Wednesday, May 2, 2012

Eulogy

I wrote the following as the eulogy I intended to deliver at dad's funeral.  I ended up delivering a somewhat different version (the reality of speaking at a funeral is that it is a rare person who delivers written remarks without giving in to emotionally-driven spontaneous changes).
* * *

I am planning to cry, so please bear with me if I need a minute during this.

I’ve given eulogies before, but I’ve stuck with facts, praise, and prose.  Dad deserves that kind of praise and prose, and he’ll get it from me and others.  But I had the privilege of spending weeks living with him in the hospital, switching nights with my mom, and helping him as he did thing after thing for the very last time.  It was hard to watch him suffer, but I am grateful I was able to give him the gift of companionship, the gift of making sure the hospital followed his wishes, and to enjoy the gift we gave each other of leaving nothing unsaid between us.  So instead of talking about how great a dad he was – and he was, and you’ll hear that over and over today –  and instead of offering a biography, I want to share his last moments with you.

I’m coming to grips with the fact my grandfather was the patriarch of the family just five years ago, dad was the patriarch until Wednesday, and that role now rests with me.  But that also means that dad isn’t 71 years old anymore.  He isn’t old, or sick, or worried, or battling cancer.  I see him reflected, as if he were still alive, in the things my daughters do day to day, in my brothers’ kindness, in my mother, and frankly in my drive to do the right thing no matter the personal cost – particularly when the right thing involves keeping my family happy and safe.

We die as we live, and his last day told the story of his life. 

He lived as a strong man, a man who knew what he wanted.  On his last day, he knew he was going to die, and he didn’t want to suffer.  In the morning, he told mom he was in respiratory failure, and she called for an ambulance.  As he left his home for the last time, even struggling to breathe, he was having a technical discussion with the paramedics about his condition, he liked the details of stuff and he loved medicine. 

Mom and I drove to the hospital and after a long wait they let her in to see him.  Mom came out and said they only would give one pass and asked if I wanted to use the pass to go in.  Mom was the love of his life and I knew he needed her by his side.  I told her that and she just nodded.  Of course, she knew it too. 

Mom is crafty, and eventually got the doctor to give me a pass.  When I got back there, I insisted that the doctor talk with us about dad’s DNR wishes.  Dad was a bit out of it, but immediately engaged.  “I do not want to be resuscitated under any circumstances.”  The doctor said intubation would help him breathe.  Dad said “I refuse to be intubated.  Instead of intubating me, just shut me down with morphine.  I’ve just about had it.  I’ve had enough.”  This is a man who was wrote on his blog that he was going to shoot the last chemo arrow in his quiver days before – but today a man who had finally concluded he was beyond any reasonable chance for a meaningful recovery.  I leaned in and promised him that we would take good care of mom no matter what happened.  You could just see him relax. 

Dad always knew what he wanted in life, and it was no different in death.  The greatest gift mom and I were able to give dad was making sure his wishes were honored.  It was also the most expensive gift I ever gave, since I loved him so much and he was asking us to let the doctors let him die.  But he was a good man, a good father, and he had long ago earned the right to have me fight to make sure he would be able to exit in the way of his choice.  I gave him my word, and I made sure the doctors and nurses followed his.

We waited for a chest x-ray.  Dad was interactive, even smiled a bit.  Then the results, pneumonia confirmed.  The doctor offered a BiPAP mask, which is a non-invasive mask that covers the mouth and nose and when you breathe, kicks up the pressure to force air in.  Dad was cogent and said he wanted it.   They fitted him with it, and he couldn’t talk easily once it was on.  Just as bad, he couldn’t wear his trifocals over the mask’s seal.  I knew he expected this to be his last day when he refused intubation, but I saw impatience in his eyes when he realized he couldn’t talk or even see properly.

They took him to the ICU, but didn’t let us in for a while.  By the time we got in, dad had asked for Dilaudid painkiller.  He was still cogent, but his plan was in action.  He looked each of us in eye.  He responded when we held him.  The details from then on aren’t critical – he eventually lost consciousness.  Dad would never wake up again, but this is where the real story of dad’s life was told.

His left arm was covered with IVs, tape, and other medical stuff.  His right arm was clear.  My mom was standing next to his left arm, and I was holding onto his right.  It didn’t seem right, and I asked her if she would switch so she could touch his skin more easily.  She paused, then walked to the end of the bed and said “no, he always loved when I rubbed his feet.  I want him to feel me rubbing his feet.”  She knew him so well, and loves him so much.

Eva had asked that I tell him she loved him, so I kissed him and said “Eva wanted me to tell you she loves you, and I love you too.”  Mom said “I love you” and kissed him.

I’d spent so much time at the hospital that I knew how to read a lot of the machines, and I saw dad was about to go.  The nurse said “it’s happening”.  Mom rubbed his feet, held him.  I held his arm and cried softly.  He died the way he lived – with his family at his side, respecting his wishes, and on his own terms.

I looked up and saw mom sitting in a chair at the foot of the bed.  I kissed dad once more on the forehead – his heart had stopped but I hoped he could still feel my love – then  I walked to mom, hugged her, and asked her what she needed.  In a strong, painful voice she said “I need them to take all of that stuff off of him so I can hug him, so I can hold him one last time.”  I told the nurse and he complied in seconds.

Then I saw the most terrifying and beautiful thing I’ve ever seen.  Something that was simultaneously the stuff of nightmares and the stuff of the endings of the most beautiful Disney princess stories.  My dad’s body, his mouth slightly open, still, not breathing, and my mother holding him.  She was holding him lightly in a physical sense, but it was the strongest hug I’ve ever seen.

I know that in intense situations people see things that aren’t real, but what I saw next I will believe to my grave to be real.  Dad’s body looked full.  It will still, he was dead, but even in death it was full.  And with every second mom held him, dad’s body emptied and mom’s grew fuller.  I could see him going into her.  She held him until I saw that migration finish, then, like she knew it was complete, she looked up, let go, and told me that that was the last time she would ever be able to hold him.

Not true, mom.  I’m not a religious man.  I do know that nothing in the universe is ever destroyed; it can change form, but is never gone.  I don’t know how I saw what I saw, I don’t know if it was really visible or just my realizing what it means to spend 50 years madly in love.  But what I do know is that dad is with you, whatever spirit he has, however it manifests, you carry him with you for the rest of your days.

I don’t expect you to suddenly follow the NCAA.  I know it isn’t literally that there are two people in your body, but the story of your lives was so intertwined with your love that at the moment of his death your merger became complete.  At the time I couldn’t figure out why you had such an urgency to give him a full body hug, with all the medical stuff gone, but when I saw what happened, I knew.

You hold in you all of the love you share.  Everybody should be so lucky to draw that much love, enough love to sustain you the rest of your days.

I love you dad.  I’ll honor you by being the best dad and the best man I can be.
* * *

The funeral was recorded on video and was uploaded in three parts.  Many voices spoke about my father, and each deserves to be linked from his blog.  Parts one, two, three.

Sunday, April 22, 2012

Thank you, MCC Google Group

I wrote an email to the Google Group for MCC (http://groups.google.com/group/merkelcell), which is a private group for those battling Merkel Cell Cancer and for the people fighting alongside them (if you have MCC or are supporting somebody with MCC, you really need to join that group).  I realized after writing it that my dad would have wanted me to share my thanks and thoughts for this group more broadly.  The email I sent is as follows:


Thank you all for your wishes and your kind praise of dad.


His memorial service is today, and while I'm not going to be distracted with technological issues, I do plan to set up a video camera to capture the event.  Since you've become his family in the same way that soldiers fighting a battle side by side become family,  In a war, there are many battles.  Some warriors are felled in battle.  Some throw themselves into the path of danger to protect others (as with experimental surgeries).  Some mentor other soldiers, preparing them to survive their part in the way (a role my dad took on).  Some get lucky and survive, and some powerful warriors are less lucky.  But in the end, spending years with a band of brothers and sisters fighting a heartless, inhuman beast turns strangers into family.  And so it was for my dad.  He implicitly sought a promise that I'd care for my mother, but the only explicit promise he asked of me on his last day was that I update his blog if he didn't make it.  This family, forged in a shared, frightening common battle against a heartless beast, this family forged in common support and empathy, this family that met not in person but in heart, this family was on his mind on his last day.  As well it should have been.  He died with me at his side, with his wife at his side, with his children and grandchildren in his heart, and with your thoughts and presence surrounding him.  Thank you for that.

I'd like to post the memorial so you can watch it.  I'm not going to be babysitting the video camera, so if there is a technical failure to record the video, so be it.  But if things go as planned, after a few days I'll be able to put up a link to the video.

I see about 3 more posts to the blog.  "Eulogy", "Dying", and "The Future" are likely titles.  I intend to post the eulogy I wrote for him after I deliver it today.  I've been drafting a pretty detailed account of his last day called "dying" (incredibly hard to write, but he found it so important to bluntly share his experiences to help others prepare for what they might face).  I then intend to close with a post about the future, although the ideas about that are kind of amorphous so I'm not sure if that post happens or if it happens the way I'm thinking about it today.

After the last substantive blog post, I'm considering a fundraising and patient support blog post.  This would be links to a PDF version of his blog, a print version, and perhaps a Kindle format version.  They would be available at cost (so PDF free, ebook free, if distributed via Amazon the minimum cost, physical book probably expensive even sold at cost).  Patients need support, and family, friends and patients would be encouraged to use the book without paying.  For those who find value in the book and who are able to afford it, I would include information about how they can pay what they wish, donating to MCC research donate voluntarily in exchange for the book.

I'm off to prepare to bury my father.  I'm having a hard day, but having just read this thread of comments [a set of emails sent by MCC group members in response to my post that he had died], my day is that much easier.

The power of community cannot be overstated, and the power of this community is particularly strong.

Thank you for your love.  I know my dad was grateful for your support to the end, since he went out of his way to expressly say so.  He was fitted with a BiPAP mask much of the day, so he spoke perhaps a thousand words or less on his last day and he reserved some of those for you.  I'm glad he did so.  You deserve it.  

Now I ask each of you to honor him by beating your own MCC.  Please make my father one of the last to die by this disease.  You've described it as a beast and a bully and by all manner of other names, as my dad did, but ultimately it is just some cells in your own bodies making the horrible mistake of thinking that they should keep on reproducing.  It isn't an intelligent enemy or even a powerful enemy.  It is nothing more than a biological mistake.  This isn't to underplay how virulent it is -- it took my dad, a powerful, determined, brilliant man.  But this isn't an intelligent enemy or even a particularly crafty enemy.  It is a mistake of biology, and it will be beaten.  I know it is disheartening to see a warrior like my dad lose his battle, but it would be a tragedy if his death were to do anything but strengthen each of your resolve to beat this thing.

I know that this group has been very civil and avoided language that wasn't family friendly, but in the heat of the moment, waiting to be let in to see my dad, I posted something to facebook that captured my feelings about MCC.  In the law, we make an exception to the hearsay rule for an "excited utterance", under the theory that when somebody is experiencing an enormously emotional, critical moment, they aren't going to lie and they will speak what they're really thinking.  So here is the post, which expressed in no uncertain terms what I was thinking at the moment:  "Just had the surreal experience of following an ambulance carrying my dad to The hospital. spO2 well <80% possible atrial fibrillation, irregular heart rate ranging from what I saw up to 180. Fuck you, cancer." 

As I prepare to bury my father, let me say that "Fuck you, cancer" was, if anything, too kind to cancer.  Cancer, you're taken my dad away from his grandchildren.  You've robbed his MCC group family of his wit, advice and love.  You've made my mom a widow.  You've made me the patriarch of my family at 45.  You've sent a man who could have saved hundreds or thousands of lives practicing medicine for another decade or two to the grave.  You, cancer, must die.  You faced a resolute foe in my dad and beat him, but he wasn't your only enemy.  There are leaders like George and Audi who are organizing forces against you.  You have smart and creative enemies like Paul Ngheim who are preparing to crush you as surely as you've crushed lives and families.  Your days are numbered, and when they write your obituary, I'll be proud of my dad's role as a member of the force that fought against you helped put you in the ground.

I love my dad and I'll miss him.  I know you all feel the same way.  Thank you, on his behalf, not just for the strength you provided him, but for the opportunity to give him to chance to beat MCC if not in himself, at least in the others he helped along the way.

Saturday, April 21, 2012

Obituary

The following obituary ran in dad's hometown newspaper:


DAVID NORMAN SHUSTER, M.D.

Dave Shuster died on April 18, 2012 after fighting a courageous battle with Merkel Cell Carcinoma.  He was born on Aug. 18, 1940 in Montreal, and moved to Fresno in 1976.  He was a talented diagnostic radiologist well respected within the medical community.

Dave met his wife, Judy, more than 50 years ago.  He was a loving father to his three children, Gary and his wife Dana, Brian, and Michael and his wife Leanna.  He was blessed with 5 grandchildren, Eva, Sara, Sammie, Bel, and Eli.  He is also survived by his mother, Isobel and his siblings, Jon, Robert and Ellie.

In addition to his professional and family accomplishments, he achieved the rank of gold life master in bridge.  He also always had a fun time with his poker buddies.  He never missed an opportunity to play with his grandchildren.

A memorial service honoring his life is scheduled at Temple Beth Israel for Sunday, April 22 at noon.  In lieu of flowers, remembrances may be made to Merkel Cell Carcinoma Research (details at http://donate.shuster.com) or to Temple Beth Israel at 6622 N. Maroa Ave., Fresno 93704.

The world is a better place for Dave’s being here.  He lives on through his children, grandchildren, and kind deeds. 


Friday, April 20, 2012

Dead

Dad died at 10:58 p.m. on April 18, 2012.  He was 46 days away from his 50th wedding anniversary.  In the week prior to his death, he conducted a Seder, watched his granddaughter open birthday gifts, watched Stanley Cup hockey, considered treatment with Votrient, and saw his doctor.  He even saw a concert a couple of weeks ago.

When he first got to the ICU on April 18, he asked me to please update his blog if he died.  I promised I would.  I will expand this post further as I get my thoughts together.  I don't want to post too much until I can do so cogently.

I miss him already.

Wednesday, April 18, 2012

Back in the ICU

Dad is back in the ICU.  His situation is very serious.

CT scan results showed that the left lung is better than the right, but the left bronchial branch is completely closed off (presumably tumor pressing it shut).  The right bronchial branch is fully open, but the right lung is very compromised with pneumonia.  There is some pleural effusion.  

One of the nurses and one of the doctors, on different occasions, said that the outlook was very bad.

Other than the Dilaudid causing him to be a bit loopy, he is very cogent when his O2 saturation is good.  When it isn't good, he is very out of it, eyes rolling back, etc.  His O2 saturation ranges from 70% to 100%.  He is on a BPAP mask as he refused intubation.  He has also given a very broad do not resuscitate order.  In relation to the intubation refusal, he said, paraphrasing, "instead of intubating me, just shut me down with morphine.  I've just about had it.  I've had enough."

His breathing is very labored.  It reminds me a lot of when my daughter Eva was a newborn and developed RSV.  You can see his stomach trying to suck in to help draw air into the lungs.

He seems to be cogent, at peace, and just wants to stop hurting.

I love him.  I hope tonight goes the way he wants it to.

Following an ambulance

It is a surreal experience to follow an ambulance with your father in it.

I got a call around 9 am from my mom saying that my dad is in severe respiratory distress and he doesn't think he can make it to the hospital in a car.  My mom said she was probably going to call an ambulance.  I told her I agreed, call the ambulance.  I arrived there just as the paramedics (full fire truck + ambulance -- I paid my taxes yesterday, and all of my annoyance at writing that check is gone with this demonstration of what those taxes pay for) were getting there.

My mom and I filled the paramedics in.

My dad is currently in the ER being seen.  There is a one-visitor-at-a-time policy, and I'm sure my dad would be more comfortable with his wife at his side, so I'm patiently waiting in the waiting room.  The doctors are confirmed atrial fibrillation.  They also hear a wheezing noise they don't like and they're taking him in for a chest x-ray.  I assume the cancer impinging on the bronchi is making them worry about pneumonia, but I'm not even close to being a doctor so that is just guessing.

I'm post more when there is more.  At this point, it is all scary, sad, and a great unknown.

Monday, April 16, 2012

About the Author -- Curriculum Vitae


                                                         CURRICULUM VITAE

                                                      DAVID N. SHUSTER, M.D.

PERSONAL DATA:

            Date of Birth:              August 18, 1940

            Place of Birth:             Montreal, Canada

            Marital Status:             Married (Judy)

            Address:                      [redacted]
                                                Fresno, CA 93720

            Telephone:                   Business:        [redacted]
                                                Home:           [redacted]

EDUCATION:

            COLLEGE:                            McGill University
                                                            B.S., 1961

            MEDICAL SCHOOL:           McGill University
                                                            M.D.C.M., 1966

            INTERNSHIP:                       Jewish General Hospital-Montreal
                                                            June 1966 - June 1967

            RESIDENCY:                                    Jewish Hospital-Brooklyn, N.Y.
                                                            Obstetrics and Gynecology
                                                            June 1967 - December 1967

                                                            Brookdale Hospital-Brooklyn, N.Y.
                                                            Pathology
                                                            January 1968 - June 1968

                                                            McGill University-Jewish General Hospital
                                                            Radiology 
                                                            July 1968 - June 1971

PRACTICE:                         Diagnostic Radiology
                                                St. Mary's Hospital, Montreal
                                                June 1971 - August 1976
                       
                                                Saint Agnes Hospital, Fresno, California
                                                September 1976 - April 1993

                                                Fresno Imaging Center Medical Group
                                                May 1993 – December 2004

                                                Sierra Imaging Associates Medical Group
                                                January 2005 to present


                                                [Note that this version of the CV predated his work at Kaiser]

LICENSES/CERTIFICATIONS:

            L.M.C.C.                                                               1968
            National Board of Medical Examiners                       1967
            Certified Specialists of Province of Quebec               1971
            Fellow of Royal College (by examination)                 1971   
            Royal College certification (Radiology)                     1971
            Diploma of American Board of Radiology                1972
            California Certificate Number                                  [redacted]

MEMBERSHIPS:

            Fresno-Madera Medical Society
            California Medical Association
            Central Valley Radiological Society
            California Radiological Society
            Radiological Society of North America
            American College of Radiology

CLINICAL ASSISTANT PROFESSOR: U.C.S.F.
                                                                        1980 - 2000

LECTURER IN RADIOLOGY:                McGill University
                                                                        1973 - 1976

PUBLICATIONS:                Shuster, D., Palayew, M.J., "Accordian-Like Compression of a Calcified Splenic Artery: A Plain Film Roentgenographic Sign of Splenic Enlargement". AJR 116:423-425, 1972.