Hospice revisited

The kids and I are looking forward with trepidation to the second round of hospice care in our lives. They were really too young at 8, 10, and 12 to be very much aware of the pain of watching my mother fade into a morphine-induced reality as breast cancer that metastasized into bone cancer slowly ate away her life.

This time, they cannot be present to see the pain their grandfather is beginning to suffer, but they understand and feel the reality of death, and I feel certain that his is not very far away. The prostate cancer he developed a decade or more ago has almost certainly metastasized into the bone, and his daughters expect hospice care to be soon on its way.

Looking back, I see a father-in-law who has always seemed to me to be something of an odd bird. His military career followed his family's history; his training in Baptist seminary may well have been his way of rejecting their tradition of alcoholism.  The combination of discipline rooted in military order and alcoholism gave him a very strong reliance on knowing rules and making sure they are followed, a distaste for spontaneity, a strong need to feel loved, but an inability to show affection to those closest to him.

As a result, I heard from his son (my ex) for the first decade or more of our marriage that the father had never been present in the son's life, always too consumed with his job responsibilities as a military chaplain to take time to be a dad. Hence the son's youthful experimentation with alcohol, tobacco, stronger drugs, and sex, and maybe his lack of ability to be present in his own children's lives. Like Cat Stevens' "Cat's in the Cradle," the son did a fine job of following in the father's footsteps.

My personal experience with Granddad was a  little confusing: he often welcomed me into his little corner of the house, but we frequently argued about one thing or another. I found the arguments stimulating; I never felt as if either of us won or lost, but we went away understanding and respecting the other's point of view. Ex was appalled at the very notion that I would argue with his dad; I thought it was a perfectly normal thing to do, and Granddad never made any attempt to stop it, so I rather assumed he appreciated the opportunity to state his point of view.

Ex's sister is a few months younger than I, and we graduated from the same university the same semester. One big difference was that I had had to pay for most of my last three years of school almost completely on my own, and Granddad had generously financed Sis's. The other difference was that Sis decided a few weeks before the end of our senior year that she didn't want the degree and walked out of school to go live as a hippie on a beach. One of her professors found her, got her back into school, and gave her a place to live since she had blown the last installment on her dorm room, so she actually graduated on time. I never heard a word out of Granddad about Sis's behavior; I was amazed that he continued to support her as if the incident had never happened. For a father who wasn't a dad, I thought his response was hugely forgiving and generous.

Years later, when Ex and I divorced, Sis made a point of letting me know she considered the issues in my marriage completely my fault and of wedging herself between me and him at every opportunity, even while we were at least nominally attempting to resolve our differences. I didn't want to cause problems with his family because they were, after all, still my children's kin, but I had a hard time believing that I would ever see any of them again.

That changed a couple of years ago when Granddad, then in his middle 80s, wrecked his car in the kind of accident that happens to lots of people when they are temporarily distracted. By this time, Ex had been remarried for several years, but neither Ex nor his wife seemed to be able to communicate to his two sisters what was going on with the accident. The sisters had not been particularly impressed with the new wife, but they were very upset that she was the only "reliable" source of information they had on the parents.

The two sisters invited me out for margaritas and asked me if I could bring myself to check in on the parents from time to time. I had been invited to their apartment for the family Christmas dinner shortly before then, and I knew the parents would be kind if not generous with me if I dropped in on them; after all, I'm about the only connection they really have with their grandchildren.

Sure enough, they greeted me warmly the first day I dropped by their apartment, and they have reprised that kindness every time I have dropped by since then. They have dutifully reported all of their latest medical information as if they thought I had the level of understanding of their younger daughter, who is head nurse in a specialty unit in a Galveston hospital; they have asked about their grandchildren; and we have generally discussed most of the conversational taboos, including politics and religion and even touching occasionally on  money.

On that first trip, they asked me why I had suddenly dropped in after years of staying away; I candidly told them the girls had asked me to because, among other things, they were appalled to hear that the parents had been eating at Taco Bell. Without missing a beat, they replied in unison, "It's good!" I also told Granddad that I had always admired him for not killing Sis when she had walked out on a college education he had paid for; he just shrugged and said, "She's my daughter and I love her." Having had my share of problems with NOS (who is now living with me again), I reconnected immediately.

I have been amused to find how liberal Granddad really is, in spite of the conservative leanings of the daughters, and I've seen that some of the things that attracted me to my ex were his similar liberal leanings. I knew that Granddad had led "ecumenical" Protestant services in the military, and over the past couple of years I've begun to see a sense of Christianity that I had not recognized in him before: he stopped attending the large church his wife and younger daughter attended for years because of his distaste for "big box" churches where individuals get lost in the shuffle. He has been impatient with any profession of Christianity that marginalizes others; he clearly takes "be ye kind" to heart. He is struggling now with whether God had a reason for keeping him alive just beyond his 88th birthday and struggling with whether this is the time when he really should let go.

That decision may actually have been made for him. Like Mother in the last few months before her death, Granddad has started complaining of gastrointestinal problems; in fact, he has already reached a stage where he is unable to eat much in the way  of solid food, and his weight has dropped precipitously in the last few weeks. He is already on a morphine-like pain patch and was asking for additional Tylenol 3 (with codeine) for pain that made sitting uncomfortable, although he is still able to navigate around the apartment under his own steam. I rather suspect his body is telling him he won't have the strength (and I suspect he doesn't have the ability to withstand pain) that Mother did, and he will likely slip away before the bone cancer has much chance to do its damage.

I think he realizes that, too. Although he was getting lots of interpretations about how much pain relief he can get right now, I stole a minute when nobody else was in the room with us to remind him that he is the only one who can feel his pain, and he can have as much medicine as he thinks he needs to cope with it. I know he could take too much too soon and reduce his life by days or weeks, but I have seen the pain of bone cancer, and I would never wish it on anybody.

Maybe a bright spot is that he is having a chance to make peace with his kids: although they have lived in the same town together for almost 20 years, Ex has only recently begun to make regular visits to the apartment, and the daughters have rented the apartment next door so they can be available to help with his care now and MeMe's after he is gone.

When I asked last week how the parents are getting along with changes the daughters are making in their lives, Granddad smiled and said, "I just say, 'yes, major!'" MeMe, on the other hand, showed me proudly around "the store" in a back bedroom where the daughters have sorted out all the combined canned goods from two households onto metal shelves to see what they have for meals until they whittle it down. I'm not sure how good the intrusion is in some ways, but in others I think it reassures her his death won't leave her alone.

My Number One Son, who shares his father's and grandfather's name, lives in town but rather hesitates to go to see him, but Darling Daughter will be in later this week and will be eager to squeeze in time with him, knowing this trip will likely be her last to see him alive. Soldier Son won't be able to come back from Germany before November, which will likely be too late, but last week I delivered a perfectly beautiful letter he had written out by hand and sent with love; his Granddad almost cried.

This afternoon when I popped in for a visit, Ex walked in shortly after I got there. To say our encounters over the decade and a half since our divorce have been strained would pretty much be an understatement, but today he was relaxed and friendly. NOS had said recently that Ex's "beer gut" may well be symptomatic of liver trouble, and I have to say it did look off balance against the gaunt appearance of his arms and legs. He blamed the hoarseness of his voice on sinus drainage, but I wonder if years of smoking are taking their toll on his lungs and throat. He had "unofficial" advice that the suspected kidney cancer he thought he had still appears to be a less-dangerous cyst, which is a good deal better than the alternative. But time is clearly taking a toll on him, too.

And so we are looking at another round of hospice in our lives and the looming loss of another loved one. As SS said when things first started looking bad for Granddad a few months ago, "It's okay if we have to let him go now; the old boy has had a pretty good run."

My prayer now is that the end of it will be peaceful, loving, and as painless as possible.