Pat
Laughner & I had suspected that Jack was coming down with dementia for some
time. Looking back on it, my own partner and now husband
(thanks to San Francisco's new mayor) Pat Lucey believe we were seeing signs
of it when we first visited Jack in early 1999.About a year ago at this time Jack was having shortness of breath and we got him to the hospital where they determined he had pneumonia for no apparent reason. He was given medication and sent home to rest for a few days. Several follow-up visits to various doctors failed to reveal the cause and all his vital signs indicated an otherwise very healthy man for his age who by then had given up alcohol, tobacco, and walked three miles a day in the park where he lived.
Around 5:20 p.m. on Friday, June 4th, I received a frantic call from Pat Laughner saying she had been trying to reach me for 45 minutes; Jack was experiencing shortness of breath, shaking uncontrollably, and acting faint; what should she do? Jack's steady increase in signs of dementia had made her afraid to make decisions that might upset Jack. I had her put Jack on the phone and told him he needed to get to the hospital immediately and he agreed with no argument whatsoever.
My Pat and I got our animals settled down, locked up the house, and jumped into the car for the hour drive up to Napa where we met Jack and Pat in the emergency room. Once again, they had diagnosed him with pneumonia but unlike last time they wanted to keep him overnight and run more tests. We stayed with Pat Laughner overnight at the house and returned to the hospital first thing the next morning where the doctor told us a chest xray had revealed a baseball size tumor on Jack's right lung along with several golf ball sized tumors scattered throughout his chest cavity. We knew instantly that it was a matter of time.
Jack was put on an IV drip to keep him hydrated for the pneumonia and administered a plethora of drugs that rendered him uncontrollable. The nurses literally had to tie him down in the bed. Unfortunately, the doctors were more concerned with treating the cancer believing that, left untreated, it could quickly spread to his brain. His behavior indicated to us who know him that it already had.
In his infrequent lucid moments, Jack was angry: "I gave up booze; I gave up cigarettes; I exercised every day. And for what? I want to go home! Get me a pack of cigarettes and a case of beer. Let's get his over with!" Even in his distressed mental state he realized that the tumor was a death sentence and from that point forward refused to eat or drink.
On Tuesday, the 8th, they finally started giving Jack ridilin to calm his mental state. The next day they changed it to Atavan and steadily increased the dosage in an effort to get him to a point where he was manageable. At 1:30 p.m. on Thursday, June 10th, Jack was discharged from the hospital over my objections and we took him home. Their hope was that being at home would calm him down.
My Pat was back in Oakland going to work and caring for two very sick cats. Once Pat Laughner and I got Jack home we made arrangements for 24-hour home nursing care. The first nurse arrived at six o'clock that evening and stayed with us until seven o'clock the next morning. Even with her help, Pat and I got very little sleep that night. The service was unable to get a replacement nurse to the house until 12:30 that afternoon. It's now Friday, the 11th, and Pat Laughner and I are totally exhausted. I sent her on for an hour of normalcy to her usual Friday morning hair appointment and stayed with Jack. During her absence I had Jack sitting out on his front porch listening to the crows, the quail, the hummingbirds, and lord knows how many other types of birds that frequent his seed feeder and hummingbird drip.
The serenity helped tremendously, albeit for a short time, and in the interim Jack and I had what would later become our last lucid conversation with each other. We both cried; he just wanted to get it over.
We had a 3 p.m. appointment scheduled for Jack at the outpatient cancer center wing of the hospital to have Jack's chest marked for the radiation treatments the doctor had scheduled for the following week. With the help of the afternoon nurse, Pat and I got Jack into my car, one inch of shuffling at a time, and the four of us drove down to Queen of the Valley, ten minutes away. It was a slow process getting Jack up and out of the car, then turning him around and persuading him to sit back down into the wheelchair positioned directly behind him. After we got him inside, I headed down to the administration offices to deliver a copy of the legal papers that gave me power of attorney.
Next I found his doctor and requested a prescription for something more powerful than Atavan to help us get him under control. As the doctor was explaining how to administer the new drug we would pick up on the way home, a ruckus started in the waiting room. Jack refused to stay seated, had started walking around, and had fallen down. I stood back to allow six orderlies to get him back up and into the wheelchair while the nurse behind the counter screamed at me, "How dare you! That's your father!!"
Ultimately we got Jack back out to my car and for twelve minutes in the hot sun we tried unsuccessfully to get him to sit down in the car seat. I finally realized that if I couldn't get him into the car then I couldn't get him home. The moment turned out to be a blessing; we had just been handed the reason to get him checked back into the hospital. With help from one of the orderlies we managed to get him seated back into the wheelchair and wheeled him over to the emergency room. Along the way, the hired nurse told me she would have to call her office when we got back to the house to tell her employer Jack had now exceeded the parameters of care they were willing to provide. If the emergency room wouldn't readmit him, Pat Laughner and I would be on our own.
They did keep him overnight and when Pat and I met with the emergency room doctor the next morning, Saturday, the 12th, he told us he had ordered a brain scan and found a marble size tumor in Jack's brain. More importantly, he discovered a whole section of Jack's brain that had been eaten away. By Sunday they were giving Jack morphine shots and oxygen and he responded by sleeping peacefully for the first time in over a week for up to six hours. When it wore off, they would give him another shot, then another, then a third to calm him back down, a process that usually took from 45 to 90 minutes due to his reduced circulation. By Tuesday, the 15th, I finally persuaded them to put him on a morphine drip and from that point forward he never regained consciousness.
During this now twelve-day-old nightmare, Pat and I had watched Jack's condition deteriorate exponentially each day. Now that we had him in a peaceful state the only thing left to observe was his breathing which became more labored and shallow. The hospital now approached us about bringing him home to die. Both Pat and I had realized and accepted early on that this was an inevitable and imminent outcome, hence we had already discussed how she felt about it. Pat had lost two husbands prior to Jack, neither of which had died at home, and she was afraid that if Jack passed at home she would have to sell the home after the fact rather than forever deal with the emotional reaction of passing by the spot where he drew his last breath. With Jack in a morphine-induced coma I concluded it was time to deal with the survivors and agreed to have him stay in the hospital.
By Wednesday evening, Jack's deteriorating breathing had leveled off and remained steady through Friday, the 18th. By now he had an oxygen mask over his nose and mouth and every few hours the nurses would increase the oxygen flow to counteract the ever decreasing blood-oxygen levels in his body. Friday afternoon, Pat Laughner's granddaughter, Rachel, a newly graduated registered nurse, took me aside and explained that the oxygen was prolonging Jack's life. Jack's living will had specified (and he had initialed it in several places) that no action be taken to revive or prolong his life and a copy of this very piece of paper had been handed over to the hospital a week prior. I was furious and demanded the floor nurse explain why he was receiving oxygen. She responded with a song and dance routine that made no sense whatsoever given the fact that he was already in a morphine-induced coma.
The nurse said she would have to speak with the doctor before she could do anything and I ordered her to do so... immediately! Forty minutes later she returned to say the doctor agreed with her song and dance routine. To remove the oxygen would cause Jack to start gasping and choking for air. I held my breath, silently prayed that I was making the right decision, and ordered her to remove the oxygen mask. It was 4:43 p.m. The nurses came into the room to turn Jack over which they had done every few hours during the past week and, as had become our custom, Pat and I left the room for a quick break. When we returned, Jack's eyes were open for the first time since the morphine drip had begun on Tuesday.
We sat on either side of his bed, me holding his left hand while Pat held his right. His breathing became shallower by the minute and you could sense that things were shutting down. Thirty seconds before the end he closed his eyes and squinted them tightly as if crying and a single tear emerged. He died precisely at 6 o'clock, exactly one hour and seventeen minutes after I had ordered the removal of the oxygen mask and two weeks from his initial admission. It was the toughest decision I've ever had to make and I felt vindicated after none of the horror scenarios the nurse and doctor had predicted had taken place. It was a very peaceful transition for Jack.