Death, Taxes and One Man's Slow End to His Life (VSED)

DFT, gone at 86. RIP, pop.

Prologue:  Many of you, Dear Reader, were aware of my mother’s passing five plus years ago when I shared briefly about her death.  Although the vast (like 98%) majority of what I write here on FatScribe is true, or based in facts with a verisimilitude to what actually happened in my life, it was difficult to share about Joan’s passing.  She was an amazing woman, my mom, who wore her heart on her sleeve, who taught her children to love deeply, and who was a lifelong procrastinator, which perhaps explained why she lingered about this place 16 years after she had a massive stroke that would have killed the average momma Grizzly bear. She loved life.  Lived it to the fullest, did she, until the bitter end. (Bitter because of the C-Diff infection she caught from her hospital which needlessly ushered her into the afterlife at the age of 79.  But, c’est la vie, n’est pas?)  And, thus began the slow descent into depression for my dad, when his lovely reason-for-being departed before he did, which, I can assure you, he did not expect nor especially want. In the end he chose to starve himself to death, rather than go on with his wine and dinners with grandkids and adult children and bridge games with other octogenarians.

Which brings me to pop, Don T., the curmudgeon with a heart of gold. I called him dad even though he was my step-father.  You see my biological father, whom I have always irreverently (with a modicum of respect) called “biological sperm donor Bob,” left before I was born.  But, my dad, however, came into my life when I was 3 yrs old and my mom was at her personal nadir, on welfare with 7 boys to care for, and reeling from despair.  Joanie, sweet mum, you see, married all 3 of her high school sweethearts. Her first marriage produced 6 boys.  Her second marriage, which lasted little more than a year, was an inarguable disaster, but produced my little brother, Chad, boy #7.  And, so it was that my dad swooped in at the exact moment his marriage (with 4 children) had ended in divorce and my mom was more than ready to be rescued.  What my dad lacked in EQ and warmth and understanding, he more than made up for in his preternatural instinct to provide for, and he loved to provide and care for Joan, as well as his own children, my amazing step brothers and sisters. Whilst he was not a “man in full,” to borrow a phrase from Tom Wolfe, he was a man full of obligation.  Gen X’ers and Millennials are all about “rights,” whilst my dad’s generation was about duties, and he met all of his obligations, and even took on those of others when asked.

Our blended family was like the cinema verité version of The Brady Bunch.  It was raw, real, and really loud. Always.  My dad’s routine was to come home – always to a house, garage, backyard, and driveway filled with his kids and his kids’ hangerson – where he would take his dinner and walk upstairs to his daily respite and fortress of solitude: his bedroom and television.  And, since 1971, his bedroom in this house in Malibu Canyon nestled against the Santa Monica Mountains, was the place he spent 80% of his time when not on the road flying around the world, bringing IT hardware to a world desperate for US technologies.  He did business in all of Europe, Eastern Europe, Asia, and yet, he never made it to Australia, which, ironically, was to be the terminus for his very last business trip.

After he had helped navigate a startup as a key marketing and sales ops exec, the public offering saw a billion-dollar tech company grow rapidly in the early 80’s.  He met with Steve Jobs and Bill Gates and others who would leave much larger footprints in the Valley’s burgeoning tech industry.  Before he retired (at the age of 51), he was asked to go on one final trip to lock-up an important busdev deal in the previously noted Australia.  On the plane trip across the Atlantic, they encountered such a violent storm that the plane he was on literally rolled-over and was forced to land in England.  Immediately upon exiting the 747 he called his CEO from a phone in the Ambassador's lounge and gave notice.  He drove to Switzerland (Zermat) and learned to ski solo over the course of 10 days, calling it a day and putting a stylish and very Swiss “schuss” on his career.  The swift punch of reality would also send him for another shocking loop-de-loop when under a Jimmy Carter administration his stock and capital gains would be taxed (federal) at a whopping 78%.  Millions of his hard-earned lifelong sought-after revenue down the proverbial drain which is our rapacious and wasteful government.  Ugh.  Ever the loyal Dem, he would not or could not bring himself to carp or complain against the President from Georgia (‘jawjuh’) or his tax-the-rich scheme; he would, however, routinely show me the six-figure checks he would send to the IRS quarterly. He stayed the lib, and I became an instant lifelong conservative at the age of 14.

Dad’s retirement lasted only a few months, and he would go on to startup two other ventures, but leave most of the heavy-lifting to his now-older sons and some former business acquaintances.  These two companies were soon performing very admirably also, but he refused to let them grow too large for fear of the actual work that would eventually, he feared, suck him back into fulltime workload.  Instead he bought a second home in Tahoe (Nevada, to help avoid state taxes) to keep his inchoate skiing skills sharp and rented a home in Kailua/Kona, Hawaii, where we would scuba dive and fish for sailfish and Marlin. He and my mom even caught a 1,195 pound Marlin that would have been a world record had they not double-teamed the landing of this HUGE fish, which last time I saw, it was hanging 20 feet off the ground in the Kona airport, where my little brother snuck “Kona gold” marijuana into my suitcase for fear of getting busted.  Ahhhh … little brothers. Someday I’ll write about him.  Anyway, now all four of them are dead. The fish, the father, the mother and the brother.  Damn. Sucks. Growing older.

T.S. Eliot said that "April is the cruelest month."  He didn't know October. My mom, dad, and little brother all died in October. But, it's also a month of births for my family. Three of my siblings and my sister in law all have birthdays in October.  Circle of life and whatnot, writ large right there in black fountain pen ink, highlighted in orange, on my humble little family's calendar.

Right about now you’re asking yourself, “I thought ole Fats was going to talk about how his dad asked him to help end his life?!”  Okay, you’re right, Dear Reader.  But, we needed a little bit of a backstory as they said in my screenwriting classes at UCLA.  Backstory and conflict. My boring stories usually have conflict, or embarrassment, or awkward moments with me acting the fool.  So, here’s the conflict.  My dad always thought he would die in his 50’s -- or in his 60’s at the latest – and he lived 26 years beyond that.  5 years after mom was gone (which was the sole raison d’etre for his life), my octogenarian father would oft-opine why do I even bother to get up in the morning?!  A 50-year plus contract bridge masters champion, he would daily play bridge with his partner, Ray, down at the club and then come home to an empty house.  His life barely had meaning for him, if any at all. A world-class life, er, glass is half empty sort of guy, he could find the "Bah! Humbug!" in every Christmas party.  In the evening he’d have dinner with one or more of his children and grandchildren, but occasionally he’d have to eat alone at one of 5 regular restaurants he’d dine at habitually. Chinese was Lakeview; Italian was Vincitore or The Landing; sushi was Sushi Wasabi; Mexican was Casa Escobar; and his all-time fave? An Americana style chop house of sorts called The Gallery in the mall that is owned by Tom Selleck.  Wine was a constant companion.  Always the wine.  If you didn’t “cork” (charge a corking fee to) Don, he’d give you $5k in business annually, plus tip 40% to your waitstaff.  White was Sauvignon Blanc from New Zealand, and red was Shiraz from Australia. Screwtop, no “real” cork, cheap but rated in the 90’s by Wine Spectator or Robert Parker? Done. He’d buy it by the caseload. Twenty Twenty Wines on Cotner in West L.A. loved Dad (Bob’s gonna miss that annual $6k to $8k). You'd wish ole Don could curl up with a glass of that tasty wine of his with a good book in front of his lovely fireplace and while away his dotage like you see in the movies. But, meh.

And then one recent fateful night he fell – hard -- during the middle of the night. (Fateful nights always come when you least expect them.)  When I got to him, I wanted to call an ambulance. No, he insisted, but would I be so kind “as to help him piss?”  Of course, pop.  That night he still went out to eat. With contusions on his head, and barely able to walk, he forced himself (willed himself is more apt) to dine with me and my brother Gilbert where he joked about elder abuse with the busboys.  Soon after, however, he became bed-ridden, where I was all too happy to play nursemaid to his nascent Gandhi hunger strike.  You see, he began a poor man’s hunger strike.  Barely eating. Maybe an occasional Ensure, or a cookie or snack, but no food to speak of, and water was ONLY when I gave him his regimen of pills.  After 8 days or so, with his excruciating back pain, not eating, and my providing baths, arse wiping, almost daily sheet changing, we eventually had to place him in one of the backgammon chairs from the living room where as kids we never were allowed to go, a rather painful position for his injury, as several of us brothers carried him down the stairs to a car and off to hospital to get some hydration and food in him.  The E.R. doctor gave him his excuse: He had several fractures in his lower sacrum (lower back), and would require a move to a therapy center, and 4 to 6 weeks to fully heal.

From that time in the hospital forward, Dad decided to stop eating completely.  And as long as he was compos mentis, we couldn’t force him to eat nor the hospital or rehab center to force him either.  He refused to drink his Ensure (2x a day was his norm) and eat his fruit and cookies or eat any meals delivered to him. After 10 days at the rehab center, Medicare would not sign off on further payment unless dad would show progress.  He began to tell anyone who would listen to “give me a pill,” and the always clear and imprecatory “I want to die.”  But, as soon as we reminded dad that Medicare would not pay for his stay unless he showed progress, money talked and dad listened.  He stopped grabbing passersby and shouting “kill me, please!” (slight exaggeration) but instead played the game of standing for a few minutes and walking bare-assed down the hall as part of “therapy,” then opening his ensure and taking ½ sip and letting it sit with the other 7 or so bottles opened and ½-sipped, then pushing his fruit around his plate with a metal fork. The game worked for several more days, Medicare paid, with my dad pretending to eat his fruit for my sister, but by then, my dad was hallucinating and his ersatz hunger strike was now all too real, and I lied to the rehab center and to the hospital and invented a follow-up appointment to get my dad treatment. The center ordered an ambulance to deliver him for his “appointment.”  I knew he’d be dead in a day or two if I didn’t push.  Big mistake, which I will regret until the day I die.  But, I thought, “Hey, if we can get dad healed and help him get past his back pain, he’ll be right as rain and then able to play bridge again, go out to eat, and drink vino with his kids!”  Those were obviously my wishes and not my dad’s.

At the hospital the original E.R. doctor came to see my dad when he recognized his name and readmission.  Dr. P. took one look at what was going on, and reluctantly ordered the IV fluids that we desperately wanted him to receive, and then he ordered me and my sister (the executor of my dad’s will/trust that I had originally drafted out of law school before my mom died) into another room where he educated us on seniors who voluntarily ask for cessation of food (VSED or voluntarily stopping eating and drinking).  It was a shock to say the least to listen to Dr. P. walk us through this exit strategy that many senior citizens choose.  Like his trip and fall in middle of the night, Dad stumbled upon his “excuse” with this new back injury … and now he had his VSED. He was in a hospital setting. He was injured. And, he was mentally sound.  There was nothing we could do to force him to eat.  Dr. P. warned us that we could go through this peaks and valleys routine for the next few months, or we could simply accept this decision by my dad and let him die … this ridiculously slow, oft-painful, but in the end pain-free death.

The transformation that Saturday after he was hydrated was miraculous.  That night I sat with my dad with some half-dozen of my family and nephews and we watched the UCLA football game. He was no longer tripping balls and hallucinating, but even joking around with us. After everyone left, I asked my dad one final time if his plan to die couldn’t be assuaged, to which he replied, “Goddamn it, John, I want to die! Just let me be, wouldja?”

Dr. P. referred hospice care to us.  Over a dozen of us, his family, met with the hospice group the next morning. It must be said that these professionals were a Godsend. I met and worked with a half-dozen of this group’s employees, and every single person was a consummate professional, courteous, and overly attentive. Extraordinary to find such helpful and comforting people at a time of real need in one’s life. 

My dad had already frontloaded his refusal to eat the four weeks after his injury (he ate maybe twice and then an Ensure every other day).  After we left the hospital he ate only once, 4 bites of vanilla ice cream the night his children and grandchildren came to say goodbye to him.  He did something he rarely did: he shook the hands of the elder children (and one personal friend of 45 years) in a purposeful way.  I was my dad’s nurse the entire 8 weeks, and tried to leave the room when he was saying his goodbyes. But, I overheard my oldest brother (who’s 16 years older than me, and was never particularly close to my dad, again our step-dad) say goodbye to Don, they shook hands and he said to my dad, “thank you for all that you did for me.”  It was profound, take my word. There were lots of profound moments, but that was one I thought I should share.

Over the next four weeks it was a long, slow, slog of a waking nightmare watching my dad die.  The hospice group provided all of the medical accouterments: the dozens and dozens of adult diapers, and “chucks,” which is a bed lining, and the protective gloves and the masks (which were quite welcomed by yours truly) during changing.  They also provided the meds (thank Christ for the meds). They provided the cleansing gels which I used constantly to wash him multiple times daily, as well as the bathing gels which I used every odd day.  But, for some reason, the hospice could not provide any wipes; I’m not sure why that was.  Must be a Medicare or a reimbursement thing.  My 16 yr-old son and I swapped out my dad’s bed and furniture for his hospital bed (we left the tv, natch).  And thank God for it, the moveable hospital bed.  He was weak, but still surprisingly strong.  I never wanted my siblings to experience what I had to go through the last 2-3 weeks. It was tough. Even now, weeks later, I still have hives from the stress.  But, only one of us needed to go through it, and since I moved in with my pop after my mom died, it was logical I should be the one.

My dad twice during this time asked me (right before he moved into a semi-comatose state), “When?” as well as "What's the regimen for how long this is taking?" which surprised me. He thought it would have been over quickly, and frankly I did not.  I knew that people survive weeks starving themselves to death. The RN that would visit our home twice a week was extraordinary.  Now, because I want to forget this experience desperately, I literally have forgotten her name.  If I tried I probably could dig it out from the recesses of my muddled brain, but I’d rather not presently.  But, she was a rock star. God bless that woman. She prepped me for something that surprised me, but gave notice to his imminent departure: terminal restlessness.  My father began to fight me to leave his bed. He had someplace to go.  “John, I have to go!” “Son, let me out!” He’d grab my arm occasionally, and sometimes he’d bargain to just sit in the chair that I had placed bedside.  He was too weak to do this, but for some stupid reason, I helped him into the chair twice. He sat there for 30 seconds and then told me, “I have to go!” and try to leave, and then I’d have to lift him back into bed.  Don’t do this if you ever have to help a loved one during these “end of life restlessness” fits.

So now we had to adjust the bed so that my feebled though freakishly strong-willed father could not get out of the bed.  I had to jury-rig his bedspread over the top of his bed rails which kept his legs in.  This all came about because I was behind in his meds delivery, reacting to his state.  After 2-3 days of “fighting” my father and his “end of life restlessness,” I determined to get in front of this scenario and administered the cocktail of drugs he was on proactively, not wanting to fight my father any more.  It worked. He was on morphine which helped with his back injury and pain, and lorazepam and haldol for the restlessness and agitation, and all were administered sublingual with a syringe.  When there were fever spikes I had to administer suppositories.  When he eventually developed a productive cough (death rattle), there was atropine to give my dad, which was odd because this med is typically used as eye drops.  Anyway, once the nurse spotted this in the charts that I fastidiously tracked and prepped (which she taught us to use), she contacted the doctor to get his approval and he responded one step better and doubled-up the dosage of the drugs my dad was given every 4 hours.  My pop was fast-tracked onto the super drug highway toward his ultimate demise in a much more pleasant state.  It wasn’t any easier. Sleep was tough. But, once my father experienced another of life’s final indicators that death was near, a massive excretion of water from all of the cells in the body from a sort of “endorphin” rush to ease the pain from his self-imposed starvation, the result was the release of a massive amount of fluids.  The nurse told me that with his spiked fever, and this, his end was 2-3 days away most likely.

I checked on my dad at 1am, and my brother set his alarm and checked on dad at 3am.  At 6:45am he woke me up and said he thought our dad had passed.  We both checked for vitals. He was warm, his eyes were open, but he was gone. We waited 10 minutes and observed him, but we knew.  I was with both of my parents for days and weeks before they passed, but missed their ultimate passing, for which I’m glad. Small blessings.  I made a promise to my dad two months prior that I would not let him go to some “old folks home” to die.  If he was going to go in this miserable fashion, he was going to be home in his own bedroom.  Plus, to be honest, I was the longest cohabitating “kid” to be with my dad during our lives, so it was my honor to escort him out of the house he said he’d never leave unless it was “feet-first.”   And that's what 5 or 6 of his children did after he passed, viz., watch two professionals who deal in human remains come and take their dad away for the very last time.

Epilogue: I hope and trust that anyone -- whether visitor or Dear Reader -- reading this account of my dad’s passing is not offended by the style and nature of the narrative that I offered up here in this space. It was something I had to get out and onto the page quickly, and if it seemed a bit flippant, it wasn’t intentional. My dad wanted to die.  He was ready, however much his children disagreed, to leave this planet. My dad was very much not a religious man.  His formative and very early years were in households of Seventh-day Adventists, but he stressed to me (the religious conservative) that he was agnostic about the whole afterlife issue.  Near the very end I prayed over and for my dad. I read to him.  Occassionally he'd look up, and we'd hold hands. It was rough to go through. So, back to the title of today's piece; of course I never helped my dad end his life in any impolitic fashion, merely loved my dad the best way I could and helped him along as his life wound down. It was odd and sad for us that loved my dad to watch him choose this path for his off-ramp.

My first memory of my dad? I was 3 years old, hiding behind my mom's couch in San Diego, wondering who this stranger was in our home. I was playing peekaboo as kids do at that age. My dad rescued my mother and brothers and me from welfare life. Even though I never got the emotional investment that all men crave from their dad or father figure, we did have a loving relationship. And for that I'm grateful. He loved my sons, and they adored him.  Their victory each time they saw this grumpy man was to make him chuckle. They'd score a small victory, then noisily clop down the stairs, "Dad, I made grandpa laugh!"  My dad was loved by all of kids and especially his grandchildren and great grandchildren.  He loved them in his inimitable way, and they loved him back in kind, in their own fashion, whatever that meant for them.

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