My dad was quite a practical and pragmatic man. He took over the operation of the family farm after a stint in the Navy during World War Two. By all accounts, he was a successful farmer and civic-minded citizen, earning recognition as "Citizen of the Year" later in life. When it became clear that none of his children would follow in his footsteps to keep the farm in operation, he sold his cattle, auctioned off the equipment and took an early retirement.
In his late 70s, he seemed to be in generally good health, when he noticed an unusual sensation initially diagnosed simply as post-nasal drip. The doctor said it was nothing to cause concern. As it persisted, that diagnosis didn’t seem quite right to Dad, so he scheduled an appointment with a specialist. Tests indicated that he had a growth in his lung that could be cancerous. This set us off on a journey unlike any that we'd ever taken before.
I went along for some of the initial consultations with the oncologists, taking notes so I could help keep track of what the doctors had to say as well as to provide a report to my three siblings via email....
Tuesday, May 11, 1999
Here's my report from the consultation that Dad had with the doctor in Salina today. First, he said that the results of the biopsy confirmed the cancer to be a form of large cell carcinoma. And again, he indicated that it was about the size of the tip of his little finger and located mid-back.
Monday, May 17, 1999
The CT scan of the chest revealed that the tumor is larger than previously thought. It's centered on a lower branch of the brachial tube, where the tube's about the size of the end of your little finger ... but it extends beyond that and is more like the size of a golf ball.
Dad had a bit of experience dealing with cancer, but nothing as personal as this. He had served as the driver on several previous occasions in which friends of his had required assistance getting to and from radiation or chemotherapy treatments. In this case, he asked if I would do the driving.
I was in the room with my parents when the oncologist presented a number of options about how to address Dad's condition. The doctor laid it out as clearly and simply as he could, which I again reported to my siblings....
Surgery is not an option, as we knew. The next option would be to do nothing and let nature take its course. There's no way to know exactly what would happen, but the bleeding would continue and probably get worse. The lung tumor could even rupture a nearby blood vessel and he could bleed to death. Aside from that, he would probably start experiencing shortness of breath and possibly develop pneumonia. When Dad asked about his life expectancy in that scenario, the answer was 6-12 months. The doctor then said that with treatment, that could be doubled or tripled ... which still isn't a whole lot of time. To cut to the chase here, his treatment recommendation involves radiation (about 10 treatments = 2 weeks) followed by chemotherapy. ( June 3, 1999)
Reflecting on the options he’d been given, Dad turned to me as we sat in the doctor’s office and said: “I’m not ready to give up. I think I should fight this. What do you think?"
As the youngest of four kids, I wasn’t accustomed to being consulted in this way. I paused for a bit, but it was obvious how to respond. Of course he should fight it if that’s how he felt!
And fight it he did. He endured those two weeks of radiation treatments first, followed by months of chemotherapy. The initial treatments took place in Kansas and the chemotherapy continued over the winter in Arizona as the folks continued their seasonal snowbird migrations. Through his WebTV connection, Dad provided his own email updates to the family....
Monday, December 13, 1999
We just got home from the clinic where it took all pm for lab, meet with nurse, a shot, ct scan, and bone scan. Any way, it's all done and all we do now is wait until next Monday unless they see something very wrong in which case they would call sooner.
Monday, December 20, 1999
Things went well with Dr today. He left it up to me as to how long to continue treatments which seem to be doing good as far as shrinking the tumors go. I said I could handle the side effects as long as it helps so that's where we left it.
Monday, January 10, 2000
A short report of todays chemo and Dr visit. Things seem to be still on track with no new problems to report . He wants another chest X-ray next Monday as well as lab work. See him on 31st. No effects of todays treatment yet.
Monday, January 27, 2000
I played 9 holes golf and had a horseshoe match today. Feel great when I can stay off chemo so will take advantage of it while I can.
Thursday, February 24, 2000
Seems like all I write about is Drs report. Hope you all can stand one more. Net result after 4 hrs this pm (C-scan and sonagram) is they don't know why I reacted to last weeks mri with swelling and bruises. Sonogram was for blood clots (negative) which I was thankful for. Anyway no more Drs till Monday.
That spring, as usual, the folks returned to Kansas, where Dad continued chemotherapy and the doctors monitored his status on an on-going basis. By the summer, test results indicated that the treatments had achieved a significant degree of success in reducing the size and extent of tumors.
During a period of time in which the cancer was kept at bay, my parents were able to enjoy a trip to Austria, where my brother Jim and his wife were living. I tagged along with them. It was a real treat to see how much Dad enjoyed himself on that trip, absorbing and savoring the moments we all shared, knowing how fortunate he was to be there.
Later, when his 80th birthday arrived, the whole family came to Kansas from across the country to spend a few days together at a church camp not far from the family farm. Everyone was quite aware of the significance of the gathering and it was obvious that Dad loved having everyone together.
At one point, we invited other friends and relatives to come join us for some cake and punch. We gathered in the dining hall and everyone had a chance to socialize for a while. We decided to put together an impromptu program, making use of the camp's PA system. I served as MC, inviting others to share whatever they wished. Laughter seemed to be the order of the day as one brother's humorous poetry rhymes gave way to another's amusing guitar riffs, with songs befitting a family not noted for its musical abilities.
When it was time to conclude the program, I started to wrap things up when I realized that I hadn't asked Dad if he wanted to say anything. He'd obviously been enjoying himself, but I didn't really expect that he would want to speak.
But I was wrong. He immediately jumped up, grabbed the microphone, and proceeded to thank all of his friends and family, expressing his heart-felt appreciation for all the support.
That special gathering gave us all a good dose of comfort and connection. Before long, however, Dad's cancer returned to a more active status and treatments were again being administered. Hospitalization became necessary at a point where he needed more acute care and attention.
When it became clear that his system wasn't going to be able to keep functioning much longer, we made arrangements to bring hospice care into the picture and prepared to bring him home.
As my oldest brother, Larry, and I arrived to pick him up at the regional medical center in Salina, the nurses administered a dose of morphine to ease the pain and discomfort he might otherwise experience with the car ride home.
Wheeling him into the elevator and down to the car, Dad beamed his gratitude at all the nurses, expressing his appreciation for their special care and attentiveness.
He was quite alert and observant as we drove through the countryside on a rural blacktop, passing fields of tall corn and pastureland recently blessed with summer rains. I drove while Larry sat behind, keeping an eye on our fragile passenger, who assured us that he was feeling no pain.
He was, in fact, quite enraptured with the scenes passing by, speaking with the grateful appreciation of a lifelong farmer who knows the value of a timely rain on green, growing crops. The Kansas landscape could hardly look more verdant and lush than it did that day as we glided along the sparsely traveled two-lane heading toward Hope (a Kansas town as well as a state of mind).
Larry wrote about it this way:
“The day was bright, the ‘blue highways’ of central Kansas almost void of traffic, the soybeans, corn, milo, and grasslands were rejoicing from a three-inch rain and wild turkeys were grazing the alfalfa. Dad said simply and peacefully - ‘This is all so beautiful it makes me forget what is really going on here.’
At one point, he wistfully expressed his desire for this journey to continue — “I could ride like this forever,” he said.
As we reached the turnoff to our destination in Herington, Dad was feeling good enough to extend the drive a few more miles, and he expressed a desire to drive on out to our family's farm. So we kept on driving for another half-hour, passing by the familiar landmarks that carried a life full of memories.
After making that loop, we arrived at Homestead Village — the new apartment units built to extend independent living for seniors. By that point, Dad was running a bit low on energy, so we helped him in to the apartment and got him settled for some rest.
I then drove back to my own home a couple hours away, feeling good about the transition we’d made that day, but also thinking how nice it would have been if we could have driven him around town to see some of his friends ... if only he had the energy to do so.
Before I returned the next day, Larry was able to deliver something just as effective, if not more so, when he got Dad back into the car and drove him over to the local football field.
It just happened to be time for the annual cancer walk, with residents circling the running track in support of friends and loved ones. Dad had taken part in this walk in previous years. This time, he was able to sit in the car and greet all who passed by.
When I returned the next day, I brought along brother Jim, who had flown in from Vienna. Early the next morning, Dad and his three sons took another drive out to the family farm. We stopped at the grove of oak trees along Clarks Creek, where our ancestors first settled — a spot Dad had maintained as a picnic ground for family, friends and neighbors. Then we drove past the ranch-style farmhouse Dad had helped build in the early ‘50s -- home to our family for 40 years before the folks sold it and moved to town. Again, memories of the past flooded into the vehicle as we paused in front of the house for a bit.
Back at Homestead Village, our sister, Carolyn, and her husband had arrived. We all sat around the table for a midday meal, during which Dad provided a heart-felt prayer even though his energy was waning.
We spent the afternoon watching old home movies and sharing pleasant memories as Dad sat with us, smiling and joining in as best he could. As Larry recalls - “Laughs were abundant and Dad, with his great smile, would say: ‘Keep talking. If you run out of stories, make some up!’”
As the afternoon moved on, Jim noted that Dad seemed to be watching the clock, and when it moved toward 7pm, he indicated that he was ready to lie down. After we got him into bed, he drifted into a state of consciousness that must have been somewhat dreamlike -- he seemed to be trying to communicate with someone about something that was very important to him.
I can't say it was an easy passage for him as he endured his final struggle that evening. To me, it seemed as though he was ready to let go, but wasn't able to free himself from his body.
As Larry later shared with us, Dad had expressed his thoughts about the power of the survival instinct as we drove him home from the hospital in Salina....
I do remember distinctly him telling me as we were riding along and I asked him what he thought of the whole situation -- "I don't like it but the survival instinct really kicks in and we'll do the best that we can."
His body's survival instinct proved to be the last major challenge he faced that night. From what I could hear him saying, he was trying to shake loose with all his might. His body simply did not want to let go.
After a while, the hospice nurse administered another dose of pain relief and Dad eventually fell asleep. Feeling pretty exhausted ourselves, the rest of us headed to bed, with Larry laying on the floor next to Dad’s bed. Around 4:30 in the morning, he woke up to find that Dad's struggle was over.
When the funeral home arrived to retrieve the body, it took all three of us brothers to pick it up and transfer it to the gurney. It was the last thing we could do for our dad, other than provide our reflections at the memorial service and continue to live in accordance with the values he instilled.
As we followed the gurney out of the apartment and rolled along the sidewalk toward the hearse, it was just starting to get light in the east. It seemed a fitting time for Dad to be departing — as if he was heading out to the barn in the pre-dawn hours to milk the cows one more time. I could imagine his spirit rising up, returning from whence it came, his wish fulfilled. “I could ride like this forever.”
Postscript: It's worth noting that Dad's final weekend at home almost didn't happen. When Larry & I arrived at the hospital to pick him up that Friday afternoon, the physician who had to sign his release papers had already gone home for the day. We were told that Dad couldn't be released until the following Monday. I would have meekly accepted that verdict, but Larry was not about to let Dad languish in the hospital when he could be home with the family. Politely, but quite firmly and in no uncertain terms, he convinced the good doctor to return and provide the necessary approvals for release. If not for his persistence, there would have been no final tours of the family farm, no chance to greet friends at the Cancer Walk, no laughter and storytelling around the home movies, and, most importantly, no opportunity for us to share an intimate goodbye. Thanks for your persistence, big brother -- you really showed me how it's done!