Undigested — Part I

Guest author Elaine Jackson, on the death of her father-in-law. This brave and vivid account reminded me of so many aspects of the death of my brother, John. Please note that Elaine has  changed the names of the family members involved to protect their confidentiality.

by Elaine Jackson

Death and I go way back. As a therapist working in gerontology, mental health, and long-term care I’ve witnessed many deaths, or have been a participant in the road trip that ends at that particular cul-de-sac. In my own circle of family and friends I’ve lost people close to me, and people who were not so close; some to old age, others to cancer, some to car accidents, and others to misadventures or suicide. I feel I have a level of comfort and acceptance that may be exceptional for someone my age. I’ve taken courses in palliative care, and any illusions I had about the dying process have long since been dispelled. However none of this prepared me for the death of Kevin, my husband’s father.

At 86, Kevin was a paragon of good health. He exercised daily, skated three times a week, ate healthy meals and distilled his tap water just to be safe. He was a germaphobe who refused to set foot in a hospital and rarely went to the doctor. He had lots of friends and was a ham radio operator. Usually he wore corduroy pants and a tightly-buttoned plaid shirt, and he could still do a full squat to tie his shoes.

He had been a sailor in his younger years and had spent a lot of time in the sun, so we weren’t terribly surprised when he needed to have a spot of skin cancer removed from his forehead. A few months afterward he returned to the doctor’s office with some concerns that the edge of the wound wasn’t healing. The doctor thought it looked all right and nothing was done. He returned a second time and was referred to a dermatologist. By the time he got to see the dermatologist he had developed a squamous cell skin cancer that had metastasized into his salivary gland. The local surgeon operated on it, but she tried to spare his facial nerve and was a little too conservative. She didn’t get all of it. The surgery left him with a mild facial paralysis and the tendency to drool. He had been a handsome man, and a proud one. The drooling disgusted him.

He was sent down to Princess Margaret Hospital in Toronto, to see a different surgeon. He called me one evening in a panic, because he’d been booked for a late night MRI downtown and had no idea how he would get there. It was out of character for him to ask for help. I often drove downtown and was happy to assist, but the round trip amounted to six hours of driving. Kevin was not a talkative man, so we spent much of the time just listening to the radio.

He was angry that he had cancer. He blamed his doctor for not identifying it early enough. I didn’t. I’ve worked on the other side of the door, and could appreciate how many people GPs see every day. They make mistakes. They’re human.

The second surgery was far more extensive than the first. My husband, Dave, and I stayed in a hotel downtown so we could be close by. The surgeon called when it was over and said that it had gone well. Visiting Kevin in the recovery room was hard. He had suction tubes in the wound and his ear had been sliced away from his face. My hubby, who has a hard time with the sight of blood, went for frequent walks around the unit while I waited for Kevin to wake up. The city had been shut down by a major snowstorm so when we left the hospital the streets were deserted. When we went out to eat Dave said to me, “He’s done.”

I tried to be more optimistic. “He’s strong. He’ll get through this,” I said.

After the second surgery Kevin had to go for radiation treatments. We couldn’t drive him there every day so he was set up with a cancer society driver. Unfortunately, he had to carpool with a number of other cancer patients, which meant that sometimes for a half-hour appointment he’d spend the whole day at the hospital. My partner and I work full-time and his only sibling, Debbie, lives in PEI so she was unable to help. Kevin ended up taking the Greyhound back and forth every day, which broke my heart, but it was the most acceptable way. He reported that the driver called him “Sunshine” and that she dropped him off in front of the hospital instead of making him walk up from the bus station.

After the radiation was finished Kevin tried to put it behind him and get on with his life, but the wound from the surgery wasn’t healing. He had severe facial paralysis and had completely lost his sense of taste and smell. He couldn’t wear his hearing aide anymore and his hearing loss was profound. His personality was changing from upbeat to surly (who could blame him?), and he stopped going out socially. One day when I was sitting next to him at lunch I noticed a frothy yellow liquid leaking from the gauze on the side of his face. His weight was dropping and his wife, Barb, was becoming deeply concerned.

Over the next few months Kevin’s weight plummeted. When his daughter Debbie came home from the east coast she pleaded with him to eat, to exercise, to make an effort. She cooked and froze dozens of meals, purchased protein powders, marched him out to the doctor and got cases of Ensure delivered to the house. As soon as she left the Ensure got carried down to the basement and he resumed his downward slide.

Kevin and I still drove back and forth to late night appointments together. He wouldn’t talk about his declining health. The topic of death was like an ugly hitch-hiker in the back seat we were pretending to ignore. He would tell me stories about when he built his cottage, or what he used to do at work, and he’d comment on the state of the traffic, but anything to do with his suffering was off-limits.

He started having falls at home, and staying up all night. He was becoming mildly confused and one day his wife, Barb called an ambulance and sent him to the hospital. They stuck an IV into him and brought him back to relative normalcy. He was so angry that he wouldn’t even look at her. She confided in me that after sixty-one years they might be getting a divorce. As soon as he was able he signed himself out of the hospital. Debbie begged us to do something. She called his doctor and had him referred back to Toronto for more options.

The surgeons we met there were kind, and pleased that Dave and I were in attendance. They removed the wound dressings to take a look and Dave and I reeled. All of the flesh on the left side of Kevin’s face was gone, leaving a gaping hole the size of a fist. I could see his jaw bones. It took everything I had not to turn away. The wound was clean, not infected, and the cancer was gone.

About the author:

Elaine Jackson is a writer, yoga and meditation teacher, occupational therapist, reader, wonderer, day-dreamer, eavesdropper, dish-washer, friend, and servant (to two cats with over-blown senses of entitlement). She and her husband Dave live just outside of Mount Albert, Ontario.