The price we pay is watching her drift in and out of consciousness.
Her husband is the real hero in all of this. Quitting his job and spending every moment he can at the hospital, he sleeps, eats, and lives his life in the small chair made available next to the hospital bed. Last week she was moved to a private room and a cot was given to her husband to sleep on. We spend more time playing backgammon than he does sleeping. Not being a person prone to sleeping much myself, I try and do all I can to keep his mind off the situation. “Time” in an Onocology unit comes to a dead stop. Hours don’t move. Days don’t change. At times, none of us knows the day or the time or even whether it is morning or night. But he is always there. He feeds her and adjusts her machinery and functions as a nurse; since getting one into the room can take up to a half hour.
Last night was a particularly bad night. Like most hospitals, this one too has a skeleton crew working the night shift. While there is clearly less work going on at night, in my opinion, the hospital has cut too many staff for night duty.
Pain management is a paramount issue. From the day she was first diagnosed and we sat around her pool and talked about the entire process ahead of her, ‘pain management’ was a paramount issue. She was more deathly afraid of the pain than of dying. Her husband cannot handle her being in pain. After a few weeks of actual training in the hospital, I showed her husband how to “motivate” hospital staff into prioritizing a response.
The goal has been to not let the pain meds work their way down to where she is in pain again before the next “gift” of pain medication is delivered. Efforts have been sincere to keep the pain medication coming on time so there is no transition down and then back up again.
Last night, the nurses “plum forgot” the 8:00 o’clock pain delivery. By 8:20, her husband and I were in the hallway standing right behind the “drug nurse” and I was talking louder than I should have about having to attend a CLE the next day and how as a trial lawyer, I find such classes to be a waste of time. After some more chatter assuring snooping ears that I was an attorney, the drug lady got right to work and headed into my friend’s room. Apparently the medical profession is deathly afraid of the legal profession; notwithstanding my refusal to engage in medical malpractice cases. They don t know that and waiving a lawyer flag in a medical professional’s face will get an immediate reaction.
I was warned not to do my Shirley McLaine impression because the husband is afraid the nurses might be mean to him or his wife when I am not around. Consequently, I kept my discussion focused and my mouth shut.
When the nurses came in, it wasn’t five minutes before my friend started to choke again on her own blood. Her lungs were siphoned clear and she was sent down to ICU for overnight monitoring. Unlike the cancer ward, the ICU is not set up for family comfort. There is no room to visit and there definitely is no room or ability to spend the night. For the first time in two months, her husband was able to go home about 9:30. We left together, went to his house, got totally shitfaced until he passed out, and then I came home.
Whether it is the lawyer in me or the asshole in me; one of those two features of my character drives me to force these folks to talk about things they otherwise refuse. The husband cannot talk about his wife’s imminent death without falling apart. Same with her family. ‘Death’ is not a subject to be breached. So that leaves just me to sit on the edge of her bed when nobody is in the room and bring up the subject with her. I let her talk and listen and try and relieve her of the stress and responsibility. She talks openly about her death and how tired she is. Over and over, I have to constantly remind her that she is no longer responsible for her husband or her business. The time has come for her to stop worrying about the FM turf vote or who is going to take over What’s Your Beef in Manlius. She worries about whether I am gowned properly or whether my daughter is doing well in school.
Me, I push her away and explain that she is done having to be responsible for anyone but herself. Even that, I remind her is outside her control as the hospital and family have taken over responsibility for her. They clean her, brush her teeth and hair, wash her, wipe her, feed her, and do everything. We share a private joke at how miserable it must be for her husband to wipe her ass after she uses the bed pan … after all the shit he made her eat during their marriage.
I am going to really miss my friends. When she dies and after the funeral, he is packing up to spend his last days and years on a houseboat off of Key West. I told him if he does, he is going to have a room mate. In the end, the outcome is the same. Two wonderful people whose presence in my life made it just that much more better will soon be gone. In their place will be forever a warm spot in my heart for I am a better person having known these two folks.
Anyway, back to the hospital for another round of backgammon and lousy television.
