Thursday, May 24, 2012


He wasn't supposed to go first.

We all thought Mom would go first. Her health has been iffy for a long time now: the out of control blood pressure, the dementia, the congestive heart failure, the repeated falls. The gastric cancer.

Her cancer odyssey started 2 1/2 years ago, on December 30th, 2009. She and Dad had come north to Ohio for Christmas, planning to stay a week. The night before the day they planned to leave, she awoke, passing blood; lots of it. The ambulance was called and she was rushed to the hospital. The Pauken clan converged upon the hospital from corners far and near. We paced, we ate, we stood watch over medical staff, we took care of Dad.

She had lost so much blood that in all, she received (I think) 5 units of blood via transfusion over the course of the next few days. The surgeon discovered an ulcer in her stomach that was bleeding. It was cauterized and we thought that was the end of it. We all exhaled.

As she slowly began to regain her strength, the surgeon reappeared and said he had seen some "suspicious" areas in her stomach "while he was in there".  He wanted to do a biopsy, which revealed the cancer in her stomach. It was a small area. The surgeon proposed a gastrectomy. He would remove the lower half of her stomach and reattach the small intestine. He would pull a few lymph nodes and then we would decide what to do next. We agreed and pushed ahead.

Following surgery, the news was pretty good: no affected lymph nodes and no invasion through the stomach wall. "Stage 1", as I recall. Mom's recovery was slow. She was so very weak from the previous blood loss. The pain medications made her hallucinate.

After a long hospital stay, she was released to a rehab facility. I will never forget the day we moved her in there. When it was time for us to leave, she looked up at us and said, "Don't leave me here." We cried. We reassured her that it would only be for a short time, until she was stronger.

All through a snowy January and February and well into March, Dad drove 40 minutes each way, every day, to be with her. She progressed; she got stronger; then a setback. She fell and broke her arm. She progressed, she got stronger, then she fell again and cut her head open. It was a long, long winter.

She didn't come home to their condo on Lake Erie until just before her birthday in March, 2010. No sooner were they home, than Dad was admitted to the hospital with pneumonia. He had completely worn himself out, taking care of her. We sisters converged on them: cooking and caretaking and helping in whatever way we could.

They both recovered, and in a few weeks were eager to set off for South Carolina. They could hardly wait to return to their home and their friends and social life; to get back to normal.

We convinced Dad that Mom shouldn't be driving any longer and that it was maybe time to think about selling their home in the south and moving back north to be nearer to family. If the events of that winter had taught us anything, it was that being near family was essential.

My Dad's perpetual optimism did not allow for the possibility of future health crises. He took care of himself and worked out several days a week. Sure, Mom had her issues, but she was on the mend and he could take care of both of them. At 84 and 83, they were not ready for assisted living.

Mom was supposed to have seen an oncologist at some point following her surgery, but with the various setbacks, the appointment had been rescheduled so many times it was ultimately forgotten. Mom and Dad weren't too crazy about the oncologist at the hospital and thought they would see a different one anyhow. We were more focused on her regaining strength and balance than about the cancer anyway. The surgeon was confident that he had gotten it all. Somehow the follow-up slipped through the cracks.

The next year brought her a number of falls, one requiring stiches to her forehead. It brought at least one hospitalization for an out-of-control UTI and congestive heart failure. This delayed but did not prevent their return north in the spring of 2011 for Mom's 85th birthday party.

Mom's dementia and other frailties made her very dependent upon Dad. He was her caretaker in every sense of the word. In the last few years he had taken over the shopping, cooking and cleaning and finally, over great protest, the laundry. Although it was exhausting, he seemed in many ways to revel in his role. He watched the food network, looked up recipes on the internet and became quite a good cook. As a launderer, he never quite measured up to her standards, but in all other respects she would say, "He takes good care of me."

That spring I started my weekly trips to their condo on the lake, to give Dad some time to golf or run errands without her. I'd take her shopping or to get her hair done and then out to lunch. It was good for everyone involved. Mom had softened as her dementia had advanced and she was no longer as argumentative and "prickly" as she sometimes used to be. She got winded easily and was unsteady on her feet. We all felt she was declining and tried to make the most of our time together. We had no idea how long she would be with us, but instinctively, we knew it couldn't be long.

It was on my May 10, 2011 visit that Dad admitted that his annual bout of bronchitis had sent him to the emergency room the previous weekend.

"They wanted to admit me, but I told them, "No, I am my wife's caregiver , just give me a z-pack and some cough medicine and I'll be fine in a few days"."

And then he dropped the bombshell:
"They said there was a spot on my lung that wasn't there last year at this time. It's probably nothing, but they said I should have it checked out just to make sure."

My stomach clenched. "What?"

"The doctor said there was a little spot on my left lung that wasn't there on the chest plate they did last year when I was there. I'm sure it's nothing. I'm not worried. I feel fine."

Except he wasn't fine. A day and a year later, he was gone.

Mom had gotten to the point over the past few weeks that she could no longer walk on her own. She used a wheelchair and moved from place to place only with assistance. She was much weaker, with virtually no appetite. She sat in her recliner, where my dad had sat just yesterday, her brow furrowed, lost in thought.

"Are you okay, Mom? Are you hurting anywhere?"

She softly placed her hand on her breastbone.

"Just here. I'll miss him for the rest of my life."

Her aquamarine eyes were watery. She looked away and then closed her eyes and dozed off.

Not 20 minutes later, she opened her eyes and looked around.

"Where's Jim? Has anybody seen Jim?"