I don't know how to tell you this...

On July 7th he had a chemo-embolism done on the two main tumors in his liver. We spent weeks discussing and preparing for this. Rich was all in favor of it. Although, if Dr McGee told him to sit in the backyard and eat green jello every afternoon at three, he would do it. I was silently, smilingly, hopefully hesitant. The day before the procedure I confessed to the few people I share with that I just had a bad feeling.

Objectively, it's a cool procedure. They enter the right femoral vein, and travel up to the liver, much the same way they would do a heart cath. Guided by CT scans, they locate the two big tumors (ignoring the dozens of minor tumors), locate and shut off their blood supplies, flood the surrounding healthy liver tissue with seaweed and oil for protection, then inject a bolus of chemo therapy into the tumor and then clamp it shut. They got both tumors. They were very pleased.

I would have been equally pleased if they could have done it in such a way that Rich would not have been in excrutiating pain. A little valium, a little versed, fentanyl..... ??? How stupid was I to believe them when they said they would always control his pain. He got a local. People getting heart catheterizations get better meds, and I know this because they all tell me they remember NOTHING.

July 9th I took him home. They gave him his discharge instructions while I was on my way to get him. He was on morphine. I did not know he was incapable of comprehending his discharge instructions until we were home and I realized that he had lost the patient's copy of the discharge instructions. Alone again, naturally.

July 11th we called his oncologist because he was running a temp of 101.3 Ten minutes later the covering partner (not McGee) called back. It was hard to tell if he was bored, sleepy, burnt out, or we had interrupted something... No cause for alarm. Spiking temps are fairly common with cancer. As long as it returns to normal after Tylenol, no cause for concern. I did not have the energy to point out that given the state of the liver I had determined that acetominophen was NOT the anti-febrile drug of choice. No. No worries, this is status quo for cancer.

July 12th Rich had an appointment for his monthly anti-growth hormone injection. They did a set of vitals and determined there was no cause for concern. He was, at that moment, in the down slope of fevers. They did not take blood or urine samples. Each day he got a little bit weaker. Maybe three or four times a day he would spike fevers for no more than an hour at a time. He was telling me he was doing well. I was at work and checking in by phone 3-4 times a day. He was eating like a champ, ample water, juice and tea, peeing well. I grilled him every couple of hours on possible signs and symptoms of infection.

By that Friday, July 16th, I could hear in his voice when I called him on my way home...something was different. Just a bit too tired? The spark was gone from him. I cried all the way home. When I got to him, he had rallied, laughing, joking, asking about my day. I made him a nice dinner. He wanted to watch “Casablanca”--our movie. Shit, in hindsight, there was my sign.

I dozed off before the end. About ten pm I woke suddenly to the bed shaking. Rich was shivering so hard the bed was shaking, his respirations were over 30. I jumped out of bed to dress so I could take him to the ER. By the time I got my shoes on he was stumbling to the bathroom, barely able to walk, totally incoherent. I tried to wrangle him and keep him safe while I dialed 911.

In the ambulance he was totally incoherent. He didn't know who he was or where he was, and he could barely form words and sentences. They thought he was having a stroke. I was trying to explain the matrix of stage four pancreatic cancer, and recent treatments and fevers, but I was falling into a well and I couldn't be sure anyone would hear me before I hit the bottom. It felt like forever in the blink of an eye.

In the ER they took him one way and two very nice people escorted me into a private room. I knew this was not good. I was getting the special treatment for Holy Shit cases. I barely had time to dial a phone number when they were coming to get me, and they started asking me the Holy Shit questions:

Q. “Are you here by yourself?”
Me: “No, I'm here with my husband.”
Q. “Is there family we can call for you?”
Me: “No, it's late, you'll wake them.”
Q. “Ma'am we really need to call someone for you. Who is closest to get here?”
Me:. “My son, Joe, but he's a __PD officer and he's on duty tonight so you can't bother him.”

I was ushered to the ER cubicle where Rich was, and there was a cup of coffee in my hand, and while I sat by the gurney with my hand on his leg I tried to make sense of where I was, what I'd missed, how I'd failed. It seemed like only seconds went by and I looked up and there was Joe, in uniform and my first thought was that he was coming to tell me that something had happened to one of his brothers.

I was still hugging Joe when Rich's brother appeared. We were in the room with him for awhile until they made us leave so they could do a cardio-version because his heart was in A-fib and beating at 240/minute. And then we were back with him. He seemed a bit more alert and oriented. He recognized us. But he also saw people who weren't in the room. He made jokes. He faded in and out. They had us leave the room again, and when they came out they were asking about Advanced Directives. The hallway we were standing in began to shrink, the fluorescent lights began to pierce my brain, and all the oxygen got sucked away into a void that I desperately wanted to dive into.

I heard myself calmly explaining what we had in place, what we had agreed upon, what I had promised. I heard the doctor tell me that now was the time to execute his final wishes, and as her very kind words of explanation continued to flow over me there was just the sound of the voices in my head and the gentle look on my son's face as he held my hand. I was trying to pay attention to what was being said, but I could not stop questioning at what point I might faint, or go numb, or in any way shape or form feel some measure of relief. I heard my own voice responding in what I assumed was intelligible words, phrases and complete sentences, since people around me were nodding--solemnly, agreeably. I was amazed at my ability to stifle the scream that was rumbling in my belly, threatening to explode my lungs, vocal chords and all ear drums withing a 27 yard radius.

Shortly my son Nick arrived. I could tell he was sleep deprived from working second shift and having a new baby, and now I was a burden to him in my own mind. He was trying to comfort me, and I could sense he wasn't sure how and suffering in the process. I was trudging through quick sand with concrete boots. It was now 2:00 am Sat morning and I'd been up since 4:30 Friday morning, having spent nine hours in a job in hell when I should have been home taking care of my husband so this wouldn't have happened, and other people who should be sleeping, or working or tending their brand new baby would not be dodging and catching the flying glass of my shattered life.

With lightening speed I skipped “IF ONLY” and went straight to “I SHOULD HAVE...” There was no IF, there was no IF ONLY, there was only I SHOULD HAVE.... what?

At three am we are watching staff tuck him into a bed on the oncology floor where he would receive Comfort Care Only. I think we all feel like we're turning a page. Rich is responsive—sometimes coherent, sometimes not. He thanks everyone for their effort, for their presence. He says “It's time for me to go to sleep now.”

I send Nick home to his wife and new baby. Joe has returned to his squad car after assuring me he will “keep an eye on Rich” throughout his shift. Ed drives me the long way home.

Not a word passes between us. I don't have the energy, and I suspect Ed is respecting my silence. When he pulls in my driveway, I say thank you, get out of the car and go in the house. A minor voice in my head points out how rude I've been; a louder voice says “shut up, and cut her some slack”. I trust that Ed understands.

I have the worst fucking headache of my life. I take two aspirins, a BIG glass of water and collapse into bed. I sob HARD for a minute, no more than two. Then I am at peace, and I feel the return of the “presence” in the ER hallway who guided my hand as I signed the papers to “let him go”. The soft feather grip at the back of my neck, the scent of warm honey like allysum in sunshine, and the gentle voice whispering against my ear, “just let go... and float...”

Hard shattering awakening to my cell phone ringing. It's 5 am. I've had maybe 90 minutes of sleep. This can't be good. I'm instantly more awake than I want to be; not as awake as I need to be.

The doctor identifies herself and apologizes for waking me. She has a wonderful voice, she seems to instinctively know how to speak to someone at 5 am who has had 90 minutes of sleep, on matters that are gut-wrenching. She speaks calmly, professionally, yet with the exact right measure of compassion and assurance. So, imagine my shock when the next thing out of her mouth is...

“I don't know how to tell you this....”