Heather Annette Altice – A Life Lived Hard, But Too Short My younger sister just ended a several-month struggle with cancer. About two months ago, she sent me an auspicious message on FaceBook. She said she had a friend with metastatic esophageal cancer who was interested in, perhaps, a clinical trial for a treatment that might prolong life. I put on my doctor’s hat and sent her pages of possible treatments, discussing the pros and cons of each possibility. Of course, my internal light bulb was flashing “oh dear goodness, can this be for her”? I hit the send button transmitting volumes of options (none of them good), but hoped against hope that it truly was her friend who needed help. It was as though if I didn’t know, a don’t ask, don’t tell conundrum, it could not be true. My clinical experience knew that she was too young to be one of “those people” with esophageal cancer, but due to my extensive training in biostatistics, I also knew that she could be an “outlier” on the bell curve – she always had been. I swallowed hard, bit my lip and waited 24 hours and sent the note to which I really did not want an answer …. “by any chance, are you the friend who needs this information?” The response came back too quickly, short but definitive with a single word, “yes”. It had been a long time since she had asked me for any help, an in recent decades, help was always disguised as help for someone else – our mother, her children and this time a friend. I had been burned before by her requests for help and there was a part of me that was hesitant to jump in blindly with both feet. This cryptic FaceBook message set in play a barrage of questions, which I tried to ask by phone, email and yes, even on FaceBook. Responses were too slow for me – in my usual fashion I wanted to know details immediately. Information trickled in. She knew it was metastatic to lymph nodes in her abdomen, she was getting chemotherapy that would prolong her life for what she incorrectly believed would be 12-18 months, she was comfortable with her oncologist and clinical team, she had told her children that she had a “minor tumor but that she was fine and getting treatment” and that she had it all under control. I took her reticence to talk to me by phone as a sign that she did not want me meddling in her affairs, but I’m not very good at sitting back quietly – I was already chomping at the bit to “make things better” because that’s what I do. When I finally reflected that she would, as she had always done, do it her way, I finally just asked “what can I do to help”? She said there was not really anything I could do (yes, I rejected that), but told her that I had some frequent flyer miles and that if she wanted, I could fly her, our mother and her kids out to Connecticut so that she could see our twins. All of our conversations invariable digressed back to our children – a nice escape since I can talk about them for hours. Breakthrough! She accepted my offer. I put in motion a ton of questions, none of which she would answer directly like which dates, closest airports for everyone to travel from and what she would like to do while here. She offered up the first week in June, after her next round of chemo, or the first week in August. I suspected that August seemed too remote but I was trying to give her space. FaceBook to the rescue again. Her friend June McGlamery, who she had met during one of her recent hospitalizations, had found me and indicated that Heather was “going to be angry with her for writing me, but that she could just not hold back anymore”. She indicated that Heather’s chemo had been stopped because she had had a complication and had turned yellow and that the doctors had said there was nothing they could do further to help her. I am truly grateful that June had conspired against Heather and contacted me because I knew that what I had proposed – flying everyone to Connecticut – was no longer an option. I went into “Rick Mode” (not sure what this really is, but those who know me can recognize it) and told her that I was flying out immediately to see her, was going to make sure that her children got there and no longer provided options. She resisted ever so slightly because while she had shared with me the truth of her eventuality, she dreaded more than anything telling her kids what was going on. I knew there was not much I could so I told her I would take care of that, help her with her last minute needs like medical power of attorney, be a decision maker for her when she could no longer make decisions and speak to her doctors to see if there was really nothing that could be done. She finally acquiesced. I was on a plane, had made arrangements for her children to come too and kept my promises. My secretary, Paula, managed to keep me together and made sure that every detail was perfectly organized. Everyone should be so lucky. I am not sure I was prepared for what I would find upon my arrival. Somehow when you feel you are most vulnerable, you find the greatest inner strength. My once stunningly beautiful sister, who really should have had a different life than the one she had, was a mere 99 pounds, fluorescently yellow, appearing years older than her stated age and despite this physical transformation – she was indeed the younger sister and little girl that I remembered from childhood. She had dressed nicely in what was her best clothing (though I doubt she had much), had styled her hair and made sure that she walked outside confidently to meet me when I parked the rental car in front of the house that she would call home for her last weeks on earth. She smiled broadly, though with a certainty of pain in her expression, and welcomed me and said she was glad I was there. If I had had any reservations about coming to see her, they were now gone. I knew that my decision to come was, as painful as it was, among the best I had made. My nephew, Adrien, had missed his flight and my niece, Monique, would not arrive until the middle of the night. I believe Heather was relieved that I was there alone, because she quickly took me to task to let me know what I believe were her many last and unresolved wishes. She got right to the business of making sure I knew that she wanted to be pain free, that hospice was needed, that June (and her husband Dave) had greatly relieved her stressors by agreeing to host her for whatever time she had left (more on that later), that she had tons of documents for living wills, medical power of attorney and last wishes that she wanted to address before her children arrived. I was at first thankful for the clinical precision and organization of these activities. It was as through she knew I was about to explode with grief, but because there were “things for me to do”, I found solace in helping carry out these last wishes. Of course, I wanted to do more, but there was a sense of level-headedness that was either her own response to her inevitability or she had mustered up all the strength she could to see me after so many years – though we had spoken about issues related to caring for our mother. At moments like these, you get a rare insight into someone’s inner fabric when you ask about how you can help with someone’s last wishes. I share them only because they might tell a bit of a story about Heather that many who knew her (including me), must not have known. Here are some of those wishes, not in any particular order: • She did not want to be present when I told her kids about the details of her condition. It was the one thing that she did not have the courage to face even though she knew her own untimely death would arrive within a matter of weeks. • She wanted to be cremated, saying that she had been somewhat nomadic in life and that burial in a fixed location, far from the ones she loved, was not part of her plan. • She had been working on an insurance policy to help with her cremation, but had tried to ensure there was enough money in it for her two children to fly her ashes to be scattered on the grave of our Little Granny, who was buried in West Virginia. • She wanted me to make sure that I told our father and stepmother, who had sacrificed greatly in raising us, that she loved them. She did not want me to share this until after she had passed. • She did not want me to bring her to Connecticut for the last of her days since she had considerable support and caring hands where she was now. She had developed a sisterly bond with June and Dave and knew that she was safest where she was and did not want me, or anyone else see her during her spiral downwards. • She knew that her daughter would be strong during her last weeks, but that she wanted to extract a promise from her son that he would join the military so he would be taken care of for the rest of his life since she thought he was the most vulnerable among those she loved and had never been able to fully care for himself. • She had wanted to see my kids, not in person because she knew she could not travel, before she died. I set up Skype on her Ipad so that I could later arrange this, which we did a few times over the past few weeks. • She did not want me to fly our mother out to see her, saying that she wanted mom to remember her as she was, but not as she is now. • She wanted me to find some photos of several family members who she wanted at her bedside in spirit. Photos of Dad and Donella, one of her with her two brothers who posed with our grandmother for her 80th birthday and many of her children. Though she did not want to ask for them to be there in person, she said that being able to see them for as long as she can and having them near was enough. Our Dad, the master of archiving photographs, provided me with thousands of photographs and Walgreens made them appear within hours. I committed these last wishes to memory, knowing there were some that I could do now and others would hopefully, happen soon. I had felt that there was a sense of accomplishment, not that I could in any way change the course of her demise, but that there were things that were tangible (and some that were not) that could give her comfort. In the early evening after my arrival, she “summarily dismissed” me saying that she was tired at about 6pm. I sensed her relief that she had been able to unburden herself and that her load, like her diminishing weight, was lightened. I drove several hours back to Sacramento to pick up Adrien and we arrived back at the hotel in the wee hours of the morning, about the time when Monique would have arrived. I had already told both kids by phone about their mother’s situation, mainly to ensure that they knew it was important to be there. The next day, I was reunited with both my niece and nephew and I met with them before going to see Heather. I wanted to prepare them further for everything that I had seen, what kinds of expectations they might anticipate and told them some of her last wishes. They both fought back tears (me included) and I reverted back to my clinical repose to keep all of us from breaking down, because I knew that Heather would be relieved if they held it together. Heather had told me the day before that she was “best” starting from about noon to 6pm and was thrilled that we were going to all go out for an early dinner. I didn’t anticipate that upon our arrival, that Heather would be almost entirely unresponsive for almost the entire day. I think that everything we had done the day before had drained her – even though she held herself high and self-assured. Her children and I kept ourselves busy trying to “do something” for her. We bought tons of groceries and things to comfort her, organized her iPad and email, ran errands for her, and went out to eat, primarily to let them talk about their own feelings. It was agony to hear them so distraught. Heather managed to wake only for moments intermittently that day to tell them she knew they were there and that she loved them, but I had not prepared them for this since the day before had been relatively good. Fortunately, after a day’s rest, the following day she was herself again and she got to spend some quality time with her children and I could see that she had gotten another of her last wishes – to see her children again. Her daughter, Monique, committed to remain near her and to see her daily thereafter since we knew that she would not last long. The level of comfort this gave her was bittersweet, because Heather was ambivalent about seeing her daughter suffer, but knew that this is what Monique needed and she acquiesced. Monique even was able to fulfill one new and last wish of her dying mother – to spend a day at the beach near the lake, which she did just a few days before went into a progressive slumber, remained pain-free under the deity Morpheus and careful and loving eyes of June and Dave. A few hours before she died, June had the good insight to call me saying that it was only a matter of hours before she would pass. Even though Heather was incoherent, I was able to say my last words to her over the phone from over 6000 miles away. Adrien too was able to tell his mom that it was ok for her to let go and that he loved her. This happened on his birthday – a legacy that I hope he will cherish rather than regret. Monique, for good or for bad, was able to do this in person – a bittersweet solace since so many never get to say what they want before someone they love leaves this world. I had been in daily touch with June who assured me that Heather was not suffering and I am eternally grateful that she was allowed to pass with dignity. If angels existed, June and Dave would be among them. They didn’t know me until Heather’s illness, but reached out to make sure that I knew what was going on, allowed me to see my sister one last time and helped keep me in touch as her health waivered. I digress to the days of our childhood. Though there were many times that I can objectively say were not those halcyon days of yore, I loved her deeply and regret not ever being able to help her despite my many attempts over the years. Though the last many years had been a struggle between us – two lives and lifestyles that could not be more different – I long for the life that she might have lived differently but know that she lived the life that she chose – her way! Despite our distance over the years, her love of her children brought her great comfort. At the end, I am grateful that I chose to resolve my differences with our two very different lives and travel to see her to say my goodbyes and bring to closure some of the last wishes of a person with limited time. Admittedly, I struggled with how to reconcile our differences. I am thankful – especially with the support of my husband – that I had the strength and commitment to overlook our differences. Instead, I can confidently say I will be able to remember a beautiful young woman that I admired – for her beauty (she truly had been a beauty pageant queen), her intelligence (it is rare to have achieved a perfect score on her SAT exam), her athleticism (having held the state record for the women’s mile and half mile for 9 years after she graduated from high school) and her talent (she had a voice that competed with songbirds on an early morning for its clarity and beauty). I can’t imagine that she is really gone now. It brings to mind my own mortality, especially painful since the arrival of our own beautiful babies 9 months ago. Though saddened by our loss at 7:43 pm (4:43 am here in Kiev), I know that she is not suffering, she is loved and that she will live on, for good or for bad, in our minds and our hearts. I got to begin to morn her over the last few months and it is remarkable how my good memories grow stronger and those less good ones retreat from my conscience. I am partially consoled by this process and despite my profound loneliness of dealing with this from afar, I am able to grieve healthily and know that my dying sister fulfilled so many of her last wishes – we should all pass from this world having made some peace with our lives! The alternative is unnerving. I am thankful for having had her in my life – through good and through bad – I learned from her struggles and her experiences contribute to who I am today. I only wish that she were here now to hear this.
Posted on: Sun, 06 Jul 2014 04:37:03 +0000
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