Love.

Sunday morning. The huge snowfall we had over the past few days is slowly yielding to the onslaught of warmer temperatures and steady rain. It will still be a few days before we can extricate the car from its cocoon of snow and ice but that’s fine because we can always use the truck to get around. Having two vehicles is a bit of an indulgence, but the security of a backup is important to us right now.

Every once in a while we hear a loud thump as large chunks of snow and ice break off of the load on the various metal roofs we have like a calving Alaskan glacier and crash to the deck or the ground below. Metal roofing creates a nice slick runway for ice and snow to slide off the roofs. We need to be vigilant when we walk under the eaves of the house or outbuildings for fear of getting walloped. I’m pretty safe though because I haven’t left the house in days, since my last visit to the hospital on Thursday actually. I’m having a rough time of it right now and I don’t rightly know if it’s because of the chemo or the myeloma. I know by my lab results on Monday that my hemoglobin counts are down and that means anemia is getting worse. Who knows why. I just know I’m exhausted for no goddamn good reason. I don’t mind being exhausted. Exhaustion can be a reward, actually, after a long run or a good workout. Being exhausted after sleeping all night and most of the day is not what I consider a reward.

I’m backing off my pain meds for a bit. I want to see where my baseline is. Getting the right dose of pain meds means constantly re-assessing pain levels. To be sure, pain varies a lot for me, not only in intensity but in kind. Lately I’ve experienced a dull, throbbing pain in my legs, particularly my right one. Every once in a while I get a spike of pain but that’s usually manageable. On my last visit to the hospital for my infusion of zeledronic acid, as I was sitting there in the chair with tubes sticking out of me, I got a cramp in my left side. I sometimes get cramps in my left side as an artifact of the surgery I had in 2002 to remove my left kidney. In any case, the nurses got very attentive all of a sudden as I writhed in my chair trying to find a comfortable position. They thought I was having a heart attack or something. It took me a while to assure them that it was just a cramp and not to worry. Pain is such a weird thing. I’ve had chronic pain for a couple of decades related to low levels of vitamin B12. Now, I have a hard time distinguishing between the chronic pain of the past few years and the new pain created by my myeloma. Not that it’s important, I guess, but doctors do want to know what kind of pain I’m having. I get pretty frustrated at times because I don’t know what’s causing my pain. It might be arthritis or degenerative disks too, but they don’t want to know about that pain. They want to know about pain associated with the myeloma. It’s not a simple thing to tell the difference. It’s funny: my orthopaedic surgeon in Campbell River asked me about pain in my right leg. I told him, yes, I have pain in my right leg, along my femur and even below the knee. Well, he said, that’s odd because your lytic lesion from your myeloma is at the distal end of your femur. Isn’t that where the pain is? Well, yes, but, but…

So, dealing with the symptoms of myeloma is one thing, explaining how I’m feeling is another thing entirely.

Some people love winter. They’re off skiing, snowshoeing, and doing other wintery stuff. I’m not a big fan. I’m a big fan of summer. You’ll never catch me complaining about how hot it is. Winter to me means short hours of daylight and long rainy nights. I am fortunate, though, in that we have a beautiful home to hunker down in and I have Carolyn as my caregiver. There’s always a hot cup of coffee ready for me in the morning and tea during the day. It’s clear I’m not the best of company a lot of the time but Carolyn is always there. I don’t know what people do if they don’t have community, family, and love, and find out later in life that they have incurable cancer. I’m feeling good knowing that I’m not on this road alone. Of course, dying is a lonely affair. You shouldn’t expect to have people accompany you into the grave like the Chinese emperor Qin Shi Huang Di, but having them along as companions until the last moments of life is as good as it gets in my books.

I meditate on my last breath.

Yesterday afternoon Carolyn tucked me into bed. The zoledronic acid infusion I got Thursday at the hospital has left me feeling like I have a nasty flu combined with a smashing hangover. I fell asleep almost immediately but when I woke up I could hear the rain beating on our metal roof. I love that sound. Today, the dexamethasone is kicking in and it’s leaving me in a state of nervous fibrillation. I’ve never done speed, but I expect the sensation must be something like that. Now is a good time to write because I have this bizarre energy that needs an outlet. However, the dex gives me the shakes making it difficult to keep my fingers singly on the keys of my computer.

So, getting back to yesterday afternoon. Like I said I slept for some time and woke to the sound of rain pounding the metal roof. I just lay there. I find that lying in bed staring at the ceiling is not a bad way to pass the time. I could never do that before. I had the work ethic really bad when I was still gainfully employed and long after truth be told. Now, my body has taken charge of my reluctant mind and has forced me to sit still, to lie down and not feel guilty about it. Cancer has its upsides I guess, but I’m not sure that I fully subscribe to its methods. One thing for sure: There is no normal in my life anymore: sleep times vary, meals are still on schedule as are the ritual pill taking, but I can’t count on feeling the same way during each new cycle of chemotherapy that I felt on the previous one. Dex is predictable but the intensity of its effect varies. I only have to take it one more time on this course of chemo lasting until January. I start taking it again in late January when I start my second course of chemo with my fifth cycle. A course of chemo lasts approximately four weeks, a cycle, one week. At least that’s the pattern now. But I digress.

I’m lying on my bed focussed on the cedar beam that crosses the ceiling in the middle of our bedroom, light pouring in from the three windows just behind me at the head of the bed. I close my eyes and think about death. Well, more about dying than death, actually. It’s the process of dying that is absorbing me, not death itself which for too long we’ve considered the opposite of life. Dying is another thing altogether. Dying is the separation of consciousness and body. Consciousness in my estimation comes to an end at the point of death but my body, this collection of matter brought together by processes millions of years old, will immediately begin to become unglued. It loses its integrity as a collection of cells and begins to decompose, that is, to lose its composition.

I don’t have to tell you this. It’s hard to live for any length of time without coming across at least one death in the family, among friends, or by reading the news or obituaries on the local papers. We know about death although we don’t quite know what to make of it or how it pertains to us. It’s strange that for most of us we take for granted that ‘we’ don’t exist before our conception and birth and that ‘we’ become ‘we’ by a combination of hereditary traits, learned behaviour, and environmental factors. ‘We’ or ‘I’ are constructs. We are not born fully operational. We become ‘I’ over time, slowly developing personality traits, habits, and idiosycracies that define us as unique individuals. But we resist very strenuously the idea that if we come we must also go. But I digress again!

So, I’m back in my bedroom, lying on my back on my bed in that state of half sleep, very relaxed and I meditate. I meditate on my last breath. I’m thinking that dying is not much different than living. When we fall asleep and lose consciousness we have no idea whether we will awaken or not, we just take if for granted that we will. I’ve had two brothers-in-law die this past year. One died during the night in bed next to my sister. We say he died in his sleep. True enough. He wasn’t conscious when he took his last breath. Neither was my mother who died nearly two years ago, but she had demential and was so hopped up on morphine that I can’t say she died in her sleep. My sisters were there at the moment of her death. I missed it by a few hours. I was in pretty bad shape myself two years ago with symptoms on myeloma that went undiagnosed at the time. I was perennially exhausted, in a great deal of pain, and I couldn’t stand the vigil as my family surrounded my mom’s death bed waiting for her to take her last breath. I prefer to think of my dying as just another falling asleep kind of experience. My last one of course, but still.

Needless to say, there are only one or two ways of being born that I know of, but millions of ways to die. I like to think that my last breath will be in the comfort of home or at least in a hospice, somewhere nice. Many, many millions of people worldwide don’t die under such benign circumstances. Violent death is common. Five thousand Canadians die in vehicle crashes a year, fifty thousand Americans meet the same fate. I don’t fancy that as a way of dying, but if it’s quick, maybe. I can’t imagine being hacked to death with a machete after watching my family meet the same fate in 1994 Rwanda, or being shot by a stray bullet in Aleppo leaving me wounded and watching the blood spill out of me. No, give me a peaceful, quiet place to die.

I’ve been diagnosed with an incurable cancer but I’m told that it’s more like a chronic treatable condition than a CANCER that kills fast and unannounced. I’ve got some time to think about my last breath. I’m not sure if that’s good or bad. Certainly, I’ll roll with it. I remember clearly when I was a kid of twenty or so. I had a fairly serious back injury while working at a sawmill on Lulu Island and I needed back surgery to remove a disk in the lumbar area of my back. I was a kid in search of meaning in my life, not such an unusual thing. I remember lying in my hospital bed after the surgery, hanging over the edge puking my guts out and thinking to myself. I can milk this for everything it’s worth. I could stay on Compensation for a long time then go on disability or something along those lines. Or I could get out of the hospital and use this time to get my shit together. And that’s what I did. I got my shit together. I enrolled in the liberal arts program at Douglas College in New Westminster and never looked back. My injury allowed me time to think about my future without the pressure of work. That was luxurious, and it worked.

Now, I don’t need to get my shit together. It’s been together for a few decades and I’m happy with my shit. My encounter with cancer, in a way similar to my experience with my back surgery, is giving me time to think about my last breath, but to also remember that every breath I take until my last one is worth paying attention to and celebrating. Whatever I do until I take my last breath is not so important. Of course, I can’t help but do something and I will do things that have always mattered to me. It’s impossible to do nothing and still be alive. Even lying on the couch ‘doing nothing’ is doing something. Whatever I do will be the right thing at the time because it will be what I do. In any case it won’t matter one iota after I’m dead because ‘I’ won’t be around to care or experience regret or any other sentiment.

Grinding It Out

My oncologist called this past Wednesday to discuss changing my chemo cocktail. The one I had been on for less than a week caused a very bad rash around my whole midsection along with a mild fever. So, I stopped taking that set of meds and am now waiting for word from the pharmacy here at the hospital telling me that my new meds have arrived. I’ve got appointments lined up for the first week of December, but I may be called to come in earlier. It’s all par for the course. Hurry up and wait.

Thing is, this new set of meds has caused some pretty significant side effects for a couple of people I know with myeloma. We’ll have to keep a close watch on symptoms, especially those related to peripheral neuropathy. Can’t say I’m looking forward to the new meds but then again, I’m not too sure what the alternatives would be. I’ve sometimes thought about what would happen if I turned down any and all chemo. I know that there are drugs that are more palliative than chemo and I seriously wonder how many more years of good quality life I could get out of benign neglect rather than with aggressive intervention. These are just things I think about late at night when I’m falling asleep along with visualizing my death bed.

I’ve been reading Barbara Ehrenreich’s book Natural Causes. She’s a couple of years older than me and had a malignant tumour removed from a breast some time ago. She’s fit, she’s healthy but she also writes that: “I gradually came to realize that I was old enough to die.” She means that she’s had a good life, a fulfilling life, which is much more than is afforded many of us. She notes that the military considers eighteen year olds old enough to die and that there is no ‘best before date’ stamped on our asses. Some political leaders lead well into their eighties and nineties. That said, there is a time, when we reach seventy or so years of age when our obituary is likely to read “died of natural causes” than anything else. At a certain age, she argues, there is no need for an explanation for dying. It’s okay to die. Of course we should expect to die. Dying is as natural as being born although we generally consider it a travesty and a high order insult to life. I visualize myself dying, but I’m not convinced that the visualization can ever be very accurate. The closest I can come to visualizing the end of my life is when I’ve had a general anesthetic. Under a general anesthetic, the first drug they administer puts one under, makes one unconscious. If that’s the way I’m going to go, I can live with that. I watched as they put our last dog Wilco down a year ago August. First the sedative, then the lethal dose of whatever it is that kills. That kind of end would be fine with me. If I have to do it, and I don’t see any way out, this is what works for me.

Pain is an entirely other matter. I’ve had too much of that in my life and I don’t want to die under a heavy blanket of pain. Some pain would be alright, but nothing overwhelming. No pain would be the best, but that’s asking a lot of this aging, crumbling body to deliver. So, I’m willing to compromise and accept some pain when my dying time comes. I watched my mother as she lay dying in her nursing home bed almost two years ago now. She had Alzheimer’s and was unable to communicate at all verbally. She did communicate her pain, however. She was under high doses of morphine but we could tell when the morphine would wear off because she would get more and more agitated. I have no idea what she was experiencing, but I have the strong sense that it wasn’t at all pleasant. I was not there in her room when she actually took her last breath but as my sister recalls it, it was all fairly anti-climactic. Chances are very good that I won’t follow my mother’s example in death. For one thing, with myeloma I’m not likely to live long enough, and for another thing, I’ll probably still be sentient and able to make some decisions myself about my own death, unlike what happened to my mother. My mother was a very fine mother, cheeky as all get out sometimes and able to maintain a sense of humour before some pretty daunting odds at times. Dementia robbed her of end of life quality of life. That’s a shame. One of my sisters died a few years ago. She was four years older then me and had lung cancer. She was sentient for most of the time or her dying, but I wasn’t there when she finally gave up her last breath. I was a ferry ride away and unable to make it. She died a half hour before I got to the hospice centre where she ‘lived’. I know one thing for sure. She was pumped full of morphine for some time before she died and that effectively shut down her ability to decide anything.

Lately I’ve been experimenting a little with my pain meds. I’m on a large dose of hydromorphone (not related to morphine- a lot stronger, actually) taking two 1mg pills every four hours. I tried to back off some and take a lower dose every four hours for a day. I felt I could probably manage that because my pain was pretty much under control. Mistake! My pain is under control because I’m taking shitloads of hydromorphone. When I tried to back off, pain started to come back in my neck, ribs, right pelvic area, legs and shoulders. I knew that if I didn’t resume my twelve mg pill load a day that I would soon be completely incapacitated and bedridden. The decision was a no-brainer, but I was hoping for a better outcome.

One of the issues, of course, is that I haven’t really started treatments yet for multiple myeloma. I’ve been diagnosed and all that, but I haven’t had any chemotherapy to mitigate the effects of the disease, so it may be that in a few weeks or months and I go into remission that I’ll be able to back off my pain meds successfully. Wow, that would be cool. For now, I’ll continue ingesting lots of hydromorphone and maybe indulge in a beer or two, maybe even a tiny bit of scotch. It’s okay, all my specialists say a couple of beer are ok. I didn’t ask them about the scotch.

One (or more) of my readers here have suggested that I don’t swear anywhere near enough in my narrative. Well, fuck that! I’ll swear if I want to, swear if I want to, swear if I want to. You’d swear too, if it happened to you! (Figure out the song this is based on). Fuck!

I watched our dog die the other day.

Actually I’ve watched all of our dogs die except two. The only two we didn’t watch die were Little One and Chitka. Little One because she was no longer in our care. It was a long time ago and we had to give her up because where we were moving to wouldn’t have her. With Chitka, neither Carolyn nor I had could go in when he was euthanized. Too painful. All the others, Cedric, Oren, Max and recently, Wilco, all died at the hands of a vet with us present. They were all old and ready to go but that never makes it any easier. None of them did us the favour or dying in their sleep at home.

On August 3rd of this year, we took Wilco to the vet for one last time but not before we took him down to the beach in Royston and for a little drive around town. I still think about him every day, remembering his goofiness. He loved the Royston beach and used to chase his ball there for as long as we’d throw it for him. He  and his ball were inseparable for the first seven years we had him.

 

After that, he lost interest, we suspect because he was in a lot of pain and it just wasn’t fun anymore. He even stopped chasing cats and rabbits about 18 months ago.

He was probably sixteen years old and couldn’t walk anymore. I had to carry him into the car and lift him out. The vet staff took him into the clinic. Our vet, Carol Champion checked him out and agreed with our decision to have him put down. A few minutes later, as he lay in his usual position on the floor she gave him a sedative. When she was certain he was sedated she injected him with what I think was pentobarbital. It took less than a minute and I noticed he wasn’t breathing anymore. I stroked his back a few times and gave him a pat on the head but he was gone. Carolyn and I were very upset but the staff at the clinic was super and so supportive. I find it very hard not to cry on these occasions so I just let it happen. I miss him a lot.

Having Wilco with us for 10 years or so, watching him with his ball, stalking the fish in the aquarium and chasing bears on the logging roads and on camping trips makes it hard to let him go. He was family.

I’ve said this before but I’ll say it again. If I’m in a lot of pain and immobile and as old as Wilco (relatively speaking) I’d be quite happy to die like he did, surrounded by caring people not willing to watch him suffer anymore.

After he was euthanized, he was taken to a pet crematorium somewhere north of Courtenay located on a working farm where he joined a number of other pets to be cremated together and have their ashes spread out on the fields.

Not all animals have the idyllic life Wilco lived, nor the peaceful, loving death. Of course every living thing is on a death trajectory. That’s no surprise. Essentially, living and dying are the same process. That’s one of the main reason we are so conflicted as a species around life and death. We fear life because we know it will bring us death. Our culture, our politics, our everything are aimed at eliminating threats, imagined or real,  to our ‘lives’. We insist that our deaths must be meaningful or we deny death altogether.

I’ll get into a long diatribe into the essence of life and death later, in another series of blog posts although you’ll find the archives in this blog full of references to death denial. Suffice it to say for now that life must consume life. Up to this time, life on this planet has been the mutual devouring of species. Can that change? Should we be more ‘humane’ in how we raise and kill other species for our own consumption? Does it matter how long a calf lives before it’s slaughtered for us? Does it matter how much pain and suffering we inflict on other species in the name of scientific research or simply to grace our dinner plates? Is life really just suffering? For now, I’ll just leave you with these questions. I may offer up answers, at least tentative ones, to these questions in future posts. Stay tuned.

From the Times Literary Supplement

https://www.the-tls.co.uk/articles/public/grave-expectations-death/

Until death do us part. This is a great review of a subject most of us dread. The fear of death and dying and the obsessions that fear engenders often keep us from living life to the fullest. Are we programmed to fear death? Is it in our genes? It is a huge part of our culture.  Fully institutionalized death denial permeates deeply into our everyday lives whether we are religiously inclined or not.

Read on.

It turns out we die from the feet up.

[Disclaimer: Don’t read this post if you are sensitive around the topic of death and dying up close.]

It turns out we die from the feet up. Well, that’s not strictly true in every circumstance, some people die from a bullet to the head,  but it has an element of truth to it. As I noted in a previous post, my amazing mom died last week, on the 13th, very near midnight. She would have been 94 on April 4th. I wrote before that she died a good death, but that’s not what this blog post is about.

For three days or so before mom died, we held a vigil by her side. I have many siblings but two of my sisters were especially attentive towards our mom and visited her virtually every day at her care facility in Coquitlam. They were especially present during this vigil, but most of my other siblings showed up at one time or another as did some of their children and even grandchildren. We spent many hours in mom’s room and out in the hallway. Some of my sisters (and a brother-in-law or two) spent nights by my mother’s side too.

My mother was 93 when she died. Her story is really astounding and is one of sacrifice, caring, selflessness and dedication. She married my father on January 28th, 1946. He had 5 daughters from his first marriage. His wife died in childbirth as she was giving birth to her first son. Because my father had to work to support the family I assume he put out the call for help and my mother, 21 at the time, answered that call. She moved into dad’s house to look after the 5 children and to do all the housework too. Long story short, my mom soon after married my father and they proceeded to have 10 more children, I being the oldest. I’m 71. I was born in 1947, a year after my parents were married. My eldest sister from dad’s first marriage is about to turn 83.

Well, it turns out that although we are a loving and caring family we are also prone to irreverence. We love to laugh and tease each other but we also care about and respect each other, despite our differences. As my mother lay dying, we got to wondering just how the staff knew that she was in fact near death. We asked questions and the nurses and care aides responded in very matter of fact ways. How can we tell when someone is near death? I had heard that when the kidneys shut down that’s a sure sign that the end is near but in this case, mom had not had food or liquids for 2 or 3 days. It would be difficult to tell if and when her kidneys shut down. All this time, mom’s pulse appeared to be quite strong and although her breathing was irregular, it seemed to be consistent.

One of the nurses then told us that it’s possible to roughly assess how long it will be before someone takes their final breath by looking at their legs. When the toes and feet get cold and a line of blotchy skin appears, that means that it won’t be long. Now, nurses and care aides have a lot of experience with having people die on their watch. It would be foolish to ignore what they have to say.

After that, we proceeded to periodically lift the blankets off of mom’s feet to see how her toes and feet were doing. We didn’t notice any special coldness at first. Even on the day of the 13th, it didn’t look as if her feet had changed much in colour or temperature. We often checked on mom’s feet to see if they were getting colder or if the line of blotchy skin was going up her leg. The nurse said that when the line gets to the knee, that’s it. Death slowly creeps up our legs. Of course, there was no question of mom coming out of this crisis alive, so it was just a waiting game now.

I left the care facility around 4:30 PM on the 13th so I could have dinner with my daughter and her family in Vancouver. We half expected mom to still be alive in the morning when we returned to the care facility. I was getting exhausted too and needed a good night’s sleep. As it turned out, that day was the last one I would see my mother alive. In the early morning minutes of the 14th I got calls from one of my sisters and a brother-in-law telling me that mom had passed away, but my phone was on vibrate and I missed their calls. At breakfast, I learned that my mother had passed away a few hours earlier. Within two hours of her death, the people from the funeral home came around and took her body away. Shortly after that, some of my family members cleaned out her room of all of her personal belongings leaving no trace of her ever having been there.

I called my sister and we talked about what happened as mom got closer and closer to taking her last breath. It so happens that the nurse was correct. Mom’s legs had indeed gotten cold and blotchy as her heart became too weak to pump blood to her extremities. By the time she died, her legs were cold up to her knees and her legs were blotchy.

So, along with the grief and sadness that we all felt as we watched our mother/grandmother/great grandmother/mother-in-law die, we learned about how the process evolves.

Right up to her last moments our wonderful caring mother had something to teach us.

My death

I’ve been thinking a lot about my death lately. I know most people would not approve of this seemingly morbid preoccupation but I find it keeps me focussed on my life and what I have left of it.

Speaking of death goes against a most important moral precept we have, one of our most cherished ideals: health. A focus on health along with wealth and happiness is supposed to keep us in a good mental state and thinking positively about our lives and our activities. Given our obsession with health, it’s not surprising that we don’t want to hear about death. Death is the ultimate failure of health, now isn’t it? We seem to love to speak about our healthy lifestyles and post comments on Facebook about our healthy diets. We are constantly bombarded with ads and opinions about how to stay healthy. We are admonished for not eating healthily, drinking too much booze or engaging in activities that could ‘damage’ our health.

Don’t get me wrong, I’m not against being healthy. I’m just saying that it’s immoral in a world that glorifies health to be unhealthy. Now before you go off telling me I’m full of crap, think about it. Think of how we speak in hushed tones when someone is found to be ill and the words we speak to the relatives of the sick and ailing. Think of how we are uncomfortable around people who are obviously ailing or seriously ill. We equate illness with weakness and mygawd we must stay strong!

Disease and death as Ernest Becker so eloquently put it are “the two principle evils of the human organismic condition. Disease defeats the joys of prosperity while one is alive, and death cuts prosperity off coldly.” (EFE, page 3)

So, why do I think about my death? Why do I anticipate the moment of my last breath? Well, I know my death is tomorrow. I was 20 years old yesterday although I’m now 70, so how far down the road can my death be? It will be on me in a moment just as old age has come in a blistering flash. Time truly does fly. So, in thinking about my death, I give my life some meaning, some urgency. Life and death are one in the same thing. One cannot exist without the other so in denying death we are denying a crucial part of what makes us alive.

Our denial of death is a great cultural conspiracy to keep us feeling guilty and to keep us in line, conforming to the moral ideals that rule our world. Yes, like most animals, we have a primordial will to live, but unlike most animals we have wreaked havoc on the world in our ill-fated attempts at guaranteeing our immortality. Anyone who dares oppose our chosen path to immortality beware because you will soon be targets of our wrath.

Tomorrow I tackle morality and wealth. If you’re poor you might as well be dead in our world.