A friend's perspective

Andrew asked me to share my perspective on Roger's last day here on earth. Here are a few of my thoughts:

I will never forget yesterday. For 10 hours I hung out in Roger's room as we walked my dear brother most of the last mile in his six year fight with the Unwanted Visitor that ended my wife Nancy's life last year.

It was agonizing. Once more I heard the labored, crackling noises that a person utters in their last hours of breathing. I remembered our nine month battle with cancer. I remembered the many miles we have walked with Roger and Karen since they welcomed us home from Ireland in 1992. I ached for the hours of grieving Karen was to face. And once more my soul raged against the insult of death.

It was glorious. I saw the fruit of this humble, loving man as friends, relatives and even a former student from Africa came to say farewell. The day was thus filled with stories, songs, scriptures and sobs. Roger was dying surrounded by those he had loved and served. God led me to share many scriptures during that watch, including passages from Psalm 48 and 142 that had been impressed upon me during the passing of others whom I deeply loved. Such a departure affirms the truth of the gospel. It also contrasted vividly with the other death occurring on the ward yesterday. We were walking Roger toward the Light, the other family was shrouded in dark gloom.

I left the hospice at 9:30. Karen wanted quiet time with her best friend by then. That was only fitting. So, I left her there with Roger and three of the kids. Yet, I am thankful that he let me help Roger take the final steps. You see, when Jesus came for Roger just a couple of hours later, a friend and I were praying for the race to end.


Again, that was fitting, we can walk one another to the Door, but in the end HE opens it for the fortunate one who is taken Home. Well done, good and faithful servant. You ran a good race. As my daughter KJ said, "he is with my mommy." --and many others who loved him. Most importantly Roger sees the face of the One who loved him best of all. Roger, thanks for helping blaze the trail for us to follow in His good time.

Dan Macha

Neighbor, Fellow New Life Elder, and Brother in Christ

Tuesday Afternoon

Last night Sandy and Cara stayed with Mom and Dad in the room. It was a long night as they slept fitfully and listened to Dad's breathing change to a rattling sound. Since then his breathing has become more labored, and the rattling sound fills the room. It is hard to watch him as his body slowly shuts down, to remember the man he once was and to see him lying in bed, so near to death.

We don't know when the end will come, but we are so encouraged by your comments, and the prayers we know you are praying.

Andrew, Daisy, Katherine, and Nana joined them at various points through the morning. It has been a long day with many visitors (Ellie, Ed, Aunt Florence, Sue, Glen, Bill, the Hollands, the Julianis, Karen Keller, Marlene Hammerschmidt, Terry Traylor, Jim Spaulding, Joe, Diane and Chuck Marsh). Dan Macha has been here through the day, faithfully praying and encouraging Dad in "finishing the race". Nana has been sitting by Dad's side holding his hand, quietly letting him know that she is there. We are singing hymns and other songs, reading scripture and telling Dad that we are there for him. There have been many moments of tears, but also moments of praise as we recall God's promises, and are reminded of the hope of heaven.

The facilities here are really quite nice, and it enables us to step out of the room and gather on the couches in the family room to decompress, and then step back in to be with Dad again. We have just received dinner, and are looking forward to a warm meal after a day of eating snack foods- it is such a blessing.

We feel that the end is near, but that Dad is holding on, waiting for Julie to arrive. She has been driving since Saturday from Texas with her family of 8. They are due to arrive anytime now.

We will keep you updated if his status changes.

I just wanted to say thanks to Becky Wilson for her encouraging comment last night about Dad's likely ability to hear us and to sense our presence, even when he is unable to speak or even to respond clearly. We had a powerful confirmation of this this morning when, after we had heard the bad news, Dad had a period of about two hours of relative alertness and responsiveness. It started about when Dr. Stadtmauer came in and was able to rouse Dad right away by saying once, directly, "Roger." The other three of us were completely surprised, because the doctor yesterday was unable to get Dad to come around, even by speaking much louder and applying several firm pats and shakes to Dad's body. But right away Dad opened his eyes and looked directly and for about a minute at Dr. Stadtmauer, squeezed his hand, and murmured, as if to acknowledge and thank him for everything they've shared over the past 6 years.

Shortly after Dr. Stadtmauer said good-bye to Dad, Dad was looking at us in a way he hadn't in days--his eyes still foggy and not quite focused, yet actually seeing--looking at us--and his murmurs and groans were expressive, and not merely the monotone, seemingly unconscious sounds of pain, discomfort or confusion that we'd become accustomed to hearing from him. We raised the bed to a sitting position, and Christine and I were able to talk to him on our own, and he was reaching out to us, and hearing and watching us, and murmuring in response. It was difficult to see him trying to talk and incapable of finding speech, but at the same time we were talking to him, telling him we loved him and knew that he loved us, and that we knew what he wanted to say--and hoping that we did. And Mom came around the bed, and he perked up still more, and tried feebly to reach out, so she hugged him and I put his reaching arm around her and held it there. And he tried to speak, and she kissed him, and held his head, and prayed with him and cried and told her she loved him, and that it would all be alright, that Jesus was near, and he was crying too, crying sounds but no tears. It was all a terrible, beautiful moment of shared pain, and love, and mutual comfort.

The decision was made, this morning, after consulting with Dr. Stadtmauer and our attending physician, to move Dad into hospice care. Though the CTscan of Dad's head came in negative last night, and Dad was looking livelier this morning, it quickly became clear that in fact Dad's condition had only deteriorated further.

The new attending, Dr. Nair, took the situation in hand immediately on seeing Dad and looking at his charts. She examined him carefully and explained his status to us, frankly and clearly, including many details that the doctors over the weekend had neglected to share with us. The long and short of it was that, while Dad's brain did appear to be clear of any bleeding or tumors, an older MRI indicated that there was cancerous growth within the actual bones of his skull. In addition, he has apparently been in acute renal failure, and his liver also is failing, in both cases due to the plasmacytoma discovered last week. In short, the doctor said, Dad's body is in a self-induced coma, and is essentially in the process of shutting itself down. The cancer, Stadtmauer said, is now moving throughout his body, and its effects are at this point non-reversible, including its effects on his mental state.

We questioned him carefully on what measures might be available to Dad now, and he said that the few things they could do could not save Dad, and would be so invasive and cause so much discomfort and additional suffering--with only a slim chance of success--that he could not really recommend them. We had to agree, especially given that these procedures, even if they "worked," could offer no promise of any real increase in his quality of life for however much longer he might survive. Add to that the fact that Dad, in his living will and in conversation with Mom and us kids, had indicated that he did not want his life prolonged merely for prolongation's sake, i.e. with no real hope of recovery. Dr. Stadtmauer said that what Dad is going through now is the "natural" way the body brings things to a close in this situation. In the end, we felt that the decision to move Dad to hospice and halt any further medical interventions in the course of the myeloma was the merciful and loving choice, and the choice Dad himself would make.

Christine had spent the night with Dad, and Mom and I arrived this morning at around 7:30; by about 9:30 the call had been made. Katherine, Daisy, Sandy and Cara have joined us here, along with Dappie (Mom's Dad), Uncle Chuck (Mom's brother), Aunt Diane and Colton. Dad's brother Bill is arriving from France in about an hour, and Nana, Uncle Wayne and Aunt Sue (Dad's bro and sis) will be coming in this evening. Marc Davis came to encourage and pray with Dad this morning, and stayed with Dad while Christine, Mom and I grabbed some lunch and spoke with the folks from hospice. John Yenchko and Mom and Dad's friend John Freeman also came to pray with Dad and say good-bye to him.

Dad will be transferred to Penn's brand new Rittenhouse hospice unit this evening. He will have a large private room, one of just 12 in the facility, which has large common areas, a kitchen and a dining room where the family can gather and be near him during this time. Please pray for Dad, for courage and confidence, and peace and relief from any suffering, that the Lord would make his presence felt to him. Pray for us as we seek to love and bless him in these final moments--however long they may turn out to be.

Sunday Afternoon

Dad's condition remains serious and the exact causes of his symptoms uncertain. He has now been basically unconscious for about 24 hours; he has moments where he opens his eyes, but rarely with anything like "seeing" going on; he has been reduced mostly to non-verbal vocalizations, and when he did speak to Mom last night it was nothing coherent. This morning he was aware enough to respond "hospital" and "HUP" when the doctor asked him where he was, but he then went on to answer "hospital" to all her other questions. Over the past four or five days there has been a gradual, but, when seen altogether, dramatic decline in Dad's overall mental and physical state.

The doctor and his team came by this afternoon, and Mom and I got a chance to hear his assessment and ask direct questions. He was unable to rouse Dad at all, and thought that his sluggishness might be caused by the medication, specifically the Oxycontin and the Ativan, so he prescribed Narcan, which would reverse the narcotic effects of these drugs. He said it may also be caused by blood viscosity, itself a result of calcium being shed from the bones into the bloodstream, as well as the increased protein numbers, both the result of myeloma activity. On the other hand, other tests seem to point away from significantly increased blood viscosity, and the specific lab result for that won't be available for a while. It's also possible that there's some bleeding in Dad's brain resulting from the lowered blood counts, but again, the doctors say that the platelets are not all that low--though he's just received a transfusion to replenish them--suggesting that the root cause is still likeliest to be plasmacytoma--myeloma tumors--in the brain or upper spinal column. The doctors are contemplating a spinal tap to analyze his spinal fluid for signs of the myeloma, but in the meantime expect that the CTscan will show any hemorrhaging or cancerous growth.

As it turns out, the Narcan didn't enable Dad to be much more responsive--he woke up, but was mostly just agitated, without very much ability to interact intelligibly. This seems to suggest that his problem is, as the doctor said, "organic" rather than narcotic. We should know more after the scan results are analyzed.

Sandy, Christine and Erin were in this morning, and Daisy, Ed, Cara and Katherine will be arriving soon via train. Erin and I are supposed to fly out in the morning, but we will still keep all of you updated. Thank you as always for your prayers and many kind calls, emails, comments and other gestures of sympathy and solidarity. Please continue to pray for all of the same things--insight and imagination for the doctors, stamina, encouragement and faith for Mom and Dad, and, still, for some measure of healing for Dad. Pray that he would not be in distress, physical or emotional, and that he would be able to have some mental clarity, some ability to interact with Mom and the rest of us, that he would know that we are with him in this, and that he is loved.

Newer News

The attending doctor from oncology has come by to see Dad, and he believes that Dad's symptoms are a result of the increased activity of the myeloma, and probably not specifically linked to any tumor growth farther up his spine. His protein levels have risen further, and because he hasn't been drinking fluids, his blood is actually thicker, making the effective level of proteins in his blood still higher, only aggravating his symptoms. The hope is that as they rehydrate him via IV, his sluggishness and discomfort will abate somewhat. In the meantime, they have begun administering a new round of steroids to reduce the tumor growth that is presumably behind all of this.

Thankfully, Dad has been transferred to a private room. The doctors no longer think that an MRI is necessary, but the ear, nose and throat specialist is checking him out now.

More soon. Please continue to pray for Dad's strength and spirits, as this is discouraging news for a very tired man. We'll keep you updated.

Saturday Morning

They were able to fit Dad in for a CT scan last night, and it didn't show anything out of the ordinary, but the MRI, scheduled for today, should tell them more. They also expect a specialist to come look at his throat. Mom ended up coming home at about 1:30 last night because Dad was placed in a very small double room and there was no way she could sleep there. She's back at the hospital now; the rest of us will be visiting later in the day.