December 2006 rolled into January 2007. Ron was still seeing a few clients. He admitted it took all he had to continue working with them, but you don’t walk away lightly from a career that has given meaning to life for so many years. I held “Stop” at the back of my tongue. He would know when it was time. His cough persisted, and the ever-stronger cough syrups the doctor prescribed did not help.
I should have offered to accompany him to the doctor’s office. Ron was a conciliator, not a confronter. He would take the cough syrup prescription without challenging why cough syrup was being prescribed when the situation seemed to need some other measures. I was the one who would say, “Look, this isn’t working. What else can we try? Can you refer me to a specialist in whatever I’ve got?”
But I did not see, at the time.
Ron began to lie in bed for most of the day. He did not want anything, he said, not even the television programs he always gratefully immersed himself in when problems piled atop his back.
Greta and I held school in the back yard. She was learning “Come” and would cavalry-charge across the yard on command—4 times out of 5. The fifth time, she would be distracted. Distraction never bothers Labs—it’s how they live. A fluttering leaf, a fluttering squirrel tail, a new scent, a discarded French fry, all had to be checked out thoroughly. The checkout, of course, meant that “Come” was wiped out of Greta’s memory to make room for squirrel and fries.
I grew impatient with Ron. We were scheduled to return to Duke for another treatment in late January, but how would I get him there if he lacked the energy to get out of bed?
“Don’t you at least want to sit up?” I said.
He did. He got dressed and sat in a chair in the living room. All day. He did not read or watch TV or watch anything that I could see. He did not speak.
“What do you do when you sit there all day?” I asked.
“I just go away,” he said.
“Where is away?”
“I don’t know. Just away.”
He seemed to need that time and space. I had read about the stages of dying, and I think now that he may have had to withdraw from all the familiar routines of our lives because there was no other way to deal with the pain of ending.
Then came a bright, cold Sunday morning. I had made scrambled eggs for breakfast, then taken Greta to the park. As always, when I pulled the leash out of the drawer, she went into her dance of joy, her rear end waving in time with her tail. Ron was sitting at the breakfast bar when we left, elbows propping him as he leaned forward slightly.
He was sitting in precisely the same position when we returned. One hour had passed. Cold scraps of egg lay untouched on his plate.
“Come on,” I said. “Let’s get you into bed where you’ll be more comfortable.”
He did not move or speak.
“Oh, my God. You can’t move.”
I can lift 40 pounds. Ron’s weight was more than five times 40 pounds. I don’t remember how I got him into bed. I remember only that I dragged the chair into the bedroom, while he remained seated.
The voice on the other end of the 911 line was crisp. “Whatcha need, fire, police or ambulance?”
I had reported that I thought Ron had suffered a stroke, but the ambulance personnel were skeptical. They found no signs of stroke, but they transported him to the emergency room. We passed right by the area where people sat for hours, waiting for someone to have time to see them, and went directly to a windowless room with a gurney for Ron and a chair for me.
There had been no stroke. What the tests eventually told us was that pneumonia had stormed through his body, and finding no defenses, had turned to meningitis. The hospital would admit Ron, but there would be a wait until a bed was available. I ran home to take Greta to the back yard for exercise and then back to the emergency room.
There was nothing in the room to read, except for labels on various medical items, nothing to do but wait. Medical personnel came, checked temperature and blood pressure, hung iv’s and went away. At last, late in the day, Ron was moved to the critical care unit, visitors limited to immediate family, 15 minutes per hour.
The telephone rang at 10 p.m. I jumped. Oh, God, what could have happened? It was a night resident, who wanted to put Ron on a blood thinner.
“No! He’s a brain tumor patient. You don’t put brain tumor patients on blood thinners.” No one would ever mistake me for a physician, but I had read enough to know that blood thinners can cause bleeding into the brain tumor.
The resident was concerned about possible blood clots. I had read about the clot danger, too, and knew it was possible to put a filter into the patient’s upper leg that looked like one of those little umbrellas you get with fruity cocktails. If a clot formed, it could not go to the heart and kill him. I told the resident about the filter option.
“We can’t do that here,” he said.
By the time of the call, Diana, our younger daughter, had come to be with her father. Renee, the older, would arrive the next day.
I turned to Diana. We would have to go to the hospital.
The resident had found on the Internet a study from the Cleveland Clinic that argued for blood thinners. I didn’t like it, but the only alternative seemed to be risking a fatal blood clot. The hospital was a small rural hospital; it could not be expected to have the resources of a larger facility.
“All right,” I said.
Diana and I went home.
The following morning, Ron’s family care practitioner came to the hospital.
“What’s he doing on blood thinners?” he asked.
“Of course we can do the filter here,” he said. “I’ll schedule it today.”