November 3, 2009
Today was a holy day as Nate stepped out of this world and into the next. The members of our family (as well as Mary and several hospice staff) had kept a vigil around his bed for three days, not leaving him alone for one minute. Pancreatic cancer is one of the most painful cancers that exists, but the nurses had taught us how to manage his pain with helpful drugs. We learned to read Nate’s body language carefully, even while he was unconscious, watching for signs of discomfort and anguish. If he paddled his feet, pinched his shoulders together, furrowed his brow or shifted in his sleep we knew he was struggling and needed help.
Yesterday morning Nate hit a new low. He was in tremendous pain, which yanked the rest of us into it with him. A nurse guided us by phone on how to escalate the meds, finally arriving in person to help us. Nothing we did seemed to settle him. The combination of drugs had gotten complicated, and we were keeping a desktop record of what we gave him, when we did it and a schedule of next doses, but even with that it was becoming more and more difficult to keep everything straight. When the drugs weren’t “getting” his pain, we were devastated.
Hospice offered to send a nurse who would stay with us through the evening and overnight. Her main function would be to manage the complicated medicine, although she would also be there to help if he passed away on her watch. We gratefully agreed.
By 5 p.m. yesterday, Nate’s pain began to subside. The added pain patches wouldn’t kick in until morning, but the increased morphine worked its magic, and he began to settle. We learned later that the orange-sized tumor in his lung had ruptured during this time, causing tremendous pain he could not tell us about in words. Later that evening fresh blood would flow from his nose, and brown fluid would spill from his mouth. Both seemed mysterious at the time, but later the puzzle pieces fit together, when the rupture was identified. From that point on, he was breathing with one lung.
Tears, love and gratitude
Nate could no longer talk to us with his voice but spoke volumes with small facial expressions we carefully looked for. All 11 of us squeezed around the bed in his tiny room once again to express love, each one taking a turn with their father/father-in-law. Tears flowed and great things were accomplished. Gratitude poured from the hearts and mouths of each person. I, too, spoke love and thanks to Nate. We repeated Scripture to him, sure of his hearing. Mary and I sang all three verses of his favorite hymn: “Blessed Assurance.”
Nurse Sonia arrived at 6 p.m. and made an assessment of his condition, concluding he probably wouldn’t live till midnight. We braced ourselves and spent every minute with him. His makeshift bedroom was filled: the hospital bed, the big oxygen-making machine, extra oxygen tanks, a desk covered with medical supplies and as many chairs and stools as could be wedged around the bed.
At about 10 p.m. it looked like he was slipping away. His breathing became more shallow with long pauses between breaths. He was in a deep unconscious state but was, at long last, resting without any signs of pain or even discomfort. His hand was relaxed as I held it. I sat on the edge of the bed and put his warm hand on my knee, a gesture very familiar to both of us. For a flash it was just like old times, before pancreatic cancer.
I began singing quietly again, and Mary joined in. Nate, a non-musical person (except for Elvis Presley songs), had often mentioned his favorite hymns: “Blessed Assurance”, “Fairest Lord Jesus” and “A Mighty Fortress”. We sang them all, and gradually each of the kids drifted back into the room, lit by a dim green lamp. Some of us were softly crying. We quoted Nate’s favorite Scripture passage, Hebrews 12:1-3, about running life’s race. I told him, nose to nose, that his race was almost over, and he was close to the finish line. He was worn out and would soon be able to rest. We told him how proud we were of him in his strong perseverance.
‘No more pain’
Despite the click-click of an oxygen machine, the little room became a sanctuary of worship. We lovingly spoke to him, caressed him, loved him. I talked right into his ear and said, “The Bible tells us an angel will escort you to Jesus. Do you see the angel yet? It’s time to stop running the race. Just walk right into heaven. No more pain. No more work pressures. No more trouble. You can leave us any time now. You’re ready to go, and we are ready to let you go.”
These words were difficult to say, but God kept my voice strong despite tears plopping on Nate’s t-shirt. The kids moved forward and said more nourishing things to their dad. Many of them broke into spontaneous prayer. The Holy Spirit was hovering over our little group, working his wonders in every heart and mind.
Finally we were quiet, listening to Nate’s erratic breathing, focusing on his face, waiting for the end. Every so often the nurse would move through our ring of protection to take his blood pressure or listen to his heart. “Not long now,” she’d say, slipping quietly into the background again.
Minutes passed, then an hour. Nate’s breathing didn’t change. Sonia was replaced with Dee at 11:30 p.m., and as she stepped into the room to make her own assessment of Nate, our kids began easing out of the room. They stoked the living room fire and settled into chairs, talking quietly, waiting, until they drifted into sleep. No one wanted to move too far away.
Mary and I settled into our sleeping chairs next to Nate’s bed for the third night of watching over him. Dee stayed close, too, and we grew to love her tender care of him through the night. Once I opened my bleary eyes and saw her reading my Bible in the dim green light, sitting in the corner on an 18″ stool.
When morning came, Nate’s blood pressure was 63 over 38, unchanged from the evening before, but his heart had weakened significantly, beating irregularly and “far away” as Nurse Dee put it. We continued to wait. Dawn came. Coffee was made. The little ones began their chatter, and life moved forward one more step. Dee shook her head in amazement as she listened to Nate’s heart.
“I can barely hear it at all,” she said. “He’s keeping himself alive by sheer willpower.”
“He has a special tenderness toward those whose husband/father has abandoned them,” I told her, “and he’s trying not to abandon us.”
“Better release him again,” she said.
Nate has always been a list-maker, so I made an audio list for him, coming close to his face. “Your taxes are paid. You have provided for me with life insurance. You have put my name on your bank account. You have completed your cards for the kids. Your children and your two brothers-in-law are going to take care of me. Your clients all send their love. Your business is being cared for.”
I listed every specific detail I could think of and then said, “And now it’s time for you to leave these things behind and go. I’m going to say goodbye now, and I’ll see you later. You’re so blessed to be going to heaven now. You’ll actually get to meet and talk to Jesus! I’ll be right behind you, and when I get there, I know you’ll welcome me.”
I kept one hand on his chest which was moving up and down ever so slightly with an occasional deeper breath. But he chose not to “go.” By 6 p.m., although he had no pulse, he was still breathing. In the rest of the house, life kept happening. Two people left to pick up Chinese food. Two more walked Jack. Someone else took the little ones to the playground. Animated conversations were in progress.
Mary and I based at Nate’s bedside, marveling at how he continued to cling to life. Dee had used the word “rare” in reference to him being a pancreatic cancer patient able to hang on so long. She also told us it was unusual for pancreatic cases to die without intense pain, yet Nate’s face was peaceful and smooth. Dee said, “As I studied him during the night, it looked like he was getting younger and younger.”
We told her of all the prayer that was going up to God on this specific issue, a peaceful passing. She nodded like a woman who knew all about it.
At 7:20 p.m., Dee was long gone, and we were wondering if we should call for another night nurse to help us. Mary said, “Well, go get your plate of food. I’ll watch.” But I hadn’t been in the kitchen 20 seconds when she came running.
“You better come. It’s happening,” she said,” and I dropped my plate and ran. The kids set their plates aside and followed.
Putting one hand on his chest and one on his face, I felt him take three more slow breaths as I spoke my goodbyes and I-love-yous into his ear, and he died. Our beloved husband and father had finished his race. And he was healed of pancreatic cancer.
Passing the box of tissue back and forth across the bed, we all wept freely. I continued to hold onto Nate, caressing the arm, hand and face of the person I loved so much. But he began to cool off immediately. His face and lips turned ashen beneath the yellowed skin of liver failure. Within minutes his body was stiff and cold. The real man had departed, and it was obvious to all of us.
We stayed in our little womb-room and talked of how Nate had not so much died as been born to eternal life. The kids surmised about what he was doing “right now.” Through tears we smiled. And we prayed together, trusting God’s Word to be true and claiming every promise about heaven.
Nelson quickly stepped into his father’s shoes, calling hospice and then the funeral home. Within a few minutes a nurse arrived with her stethoscope, listening to Nate’s heart for the full legal 60 seconds before pronouncing him dead. But one look at him could have made that pronouncement.
The funeral director and his assistant arrived and wrapped his body in the sheets from the bed and simply carried him out of the house. I told all the kids not to look as they walked by, but I had to see. One man held him at the shoulders, one at the hips. His legs stuck straight out as if he was still lying in the bed. How quickly our “shells” become useless baggage once the God of life and death removes the real us.
By 10 p.m. we were sitting together without nurses, funeral personnel or Nate. I said, “Now. What would Papa want us to do next?”
Several of the kids answered in unison, “Eat our Chinese dinner.”
And so we did.
“We grow weary in our present bodies, and we long to put on our heavenly bodies like new clothing. Yes, we are fully confident, and we would rather be away from these earthly bodies, for then we will be at home with the Lord. Precious in the sight of the Lord is the death of his saints.”
Guest contributor Margaret Nyman chronicles the 42 days after her husband Nate, a patient at Rush University Medical Center, was diagnosed with pancreatic cancer. Read more posts by visiting the Coping With Cancer section or subscribing to the RSS feed. Her personal blog is at www.GettingThroughThis.com.