Sunday, July 27, 2014

An extra ordinary day with Ray

Our Passat packed with laden memories raced inexorably west towards Madison on this sunny tennis-friendly summer day.  As the time became compressed by distance, I wondered what to say at Ray’s memorial service.  There was so much history together.  How could I even begin to tell it?

Back in time

It began during my pediatric residency.  Ray and Memée were both teachers, as chief of neurology and as general pediatrician, and Memée became Rachel and Ben’s first pediatrician.  As surrogate parents, they adopted Teri and I, inviting us over for regular and Thanksgiving dinners.  We experienced immediate warmth, unequivocal acceptance, and a home away from distant homes.  We came to know Michael, Ru and Mark each.  And, Ray and Memée entrusted us with their brood and Mr. Chips (feisty terrier) for a week while they went on their first vacation by themselves.  We became … extended family.

More memories.  He plays with a child on the clinic floor to diagnose subtly and nonthreateningly.  He begins the work day with a communal effort on the NY Times X-word puzzle.  He patiently plays the human backboard, ala Pancho Gonzales Chun, with those of us with lesser abilities with the racquet.  He lends us his station wagon to cart two families, two dogs, and camping gear to Michigan.  He blends professionalism, humanity, fun and family, perfectly.  Ever kind, respectful, present in the moment, Asian.  He is my role model.

Fast forwarding, all three Chun ‘kids’ babysit our Rachel and Ben for our nights out.  Further forward, we/they visit/stay with Ru/Jim, Mark/Marianne and Michael/Tina and their kids in Madison, Columbus, Chicago, Milwaukee, Manhattan (KS and NY!), Seattle, and Hilo HI.  We peak together atop Manau Kea on the Big Island from which we view the majesty of all the Islands.  It is a unique multigenerational relationship. 

Our last day

The talk to the UW APAMSA Chapter was a scheduled excuse to spend time with Ray and Memée.  Teri and I would typically stay overnight at their Madison B&B every few months.  Apart from whatever specific stories we shared about our kids and our lives, we would always experience the timelessness of profound friendship, whatever the time gaps, and always the parting nostalgia of leaving the warm hearth of home

Ray had AML that he ‘shared' with Teri that had now become refractory to treatment.  By all measures, he had far out survived all projections withstanding 26 rounds of monthly chemotherapy.  He spent his good interludes working out, spending time with family and friends, and even playing his beloved tennis!  But we all knew the time was becoming essence.

I had some trepidation about whether I would intrude, but Memée reassured me that I could be helpful.  I received a text from Ru that he was in the clinic that morning with a fever, possibly to be admitted, but desiring to come home. 

Ray was propped up on the couch in his comfortable sweat suit, pale, wan and uncomfortable.  He greeted me warmly with a smile and hug.  He was feverish, sweating.  A large mouth sore rendered it painful to eat.  Low back pain made it difficult to find a comfortable position,. 

Memée fastidiously administered all of his routine medications and new antibiotics as if on a Japanese train timetable.

We had a quiet dinner.  He reminded me about a dinner at the Ichiban Sichuan Restaurant that the UW students had organized for me in 2008.  I was ponderously blank and then, yes, his recollection was immaculate.  And, he had not attended that dinner! 

Memée asked me how long.  Despite my experiences with Teri, I said I didn’t know exactly, but given all the signs, not long. 

Then, Saturday arrived, and the portentous clouds miraculously dissipated.  Ray’s fever abated.  His color returned.  His mouth was feeling better.  Ray... was … his usual self.

At breakfast, he queried me about how I’m working with our new Chairman of Pediatrics.  Amidst the impending kismet why in the world is he asking about me?  But then I realized that is Ray, always concerned about others.  Genuinely curious about me. 

We hung out, quietly aware of the other’s presence. 

A grand luncheon with friends and family together.  Kok Peng and Anna, Aaron and Sal, Ru, Jim, Elliot and Althea for lunch.  Eclectic, Vietnamese and Chinese food.  Ray’s mouth was feeling sufficiently better that he ate won tons and noodles brought back from Vancouver … more than he had in 3 weeks according to Memée. 

His back was sore so I spontaneously gave him a rub.  He said it felt better.

As our day came to a close, I was both in the moment and outside looking upon the moment, aware that it was likely our last time.  I marveled at Ray’s effervescent glow, his centered equanimity and his considerate grace to the very end.  Other worldly

As I was leaving, we gave each other a hug, and spontaneously I whispered for the first time, “I love you.”

A few days later, Ray passed away quietly in his sleep.  Ru told me his last words were ‘thank you’ to his nurses.  At peace, true to himself.

Ray’s memorial service

There in front of Ray’s extended family, former fellow residents and former professors, my eyes welled and chest heaved.  In a moment of clarity, I realized that I would share that singular, unforgettable day.  A last day, a last good day, a quintessentially Ray day. 

So ordinary, yet in that way, so remarkably extraordinary. 

So I did.  

Friday, July 18, 2014

Two close calls

It culminated on June 4th – the 25th anniversary of the Tian An Mian massacre – a cataclysmic day in Chinese history. 

Dad became weak at the dinner table in his assisted living abode at St Johns on the Lake where he had been living since January.  Prior, he had fallen repeatedly.  Either I or his helper kept discovering him on the floor, necessitating visits to the Emergency Room.  He also set off the fire alarm with consequent police and fire response.  Although he could no longer live unattended, he became understandably disconsolate with the move out of his apartment.  

On that recent night, he was taken to the Emergency Room and admitted to Columbia St Mary’s Hospital.  In short order he was discovered to have a superbug infection in his blood emanating from either his bladder or lungs.      

Ben asked if he should come home.  I didn’t know how imminent Dad was, but encouraged him to come home that weekend. 

Dad perked up by day 3, presumably from the antibiotics, then began to pass massive blood clots from internal bleeding.  He was transferred promptly to Intensive Care.  Over the next few days, he received 4 packs of red blood cells (40% of his blood volume) and 4 units of fresh frozen plasma to reverse the effects of the chronic blood thinner.  His blood pressure dropped precipitously and his nurse called Ben and I to return to the hospital that night. 

The doctors asked us if we would be willing to use pressor (vasoconstricting) agents to boost his blood pressure.  His living will states no CPR, or endotracheal intubation.  But there remain key decisions on intermediary interventions lying somewhere between supportive and aggressive measures.  A difficult decision.  I felt that that support was appropriate short term.  Should we do a non-invasive bleeding scan and/or an invasive colonoscopy to localize the source?  Since the bleeding was presumed to derive from diverticula (abnormal outpouchings), the end game would include surgery, for which I felt he was not a candidate.  Therefore, we didn’t proceed to do the tests (but perhaps should have in hindsight).  Finally, the bleeding stopped and his blood pressure stabilized.

He recognized Ben and I, and asked appropriate questions of Ben.  How is school?  Is Theresa still in San Francisco?  But he had no recollection of how he came to be admitted.  Nine days later, he was transferred back the nursing area of St. John’s

Dad survived a catastrophic double hit, a superbug infection and gastrointestinal bleeding.  A near miss.

Then, six days later, after I had fed him and tucked him in for the night, he began to pass large clots again.  To the Emergency Room to be admitted to the Intensive Care, followed by three more units of blood (70% now replaced).  Another gastroenterologist felt it could be helpful to do a colonoscopy and indeed he was right.  He found the source.  Two ulcers one with a visible bleeding vessel that was cauterized.  The bleeding stopped.  In a gesture of professional courtesy, he showed it to me endoscopically. 

He survived another life threatening bleeding episode.

Back to the nursing area.  He needed 3 weeks of IV antibiotics to eradicate the superbug.  He required continuous oxygen.  He had difficulty swallowing and all liquids were thickened.  He was no longer able to dress himself or ambulate.  He lost 20+ lbs.  I fed him because he ate better for me than the staff.  He spoke once about this ‘being his last phase’.   However, he remains optimistic and awaits ‘the Mongolian prime minister who will bring a special potion to restore my memory and eyesight to the age of 65 – the effect will last for 2 years.’  I told him that I too need a sip.

So here we stand at the precipice, on a historic anniversary, for the penultimate historian.  As his 22/7 care taker until January, I only know too well the cracks and crevices at the edge.  And he’s been over the edge more than once.  Yet all in all it is quite amazing how far he has journeyed.  Last summer I took him at the age of 93 to Vancouver for 5 weeks with all its challenges.  I brought him home every other week for dinners until May.  I took him out to a restaurant on his 94th birthday just a few days before this transpired.

Watching accelerating physical and mental decline and serious medical crises in such a vigorous individual.  I know it happens to all, in individualized ways, but it is nevertheless difficult to experience up close. 

Yet I have to appreciate how far we’ve travelled both psychologically and geographically (Lawrence, Mendham, Vancouver twice), recently, together … and this past year I’ve come to equanimity with my life with Dad as it is now, was (or was not), and will be.  

Thank you for your support and kind comments to me.