Death’s dark angel

As winter feathered into spring, the early weeks of March brought miserable weather, front following front.  One day would have the semblance of spring, the next heralded winter.  Back home from China, looking to come back to the States for good from the Middle Kingdom, I was looking for work.  In the winter ritual of watching Pro football screens together with my father on his big screen, the winter weeks went by as I looked for gainful employment.  With a stubborn, self-possession, my father, now in his tenth decade, was of the generation who never complained of minor ailments or physical irritations, went about life like one a generation or two younger.  It was while we watched the Super Bowl that he first complained of left shoulder pain that he mentioned he had had for a week.  As he sat in his recliner watching the game, he placed a heating pad to the shoulder and took a couple tablets of Tylenol.  He complained no further about it.  Otherwise, his health was ostensibly good, as good as anyone could expect for a ninety-two year old man who flew as a top turret gunner on a B-24 in the Pacific Theater of the cataclysm of the Second World War at the age of sixteen.

Five years previously, a lymph node burst-forth in the inguinal crease of the right leg.  Upon biopsy, it revealed a cancerous core.  The oncologist inspected and scanned my father from head to toe and could find no primary tumor that would have given rise to the tumor.  For lack of any better plan to attack the cancer, they resorted to radiation treatments to the groin.  Undergoing thirty treatments, they appeared to have eradicated the disease for it never arose as ghosts on the biannual chest CT scans they performed on my father for the next five years.

On the Tuesday following the Super Bowl debacle for the Los Angeles Rams, I drove my father in for his last appointment with the radiation oncologist who was following him, examining chest CTs for tumor-like particles in a cloud chamber.  He had me drop him off for the appointment, expecting no astonishments from the test.  My father greeted me as I drove up, where he opened the door.

“They found fluid in my chest.”

My heart sank.  My father’s tumor had returned; that was all it could be.

I parked the pickup and followed him into Dr. McCloud’s office in the oncology center of the hospital.  Greeting McCloud, he showed me the scan, which showed a white cloud of fluid settling into the left cavity of his chest.  Encasing the fluid was what appeared like an orange rind.

McCloud addressed the two of us.

“John, we need to present this to the Tumor Conference and decide what to do about it.”

That surprised me, for when I was a resident in internal medicine, we would have performed a thoracentesis, by the latest, the very next day.  The tumor board would not even meet until the next day.

“John, this fluid might be a tumor, it might be an infection, and it could be other things.”

“What do you think it is?” inquired my father.

“It’s too early to say.”

Walking back to the pickup was somber.  Driving back to the house, my father told me to turn off the radio, which was broadcasting NPR at very low volume.  My father and I remained silent, until he, who hardly ever swore, uttered one last thing before we reached home.

“Shit, if it isn’t one thing, it’s another.”

In the small city of Riverton, my father was legendary for his sense of humor, his grin, his affability.  Everyone he knew, he regarded as a friend.  Over the next few days, as we wondered when they would get around to obtaining a sample of the fluid, my father greeted everyone as he always had, with a smile and a quick quip.

A week later, when they finally got around to it, McCloud had a radiologist introduce a needle into the thoracic cavity and with the thoracentesis, drew out five hundred cc’s of the offending fluid, which showed squamous cancer cells when the pathologist examined it.  Technically, what my father had was a malignant pleural effusion without a primary tumor.  McCloud offered him radiation treatments, not for cure, but for palliation.

At first, nothing seemed wrong.  When one of my friends (really more attached to my father than he was to me), came over shortly after the biopsy results came back, I invited him in asking if he wanted a beer, my dad greeted him.

“Bill, that Rolex you gave me for Christmas is nice, but it turns my wrist green.”

But this was the eye of the storm.  Soon, it came upon him.  He refused to tell anyone that he had cancer and had only a short time.

His health rapidly failing, my father retreated to the confines of his house.  With each coming day, his cheeks were more sunken; with each day, his strength surrendered bit by bit; and, each day he slept more and more.  This from a man who had made his way through life meeting each morning early, moving heavy drilling rods or cement bags, while he managed his business of drilling oil and gas and exploration wells in the waste lands of western Colorado and eastern Utah, and all across Wyoming.  His biceps, that once looked like those of a pipe fitter, becoming tenuous in their atrophy, his legs like pipe stems, he now walked unsteadily through the house, but made it upstairs to the master bedroom where he’d crash into bed often sleeping until shortly before noon.

He refused to take phone calls just as he refused to go out except for the radiation treatments.  My sister and I screened his calls, telling the party on the other end of the line that he was asleep.  Everyone was suspicious, but my sister and I kept his secret dear to our hearts.  I suppose it was mainly his pride in this matter, but I suspect it was also due to his vanity – he wanted no one to see him in this state.

In the mornings, my sister would drive the three of us to the clinic where they administered the radiation treatments.  The same faces were always there, the emaciated wife rent with cancer, accompanied by her husband; the eroded frame of a husband helped in by his stout wife.  The first or second time he went for treatments, a nurse came out, handing him a warm blanket after he took off his shirt, taking him by the arm into the treatment room.

“Say, you don’t have some of those blankets I can take home?” he said with a wan, innocent look on his face.

The final two weeks he was among us, he confined himself to his bedroom and did not come downstairs.  By this time, he was followed by hospice.  About the time he exiled himself to his room, he told me and my sister that he just wanted to go, to pass on in his sleep.  In Colorado, in the last election, a referendum called the Death with Dignity Act passed.  Like Oregon, it allowed for physician-assisted suicide for those with terminal illness.  In Colorado’s law, it required two doctors to sign off two weeks apart, both stating the patient had less than six months to live.  At the time of the election it was a very controversial subject, not only for the medical community, but also for the public in general.  A family practitioner who was my friend offered to be one of the doctors.  He quickly consented.  He went over my dad’s records.  When it came to finding another doctor to pledge the patient was in the late stages of a terminal disease, he could not find any other health practitioner to be in the second.  So, my father subsequently endured an insufferable death.

The last night before he died, I woke at one in the morning and could not fall asleep.  Knowing I could not sleep the rest of the night despite having sleeping pills and plenty of books to read.  I went upstairs to check on my dad.  At first he seemed like he was sleeping.  I whispered to him to wake up.  But he didn’t.  Seeing his chest rising, I knew he was alive, but when I scratched his foot, he didn’t rouse.  I suspected he was slipping into a coma.  Every hour for the rest of the night, I checked on him.  Nothing had changed.  Then about seven-thirty, I thought I heard something stirring upstairs.  I proceeded upstairs, to find my sister, who was also roused by the noise.  Posed face down on the carpeted floor, was my father, this time without a pulse, without any spontaneous respirations.  I turned to my sister.

“He’s gone.”

 

By Joseph Dylan

 

 

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