A death in the family

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgWhile I am on vacation, I’m reprinting a number of “Classic Insolence” posts to keep the blog active while I’m gone. (It also has the salutory effect of allowing me to move some of my favorite posts from the old blog over to the new blog, and I’m guessing that quite a few of my readers have probably never seen many of these old posts, most of which are more than a year old.) These posts will be interspersed with occasional fresh material. This post originally appeared on December 30, 2005, and I’m reposting it today because today marks one year since my uncle died. I rarely blog about personal matters, but I made an exception last year.

I wrote on Tuesday that this is turning into a memorable Christmas, but not for good reasons. I was intentionally vague, mainly because I didn’t yet know how things would turn out and I wasn’t quite ready to write about it.

Now I know. I’m not sure if I’m actually ready yet, but here goes anyway.

I was informed yesterday that my uncle had died the night before. It was not unexpected. In actuality, what was unexpected (to me, at least) was that he had held on so many days. That doesn’t make it any less hard to take, although in a way it was a bit of a relief when the news finally came.

It was early in the morning the Friday before Christmas when I got a phone call. I was at my in-laws’ house in Ohio, and my cell phone rang. The ring tone told me it was my parents. As I tried to rouse myself to some semblance of consciousness, I wondered what it was about. I knew from experience that phone calls before 7 AM are almost never good news. This one was no exception. My mom was calling to tell me that my uncle had suffered a massive heart attack and was in the ICU on a ventilator.

I had been worried that the end was near for my uncle for several months, but this was actually unexpected. You see, my uncle had been battling non-Hodgkin’s lymphoma for three and a half years. I remember well the evening when, while I was at our year-end departmental banquet, the ring of my cell phone startled me (not that many people call my cell). It was my cousin, calling to tell me about the new diagnosis and ask me for advice. Since his initial presentation, he had done well for quite a while, but recently had learned the tumor had relapsed. Having been in a lot of pain for the last couple of months, he was depressed and was not looking forward to the last-ditch attempt at high dose chemotherapy and stem cell transplantation, which would have involved at minimum a month of extreme unpleasantness in the hospital–and that’s if everything went smoothly. Consequently, although I had expected that the end might be near, I didn’t really expect it for a few months at least and was surprised at the form it appeared to be taking.

My wife and I headed from Ohio to southeast Michigan as planned later on Friday. On Christmas Eve, my father and I headed to the hospital. I hadn’t seen my uncle in several months; surprisingly, other than some edema he didn’t look all that different from how I remembered him.

Here’s one thing that sucks about being a doctor. Having a critically ill family member in the ICU like this brings up a load of conflicted feelings and thoughts. Prior to this, I had only had to deal with them twice before, once 16 years ago when I was just an intern and then a couple of years ago. Standing there in that room, it was hard to shut off the physician-analytical part of my brain. I looked at the ventilator settings. I looked at the drips. (He’s on high doses of dobutamine, dopamine, and Levophed, I thought. Not good. Not good at all.) I approvingly looked at the Diprivan drip used to keep him sedated. At the same time, I hated myself for thinking like a doctor in this situation. That wasn’t just any patient lying there! It didn’t help, either, that my uncle bore a strong resemblance to his brother, my father. In fact, other than his being considerably taller than my father, my uncle could almost pass for him.

Perhaps that was why I had always found my uncle a bit intimidating when I was a child, and it could never really be said that we were particularly close. Nonetheless, later on, I came to realize that he was a pretty cool guy. He had joined the Marines right out of high school, and during recent holidays he had enthralled us with some of his tales of Marine life and some misadventures he had had with his buddies in basic training. He had a strong love of jazz and the blues, and loved to check out the blues clubs in Chicago whenever he went there to visit relatives. In fact, if you want to know how teenagers annoyed their parents before the advent of rock ‘n’ roll, he had shown me one way: blasting jazz at loud volumes until my grandmother told him to turn it down. After his stint in the Marines was over, he married, went to work for GM in a personnel office at one of their Detroit area plants (where he ultimately retired around 10 years ago), and started a family. Over the last three years, I had come to admire his stoicism in the face of such a serious illness. He rarely complained. He even kept up a part-time job at Starbucks to keep busy. (For some reason, he really loved Starbucks, and would go there nearly every day for coffee, sometimes more than once a day.) My cousin related to me that he would sometimes tell her that it wouldn’t be the cancer that got him in the end.

It turns out that he was right.

As I alluded to, there’s definitely a downside to being a physician in situations like this. Normal reactions are infused with our physician’s training. The hope that nonphysicians hang onto, no matter how small, we know to be unrealistic. Our training tells us as much. His daughter and wife were at the bedside. I feared for his wife, because she always depended upon him for so much. I knew the odds of his pulling out of this were very slim. (So did pretty much everyone else, but I also knew that, even if he did pull out of it, he wouldn’t have long to live because the cancer would get him, especially since the heart attack would eliminated even the small hope that the high dose chemotherapy and stem cell transplant offered. I wondered if she knew, really knew. In the background on TV, of all things, Lethal Weapon was playing. (Yes, I know it’s strange, given how I’ve been ragging on Mel Gibson lately.) Complaining about having had Mel Gibson’s crazy cop (Riggs) assigned as his partner, Danny Glover’s character muttered a comment that God hates him. Mel’s character responded: “Hate Him back. It works for me.”

At a moment like that, I understood that sentiment a bit more than I would like to have admitted. We turned the TV off.

Later, our usual Christmas Eve celebration was a bit eerie, because none of us could keep my uncle’s predicament out of our minds. The kids seemed pretty much oblivious, thankfully, and the unwrapping of the presents proceeded in its usual chaotic and noisy fashion, but none of the adults seemed to be as into it as usual. How could we be? The disconnect between the joyous shouts of the kids as they unwrapped their toys and my own thoughts weighed heavily on me. It didn’t help when later on that night, I found myself in the emergency room with a different family member for two or three hours. Fortunately, it turned out to be nothing serious, but the whole experience simply added to the feeling of unreality that night.

Christmas Day we traveled back to Ohio to see my wife’s side of the family. It was a typical Christmas, and I managed to have a good time in spite of myself, although I definitely drank more than I should have. It was stupid of me.

On Monday, I was informed that my uncle had been taken off the ventilator and off all drips other than sedation and morphine. Stubbornly, he held on, even in the face of a pneumonia, high fever, and the progressive shutting down of his kidneys. On Tuesday evening we returned to my parents’ house.

Sometime early Wednesday morning, my uncle finally succumbed.

Now I’m reminded once again why I detest living so far away from the bulk of my family. Because of the holidays and a couple of other reasons, the funeral couldn’t be arranged until the middle of next week. Because of work obligations, staying in Michigan until then is not practical, and I’m not sure if I’ll be able to come back for the funeral. Some may find living far away from their family to be a good thing. I’m not one of those people. All we could do for the moment was to visit my cousins and aunt and pay our respects last night, tell tales of my uncle, and peruse his old basic training yearbook. I was amazed to discover that, in the 1950’s at least, the Marine Corps produced what looked very much like a high school yearbook for each group that came through basic training, in my uncle’s case the Fourth Battalion, 234th Platoon. There, quite incongruous after the pictures portraying classes on map reading, rifle assembly, and hygiene and photos of young recruits learning how to throw grenades, skewer the enemy with their bayonets, fry them with flamethrowers, and fire rifles, were rows upon rows of pictures of smiling recruits, looking so young–just like the high school seniors most of them were a few months before. And there, among the rows of recruits, was a picture of my uncle, looking every bit the 17 year old that he was. Odd that I had never seen his Marine photo before until now, after his death.

That’s not a bad way to remember him. Not a bad way at all.

Rest in peace.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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